RN Nursing Skills Competency Exam —
Code: RN-SKILLS | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse is preparing to administer IV potassium chloride to a patient with a
serum potassium of 2.8 mEq/L. Which action is most appropriate?
A. Administer potassium chloride by IV push
B. Dilute the potassium and administer it using an infusion pump
C. Administer the medication undiluted through the peripheral IV
D. Mix potassium chloride with sodium bicarbonate
Answer: B. Dilute the potassium and administer it using an infusion pump
Rationale: IV potassium must never be administered by IV push because rapid
administration can cause fatal cardiac dysrhythmias. It should be appropriately
,diluted and administered at a controlled rate, preferably using an infusion
pump.
2. A patient receiving a blood transfusion develops chills, fever, and flank pain
15 minutes after initiation. What is the nurse's priority action?
A. Slow the transfusion
B. Administer acetaminophen
C. Stop the transfusion immediately
D. Obtain another blood specimen
Answer: C. Stop the transfusion immediately
Rationale: Fever, chills, and flank pain may indicate an acute hemolytic
transfusion reaction. The transfusion must be stopped immediately, followed by
maintaining IV access with compatible fluid according to protocol and notifying
the appropriate clinicians and blood bank.
3. A nurse is caring for a patient with a newly inserted central venous
catheter. Which finding requires immediate intervention?
A. Mild tenderness at the insertion site
B. Transparent dressing intact
C. Sudden dyspnea and unilateral absent breath sounds
D. Catheter flushed with saline
Answer: C. Sudden dyspnea and unilateral absent breath sounds
Rationale: Sudden respiratory distress and absent unilateral breath sounds after
central-line insertion suggest pneumothorax, which can rapidly become life-
threatening.
4. A patient receiving enteral feeding through a nasogastric tube begins
coughing and develops oxygen saturation of 84%. What should the nurse
do first?
A. Increase the feeding rate
B. Stop the feeding
,C. Flush the tube with water
D. Place the patient flat
Answer: B. Stop the feeding
Rationale: Coughing and hypoxemia during enteral feeding may indicate
aspiration. The feeding should be stopped immediately while the nurse assesses
airway and respiratory status and intervenes to protect the airway.
5. A nurse is preparing to insert an indwelling urinary catheter in a female
patient. Which technique is correct?
A. Insert the catheter until urine appears, then advance it farther before inflating
the balloon
B. Inflate the balloon immediately when the catheter enters the urethra
C. Clean from the anus toward the urethra
D. Touch the catheter tip to the sterile drape before insertion
Answer: A. Insert the catheter until urine appears, then advance it farther
before inflating the balloon
Rationale: Once urine appears, the catheter should be advanced farther into the
bladder before balloon inflation to reduce the risk of inflating the balloon within
the urethra.
6. A patient with a tracheostomy has thick secretions and increasing
respiratory effort. Which intervention is most appropriate?
A. Suction continuously for 30 seconds
B. Preoxygenate and suction using sterile technique
C. Instill routine saline before every suction pass
D. Suction only after the patient becomes cyanotic
Answer: B. Preoxygenate and suction using sterile technique
Rationale: Tracheostomy suctioning should be performed when clinically
indicated. Preoxygenation helps reduce hypoxemia, and sterile technique
reduces infection risk. Suction should be brief and intermittent.
, 7. During wound assessment, a nurse observes a pressure injury with full-
thickness skin loss and visible adipose tissue but no exposed fascia, muscle,
tendon, cartilage, or bone. How should this injury be classified?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
Answer: C. Stage 3
Rationale: Stage 3 pressure injury involves full-thickness skin loss with visible
adipose tissue and granulation or epibole. Deeper structures such as fascia,
muscle, tendon, cartilage, and bone are not exposed.
8. A nurse is changing a sterile dressing on a central venous catheter. Which
action maintains sterility?
A. Cleaning outward from the insertion site using the prescribed antiseptic
B. Reusing the same swab over the insertion site
C. Touching the catheter hub with a clean glove
D. Placing sterile supplies below waist level
Answer: A. Cleaning outward from the insertion site using the prescribed
antiseptic
Rationale: Central-line dressing changes require aseptic technique. Antiseptic
preparation is performed according to institutional protocol, generally moving
from the insertion site outward without returning to a previously contaminated
area.
9. A patient receiving oxygen through a nonrebreather mask has an oxygen
saturation of 88%. The reservoir bag repeatedly collapses during
inspiration. What should the nurse do?
A. Remove the mask
B. Increase the oxygen flow rate as prescribed or per protocol
Code: RN-SKILLS | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse is preparing to administer IV potassium chloride to a patient with a
serum potassium of 2.8 mEq/L. Which action is most appropriate?
A. Administer potassium chloride by IV push
B. Dilute the potassium and administer it using an infusion pump
C. Administer the medication undiluted through the peripheral IV
D. Mix potassium chloride with sodium bicarbonate
Answer: B. Dilute the potassium and administer it using an infusion pump
Rationale: IV potassium must never be administered by IV push because rapid
administration can cause fatal cardiac dysrhythmias. It should be appropriately
,diluted and administered at a controlled rate, preferably using an infusion
pump.
2. A patient receiving a blood transfusion develops chills, fever, and flank pain
15 minutes after initiation. What is the nurse's priority action?
A. Slow the transfusion
B. Administer acetaminophen
C. Stop the transfusion immediately
D. Obtain another blood specimen
Answer: C. Stop the transfusion immediately
Rationale: Fever, chills, and flank pain may indicate an acute hemolytic
transfusion reaction. The transfusion must be stopped immediately, followed by
maintaining IV access with compatible fluid according to protocol and notifying
the appropriate clinicians and blood bank.
3. A nurse is caring for a patient with a newly inserted central venous
catheter. Which finding requires immediate intervention?
A. Mild tenderness at the insertion site
B. Transparent dressing intact
C. Sudden dyspnea and unilateral absent breath sounds
D. Catheter flushed with saline
Answer: C. Sudden dyspnea and unilateral absent breath sounds
Rationale: Sudden respiratory distress and absent unilateral breath sounds after
central-line insertion suggest pneumothorax, which can rapidly become life-
threatening.
4. A patient receiving enteral feeding through a nasogastric tube begins
coughing and develops oxygen saturation of 84%. What should the nurse
do first?
A. Increase the feeding rate
B. Stop the feeding
,C. Flush the tube with water
D. Place the patient flat
Answer: B. Stop the feeding
Rationale: Coughing and hypoxemia during enteral feeding may indicate
aspiration. The feeding should be stopped immediately while the nurse assesses
airway and respiratory status and intervenes to protect the airway.
5. A nurse is preparing to insert an indwelling urinary catheter in a female
patient. Which technique is correct?
A. Insert the catheter until urine appears, then advance it farther before inflating
the balloon
B. Inflate the balloon immediately when the catheter enters the urethra
C. Clean from the anus toward the urethra
D. Touch the catheter tip to the sterile drape before insertion
Answer: A. Insert the catheter until urine appears, then advance it farther
before inflating the balloon
Rationale: Once urine appears, the catheter should be advanced farther into the
bladder before balloon inflation to reduce the risk of inflating the balloon within
the urethra.
6. A patient with a tracheostomy has thick secretions and increasing
respiratory effort. Which intervention is most appropriate?
A. Suction continuously for 30 seconds
B. Preoxygenate and suction using sterile technique
C. Instill routine saline before every suction pass
D. Suction only after the patient becomes cyanotic
Answer: B. Preoxygenate and suction using sterile technique
Rationale: Tracheostomy suctioning should be performed when clinically
indicated. Preoxygenation helps reduce hypoxemia, and sterile technique
reduces infection risk. Suction should be brief and intermittent.
, 7. During wound assessment, a nurse observes a pressure injury with full-
thickness skin loss and visible adipose tissue but no exposed fascia, muscle,
tendon, cartilage, or bone. How should this injury be classified?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
Answer: C. Stage 3
Rationale: Stage 3 pressure injury involves full-thickness skin loss with visible
adipose tissue and granulation or epibole. Deeper structures such as fascia,
muscle, tendon, cartilage, and bone are not exposed.
8. A nurse is changing a sterile dressing on a central venous catheter. Which
action maintains sterility?
A. Cleaning outward from the insertion site using the prescribed antiseptic
B. Reusing the same swab over the insertion site
C. Touching the catheter hub with a clean glove
D. Placing sterile supplies below waist level
Answer: A. Cleaning outward from the insertion site using the prescribed
antiseptic
Rationale: Central-line dressing changes require aseptic technique. Antiseptic
preparation is performed according to institutional protocol, generally moving
from the insertion site outward without returning to a previously contaminated
area.
9. A patient receiving oxygen through a nonrebreather mask has an oxygen
saturation of 88%. The reservoir bag repeatedly collapses during
inspiration. What should the nurse do?
A. Remove the mask
B. Increase the oxygen flow rate as prescribed or per protocol
