SCFHS-STYLE CLINICAL FINAL EXAM-LEVEL 3 NURSE -
CLINICAL COMPETENCY EXAMINATION | ALL PRACTICE
Q&A 2026/2027 | A+ GRADED | COMPREHENSIVE
EXAM GUIDE 2026&2027
1. A Level 3 nurse is caring for a patient who suddenly develops dyspnea, tachycardia, and
an oxygen saturation of 86% on room air. What should the nurse do FIRST?
A. Obtain a complete medical history
B. Apply oxygen and perform an immediate focused assessment
C. Encourage the patient to ambulate
D. Administer the patient's scheduled oral medications
Answer: B
The priority is immediate stabilization and assessment of airway, breathing, and circulation.
Supplemental oxygen addresses hypoxemia while the focused assessment identifies the cause
and guides further intervention.
2. A postoperative patient reports increasing abdominal pain despite receiving prescribed
analgesia. The abdomen is becoming rigid and distended. Which finding requires the most
urgent response?
A. Pain rated 7/10
B. Mild nausea
C. Rigid, distended abdomen with worsening pain
D. Request for an additional blanket
Answer: C
A rigid and distended abdomen with worsening pain may indicate an acute intra-abdominal
complication such as peritonitis or hemorrhage. Immediate clinical reassessment is required.
3. Before administering a high-alert medication, which nursing action best reduces
medication error risk?
A. Verify the medication against the prescription and perform required independent checks
B. Ask another patient whether the medication looks familiar
C. Prepare the medication before reviewing the order
D. Rely solely on the electronic medication administration system
Answer: A
High-alert medications require careful verification because errors can cause significant harm.
Following the prescribed verification and independent double-check process reduces risk.
,4. A patient with suspected sepsis has a temperature of 39.2°C, heart rate of 128/min,
respiratory rate of 30/min, and altered mental status. Which assessment finding is most
concerning for worsening tissue perfusion?
A. Warm skin
B. Temperature of 39.2°C
C. Heart rate of 128/min
D. New confusion with reduced urine output
Answer: D
Altered mental status and oliguria can indicate impaired organ perfusion and evolving septic
shock. These findings require immediate escalation and treatment.
5. A nurse receives a verbal medication order in an emergency. Which action is most
appropriate?
A. Administer the medication without repeating the order
B. Ask another nurse to interpret the order later
C. Read the order back to the prescriber for confirmation
D. Document the order only after the patient's condition improves
Answer: C
Read-back confirmation helps prevent errors involving medication name, dose, route, and
frequency, particularly when verbal communication is necessary during urgent care.
6. A patient with diabetes becomes sweaty, shaky, and confused. The bedside glucose is 48
mg/dL, and the patient is awake and able to swallow. What is the priority intervention?
A. Give a rapid-acting carbohydrate
B. Administer long-acting insulin
C. Restrict oral intake
D. Encourage exercise
Answer: A
A conscious patient who can safely swallow should receive a rapidly absorbed carbohydrate
to correct symptomatic hypoglycemia, followed by reassessment.
7. A nurse is preparing to administer insulin. Which practice is safest?
A. Draw up all insulin for the entire shift at once
B. Verify the insulin type, concentration, dose, and timing against the order
C. Estimate the dose based on the patient's previous admission
D. Skip glucose verification if the patient has eaten
Answer: B
,Insulin is a high-alert medication. Correct verification of the prescribed insulin type,
concentration, dose, and timing is essential to prevent potentially serious medication errors.
8. A patient receiving a blood transfusion develops chills, fever, and back pain 15 minutes
after initiation. What should the nurse do FIRST?
A. Slow the transfusion rate
B. Give an antipyretic and continue the transfusion
C. Stop the transfusion immediately
D. Reassure the patient that mild chills are expected
Answer: C
The symptoms may indicate an acute transfusion reaction. The transfusion must be stopped
immediately while the patient's airway, circulation, and institutional transfusion-reaction
protocol are addressed.
9. A patient receiving an opioid analgesic has a respiratory rate of 7/min and is difficult to
arouse. Which assessment takes priority?
A. Bowel sounds
B. Respiratory status and oxygenation
C. Nutritional intake
D. Skin integrity
Answer: B
Opioid-induced respiratory depression is potentially life-threatening. Airway, breathing,
oxygenation, and level of consciousness require immediate attention.
10. A nurse is caring for a patient with a central venous catheter. Which finding should be
reported immediately?
A. Dressing changed according to policy
B. Catheter flushed according to protocol
C. Mild bruising present from an old procedure
D. New redness, drainage, and tenderness at the insertion site
Answer: D
New redness, drainage, and tenderness may indicate a catheter-related infection. Prompt
assessment and escalation can prevent progression to systemic infection.
11. A patient with heart failure suddenly develops severe dyspnea, crackles, and pink
frothy sputum. Which condition is most likely?
A. Acute pulmonary edema
B. Constipation
C. Mild dehydration
D. Hypoglycemia
, Answer: A
Severe dyspnea, pulmonary crackles, and pink frothy sputum are classic indicators of acute
pulmonary edema, requiring immediate respiratory and cardiovascular intervention.
12. A nurse is assessing a patient after a fall. Which action should occur FIRST?
A. Complete the incident report
B. Ask the patient why they fell
C. Assess airway, breathing, circulation, and possible injury
D. Return the patient to bed without assessment
Answer: C
The patient's immediate clinical condition takes priority after a fall. A systematic assessment
identifies life-threatening injury before documentation or investigation.
13. A patient receiving IV potassium reports burning at the infusion site. The site appears
swollen and cool. What should the nurse do?
A. Increase the infusion rate
B. Stop the infusion and assess the IV site
C. Apply pressure and continue the infusion
D. Ignore the finding if blood pressure is stable
Answer: B
Pain, swelling, and coolness suggest infiltration or extravasation. The infusion should be
stopped and the IV site assessed according to the medication and institutional protocol.
14. A patient with COPD is receiving oxygen therapy. Which nursing action is
appropriate?
A. Titrate oxygen according to the prescribed target and clinical condition
B. Automatically administer the highest available oxygen flow
C. Withhold oxygen whenever carbon dioxide retention is suspected
D. Discontinue monitoring once oxygen is applied
Answer: A
Patients with COPD require individualized oxygen therapy. Oxygen should be titrated to the
prescribed or clinically appropriate target while respiratory status is continuously assessed.
15. A nurse is caring for a patient with a new tracheostomy. Which finding requires
immediate attention?
A. Small amount of expected secretions
B. Patient communicating by writing
C. Sudden respiratory distress with absent airflow through the tracheostomy
D. Mild discomfort during movement
CLINICAL COMPETENCY EXAMINATION | ALL PRACTICE
Q&A 2026/2027 | A+ GRADED | COMPREHENSIVE
EXAM GUIDE 2026&2027
1. A Level 3 nurse is caring for a patient who suddenly develops dyspnea, tachycardia, and
an oxygen saturation of 86% on room air. What should the nurse do FIRST?
A. Obtain a complete medical history
B. Apply oxygen and perform an immediate focused assessment
C. Encourage the patient to ambulate
D. Administer the patient's scheduled oral medications
Answer: B
The priority is immediate stabilization and assessment of airway, breathing, and circulation.
Supplemental oxygen addresses hypoxemia while the focused assessment identifies the cause
and guides further intervention.
2. A postoperative patient reports increasing abdominal pain despite receiving prescribed
analgesia. The abdomen is becoming rigid and distended. Which finding requires the most
urgent response?
A. Pain rated 7/10
B. Mild nausea
C. Rigid, distended abdomen with worsening pain
D. Request for an additional blanket
Answer: C
A rigid and distended abdomen with worsening pain may indicate an acute intra-abdominal
complication such as peritonitis or hemorrhage. Immediate clinical reassessment is required.
3. Before administering a high-alert medication, which nursing action best reduces
medication error risk?
A. Verify the medication against the prescription and perform required independent checks
B. Ask another patient whether the medication looks familiar
C. Prepare the medication before reviewing the order
D. Rely solely on the electronic medication administration system
Answer: A
High-alert medications require careful verification because errors can cause significant harm.
Following the prescribed verification and independent double-check process reduces risk.
,4. A patient with suspected sepsis has a temperature of 39.2°C, heart rate of 128/min,
respiratory rate of 30/min, and altered mental status. Which assessment finding is most
concerning for worsening tissue perfusion?
A. Warm skin
B. Temperature of 39.2°C
C. Heart rate of 128/min
D. New confusion with reduced urine output
Answer: D
Altered mental status and oliguria can indicate impaired organ perfusion and evolving septic
shock. These findings require immediate escalation and treatment.
5. A nurse receives a verbal medication order in an emergency. Which action is most
appropriate?
A. Administer the medication without repeating the order
B. Ask another nurse to interpret the order later
C. Read the order back to the prescriber for confirmation
D. Document the order only after the patient's condition improves
Answer: C
Read-back confirmation helps prevent errors involving medication name, dose, route, and
frequency, particularly when verbal communication is necessary during urgent care.
6. A patient with diabetes becomes sweaty, shaky, and confused. The bedside glucose is 48
mg/dL, and the patient is awake and able to swallow. What is the priority intervention?
A. Give a rapid-acting carbohydrate
B. Administer long-acting insulin
C. Restrict oral intake
D. Encourage exercise
Answer: A
A conscious patient who can safely swallow should receive a rapidly absorbed carbohydrate
to correct symptomatic hypoglycemia, followed by reassessment.
7. A nurse is preparing to administer insulin. Which practice is safest?
A. Draw up all insulin for the entire shift at once
B. Verify the insulin type, concentration, dose, and timing against the order
C. Estimate the dose based on the patient's previous admission
D. Skip glucose verification if the patient has eaten
Answer: B
,Insulin is a high-alert medication. Correct verification of the prescribed insulin type,
concentration, dose, and timing is essential to prevent potentially serious medication errors.
8. A patient receiving a blood transfusion develops chills, fever, and back pain 15 minutes
after initiation. What should the nurse do FIRST?
A. Slow the transfusion rate
B. Give an antipyretic and continue the transfusion
C. Stop the transfusion immediately
D. Reassure the patient that mild chills are expected
Answer: C
The symptoms may indicate an acute transfusion reaction. The transfusion must be stopped
immediately while the patient's airway, circulation, and institutional transfusion-reaction
protocol are addressed.
9. A patient receiving an opioid analgesic has a respiratory rate of 7/min and is difficult to
arouse. Which assessment takes priority?
A. Bowel sounds
B. Respiratory status and oxygenation
C. Nutritional intake
D. Skin integrity
Answer: B
Opioid-induced respiratory depression is potentially life-threatening. Airway, breathing,
oxygenation, and level of consciousness require immediate attention.
10. A nurse is caring for a patient with a central venous catheter. Which finding should be
reported immediately?
A. Dressing changed according to policy
B. Catheter flushed according to protocol
C. Mild bruising present from an old procedure
D. New redness, drainage, and tenderness at the insertion site
Answer: D
New redness, drainage, and tenderness may indicate a catheter-related infection. Prompt
assessment and escalation can prevent progression to systemic infection.
11. A patient with heart failure suddenly develops severe dyspnea, crackles, and pink
frothy sputum. Which condition is most likely?
A. Acute pulmonary edema
B. Constipation
C. Mild dehydration
D. Hypoglycemia
, Answer: A
Severe dyspnea, pulmonary crackles, and pink frothy sputum are classic indicators of acute
pulmonary edema, requiring immediate respiratory and cardiovascular intervention.
12. A nurse is assessing a patient after a fall. Which action should occur FIRST?
A. Complete the incident report
B. Ask the patient why they fell
C. Assess airway, breathing, circulation, and possible injury
D. Return the patient to bed without assessment
Answer: C
The patient's immediate clinical condition takes priority after a fall. A systematic assessment
identifies life-threatening injury before documentation or investigation.
13. A patient receiving IV potassium reports burning at the infusion site. The site appears
swollen and cool. What should the nurse do?
A. Increase the infusion rate
B. Stop the infusion and assess the IV site
C. Apply pressure and continue the infusion
D. Ignore the finding if blood pressure is stable
Answer: B
Pain, swelling, and coolness suggest infiltration or extravasation. The infusion should be
stopped and the IV site assessed according to the medication and institutional protocol.
14. A patient with COPD is receiving oxygen therapy. Which nursing action is
appropriate?
A. Titrate oxygen according to the prescribed target and clinical condition
B. Automatically administer the highest available oxygen flow
C. Withhold oxygen whenever carbon dioxide retention is suspected
D. Discontinue monitoring once oxygen is applied
Answer: A
Patients with COPD require individualized oxygen therapy. Oxygen should be titrated to the
prescribed or clinically appropriate target while respiratory status is continuously assessed.
15. A nurse is caring for a patient with a new tracheostomy. Which finding requires
immediate attention?
A. Small amount of expected secretions
B. Patient communicating by writing
C. Sudden respiratory distress with absent airflow through the tracheostomy
D. Mild discomfort during movement
