RN Specialty Certifications Advanced
Practice Test Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
Pdf
1.
A patient with septic shock remains hypotensive despite receiving 30
mL/kg of crystalloid. MAP is 58 mm Hg. Which intervention should the
nurse anticipate first?
A. Administer IV furosemide
B. Begin enteral feeding
C. Administer a vasopressor
D. Restrict all IV fluids
Answer: C. Administer a vasopressor
Rationale: Persistent hypotension after adequate initial fluid
resuscitation indicates the need for vasopressor support, with
norepinephrine commonly used as first-line therapy to restore
adequate MAP and organ perfusion.
2.
,A patient receiving norepinephrine through a peripheral IV develops
blanching and coolness around the insertion site. What is the nurse's
priority action?
A. Increase the infusion rate
B. Apply a cold compress
C. Stop the infusion and follow extravasation protocol
D. Flush the IV rapidly
Answer: C. Stop the infusion and follow extravasation protocol
Rationale: Norepinephrine extravasation can cause severe tissue
ischemia and necrosis. The infusion should be stopped and the
facility's extravasation protocol initiated promptly.
3.
A mechanically ventilated patient suddenly develops hypotension,
tachycardia, absent breath sounds on the right, and tracheal deviation.
Which condition is most likely?
A. Pulmonary edema
B. Tension pneumothorax
C. Atelectasis
D. Pleural effusion
Answer: B. Tension pneumothorax
Rationale: Sudden respiratory deterioration, unilateral absent breath
sounds, hypotension, and tracheal deviation strongly indicate tension
pneumothorax, a life-threatening emergency requiring immediate
decompression.
,4.
A patient with diabetic ketoacidosis has glucose 240 mg/dL, pH 7.21,
and persistent ketonemia. Which intervention is appropriate?
A. Stop insulin because glucose is below 250 mg/dL
B. Add dextrose while continuing insulin
C. Administer sodium bicarbonate routinely
D. Restrict IV fluids
Answer: B. Add dextrose while continuing insulin
Rationale: Once glucose falls while ketoacidosis persists, dextrose can
be added to the IV fluid so insulin can continue suppressing
ketogenesis until the metabolic acidosis resolves.
5.
A patient with acute myocardial infarction suddenly develops a new
loud holosystolic murmur and pulmonary edema. Which complication
should the nurse suspect?
A. Pericarditis
B. Papillary muscle rupture
C. Sinus bradycardia
D. Stable angina
Answer: B. Papillary muscle rupture
Rationale: Acute papillary muscle rupture can cause severe mitral
regurgitation, producing a new holosystolic murmur and acute
pulmonary edema.
6.
, A patient with increased intracranial pressure develops hypertension,
bradycardia, and irregular respirations. What does this finding
represent?
A. Beck triad
B. Cushing response
C. Neurogenic shock
D. Spinal shock
Answer: B. Cushing response
Rationale: The combination of hypertension with widening pulse
pressure, bradycardia, and abnormal respirations is the Cushing
response and indicates potentially dangerous intracranial pressure
elevation.
7.
A patient with severe asthma has a PaCO₂ that has increased from 32 to
48 mm Hg despite worsening wheezing. How should the nurse interpret
this finding?
A. Improvement in ventilation
B. Expected compensation
C. Impending respiratory failure
D. Resolution of bronchospasm
Answer: C. Impending respiratory failure
Rationale: In severe asthma, patients initially hyperventilate and have
low PaCO₂. A rising or normalizing PaCO₂ can indicate respiratory
muscle fatigue and deteriorating ventilation.
Practice Test Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
1.
A patient with septic shock remains hypotensive despite receiving 30
mL/kg of crystalloid. MAP is 58 mm Hg. Which intervention should the
nurse anticipate first?
A. Administer IV furosemide
B. Begin enteral feeding
C. Administer a vasopressor
D. Restrict all IV fluids
Answer: C. Administer a vasopressor
Rationale: Persistent hypotension after adequate initial fluid
resuscitation indicates the need for vasopressor support, with
norepinephrine commonly used as first-line therapy to restore
adequate MAP and organ perfusion.
2.
,A patient receiving norepinephrine through a peripheral IV develops
blanching and coolness around the insertion site. What is the nurse's
priority action?
A. Increase the infusion rate
B. Apply a cold compress
C. Stop the infusion and follow extravasation protocol
D. Flush the IV rapidly
Answer: C. Stop the infusion and follow extravasation protocol
Rationale: Norepinephrine extravasation can cause severe tissue
ischemia and necrosis. The infusion should be stopped and the
facility's extravasation protocol initiated promptly.
3.
A mechanically ventilated patient suddenly develops hypotension,
tachycardia, absent breath sounds on the right, and tracheal deviation.
Which condition is most likely?
A. Pulmonary edema
B. Tension pneumothorax
C. Atelectasis
D. Pleural effusion
Answer: B. Tension pneumothorax
Rationale: Sudden respiratory deterioration, unilateral absent breath
sounds, hypotension, and tracheal deviation strongly indicate tension
pneumothorax, a life-threatening emergency requiring immediate
decompression.
,4.
A patient with diabetic ketoacidosis has glucose 240 mg/dL, pH 7.21,
and persistent ketonemia. Which intervention is appropriate?
A. Stop insulin because glucose is below 250 mg/dL
B. Add dextrose while continuing insulin
C. Administer sodium bicarbonate routinely
D. Restrict IV fluids
Answer: B. Add dextrose while continuing insulin
Rationale: Once glucose falls while ketoacidosis persists, dextrose can
be added to the IV fluid so insulin can continue suppressing
ketogenesis until the metabolic acidosis resolves.
5.
A patient with acute myocardial infarction suddenly develops a new
loud holosystolic murmur and pulmonary edema. Which complication
should the nurse suspect?
A. Pericarditis
B. Papillary muscle rupture
C. Sinus bradycardia
D. Stable angina
Answer: B. Papillary muscle rupture
Rationale: Acute papillary muscle rupture can cause severe mitral
regurgitation, producing a new holosystolic murmur and acute
pulmonary edema.
6.
, A patient with increased intracranial pressure develops hypertension,
bradycardia, and irregular respirations. What does this finding
represent?
A. Beck triad
B. Cushing response
C. Neurogenic shock
D. Spinal shock
Answer: B. Cushing response
Rationale: The combination of hypertension with widening pulse
pressure, bradycardia, and abnormal respirations is the Cushing
response and indicates potentially dangerous intracranial pressure
elevation.
7.
A patient with severe asthma has a PaCO₂ that has increased from 32 to
48 mm Hg despite worsening wheezing. How should the nurse interpret
this finding?
A. Improvement in ventilation
B. Expected compensation
C. Impending respiratory failure
D. Resolution of bronchospasm
Answer: C. Impending respiratory failure
Rationale: In severe asthma, patients initially hyperventilate and have
low PaCO₂. A rising or normalizing PaCO₂ can indicate respiratory
muscle fatigue and deteriorating ventilation.
