RN Final Nurse Refresher Competency
Exam — Code: RN-NR-FINAL | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse returning to practice assesses a client with pneumonia who has a
respiratory rate of 32/min, oxygen saturation of 86% on room air, and new
confusion. Which action should the nurse take first?
A. Obtain a sputum specimen
B. Encourage oral fluids
C. Apply supplemental oxygen
D. Administer the prescribed antibiotic
Answer: C. Apply supplemental oxygen
Rationale: The client has significant hypoxemia and altered mental status,
indicating impaired oxygenation. Airway and breathing take priority before
diagnostic procedures or antimicrobial therapy.
,2. A client with heart failure suddenly develops severe dyspnea, pink frothy
sputum, and bilateral crackles. Which intervention is the priority?
A. Place the client supine
B. Encourage oral fluids
C. Position the client upright and administer oxygen
D. Obtain a routine daily weight
Answer: C. Position the client upright and administer oxygen
Rationale: The findings strongly suggest acute pulmonary edema. Upright
positioning improves ventilation, while oxygen supports oxygenation. Additional
interventions such as prescribed diuretics and vasodilators follow rapid
stabilization.
3. A nurse is caring for a client receiving IV potassium chloride. Which finding
requires immediate intervention?
A. Potassium level of 3.4 mEq/L
B. Burning at the IV site
C. Urine output of 40 mL/hr
D. Heart rate of 88/min
Answer: B. Burning at the IV site
Rationale: IV potassium is highly irritating and can cause tissue injury if
extravasation occurs. The infusion should be stopped or assessed according to
facility protocol, and the IV site evaluated immediately.
4. A client receiving unfractionated heparin develops bleeding gums and
hematuria. Which laboratory value is most important to review?
,A. INR
B. aPTT
C. Hemoglobin A1c
D. Serum sodium
Answer: B. aPTT
Rationale: Unfractionated heparin is commonly monitored using the activated
partial thromboplastin time. Significant bleeding requires assessment of
anticoagulation status and prompt provider notification.
5. A client taking warfarin has an INR of 6.2 and no active bleeding. What is the
nurse's priority?
A. Administer the next dose as scheduled
B. Encourage foods high in vitamin K immediately
C. Hold the medication and notify the provider
D. Administer aspirin
Answer: C. Hold the medication and notify the provider
Rationale: An INR of 6.2 represents excessive anticoagulation and increases
bleeding risk. The medication should be withheld and the provider notified for
further management.
6. A postoperative client becomes restless, tachycardic, and hypotensive with
cool clammy skin. Which complication should the nurse suspect?
A. Hypovolemic shock
B. Hyperthyroidism
C. Fluid overload
D. Increased intracranial pressure
Answer: A. Hypovolemic shock
, Rationale: Tachycardia, hypotension, restlessness, cool clammy skin, and poor
perfusion are characteristic of hypovolemia and early shock, particularly after
surgery where hemorrhage is possible.
7. A client with suspected sepsis has a temperature of 39.4°C, heart rate of
128/min, respiratory rate of 30/min, and hypotension. Which intervention is
most important?
A. Delay treatment until cultures are finalized
B. Initiate the prescribed sepsis-management protocol
C. Restrict fluids
D. Encourage ambulation
Answer: B. Initiate the prescribed sepsis-management protocol
Rationale: Sepsis can progress rapidly to organ dysfunction and shock. Prompt
cultures, antimicrobial therapy, fluid resuscitation, lactate assessment, and
other protocol-based interventions are essential.
8. A client with diabetes is awake, diaphoretic, trembling, and has a blood
glucose of 48 mg/dL. What should the nurse do first?
A. Administer rapid-acting insulin
B. Give approximately 15 g of fast-acting carbohydrate
C. Administer long-acting insulin
D. Restrict oral intake
Answer: B. Give approximately 15 g of fast-acting carbohydrate
Rationale: A conscious client with symptomatic hypoglycemia should receive
rapid-acting carbohydrate, followed by reassessment of glucose and additional
treatment if necessary.
Exam — Code: RN-NR-FINAL | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse returning to practice assesses a client with pneumonia who has a
respiratory rate of 32/min, oxygen saturation of 86% on room air, and new
confusion. Which action should the nurse take first?
A. Obtain a sputum specimen
B. Encourage oral fluids
C. Apply supplemental oxygen
D. Administer the prescribed antibiotic
Answer: C. Apply supplemental oxygen
Rationale: The client has significant hypoxemia and altered mental status,
indicating impaired oxygenation. Airway and breathing take priority before
diagnostic procedures or antimicrobial therapy.
,2. A client with heart failure suddenly develops severe dyspnea, pink frothy
sputum, and bilateral crackles. Which intervention is the priority?
A. Place the client supine
B. Encourage oral fluids
C. Position the client upright and administer oxygen
D. Obtain a routine daily weight
Answer: C. Position the client upright and administer oxygen
Rationale: The findings strongly suggest acute pulmonary edema. Upright
positioning improves ventilation, while oxygen supports oxygenation. Additional
interventions such as prescribed diuretics and vasodilators follow rapid
stabilization.
3. A nurse is caring for a client receiving IV potassium chloride. Which finding
requires immediate intervention?
A. Potassium level of 3.4 mEq/L
B. Burning at the IV site
C. Urine output of 40 mL/hr
D. Heart rate of 88/min
Answer: B. Burning at the IV site
Rationale: IV potassium is highly irritating and can cause tissue injury if
extravasation occurs. The infusion should be stopped or assessed according to
facility protocol, and the IV site evaluated immediately.
4. A client receiving unfractionated heparin develops bleeding gums and
hematuria. Which laboratory value is most important to review?
,A. INR
B. aPTT
C. Hemoglobin A1c
D. Serum sodium
Answer: B. aPTT
Rationale: Unfractionated heparin is commonly monitored using the activated
partial thromboplastin time. Significant bleeding requires assessment of
anticoagulation status and prompt provider notification.
5. A client taking warfarin has an INR of 6.2 and no active bleeding. What is the
nurse's priority?
A. Administer the next dose as scheduled
B. Encourage foods high in vitamin K immediately
C. Hold the medication and notify the provider
D. Administer aspirin
Answer: C. Hold the medication and notify the provider
Rationale: An INR of 6.2 represents excessive anticoagulation and increases
bleeding risk. The medication should be withheld and the provider notified for
further management.
6. A postoperative client becomes restless, tachycardic, and hypotensive with
cool clammy skin. Which complication should the nurse suspect?
A. Hypovolemic shock
B. Hyperthyroidism
C. Fluid overload
D. Increased intracranial pressure
Answer: A. Hypovolemic shock
, Rationale: Tachycardia, hypotension, restlessness, cool clammy skin, and poor
perfusion are characteristic of hypovolemia and early shock, particularly after
surgery where hemorrhage is possible.
7. A client with suspected sepsis has a temperature of 39.4°C, heart rate of
128/min, respiratory rate of 30/min, and hypotension. Which intervention is
most important?
A. Delay treatment until cultures are finalized
B. Initiate the prescribed sepsis-management protocol
C. Restrict fluids
D. Encourage ambulation
Answer: B. Initiate the prescribed sepsis-management protocol
Rationale: Sepsis can progress rapidly to organ dysfunction and shock. Prompt
cultures, antimicrobial therapy, fluid resuscitation, lactate assessment, and
other protocol-based interventions are essential.
8. A client with diabetes is awake, diaphoretic, trembling, and has a blood
glucose of 48 mg/dL. What should the nurse do first?
A. Administer rapid-acting insulin
B. Give approximately 15 g of fast-acting carbohydrate
C. Administer long-acting insulin
D. Restrict oral intake
Answer: B. Give approximately 15 g of fast-acting carbohydrate
Rationale: A conscious client with symptomatic hypoglycemia should receive
rapid-acting carbohydrate, followed by reassessment of glucose and additional
treatment if necessary.
