Question 1 Assignment & Acuity Which client should be assigned to the most experienced RN on a med-surg unit?
A. 45-year-old type 2 diabetic needing insulin before meals B. 62-year-old with COPD needing routine respiratory assessments C. 38-year-old with acute pancreatitis, hemodynamically unstable, worsening vitals D. 70-year-old with osteoarthritis needing ADL assistance
Question 2 Delegation/Supervision Which task delegated to UAP requires additional supervision on a postoperative ortho unit?
A. Assisting client with TKA to ambulate using a walker B. Measuring intake/output for a client with indwelling catheter C. Reapplying CPM machine after PT D. Checking for warmth and redness around a surgical incision site
Question 3 Discharge/Prioritization Telemetry unit must discharge one client. Most appropriate?
A. HF with 2+ pitting edema and SOB walking to bathroom B. HTN with BP 128–132/78–84 for past 24 hours C. AF with new confusion and HR 118 D. Unstable angina who needed NTG twice overnight
Question 4 Delegation Scope Most appropriate task for the RN to assign to the LPN?
A. Administer IV push morphine for 8/10 postop pain B. Perform initial admission assessment for new respiratory distress client C. Reinforce teaching about insulin administration to a newly diagnosed diabetic D. Insert an indwelling urinary catheter for a client with retention
Question 5 HIPAA/Confidentiality The nurse overhears colleagues discussing room 412's HIV status in the cafeteria. First action?
A. Report the conversation to the unit manager immediately B. Join the conversation and remind colleagues about confidentiality C. Document the incident in the client's medical record D. Ignore the conversation since no identifying information was used
Question 6 Delegation/Evaluation Which statement by a new graduate indicates need for further teaching about delegation?
A. "I can delegate routine VS to UAP for stable clients." B. "I am responsible for follow-up after delegating a task." C. "I can delegate feeding a client with dysphagia after I assess their swallowing." D. "I can delegate pain reassessment to UAP 30 minutes after I administer an analgesic."
Question 7 Ethics Family is divided about withdrawing life support for a brain-dead client. Best resource?
A. The hospital's risk management department B. The hospital's ethics committee C. The client's primary care provider D. The hospital's legal department
Question 8 Quality/Safety Which incident requires immediate follow-up and system change?
A. Client fell while attempting bathroom independently despite fall risk armband B. Medication delivered 30 minutes late by pharmacy C. Family complained staff slow to answer call lights at night D. Two clients received wrong food trays due to similar last names
Question 9 Floating Postpartum nurse floated to med-surg. Most appropriate client to assign?
A. ARDS on ventilator B. MRSA needing contact precautions and wound care C. Newly diagnosed leukemia receiving induction chemo D. Post-cardiac arrest needing vasopressor titration
Question 10 Communication (SBAR) Which statement is the "Recommendation" in SBAR?
A. "The client was admitted 3 days ago with community-acquired pneumonia." B. "The client's oxygen saturation dropped to 88% on room air this morning." C. "I recommend increasing oxygen to 3 liters and obtaining a chest x-ray." D. "The client has a history of COPD and previous admissions for respiratory failure."
Question 11 Ethics/Advocacy DNR client is actively dying; family demands "do everything" and threatens lawsuit. First action?
A. Call security to remove the family member B. Notify the healthcare provider to discuss the DNR with family C. Initiate CPR per family request to prevent legal action D. Document the family member's threat in the chart
Question 12 Quality Improvement Best way to promote staff adoption of a new CAUTI prevention protocol?
A. Posting the protocol on the bulletin board B. Requiring staff to sign acknowledgment statement C. Involving staff nurses in implementation and seeking input D. Disciplining staff who fail to follow it after one week
Question 13 Safety/Reporting Colleague gave wrong insulin dose; client stable. Colleague asks you not to report. Action?
A. Agree not to report since no harm occurred B. Report the error through the facility's incident reporting system C. Document the conversation in the client's chart D. Warn the colleague that future errors will be reported
Question 14 Infection Control After contact precautions care, RN removes gloves, gown, mask, then hand hygiene. Action?
A. Document for annual performance review B. Correct the RN immediately and demonstrate proper removal technique C. Ignore the observation since hand hygiene was performed D. Report the RN to the state board for unsafe practice
Question 15 Ethics/Refusal Jehovah's Witness refuses transfusion; provider says give it anyway. Action?
A. Administer the transfusion as ordered B. Refuse to administer and notify the nursing supervisor C. Have the client sign a refusal form before administering D. Administer half the transfusion to partially comply
Question 16 Quality/Discharge Survey comment indicating discharge teaching needs improvement?
A. "The nurse explained my medications, but I don't remember what the yellow pill is for." B. "The room was clean and the staff were friendly." C. "My nurse answered all my questions before I left." D. "The discharge papers were ready when I was ready to leave."
Question 17 Delegation Scope Which task is appropriately delegated to the LPN on a busy med unit?
A. "Please complete the admission assessment on the new client." B. "Please change the wound dressing on the stable client using the prescribed protocol." C. "Please develop a care plan for the new diabetic." D. "Please evaluate whether the client's pain medication was effective after one hour."
Question 18 Prioritization Which client should the nurse assess first?
A. 50-year-old with cirrhosis with new confusion and asterixis B. 65-year-old with osteoarthritis, pain 5/10 C. 40-year-old with gastroenteritis, 3 loose stools in 4 hours D. 75-year-old with BPH, no voiding in 6 hours
Question 19 Medication Safety Which warfarin teaching by a new grad needs immediate correction?
A. "Eat consistent amounts of green leafy vegetables each week." B. "Have your blood tested regularly to check INR levels." C. "You can take ibuprofen for headaches as long as you don't take it every day." D. "Notify your dentist that you take this medication before any procedures."
Question 20 Continuity of Care Best referral for stroke client to regain dressing/bathing independence?
A. Physical therapy B. Occupational therapy C. Speech therapy D. Home health aide
Question 21 Communication/Bedside Report Which statement shows understanding of bedside shift report?
A. "I will give report at the nurses' station to protect confidentiality." B. "I will invite the client to participate and ask if they have any questions." C. "I will limit report to 2 minutes so I can start assessments quickly." D. "I will ask family members to leave the room during report."
Question 22 Legal/AMA Competent client leaving AMA. Required action before leaving?
A. Call security to prevent leaving B. Have the client sign a form indicating understanding of risks C. Administer all scheduled medications before discharge D. Notify the client's family of the decision
Question 23 Assignment Which client should be assigned to the LPN on a postoperative unit?
A. 2 hours post-abdominal surgery, BP 88/52 B. 1 day post-hip replacement needing pain meds q4h C. Newly admitted with chest pain and ECG changes D. Post-cardiac arrest needing vasopressor titration
Question 24 Safety A colleague is preparing to give potassium chloride IV push. First action?
A. Ignore and focus on own clients B. Report to nurse manager after the shift C. Stop the colleague and explain that IV potassium should never be given as a push D. Ask if the colleague has administered potassium before
Question 25 Therapeutic Communication Best UAP instruction for bathing an agitated client with dementia?
A. "Hold the client's arms if needed to complete the bath quickly." B. "Use a calm voice, explain each step, and stop if the client becomes very agitated." C. "Skip the bath today if the client seems resistant." D. "Ask family to help restrain the client during the bath."
Question 26 Quality/Safety Wrong med given 2 hours ago, client has no adverse effects. First action?
A. Notify the healthcare provider B. Complete an incident report C. Assess the client for delayed adverse effects D. Discipline the nurse who administered the medication
Question 27 Ethics/DNR DNR client arrests; a new grad RN starts compressions. Action?
A. Stop the new graduate and remind them of the DNR order B. Join the resuscitation attempt C. Call a code blue and notify the rapid response team D. Document that the client expired without resuscitation
Question 28 Quality/Readmissions Best intervention to reduce HF readmissions?
A. Discharge clients early to avoid hospital infections B. Comprehensive discharge teaching with med review and follow-up appointments C. Limit education to written materials for consistency D. Require clients to sign a contract agreeing to follow instructions
Question 29 Education/Errors Nursing student gave med to wrong client; says they'll fail school. Best response?
A. "Don't worry, we won't report this since you're a student." B. "Mistakes happen. Let's assess the client together and complete an incident report." C. "You should have been more careful. This is a serious error." D. "I'll take responsibility for the error since I was supervising you."
Question 30 Floating/Competency Most important factor when floating an RN to ICU?
A. Years of experience on med-surg unit B. Certification in basic life support (BLS) C. Demonstrated competency caring for unstable clients D. Willingness to float to the ICU
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