PN COMPREHENSIVE ONLINE PRACTICE FORM A – 2026/2027 – ALL 150
QUESTIONS WITH DETAILED RATIONALES
SAFE AND EFFECTIVE CARE ENVIRONMENT: MANAGEMENT OF CARE
A charge nurse is assigning tasks to an unlicensed assistive personnel (UAP).
Which of the following tasks is most appropriate to delegate to the UAP?
A) Administering a tuberculin skin test (PPD)
B) Performing a sterile dressing change on a central line
C) Measuring and recording vital signs on a stable client
D) Evaluating the effectiveness of a pain medication
Answer: C
1. Rationale: The scope of practice for a UAP includes basic care tasks such as
measuring and recording vital signs for stable clients. Administering a PPD
(intradermal injection) and performing a sterile central line dressing
change require licensed nursing education and scope. Evaluating the
effectiveness of medication requires critical thinking and clinical judgment,
which is strictly within the RN or LPN scope depending on state laws, but
never UAP scope.
The nurse is caring for a client who is scheduled for a colonoscopy. The client
states, "I don't understand why I need to drink this awful stuff and be sedated
just for a doctor to look inside me." Which response by the nurse is most
appropriate?
A) "The doctor ordered it, so you really need to do it."
B) "The preparation clears your bowels so the doctor can see clearly, and the
sedation keeps you comfortable."
C) "Most people have this done without asking questions."
D) "You should have read the consent form more carefully."
Answer: B
2. Rationale: This response provides factual, therapeutic information
addressing the client's knowledge deficit regarding the procedure and
informed consent. Option A is authoritarian and blocks communication.
Option C is dismissive and non-therapeutic. Option D is blaming and does
not foster a therapeutic nurse-client relationship.
The nurse is reviewing the medical record of a newly admitted client. Which of
the following documents is legally required to be on the chart before a surgical
procedure can be performed? (Select all that apply.)
,A) Signed informed consent form
B) History and physical examination
C) Anesthesia record
D) Preoperative checklist
E) Progress notes from the day of surgery
Answer: A, B, D
3. Rationale: Before a surgical procedure, legally required documents include a
signed informed consent form (validating client agreement and
understanding), a current History and Physical (H&P) completed within 30
days/24 hrs depending on facility policy to establish baseline, and a
preoperative checklist (verifying safety steps like ID, allergies, and labs are
complete). The anesthesia record is completed during/after the procedure,
and intraoperative progress notes are written as they happen, not before.
A client with terminal cancer has a documented Do-Not-Resuscitate (DNR)
order. The nurse enters the room and finds the client unresponsive and not
breathing. What is the priority action by the nurse?
A) Call a code and initiate full cardiopulmonary resuscitation (CPR)
B) Verify the DNR order in the medical record and withhold CPR
C) Administer oxygen via nasal cannula
D) Call the family to the bedside immediately
Answer: B
4. Rationale: A DNR order explicitly instructs healthcare providers not to
initiate resuscitative efforts in the event of cardiopulmonary arrest. The
nurse must first verify the order exists and is valid before withholding CPR
to ensure client safety and legal compliance. Initiating CPR (Option A)
violates the client's legal right to refuse treatment. Oxygen (Option C) is a
comfort measure, but verifying the DNR is the immediate legal priority.
Option D is important but not the first priority over verifying the legal
order.
The nurse receives a hand-off report on four clients. Which client should the
nurse assess first?
A) A client with type 2 diabetes who has a fasting blood glucose of 140 mg/dL
B) A client with heart failure who reports a 2-pound weight gain over the
weekend
C) A client with pneumonia who has a new onset of confusion and a
temperature of 101.5°F (38.6°C)
,D) A client recovering from a cholecystectomy who is requesting pain
medication
Answer: C
5. Rationale: Using the ABC (Airway, Breathing, Circulation) priority
framework and Maslow's hierarchy, a new onset of confusion in an older
adult with pneumonia is a classic sign of hypoxia or sepsis, representing an
immediate life-threatening alteration in oxygenation/neurological status.
Option A requires intervention but is not emergent. Option B indicates fluid
retention but is a gradual change. Option D is an comfort issue that can be
addressed after assessing the unstable client in Option C.
The nurse is admitting a client to the medical unit. Which action by the nurse
violates the client's right to confidentiality as outlined by HIPAA?
A) Sharing the client's diagnosis with the nursing assistant caring for the client
B) Pulling the privacy curtain while performing a physical assessment
C) Discussing the client's lab results in the hospital elevator with another nurse
D) Asking the client to sign a form acknowledging receipt of privacy practices
Answer: C
6. Rationale: HIPAA prohibits discussing Protected Health Information (PHI)
in public areas where it can be overheard by unauthorized persons, such as
an elevator or cafeteria. Sharing information with the UAP directly caring
for the client (Option A) is part of the "minimum necessary" rule for
treatment. Option B protects physical privacy. Option D is a legal
requirement upon admission.
An LPN is working under the supervision of an RN. Which of the following tasks
should the LPN question the RN about before performing?
A) Reinforcing discharge teaching about a low-sodium diet
B) Administering an initial dose of an intravenous antibiotic
C) Obtaining a urine specimen from a client with a Foley catheter
D) Ambulating a post-operative client with a walker
Answer: B
7. Rationale: Depending on state NPA and facility policy, LPNs generally
cannot administer the initial dose of an IV medication, especially high-risk
drugs like antibiotics, because the first dose requires rigorous RN
assessment for adverse/anaphylactic reactions. Reinforcing teaching
(Option A), routine specimen collection (Option C), and ambulation (Option
D) are standard within the LPN scope.
, A nurse manager is planning the shift assignment. Which staffing model uses a
predetermined number of nursing hours per patient day (NHPPD) to determine
staffing levels?
A) Primary nursing
B) Team nursing
C) Case method
D) Patient classification system
Answer: D
8. Rationale: A patient classification system (or acuity system) categorizes
patients based on care needs and uses NHPPD to calculate the required
number of staff. Primary nursing (Option A) involves one nurse assuming
total care for a client. Team nursing (Option B) involves a team led by an
RN. Case method (Option C) is total patient care by one nurse.
A client is being discharged home with a new prescription for anticoagulant
therapy. The nurse understands that continuity of care is best maintained by
making which referral?
A) Physical therapy
B) Home health nursing
C) Occupational therapy
D) Social work
Answer: B
9. Rationale: Home health nursing will assess the client's ability to manage the
anticoagulant safely at home, monitor for signs of bleeding, and draw lab
work (INR) as needed, ensuring direct continuity of medical/nursing care.
PT, OT, and Social Work address specific functional or socioeconomic needs
but do not provide the same level of medical continuity for high-risk
medications.
A client is scheduled for an elective surgery and asks the nurse, "What happens
if I change my mind and decide not to have the surgery?" Which response by
the nurse is accurate regarding informed consent?
A) "You cannot change your mind once you sign the form."
B) "You can withdraw consent at any time, even after signing the form."
C) "The doctor will have to get a court order to cancel the surgery."
D) "Your insurance company will not pay for your hospital stay if you cancel."
Answer: B
QUESTIONS WITH DETAILED RATIONALES
SAFE AND EFFECTIVE CARE ENVIRONMENT: MANAGEMENT OF CARE
A charge nurse is assigning tasks to an unlicensed assistive personnel (UAP).
Which of the following tasks is most appropriate to delegate to the UAP?
A) Administering a tuberculin skin test (PPD)
B) Performing a sterile dressing change on a central line
C) Measuring and recording vital signs on a stable client
D) Evaluating the effectiveness of a pain medication
Answer: C
1. Rationale: The scope of practice for a UAP includes basic care tasks such as
measuring and recording vital signs for stable clients. Administering a PPD
(intradermal injection) and performing a sterile central line dressing
change require licensed nursing education and scope. Evaluating the
effectiveness of medication requires critical thinking and clinical judgment,
which is strictly within the RN or LPN scope depending on state laws, but
never UAP scope.
The nurse is caring for a client who is scheduled for a colonoscopy. The client
states, "I don't understand why I need to drink this awful stuff and be sedated
just for a doctor to look inside me." Which response by the nurse is most
appropriate?
A) "The doctor ordered it, so you really need to do it."
B) "The preparation clears your bowels so the doctor can see clearly, and the
sedation keeps you comfortable."
C) "Most people have this done without asking questions."
D) "You should have read the consent form more carefully."
Answer: B
2. Rationale: This response provides factual, therapeutic information
addressing the client's knowledge deficit regarding the procedure and
informed consent. Option A is authoritarian and blocks communication.
Option C is dismissive and non-therapeutic. Option D is blaming and does
not foster a therapeutic nurse-client relationship.
The nurse is reviewing the medical record of a newly admitted client. Which of
the following documents is legally required to be on the chart before a surgical
procedure can be performed? (Select all that apply.)
,A) Signed informed consent form
B) History and physical examination
C) Anesthesia record
D) Preoperative checklist
E) Progress notes from the day of surgery
Answer: A, B, D
3. Rationale: Before a surgical procedure, legally required documents include a
signed informed consent form (validating client agreement and
understanding), a current History and Physical (H&P) completed within 30
days/24 hrs depending on facility policy to establish baseline, and a
preoperative checklist (verifying safety steps like ID, allergies, and labs are
complete). The anesthesia record is completed during/after the procedure,
and intraoperative progress notes are written as they happen, not before.
A client with terminal cancer has a documented Do-Not-Resuscitate (DNR)
order. The nurse enters the room and finds the client unresponsive and not
breathing. What is the priority action by the nurse?
A) Call a code and initiate full cardiopulmonary resuscitation (CPR)
B) Verify the DNR order in the medical record and withhold CPR
C) Administer oxygen via nasal cannula
D) Call the family to the bedside immediately
Answer: B
4. Rationale: A DNR order explicitly instructs healthcare providers not to
initiate resuscitative efforts in the event of cardiopulmonary arrest. The
nurse must first verify the order exists and is valid before withholding CPR
to ensure client safety and legal compliance. Initiating CPR (Option A)
violates the client's legal right to refuse treatment. Oxygen (Option C) is a
comfort measure, but verifying the DNR is the immediate legal priority.
Option D is important but not the first priority over verifying the legal
order.
The nurse receives a hand-off report on four clients. Which client should the
nurse assess first?
A) A client with type 2 diabetes who has a fasting blood glucose of 140 mg/dL
B) A client with heart failure who reports a 2-pound weight gain over the
weekend
C) A client with pneumonia who has a new onset of confusion and a
temperature of 101.5°F (38.6°C)
,D) A client recovering from a cholecystectomy who is requesting pain
medication
Answer: C
5. Rationale: Using the ABC (Airway, Breathing, Circulation) priority
framework and Maslow's hierarchy, a new onset of confusion in an older
adult with pneumonia is a classic sign of hypoxia or sepsis, representing an
immediate life-threatening alteration in oxygenation/neurological status.
Option A requires intervention but is not emergent. Option B indicates fluid
retention but is a gradual change. Option D is an comfort issue that can be
addressed after assessing the unstable client in Option C.
The nurse is admitting a client to the medical unit. Which action by the nurse
violates the client's right to confidentiality as outlined by HIPAA?
A) Sharing the client's diagnosis with the nursing assistant caring for the client
B) Pulling the privacy curtain while performing a physical assessment
C) Discussing the client's lab results in the hospital elevator with another nurse
D) Asking the client to sign a form acknowledging receipt of privacy practices
Answer: C
6. Rationale: HIPAA prohibits discussing Protected Health Information (PHI)
in public areas where it can be overheard by unauthorized persons, such as
an elevator or cafeteria. Sharing information with the UAP directly caring
for the client (Option A) is part of the "minimum necessary" rule for
treatment. Option B protects physical privacy. Option D is a legal
requirement upon admission.
An LPN is working under the supervision of an RN. Which of the following tasks
should the LPN question the RN about before performing?
A) Reinforcing discharge teaching about a low-sodium diet
B) Administering an initial dose of an intravenous antibiotic
C) Obtaining a urine specimen from a client with a Foley catheter
D) Ambulating a post-operative client with a walker
Answer: B
7. Rationale: Depending on state NPA and facility policy, LPNs generally
cannot administer the initial dose of an IV medication, especially high-risk
drugs like antibiotics, because the first dose requires rigorous RN
assessment for adverse/anaphylactic reactions. Reinforcing teaching
(Option A), routine specimen collection (Option C), and ambulation (Option
D) are standard within the LPN scope.
, A nurse manager is planning the shift assignment. Which staffing model uses a
predetermined number of nursing hours per patient day (NHPPD) to determine
staffing levels?
A) Primary nursing
B) Team nursing
C) Case method
D) Patient classification system
Answer: D
8. Rationale: A patient classification system (or acuity system) categorizes
patients based on care needs and uses NHPPD to calculate the required
number of staff. Primary nursing (Option A) involves one nurse assuming
total care for a client. Team nursing (Option B) involves a team led by an
RN. Case method (Option C) is total patient care by one nurse.
A client is being discharged home with a new prescription for anticoagulant
therapy. The nurse understands that continuity of care is best maintained by
making which referral?
A) Physical therapy
B) Home health nursing
C) Occupational therapy
D) Social work
Answer: B
9. Rationale: Home health nursing will assess the client's ability to manage the
anticoagulant safely at home, monitor for signs of bleeding, and draw lab
work (INR) as needed, ensuring direct continuity of medical/nursing care.
PT, OT, and Social Work address specific functional or socioeconomic needs
but do not provide the same level of medical continuity for high-risk
medications.
A client is scheduled for an elective surgery and asks the nurse, "What happens
if I change my mind and decide not to have the surgery?" Which response by
the nurse is accurate regarding informed consent?
A) "You cannot change your mind once you sign the form."
B) "You can withdraw consent at any time, even after signing the form."
C) "The doctor will have to get a court order to cancel the surgery."
D) "Your insurance company will not pay for your hospital stay if you cancel."
Answer: B
