RN Nurse Refresher Course Final Exam
— Code: RN-NR-FE | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse is caring for a client 12 hours after abdominal surgery. The client
reports increasing abdominal pain despite prescribed analgesia. The
abdomen is rigid, bowel sounds are absent, temperature is 38.7°C
(101.7°F), and heart rate is 124/min. Which action is the priority?
A. Administer the next dose of opioid analgesic
B. Encourage oral fluids
C. Notify the provider immediately
D. Apply a heating pad to the abdomen
Answer: Notify the provider immediately
,Rationale: The combination of rigid abdomen, fever, tachycardia, absent bowel
sounds, and worsening pain suggests peritonitis or another acute intra-
abdominal complication. Immediate provider notification and further evaluation
are required.
2. A client with heart failure is receiving furosemide. Which laboratory value
requires the nurse's most immediate attention?
A. Sodium 137 mEq/L
B. Potassium 2.8 mEq/L
C. Calcium 9.1 mg/dL
D. Chloride 101 mEq/L
Answer: Potassium 2.8 mEq/L
Rationale: Furosemide promotes potassium loss. Severe hypokalemia increases
the risk of potentially life-threatening dysrhythmias and requires prompt
intervention.
3. A client with chronic obstructive pulmonary disease is receiving oxygen at 6
L/min by nasal cannula. The client becomes increasingly somnolent. Which
action should the nurse take first?
A. Increase oxygen to 10 L/min
B. Assess respiratory status and oxygenation
C. Administer a sedative
D. Place the client flat in bed
Answer: Assess respiratory status and oxygenation
Rationale: Excessive oxygen administration in some clients with chronic CO₂
retention can worsen hypercapnia. The nurse should immediately assess
respiratory status, oxygen saturation, and level of consciousness before
determining further intervention.
4. A client receiving warfarin has an INR of 6.2 and reports bleeding gums.
Which prescription should the nurse anticipate?
,A. Additional warfarin
B. Vitamin K administration
C. Aspirin therapy
D. Heparin infusion
Answer: Vitamin K administration
Rationale: A markedly elevated INR accompanied by active bleeding indicates
excessive anticoagulation. Vitamin K may be prescribed to reverse warfarin's
effects, depending on the severity of bleeding and clinical circumstances.
5. A client with diabetic ketoacidosis has a serum potassium level of 3.0
mEq/L. Which prescription should the nurse question?
A. IV potassium replacement
B. Cardiac monitoring
C. Regular insulin infusion immediately
D. Frequent electrolyte monitoring
Answer: Regular insulin infusion immediately
Rationale: Insulin shifts potassium intracellularly and can cause a dangerous
further decline in serum potassium. When potassium is significantly low,
potassium replacement generally takes priority before insulin therapy is
initiated.
6. A postoperative client suddenly develops dyspnea, pleuritic chest pain,
tachycardia, and oxygen saturation of 86%. Which complication should the
nurse suspect?
A. Atelectasis
B. Pulmonary embolism
C. Fluid overload
D. Hypoglycemia
Answer: Pulmonary embolism
, Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia in
a postoperative client are classic findings associated with pulmonary embolism.
This is an emergency requiring immediate assessment and intervention.
7. 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. Hold digoxin and notify the provider
C. Give an additional dose
D. Encourage ambulation
Answer: Hold digoxin and notify the provider
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are
concerning for digoxin toxicity. The medication should be withheld and the
provider notified.
8. A client with suspected bacterial meningitis is admitted to the emergency
department. Which intervention is most appropriate?
A. Initiate airborne precautions
B. Initiate droplet precautions
C. Place the client in protective isolation
D. Use only standard precautions
Answer: Initiate droplet precautions
Rationale: Suspected bacterial meningitis requires droplet precautions because
respiratory and oral secretions may transmit the causative organisms.
9. A client with SIADH has a sodium level of 118 mEq/L and develops
confusion and a seizure. Which intervention is the priority?
A. Encourage free-water intake
B. Initiate seizure precautions and notify the provider
C. Administer hypotonic IV fluids
D. Encourage increased oral fluids
— Code: RN-NR-FE | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse is caring for a client 12 hours after abdominal surgery. The client
reports increasing abdominal pain despite prescribed analgesia. The
abdomen is rigid, bowel sounds are absent, temperature is 38.7°C
(101.7°F), and heart rate is 124/min. Which action is the priority?
A. Administer the next dose of opioid analgesic
B. Encourage oral fluids
C. Notify the provider immediately
D. Apply a heating pad to the abdomen
Answer: Notify the provider immediately
,Rationale: The combination of rigid abdomen, fever, tachycardia, absent bowel
sounds, and worsening pain suggests peritonitis or another acute intra-
abdominal complication. Immediate provider notification and further evaluation
are required.
2. A client with heart failure is receiving furosemide. Which laboratory value
requires the nurse's most immediate attention?
A. Sodium 137 mEq/L
B. Potassium 2.8 mEq/L
C. Calcium 9.1 mg/dL
D. Chloride 101 mEq/L
Answer: Potassium 2.8 mEq/L
Rationale: Furosemide promotes potassium loss. Severe hypokalemia increases
the risk of potentially life-threatening dysrhythmias and requires prompt
intervention.
3. A client with chronic obstructive pulmonary disease is receiving oxygen at 6
L/min by nasal cannula. The client becomes increasingly somnolent. Which
action should the nurse take first?
A. Increase oxygen to 10 L/min
B. Assess respiratory status and oxygenation
C. Administer a sedative
D. Place the client flat in bed
Answer: Assess respiratory status and oxygenation
Rationale: Excessive oxygen administration in some clients with chronic CO₂
retention can worsen hypercapnia. The nurse should immediately assess
respiratory status, oxygen saturation, and level of consciousness before
determining further intervention.
4. A client receiving warfarin has an INR of 6.2 and reports bleeding gums.
Which prescription should the nurse anticipate?
,A. Additional warfarin
B. Vitamin K administration
C. Aspirin therapy
D. Heparin infusion
Answer: Vitamin K administration
Rationale: A markedly elevated INR accompanied by active bleeding indicates
excessive anticoagulation. Vitamin K may be prescribed to reverse warfarin's
effects, depending on the severity of bleeding and clinical circumstances.
5. A client with diabetic ketoacidosis has a serum potassium level of 3.0
mEq/L. Which prescription should the nurse question?
A. IV potassium replacement
B. Cardiac monitoring
C. Regular insulin infusion immediately
D. Frequent electrolyte monitoring
Answer: Regular insulin infusion immediately
Rationale: Insulin shifts potassium intracellularly and can cause a dangerous
further decline in serum potassium. When potassium is significantly low,
potassium replacement generally takes priority before insulin therapy is
initiated.
6. A postoperative client suddenly develops dyspnea, pleuritic chest pain,
tachycardia, and oxygen saturation of 86%. Which complication should the
nurse suspect?
A. Atelectasis
B. Pulmonary embolism
C. Fluid overload
D. Hypoglycemia
Answer: Pulmonary embolism
, Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia in
a postoperative client are classic findings associated with pulmonary embolism.
This is an emergency requiring immediate assessment and intervention.
7. 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. Hold digoxin and notify the provider
C. Give an additional dose
D. Encourage ambulation
Answer: Hold digoxin and notify the provider
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are
concerning for digoxin toxicity. The medication should be withheld and the
provider notified.
8. A client with suspected bacterial meningitis is admitted to the emergency
department. Which intervention is most appropriate?
A. Initiate airborne precautions
B. Initiate droplet precautions
C. Place the client in protective isolation
D. Use only standard precautions
Answer: Initiate droplet precautions
Rationale: Suspected bacterial meningitis requires droplet precautions because
respiratory and oral secretions may transmit the causative organisms.
9. A client with SIADH has a sodium level of 118 mEq/L and develops
confusion and a seizure. Which intervention is the priority?
A. Encourage free-water intake
B. Initiate seizure precautions and notify the provider
C. Administer hypotonic IV fluids
D. Encourage increased oral fluids
