RN Nurse Refresher Comprehensive
Exam — Code: RN-NR-CE | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse is caring for a patient with septic shock who has received an initial
crystalloid bolus. The patient's blood pressure remains 82/48 mm Hg, and the
mean arterial pressure is 59 mm Hg. Which intervention should the nurse
anticipate next?
A. Administer IV furosemide
B. Initiate a vasopressor infusion
C. Restrict additional fluids
D. Administer oral antihypertensive medication
Answer: B. Initiate a vasopressor infusion
Rationale: Persistent hypotension after adequate fluid resuscitation in septic
shock requires vasopressor support, commonly norepinephrine, to restore
adequate organ perfusion.
,2. A patient with heart failure suddenly develops severe dyspnea, crackles
throughout both lungs, and pink frothy sputum. Which action has the highest
priority?
A. Place the patient flat
B. Encourage oral fluids
C. Position the patient upright and provide oxygen
D. Administer a potassium supplement
Answer: C. Position the patient upright and provide oxygen
Rationale: Acute pulmonary edema threatens oxygenation immediately. Upright
positioning decreases venous return and improves lung expansion while oxygen
supports gas exchange.
3. A patient receiving digoxin has an apical pulse of 48/min, nausea, and newly
developed visual disturbances. What should the nurse do first?
A. Administer the scheduled dose
B. Hold digoxin and notify the provider
C. Give an additional dose of potassium
D. Encourage ambulation
Answer: B. Hold digoxin and notify the provider
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are
classic manifestations of digoxin toxicity. The medication should be withheld
and the patient evaluated promptly.
4. A patient with diabetic ketoacidosis has a serum potassium of 3.0 mEq/L. An
insulin infusion is prescribed. Which action is most appropriate?
,A. Start insulin immediately
B. Administer potassium replacement before initiating insulin
C. Restrict IV fluids
D. Administer sodium bicarbonate routinely
Answer: B. Administer potassium replacement before initiating insulin
Rationale: Insulin drives potassium into cells and can cause life-threatening
hypokalemia. When potassium is significantly low, potassium replacement takes
priority before insulin therapy.
5. A patient with COPD receiving oxygen at 6 L/min develops increasing
somnolence and a respiratory rate of 8/min. Which complication should the
nurse suspect?
A. Acute hypoglycemia
B. Worsening carbon dioxide retention
C. Pulmonary embolism
D. Metabolic alkalosis
Answer: B. Worsening carbon dioxide retention
Rationale: Some patients with severe COPD are vulnerable to oxygen-induced
worsening hypercapnia. New somnolence and hypoventilation require
immediate assessment of ventilation and arterial blood gases.
6. A patient develops facial drooping, right-sided weakness, and aphasia 45
minutes before arrival in the emergency department. What information is most
important to establish?
A. Last oral intake
B. Last known well time
C. Previous vaccination history
D. Family history of cancer
, Answer: B. Last known well time
Rationale: The time the patient was last known to be neurologically normal
determines eligibility for time-sensitive acute stroke interventions.
7. A patient with suspected increased intracranial pressure becomes
increasingly lethargic and develops unequal pupils. Which action should the
nurse prioritize?
A. Encourage coughing
B. Lower the head of the bed
C. Notify the provider immediately and protect airway function
D. Administer oral fluids
Answer: C. Notify the provider immediately and protect airway function
Rationale: Declining level of consciousness and anisocoria may indicate
worsening intracranial pressure or herniation. Rapid neurologic and airway
intervention is essential.
8. A patient receiving heparin develops a platelet count decrease from
220,000/mm³ to 92,000/mm³ several days after treatment begins. What is the
nurse's priority concern?
A. Disseminated intravascular coagulation
B. Heparin-induced thrombocytopenia
C. Iron-deficiency anemia
D. Vitamin K deficiency
Answer: B. Heparin-induced thrombocytopenia
Rationale: A significant platelet decline occurring several days after heparin
exposure is highly concerning for HIT, a prothrombotic immune-mediated
Exam — Code: RN-NR-CE | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse is caring for a patient with septic shock who has received an initial
crystalloid bolus. The patient's blood pressure remains 82/48 mm Hg, and the
mean arterial pressure is 59 mm Hg. Which intervention should the nurse
anticipate next?
A. Administer IV furosemide
B. Initiate a vasopressor infusion
C. Restrict additional fluids
D. Administer oral antihypertensive medication
Answer: B. Initiate a vasopressor infusion
Rationale: Persistent hypotension after adequate fluid resuscitation in septic
shock requires vasopressor support, commonly norepinephrine, to restore
adequate organ perfusion.
,2. A patient with heart failure suddenly develops severe dyspnea, crackles
throughout both lungs, and pink frothy sputum. Which action has the highest
priority?
A. Place the patient flat
B. Encourage oral fluids
C. Position the patient upright and provide oxygen
D. Administer a potassium supplement
Answer: C. Position the patient upright and provide oxygen
Rationale: Acute pulmonary edema threatens oxygenation immediately. Upright
positioning decreases venous return and improves lung expansion while oxygen
supports gas exchange.
3. A patient receiving digoxin has an apical pulse of 48/min, nausea, and newly
developed visual disturbances. What should the nurse do first?
A. Administer the scheduled dose
B. Hold digoxin and notify the provider
C. Give an additional dose of potassium
D. Encourage ambulation
Answer: B. Hold digoxin and notify the provider
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are
classic manifestations of digoxin toxicity. The medication should be withheld
and the patient evaluated promptly.
4. A patient with diabetic ketoacidosis has a serum potassium of 3.0 mEq/L. An
insulin infusion is prescribed. Which action is most appropriate?
,A. Start insulin immediately
B. Administer potassium replacement before initiating insulin
C. Restrict IV fluids
D. Administer sodium bicarbonate routinely
Answer: B. Administer potassium replacement before initiating insulin
Rationale: Insulin drives potassium into cells and can cause life-threatening
hypokalemia. When potassium is significantly low, potassium replacement takes
priority before insulin therapy.
5. A patient with COPD receiving oxygen at 6 L/min develops increasing
somnolence and a respiratory rate of 8/min. Which complication should the
nurse suspect?
A. Acute hypoglycemia
B. Worsening carbon dioxide retention
C. Pulmonary embolism
D. Metabolic alkalosis
Answer: B. Worsening carbon dioxide retention
Rationale: Some patients with severe COPD are vulnerable to oxygen-induced
worsening hypercapnia. New somnolence and hypoventilation require
immediate assessment of ventilation and arterial blood gases.
6. A patient develops facial drooping, right-sided weakness, and aphasia 45
minutes before arrival in the emergency department. What information is most
important to establish?
A. Last oral intake
B. Last known well time
C. Previous vaccination history
D. Family history of cancer
, Answer: B. Last known well time
Rationale: The time the patient was last known to be neurologically normal
determines eligibility for time-sensitive acute stroke interventions.
7. A patient with suspected increased intracranial pressure becomes
increasingly lethargic and develops unequal pupils. Which action should the
nurse prioritize?
A. Encourage coughing
B. Lower the head of the bed
C. Notify the provider immediately and protect airway function
D. Administer oral fluids
Answer: C. Notify the provider immediately and protect airway function
Rationale: Declining level of consciousness and anisocoria may indicate
worsening intracranial pressure or herniation. Rapid neurologic and airway
intervention is essential.
8. A patient receiving heparin develops a platelet count decrease from
220,000/mm³ to 92,000/mm³ several days after treatment begins. What is the
nurse's priority concern?
A. Disseminated intravascular coagulation
B. Heparin-induced thrombocytopenia
C. Iron-deficiency anemia
D. Vitamin K deficiency
Answer: B. Heparin-induced thrombocytopenia
Rationale: A significant platelet decline occurring several days after heparin
exposure is highly concerning for HIT, a prothrombotic immune-mediated
