ADVANCED MEDICAL-SURGICAL
NURSING COMPETENCY EXAM
QUESTIONS AND ANSWERS
1. A client with a history of heart failure is admitted with orthopnea and bilateral pulmonary
crackles. Which assessment finding requires immediate intervention?
A. Pulse oximetry of 94% on room air
B. Production of pink, frothy sputum
C. Weight gain of 2 pounds in 24 hours
D. Pitting edema in the lower extremities
Answer: B
Conceptual Explanation: Pink, frothy sputum is a hallmark sign of acute pulmonary
edema, a life-threatening complication requiring immediate intervention to improve
oxygenation and reduce preload.
2. An arterial blood gas (ABG) report shows pH 7.30, PaCO2 55 mmHg, and HCO3 26 mEq/L.
Which condition does the nurse suspect?
A. Metabolic Acidosis
,B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Conceptual Explanation: A pH below 7.35 indicates acidosis, and a PaCO2 above 45
mmHg with a normal bicarbonate level indicates a respiratory origin.
3. Which dietary instruction is most important for a client diagnosed with Chronic Kidney
Disease (CKD) who is not yet on dialysis?
A. Increase intake of phosphorus-rich foods
B. Consume at least 3 liters of water daily
C. Restrict protein and potassium intake
D. Supplement with high doses of Vitamin C
Answer: C
Conceptual Explanation: Restricting protein reduces the accumulation of nitrogenous
waste, and restricting potassium prevents life-threatening cardiac arrhythmias in CKD
patients.
4. A nurse is assessing a client following a head injury. Which finding is indicative of Cushing’s
Triad?
A. Tachycardia, hypotension, and tachypnea
, B. Bradycardia, hypertension, and irregular respirations
C. Hypotension, bradycardia, and Cheyne-Stokes breathing
D. Tachycardia, hypertension, and narrowed pulse pressure
Answer: B
Conceptual Explanation: Cushing’s Triad (bradycardia, hypertension with widened pulse
pressure, and irregular respirations) is a late sign of increased intracranial pressure.
5. A client with type 1 diabetes mellitus is found unconscious and diaphoretic. What is the
nurse’s priority action?
A. Administer 15 grams of oral glucose gel
B. Check the client’s blood glucose level
C. Administer intramuscular glucagon
D. Start an intravenous infusion of Normal Saline
Answer: C
Conceptual Explanation: In an unconscious client with suspected hypoglycemia,
providing a quick source of glucose via glucagon or IV Dextrose is the priority when oral
intake is impossible.
6. Following a femur fracture, a client reports sudden chest pain and dyspnea. The nurse
notes petechiae on the chest. What should the nurse do first?
A. Administer a bolus of intravenous heparin
NURSING COMPETENCY EXAM
QUESTIONS AND ANSWERS
1. A client with a history of heart failure is admitted with orthopnea and bilateral pulmonary
crackles. Which assessment finding requires immediate intervention?
A. Pulse oximetry of 94% on room air
B. Production of pink, frothy sputum
C. Weight gain of 2 pounds in 24 hours
D. Pitting edema in the lower extremities
Answer: B
Conceptual Explanation: Pink, frothy sputum is a hallmark sign of acute pulmonary
edema, a life-threatening complication requiring immediate intervention to improve
oxygenation and reduce preload.
2. An arterial blood gas (ABG) report shows pH 7.30, PaCO2 55 mmHg, and HCO3 26 mEq/L.
Which condition does the nurse suspect?
A. Metabolic Acidosis
,B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Conceptual Explanation: A pH below 7.35 indicates acidosis, and a PaCO2 above 45
mmHg with a normal bicarbonate level indicates a respiratory origin.
3. Which dietary instruction is most important for a client diagnosed with Chronic Kidney
Disease (CKD) who is not yet on dialysis?
A. Increase intake of phosphorus-rich foods
B. Consume at least 3 liters of water daily
C. Restrict protein and potassium intake
D. Supplement with high doses of Vitamin C
Answer: C
Conceptual Explanation: Restricting protein reduces the accumulation of nitrogenous
waste, and restricting potassium prevents life-threatening cardiac arrhythmias in CKD
patients.
4. A nurse is assessing a client following a head injury. Which finding is indicative of Cushing’s
Triad?
A. Tachycardia, hypotension, and tachypnea
, B. Bradycardia, hypertension, and irregular respirations
C. Hypotension, bradycardia, and Cheyne-Stokes breathing
D. Tachycardia, hypertension, and narrowed pulse pressure
Answer: B
Conceptual Explanation: Cushing’s Triad (bradycardia, hypertension with widened pulse
pressure, and irregular respirations) is a late sign of increased intracranial pressure.
5. A client with type 1 diabetes mellitus is found unconscious and diaphoretic. What is the
nurse’s priority action?
A. Administer 15 grams of oral glucose gel
B. Check the client’s blood glucose level
C. Administer intramuscular glucagon
D. Start an intravenous infusion of Normal Saline
Answer: C
Conceptual Explanation: In an unconscious client with suspected hypoglycemia,
providing a quick source of glucose via glucagon or IV Dextrose is the priority when oral
intake is impossible.
6. Following a femur fracture, a client reports sudden chest pain and dyspnea. The nurse
notes petechiae on the chest. What should the nurse do first?
A. Administer a bolus of intravenous heparin
