Accuplacer Writing 2026 Exam

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Sample questions from Accuplacer Writing 2026 Exam

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.At change of shift on a pediatric unit, the nurse receives report on four clients. Which client should the nurse assess first?

   • A.A 4-year-old with gastroenteritis who has had no urine for 7 hours, capillary refill of 3 seconds, and a heart rate of 132/min
   • B.An 8-month-old with bronchiolitis whose oxygen saturation is 92% on room air and who has mild subcostal retractions while asleep
   • C.A 12-year-old with sickle cell disease reporting pain of 8/10 despite receiving prescribed oral analgesia 1 hour ago
   • D.A 3-day-old newborn with jaundice whose total bilirubin increased from 11 to 14 mg/dL in 12 hours and who is feeding less

   Rationale: The newborn needs immediate assessment because a rapidly rising bilirubin level combined with reduced feeding may indicate worsening hyperbilirubinemia and risk of neurologic injury. The child with gastroenteritis also has concerning dehydration cues, but the newborn's time-sensitive risk takes priority. The infant's oxygenation and mild retractions require follow-up, while the adolescent's uncontrolled pain needs reassessment after immediate threats are addressed. Prioritize a subtle, rapidly changing risk over a stable chronic concern.

2. 2.In a long-term care facility, an 84-year-old resident with dementia is newly restless and repeatedly tries to leave the dining room. Temperature is 37.8 C, HR 104/min, BP 108/64 mm Hg, and staff report new urinary incontinence. Which action should the charge nurse take first?

   • A.Document the behavior as progression of dementia and discuss a possible room change at the next care conference
   • B.Assign a nursing assistant to keep the resident in the room and report any further behavior changes
   • C.Arrange prompt nursing assessment for an acute change and possible infection, including focused assessment and vital-sign follow-up
   • D.Ask the provider to prescribe a sedative so the resident can remain safely in the dining room

   Rationale: New restlessness, low-grade temperature, tachycardia, and incontinence can signal acute illness in an older adult and require nursing assessment rather than attribution to dementia. A sedative may obscure deterioration and increase fall risk; a nursing assistant can observe but cannot assess the cause. Documentation and a care conference are appropriate later if the change is not explained by an acute problem. Evaluate sudden cognitive or behavioral changes for reversible causes first.

3. 3.A provider prescribes an intravenous heparin infusion for a 57-year-old client with a new pulmonary embolism. The client weighs 72 kg, and the electronic record displays a weight of 92 kg; the prescribed bolus is weight based. What should the nurse do?

   • A.Calculate the dose using the client's stated weight and ask another nurse to cosign it
   • B.Hold the weight-based dose and verify the client's current weight and prescription before administration
   • C.Use the recorded weight because it is already documented in the electronic record
   • D.Give the infusion without the bolus and ask the provider to clarify the dose during rounds

   Rationale: The discrepancy could cause a substantial heparin dosing error, so the nurse should verify the current weight and clarify the prescription before giving the weight-based bolus. Using the chart value risks overdose, while independently substituting the client's stated weight does not resolve the documentation conflict. Omitting a prescribed component without clarification is also an unsafe change to the order. High-alert medication calculations require accurate inputs and resolution of discrepancies before administration.

4. 4.Refer to the client's chart. The charge nurse is assigning care for the next hour. Which actions are appropriate to delegate to the experienced nursing assistant? Select all that apply.

   • A.Immediately report new confusion, a lower oxygen saturation, or a change in responsiveness to the nurse
   • B.Teach the client how to use the incentive spirometer before the next ambulation
   • C.Obtain and report the client's repeat vital signs at 1000
   • D.Assist the client to the bedside commode after the nurse confirms the client is stable to transfer
   • E.Assess whether the client's increasing restlessness is caused by pain or hypoxemia

   Answer and rationale are in the full material.

5. 5.During a home visit, a 68-year-old client with heart failure says, "I take an extra water pill whenever my shoes feel tight." The medication list includes digoxin and furosemide. The client reports nausea and poor appetite; apical pulse is 54/min and irregular. Which action should the nurse take first?

   • A.Withhold the digoxin dose and promptly contact the provider for evaluation and medication guidance
   • B.Ask the client to take the usual digoxin dose with food to reduce nausea
   • C.Advise the client to take an additional furosemide dose and check weight the following morning
   • D.Reinforce the prescribed low-sodium diet and schedule a routine follow-up visit

   Answer and rationale are in the full material.