The Elite Universal Test
Bank: Pennsylvania
Nursing Practice Act
Jurisprudence Exam
PART 0: THE NAVIGATOR
● Tier 1 (Questions 1–28) - Foundational Syntax & Application: Testing "Hard Deck"
definitions, core Pennsylvania legislative acts (e.g., Act 102, Act 109, Act 31), and primary
scope of practice boundaries.
● Tier 2 (Questions 29–58) - Complex Application & Simulation: Analyzing
multi-variable clinical simulations, including Unlicensed Assistive Personnel (UAP)
delegation restrictions, LPN intravenous therapy limits, and cross-state Nurse Licensure
Compact (NLC) telehealth jurisprudence.
● Tier 3 (Questions 59–88) - Grandmaster Synthesis: High-stakes scenarios requiring
the synthesis of multiple competing statutes, including disciplinary evasion, mandatory
reporting cascades (MCARE/OAPSA), and Certified Registered Nurse Practitioner
(CRNP) prescriptive liabilities.
PART I: THE PRIMER
Mastering this specific test bank translates directly to elite clinical and professional performance
by embedding the complex legal boundaries of Pennsylvania nursing directly into your clinical
intuition. You will not merely memorize regulations; you will forge an impenetrable legal shield
around your license, ensuring every delegation, documentation, and operational decision aligns
flawlessly with current Pennsylvania Board of Nursing mandates.
The "Critical Axioms" Cheat Sheet
● Non-Delegation to UAPs: Pennsylvania law contains zero delegation language for
UAPs; Registered Nurses (RNs) retain absolute accountability and cannot legally
delegate nursing functions to unlicensed persons.
● The 2026 CE Baseline: RNs owe 30 hours of continuing education (CE) per biennium,
explicitly including 2 hours of Act 31 Child Abuse training and 2 hours of Act 90
Organ/Tissue Donation training.
● Act 102 (Mandatory Overtime): Facilities are strictly prohibited from mandating overtime
beyond an agreed-upon shift; chronic short-staffing is legally invalid as an "unforeseeable
, emergent circumstance".
● Act 109 (Certified Medication Aides): CMAs may administer routine medications to
stable long-term care residents but are strictly prohibited from pushing IVs, initiating new
medications, or administering controlled substances.
● VRP vs. DMU: The Voluntary Recovery Program (VRP) shields an impaired nurse's
license via a confidential 3-year agreement, whereas the Disciplinary Monitoring Unit
(DMU) imposes public discipline; sexual boundary violations render a nurse permanently
ineligible for the VRP.
PA Legislative Act Target Population/Scope Core Mandate for PA Nurses
Act 31 Child Abuse Recognition 3 hours initial CE; 2 hours
biennial CE required for license
renewal.
Act 102 Mandatory Overtime Prohibits forced overtime;
protects nurses from retaliation
for refusing.
Act 109 Certified Medication Aides Authorizes CMAs in long-term
care; strictly limits invasive
administration.
Act 124 Opioid Prescribing Requires CRNPs with
prescriptive authority to
complete 2 hours of opioid CE.
Act 137 LPN Death Pronouncement Authorizes LPNs to pronounce
death exclusively in hospice
settings with a valid DNR.
Act 90 Organ/Tissue Donation Mandates 2 hours of CE for
RNs within 5 years of initial
license or renewal.
PART II: THE ELITE TEST BANK
Tier 1 - Foundational Syntax & Application
Q1: Under the 2026 Pennsylvania Board of Nursing mandates (Act 90), which continuing
education requirement is explicitly mandated for Registered Nurses? A) 4 hours of Act 124
opioid prescribing education per biennium. B) 2 hours of organ and tissue donation education
one time within 5 years of initial licensure or renewal. C) 5 hours of elder abuse recognition
training per biennium. D) 30 hours of pharmacology exclusively for RNs practicing in critical
care.
● The Answer: B (2 hours of organ and tissue donation education one time within 5 years of
initial licensure or renewal.)
● Distractor Analysis:
○ A is incorrect: Act 124 opioid education applies specifically to prescribers (CRNPs),
not general RNs.
○ C is incorrect: Elder abuse training is required under OAPSA, but not at 5 hours per
biennium.
○ D is incorrect: 30 hours is the total CE requirement, but pharmacology specificity
applies to CRNPs.
,The Mentor's Analysis: Act 90 of 2018 triggered a 2026 activation requiring organ donation CE
to combat donor shortages. When managing biennial renewals, the immediate priority is fulfilling
specific statutory carve-outs. By utilizing targeted CE courses, you bypass the common trap of
failing an audit despite having 30 total hours. Professional/Academic Intuition: RNs owe 30
hours total CE: 2 must be Child Abuse (Act 31), and 2 must be Organ Donation (Act 90).
Q2: An RN at a PA hospital completes a 12-hour shift. The nursing supervisor IMMEDIATELY
mandates the RN stay for another 4 hours due to chronic short-staffing. Under Act 102, what is
the RN's legal right? A) The RN must stay, as call-offs constitute an unforeseeable emergent
circumstance. B) The RN may refuse the overtime without fear of termination, discrimination, or
disciplinary retaliation. C) The RN may refuse only if they secure their own replacement. D) The
RN must stay but is entitled to double-time pay.
● The Answer: B (The RN may refuse the overtime without fear of termination,
discrimination, or disciplinary retaliation.)
● Distractor Analysis:
○ A is incorrect: Act 102 explicitly excludes chronic short-staffing from the definition of
unforeseeable emergent circumstances.
○ C is incorrect: Finding a replacement is a management responsibility, not a
prerequisite for refusing illegal mandatory overtime.
○ D is incorrect: Premium pay does not legalize an Act 102 violation.
The Mentor's Analysis: Act 102 protects the public from fatigued nurses. Refusal to work illegal
overtime is legally protected advocacy. By utilizing Act 102, you bypass the common trap of
accepting unsafe assignments out of fear. Professional/Academic Intuition: Chronic
short-staffing never justifies mandatory overtime.
Q3: Under Act 109 of 2024, a Certified Medication Aide (CMA) working in a long-term care
facility is directed to administer an initial dose of a newly prescribed antibiotic. Is this permitted?
A) Yes, provided the CMA operates under direct RN supervision. B) Yes, CMAs handle all oral
medication administration in long-term care. C) No, CMAs are statutorily prohibited from
administering the first dose of any new medication. D) No, only physicians may administer initial
doses of antibiotics in long-term care.
● The Answer: C (No, CMAs are statutorily prohibited from administering the first dose of
any new medication.)
● Distractor Analysis:
○ A is incorrect: RN supervision does not override the statutory prohibition on
first-dose administration by a CMA.
○ B is incorrect: CMAs are restricted to stable patients and established medication
regimens.
○ D is incorrect: RNs and LPNs routinely administer first doses.
The Mentor's Analysis: Act 109 offloads routine tasks but guards high-risk clinical moments. The
first dose requires nursing assessment for anaphylaxis. By utilizing licensed nurses for
initiations, you bypass the common trap of delegating assessment. Professional/Academic
Intuition: CMAs execute routine maintenance; licensed nurses manage clinical initiation.
Q4: Under the Nurse Licensure Compact (NLC) implemented in PA, a nurse with a
Pennsylvania Multistate License (MSL) practices telehealth on a patient located in Ohio. Which
state's nursing practice act dictates the nurse's scope of practice? A) Pennsylvania, as the state
of issuance. B) Ohio, as the state where the patient is located. C) Federal telehealth guidelines
supersede both states. D) The state where the nurse's employing hospital is headquartered.
● The Answer: B (Ohio, as the state where the patient is located.)
● Distractor Analysis:
, ○ A is incorrect: The MSL grants the privilege to practice, but the nurse must follow
the laws of the patient's location.
○ C is incorrect: Nursing scope is entirely state-regulated; there is no federal scope of
practice.
○ D is incorrect: Corporate location is irrelevant to clinical jurisprudence.
The Mentor's Analysis: Telehealth legally occurs where the patient sits. The MSL is a passport,
but you must obey local laws upon arrival. By utilizing the remote state's practice act, you
bypass the common trap of cross-border malpractice. Professional/Academic Intuition: Scope
of practice is always anchored to the patient's physical location.
Q5: An LPN working in a Pennsylvania hospice facility observes that a patient has ceased
breathing. The patient has a valid DNR. Under Act 137 of 2024, what is the LPN's legal
authority? A) The LPN must wait for an RN or physician to pronounce death. B) The LPN has
the authority to pronounce death in this specific setting. C) The LPN may pronounce death only
if the medical director is on the phone. D) The LPN may pronounce death but cannot document
it in the permanent record.
● The Answer: B (The LPN has the authority to pronounce death in this specific setting.)
● Distractor Analysis:
○ A is incorrect: Act 137 was specifically drafted to eliminate this bottleneck and
empower LPNs in hospice.
○ C is incorrect: Telephone supervision is not required; the authority is granted by
statute based on the DNR.
○ D is incorrect: Pronouncement inherently requires legal documentation.
The Mentor's Analysis: To alleviate hospice staffing burdens, Act 137 extended death
pronouncement authority to LPNs. When facing an expected death, the immediate priority is
timely pronouncement. By utilizing Act 137, you bypass the common trap of delaying
post-mortem care. Professional/Academic Intuition: Hospice LPNs can legally pronounce
death if a valid DNR is present.
Q6: Pursuant to 49 Pa. Code § 21.145a, an LPN is assigned to an oncology patient receiving an
IV infusion of an antineoplastic agent. The LPN is instructed to verify the infusion rate. Is this
within the LPN scope of practice? A) Yes, LPNs may monitor and assess peripheral IV sites for
all infusions. B) No, LPNs are completely barred from interacting with antineoplastic agents. C)
Yes, but only if the LPN possesses specialized chemotherapy certification. D) No, because
LPNs cannot perform patient assessments under PA law.
● The Answer: B (No, LPNs are completely barred from interacting with antineoplastic
agents.)
● Distractor Analysis:
○ A is incorrect: Antineoplastic agents are explicitly carved out as a prohibited act for
LPNs under § 21.145a, even for maintenance.
○ C is incorrect: Board regulations do not allow facility certifications to override
statutory prohibitions.
○ D is incorrect: LPNs perform "focused assessments," but the drug type is the
limiting factor here.
The Mentor's Analysis: The PA Board designates certain high-risk IV infusions as strictly
RN-only. When delegating IV care, the immediate priority is verifying the drug class. By utilizing
RNs for chemo, you bypass the common trap of scope violation. Professional/Academic
Intuition: LPNs never touch antineoplastics or blood products.
Q7: A Pennsylvania RN is arrested over the weekend for a DUI. The RN does not inform the
Board of Nursing and continues to practice. Under the Mandatory Reporting of Crimes Act (Act
Bank: Pennsylvania
Nursing Practice Act
Jurisprudence Exam
PART 0: THE NAVIGATOR
● Tier 1 (Questions 1–28) - Foundational Syntax & Application: Testing "Hard Deck"
definitions, core Pennsylvania legislative acts (e.g., Act 102, Act 109, Act 31), and primary
scope of practice boundaries.
● Tier 2 (Questions 29–58) - Complex Application & Simulation: Analyzing
multi-variable clinical simulations, including Unlicensed Assistive Personnel (UAP)
delegation restrictions, LPN intravenous therapy limits, and cross-state Nurse Licensure
Compact (NLC) telehealth jurisprudence.
● Tier 3 (Questions 59–88) - Grandmaster Synthesis: High-stakes scenarios requiring
the synthesis of multiple competing statutes, including disciplinary evasion, mandatory
reporting cascades (MCARE/OAPSA), and Certified Registered Nurse Practitioner
(CRNP) prescriptive liabilities.
PART I: THE PRIMER
Mastering this specific test bank translates directly to elite clinical and professional performance
by embedding the complex legal boundaries of Pennsylvania nursing directly into your clinical
intuition. You will not merely memorize regulations; you will forge an impenetrable legal shield
around your license, ensuring every delegation, documentation, and operational decision aligns
flawlessly with current Pennsylvania Board of Nursing mandates.
The "Critical Axioms" Cheat Sheet
● Non-Delegation to UAPs: Pennsylvania law contains zero delegation language for
UAPs; Registered Nurses (RNs) retain absolute accountability and cannot legally
delegate nursing functions to unlicensed persons.
● The 2026 CE Baseline: RNs owe 30 hours of continuing education (CE) per biennium,
explicitly including 2 hours of Act 31 Child Abuse training and 2 hours of Act 90
Organ/Tissue Donation training.
● Act 102 (Mandatory Overtime): Facilities are strictly prohibited from mandating overtime
beyond an agreed-upon shift; chronic short-staffing is legally invalid as an "unforeseeable
, emergent circumstance".
● Act 109 (Certified Medication Aides): CMAs may administer routine medications to
stable long-term care residents but are strictly prohibited from pushing IVs, initiating new
medications, or administering controlled substances.
● VRP vs. DMU: The Voluntary Recovery Program (VRP) shields an impaired nurse's
license via a confidential 3-year agreement, whereas the Disciplinary Monitoring Unit
(DMU) imposes public discipline; sexual boundary violations render a nurse permanently
ineligible for the VRP.
PA Legislative Act Target Population/Scope Core Mandate for PA Nurses
Act 31 Child Abuse Recognition 3 hours initial CE; 2 hours
biennial CE required for license
renewal.
Act 102 Mandatory Overtime Prohibits forced overtime;
protects nurses from retaliation
for refusing.
Act 109 Certified Medication Aides Authorizes CMAs in long-term
care; strictly limits invasive
administration.
Act 124 Opioid Prescribing Requires CRNPs with
prescriptive authority to
complete 2 hours of opioid CE.
Act 137 LPN Death Pronouncement Authorizes LPNs to pronounce
death exclusively in hospice
settings with a valid DNR.
Act 90 Organ/Tissue Donation Mandates 2 hours of CE for
RNs within 5 years of initial
license or renewal.
PART II: THE ELITE TEST BANK
Tier 1 - Foundational Syntax & Application
Q1: Under the 2026 Pennsylvania Board of Nursing mandates (Act 90), which continuing
education requirement is explicitly mandated for Registered Nurses? A) 4 hours of Act 124
opioid prescribing education per biennium. B) 2 hours of organ and tissue donation education
one time within 5 years of initial licensure or renewal. C) 5 hours of elder abuse recognition
training per biennium. D) 30 hours of pharmacology exclusively for RNs practicing in critical
care.
● The Answer: B (2 hours of organ and tissue donation education one time within 5 years of
initial licensure or renewal.)
● Distractor Analysis:
○ A is incorrect: Act 124 opioid education applies specifically to prescribers (CRNPs),
not general RNs.
○ C is incorrect: Elder abuse training is required under OAPSA, but not at 5 hours per
biennium.
○ D is incorrect: 30 hours is the total CE requirement, but pharmacology specificity
applies to CRNPs.
,The Mentor's Analysis: Act 90 of 2018 triggered a 2026 activation requiring organ donation CE
to combat donor shortages. When managing biennial renewals, the immediate priority is fulfilling
specific statutory carve-outs. By utilizing targeted CE courses, you bypass the common trap of
failing an audit despite having 30 total hours. Professional/Academic Intuition: RNs owe 30
hours total CE: 2 must be Child Abuse (Act 31), and 2 must be Organ Donation (Act 90).
Q2: An RN at a PA hospital completes a 12-hour shift. The nursing supervisor IMMEDIATELY
mandates the RN stay for another 4 hours due to chronic short-staffing. Under Act 102, what is
the RN's legal right? A) The RN must stay, as call-offs constitute an unforeseeable emergent
circumstance. B) The RN may refuse the overtime without fear of termination, discrimination, or
disciplinary retaliation. C) The RN may refuse only if they secure their own replacement. D) The
RN must stay but is entitled to double-time pay.
● The Answer: B (The RN may refuse the overtime without fear of termination,
discrimination, or disciplinary retaliation.)
● Distractor Analysis:
○ A is incorrect: Act 102 explicitly excludes chronic short-staffing from the definition of
unforeseeable emergent circumstances.
○ C is incorrect: Finding a replacement is a management responsibility, not a
prerequisite for refusing illegal mandatory overtime.
○ D is incorrect: Premium pay does not legalize an Act 102 violation.
The Mentor's Analysis: Act 102 protects the public from fatigued nurses. Refusal to work illegal
overtime is legally protected advocacy. By utilizing Act 102, you bypass the common trap of
accepting unsafe assignments out of fear. Professional/Academic Intuition: Chronic
short-staffing never justifies mandatory overtime.
Q3: Under Act 109 of 2024, a Certified Medication Aide (CMA) working in a long-term care
facility is directed to administer an initial dose of a newly prescribed antibiotic. Is this permitted?
A) Yes, provided the CMA operates under direct RN supervision. B) Yes, CMAs handle all oral
medication administration in long-term care. C) No, CMAs are statutorily prohibited from
administering the first dose of any new medication. D) No, only physicians may administer initial
doses of antibiotics in long-term care.
● The Answer: C (No, CMAs are statutorily prohibited from administering the first dose of
any new medication.)
● Distractor Analysis:
○ A is incorrect: RN supervision does not override the statutory prohibition on
first-dose administration by a CMA.
○ B is incorrect: CMAs are restricted to stable patients and established medication
regimens.
○ D is incorrect: RNs and LPNs routinely administer first doses.
The Mentor's Analysis: Act 109 offloads routine tasks but guards high-risk clinical moments. The
first dose requires nursing assessment for anaphylaxis. By utilizing licensed nurses for
initiations, you bypass the common trap of delegating assessment. Professional/Academic
Intuition: CMAs execute routine maintenance; licensed nurses manage clinical initiation.
Q4: Under the Nurse Licensure Compact (NLC) implemented in PA, a nurse with a
Pennsylvania Multistate License (MSL) practices telehealth on a patient located in Ohio. Which
state's nursing practice act dictates the nurse's scope of practice? A) Pennsylvania, as the state
of issuance. B) Ohio, as the state where the patient is located. C) Federal telehealth guidelines
supersede both states. D) The state where the nurse's employing hospital is headquartered.
● The Answer: B (Ohio, as the state where the patient is located.)
● Distractor Analysis:
, ○ A is incorrect: The MSL grants the privilege to practice, but the nurse must follow
the laws of the patient's location.
○ C is incorrect: Nursing scope is entirely state-regulated; there is no federal scope of
practice.
○ D is incorrect: Corporate location is irrelevant to clinical jurisprudence.
The Mentor's Analysis: Telehealth legally occurs where the patient sits. The MSL is a passport,
but you must obey local laws upon arrival. By utilizing the remote state's practice act, you
bypass the common trap of cross-border malpractice. Professional/Academic Intuition: Scope
of practice is always anchored to the patient's physical location.
Q5: An LPN working in a Pennsylvania hospice facility observes that a patient has ceased
breathing. The patient has a valid DNR. Under Act 137 of 2024, what is the LPN's legal
authority? A) The LPN must wait for an RN or physician to pronounce death. B) The LPN has
the authority to pronounce death in this specific setting. C) The LPN may pronounce death only
if the medical director is on the phone. D) The LPN may pronounce death but cannot document
it in the permanent record.
● The Answer: B (The LPN has the authority to pronounce death in this specific setting.)
● Distractor Analysis:
○ A is incorrect: Act 137 was specifically drafted to eliminate this bottleneck and
empower LPNs in hospice.
○ C is incorrect: Telephone supervision is not required; the authority is granted by
statute based on the DNR.
○ D is incorrect: Pronouncement inherently requires legal documentation.
The Mentor's Analysis: To alleviate hospice staffing burdens, Act 137 extended death
pronouncement authority to LPNs. When facing an expected death, the immediate priority is
timely pronouncement. By utilizing Act 137, you bypass the common trap of delaying
post-mortem care. Professional/Academic Intuition: Hospice LPNs can legally pronounce
death if a valid DNR is present.
Q6: Pursuant to 49 Pa. Code § 21.145a, an LPN is assigned to an oncology patient receiving an
IV infusion of an antineoplastic agent. The LPN is instructed to verify the infusion rate. Is this
within the LPN scope of practice? A) Yes, LPNs may monitor and assess peripheral IV sites for
all infusions. B) No, LPNs are completely barred from interacting with antineoplastic agents. C)
Yes, but only if the LPN possesses specialized chemotherapy certification. D) No, because
LPNs cannot perform patient assessments under PA law.
● The Answer: B (No, LPNs are completely barred from interacting with antineoplastic
agents.)
● Distractor Analysis:
○ A is incorrect: Antineoplastic agents are explicitly carved out as a prohibited act for
LPNs under § 21.145a, even for maintenance.
○ C is incorrect: Board regulations do not allow facility certifications to override
statutory prohibitions.
○ D is incorrect: LPNs perform "focused assessments," but the drug type is the
limiting factor here.
The Mentor's Analysis: The PA Board designates certain high-risk IV infusions as strictly
RN-only. When delegating IV care, the immediate priority is verifying the drug class. By utilizing
RNs for chemo, you bypass the common trap of scope violation. Professional/Academic
Intuition: LPNs never touch antineoplastics or blood products.
Q7: A Pennsylvania RN is arrested over the weekend for a DUI. The RN does not inform the
Board of Nursing and continues to practice. Under the Mandatory Reporting of Crimes Act (Act
