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RN Medical-Surgical Competency Exam
— Code: RN-MEDSURG-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A client with septic shock has received 30 mL/kg of crystalloid but remains
hypotensive with a MAP of 58 mm Hg. Which intervention should the nurse
anticipate next?
A. Administer IV furosemide
B. Initiate a norepinephrine infusion
C. Restrict all IV fluids
D. Administer oral antihypertensive medication
Answer: Initiate a norepinephrine infusion
Rationale: Norepinephrine is a first-line vasopressor for persistent hypotension
in septic shock after adequate fluid resuscitation. The goal is generally to
maintain a MAP of at least 65 mm Hg.
, 2. A client with acute heart failure develops severe dyspnea, crackles, pink
frothy sputum, and an oxygen saturation of 82%. Which action is the
priority?
A. Place the client flat
B. Encourage oral fluids
C. Position the client upright and administer oxygen
D. Obtain a routine weight
Answer: Position the client upright and administer oxygen
Rationale: The findings indicate acute pulmonary edema. Upright positioning
improves ventilation, while oxygen supports oxygenation while definitive
treatment is initiated.
3. A client receiving digoxin has an apical pulse of 48/min and reports nausea
and yellow-green visual disturbances. What should the nurse do?
A. Administer the medication with food
B. Give the next dose early
C. Hold digoxin and notify the provider
D. Encourage increased potassium intake without further assessment
Answer: Hold digoxin and notify the provider
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are
classic findings of digoxin toxicity. The medication should be withheld and the
provider notified.
4. A client with COPD is receiving oxygen at 6 L/min by nasal cannula and
becomes increasingly somnolent. Which action is most appropriate?
A. Immediately discontinue oxygen
B. Assess respiratory status and obtain an arterial blood gas
C. Place the client in Trendelenburg position
D. Encourage rapid deep breathing
Answer: Assess respiratory status and obtain an arterial blood gas
,Rationale: Increasing somnolence may indicate worsening hypercapnia or
respiratory failure. Oxygen should not be abruptly discontinued; the nurse
should assess ventilation and oxygenation and obtain appropriate diagnostic
data.
5. A client with diabetic ketoacidosis has a serum potassium of 3.0 mEq/L.
Which prescription should the nurse question?
A. IV regular insulin infusion
B. Cardiac monitoring
C. Potassium replacement
D. Isotonic IV fluids
Answer: IV regular insulin infusion
Rationale: Insulin shifts potassium into cells and can cause life-threatening
hypokalemia. When potassium is significantly low, potassium replacement is
generally required before insulin is started.
6. A client with SIADH has a serum sodium of 118 mEq/L and develops
confusion and a seizure. Which intervention is anticipated?
A. Administer hypotonic fluids
B. Encourage large amounts of free water
C. Administer prescribed hypertonic saline with close monitoring
D. Administer potassium-free IV fluids rapidly
Answer: Administer prescribed hypertonic saline with close monitoring
Rationale: Severe symptomatic hyponatremia can cause cerebral edema and
seizures. Carefully administered hypertonic saline may be prescribed, with close
monitoring to avoid overly rapid sodium correction.
7. A client with a suspected pulmonary embolism suddenly develops dyspnea,
pleuritic chest pain, tachycardia, and hypoxemia. What is the nurse's
priority?
, A. Encourage ambulation
B. Apply oxygen and rapidly assess the client
C. Administer oral fluids
D. Place the client prone
Answer: Apply oxygen and rapidly assess the client
Rationale: Acute hypoxemia is the immediate threat. Oxygen and rapid
assessment are priorities while diagnostic evaluation and anticoagulation or
other treatment are initiated.
8. A client with chronic kidney disease has potassium of 6.8 mEq/L and
peaked T waves. Which medication should the nurse anticipate
administering immediately to stabilize the myocardium?
A. Calcium gluconate
B. Oral potassium chloride
C. Ferrous sulfate
D. Sodium chloride tablets
Answer: Calcium gluconate
Rationale: IV calcium gluconate stabilizes the cardiac membrane in severe
hyperkalemia with ECG changes. It does not lower serum potassium but reduces
the immediate risk of fatal dysrhythmias.
9. A client with an upper gastrointestinal hemorrhage has BP 82/48 mm Hg,
HR 132/min, cool skin, and altered mental status. Which action has the
highest priority?
A. Offer clear liquids
B. Establish large-bore IV access
C. Administer a stool softener
D. Obtain a routine abdominal x-ray
Answer: Establish large-bore IV access
RN Medical-Surgical Competency Exam
— Code: RN-MEDSURG-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A client with septic shock has received 30 mL/kg of crystalloid but remains
hypotensive with a MAP of 58 mm Hg. Which intervention should the nurse
anticipate next?
A. Administer IV furosemide
B. Initiate a norepinephrine infusion
C. Restrict all IV fluids
D. Administer oral antihypertensive medication
Answer: Initiate a norepinephrine infusion
Rationale: Norepinephrine is a first-line vasopressor for persistent hypotension
in septic shock after adequate fluid resuscitation. The goal is generally to
maintain a MAP of at least 65 mm Hg.
, 2. A client with acute heart failure develops severe dyspnea, crackles, pink
frothy sputum, and an oxygen saturation of 82%. Which action is the
priority?
A. Place the client flat
B. Encourage oral fluids
C. Position the client upright and administer oxygen
D. Obtain a routine weight
Answer: Position the client upright and administer oxygen
Rationale: The findings indicate acute pulmonary edema. Upright positioning
improves ventilation, while oxygen supports oxygenation while definitive
treatment is initiated.
3. A client receiving digoxin has an apical pulse of 48/min and reports nausea
and yellow-green visual disturbances. What should the nurse do?
A. Administer the medication with food
B. Give the next dose early
C. Hold digoxin and notify the provider
D. Encourage increased potassium intake without further assessment
Answer: Hold digoxin and notify the provider
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are
classic findings of digoxin toxicity. The medication should be withheld and the
provider notified.
4. A client with COPD is receiving oxygen at 6 L/min by nasal cannula and
becomes increasingly somnolent. Which action is most appropriate?
A. Immediately discontinue oxygen
B. Assess respiratory status and obtain an arterial blood gas
C. Place the client in Trendelenburg position
D. Encourage rapid deep breathing
Answer: Assess respiratory status and obtain an arterial blood gas
,Rationale: Increasing somnolence may indicate worsening hypercapnia or
respiratory failure. Oxygen should not be abruptly discontinued; the nurse
should assess ventilation and oxygenation and obtain appropriate diagnostic
data.
5. A client with diabetic ketoacidosis has a serum potassium of 3.0 mEq/L.
Which prescription should the nurse question?
A. IV regular insulin infusion
B. Cardiac monitoring
C. Potassium replacement
D. Isotonic IV fluids
Answer: IV regular insulin infusion
Rationale: Insulin shifts potassium into cells and can cause life-threatening
hypokalemia. When potassium is significantly low, potassium replacement is
generally required before insulin is started.
6. A client with SIADH has a serum sodium of 118 mEq/L and develops
confusion and a seizure. Which intervention is anticipated?
A. Administer hypotonic fluids
B. Encourage large amounts of free water
C. Administer prescribed hypertonic saline with close monitoring
D. Administer potassium-free IV fluids rapidly
Answer: Administer prescribed hypertonic saline with close monitoring
Rationale: Severe symptomatic hyponatremia can cause cerebral edema and
seizures. Carefully administered hypertonic saline may be prescribed, with close
monitoring to avoid overly rapid sodium correction.
7. A client with a suspected pulmonary embolism suddenly develops dyspnea,
pleuritic chest pain, tachycardia, and hypoxemia. What is the nurse's
priority?
, A. Encourage ambulation
B. Apply oxygen and rapidly assess the client
C. Administer oral fluids
D. Place the client prone
Answer: Apply oxygen and rapidly assess the client
Rationale: Acute hypoxemia is the immediate threat. Oxygen and rapid
assessment are priorities while diagnostic evaluation and anticoagulation or
other treatment are initiated.
8. A client with chronic kidney disease has potassium of 6.8 mEq/L and
peaked T waves. Which medication should the nurse anticipate
administering immediately to stabilize the myocardium?
A. Calcium gluconate
B. Oral potassium chloride
C. Ferrous sulfate
D. Sodium chloride tablets
Answer: Calcium gluconate
Rationale: IV calcium gluconate stabilizes the cardiac membrane in severe
hyperkalemia with ECG changes. It does not lower serum potassium but reduces
the immediate risk of fatal dysrhythmias.
9. A client with an upper gastrointestinal hemorrhage has BP 82/48 mm Hg,
HR 132/min, cool skin, and altered mental status. Which action has the
highest priority?
A. Offer clear liquids
B. Establish large-bore IV access
C. Administer a stool softener
D. Obtain a routine abdominal x-ray
Answer: Establish large-bore IV access
