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Seneca College – PNR300 Final Exam Review
| Practice Questions and Verified Answers
QUESTION 1:
According to the CNO (College of Nurses of Ontario), what is the primary purpose of the
Therapeutic Nurse-Client Relationship standard? A) To establish boundaries that protect nurses
from legal liability
B) To promote client autonomy, dignity, and safe, ethical care
C) To document all nurse-client interactions for regulatory review
D) To limit physical contact between nurses and clients
CORRECT ANSWER: B
RATIONALE: The CNO Therapeutic Nurse-Client Relationship standard exists to promote client
autonomy, dignity, and the provision of safe, competent, and ethical care. It establishes
professional boundaries while prioritizing the client's needs and well-being within the
therapeutic relationship.
QUESTION 2:
A practical nurse discovers a medication error was made on the previous shift. The client is
stable with no adverse effects. What is the PN's FIRST action according to CNO standards? A)
Complete an incident report and place it in the client's chart
B) Notify the client's family before documenting the error
C) Report the error to the supervising RN or physician immediately
D) Do nothing since the client is stable and no harm occurred
CORRECT ANSWER: C
RATIONALE: CNO standards require immediate reporting of medication errors to the
appropriate supervisor (RN or physician) regardless of client outcome. Timely reporting allows
for assessment of potential delayed effects and demonstrates accountability and transparency
in nursing practice.
QUESTION 3:
A client with type 2 diabetes has a fasting blood glucose of 3.8 mmol/L and is alert but
diaphoretic. What is the priority nursing intervention? A) Administer 15g of fast-acting
carbohydrate (e.g., 150 mL juice)
B) Administer glucagon intramuscularly immediately
C) Recheck blood glucose in 15 minutes without intervention
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D) Provide a full meal with protein and complex carbohydrates
CORRECT ANSWER: A
RATIONALE: A blood glucose of 3.8 mmol/L indicates hypoglycemia in a conscious, alert client.
The priority is 15g of fast-acting carbohydrate (oral glucose, juice, regular soda) followed by
rechecking in 15 minutes. Glucagon is reserved for unconscious clients or those unable to
swallow safely.
QUESTION 4:
Which of the following is an example of a CNO-controlled act authorized to practical nurses in
Ontario? A) Performing a comprehensive health assessment independently
B) Administering medications by inhalation or intradermal, intramuscular, subcutaneous, or
topical routes
C) Ordering diagnostic laboratory tests without physician delegation
D) Performing surgical procedures under local anesthesia
CORRECT ANSWER: B
RATIONALE: Under Ontario's Regulated Health Professions Act, practical nurses are authorized
to administer medications by inhalation, intradermal, intramuscular, subcutaneous, and topical
routes. Comprehensive assessments and test ordering are not within the PN scope without
additional authorization.
QUESTION 5:
A postpartum client reports a gush of blood and a firm, contracted uterus. The perineal pad is
saturated with bright red blood. What is the most likely cause? A) Uterine atony
B) Retained placental fragments
C) Vaginal hematoma
D) Normal lochia rubra
CORRECT ANSWER: B
RATIONALE: A firm, contracted uterus with bright red bleeding and gush of blood suggests
retained placental fragments. Uterine atony would present with a boggy uterus. Normal lochia
rubra should not saturate a pad rapidly. Vaginal hematoma typically presents with severe pain
and bulging.
QUESTION 6:
A practical nurse is caring for a client with dementia who becomes agitated and attempts to
leave the unit. Which de-escalation technique is most appropriate FIRST? A) Apply soft wrist
restraints to prevent elopement
B) Administer PRN lorazepam as ordered for agitation
C) Redirect the client to a preferred activity using a calm, reassuring voice
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D) Call security to physically block the exit door
CORRECT ANSWER: C
RATIONALE: The least-restrictive approach is redirection using a calm, reassuring voice and
engaging the client in a preferred activity. Restraints and chemical sedation are last resorts after
non-pharmacological interventions fail. Physical blocking may escalate agitation further.
QUESTION 7:
A client receiving IV heparin has an aPTT of 90 seconds (normal 25-35 seconds). What is the
priority nursing action? A) Continue the infusion at the current rate and monitor
B) Notify the physician immediately and prepare to administer protamine sulfate
C) Reduce the infusion rate per protocol and recheck aPTT in 4 hours
D) Stop the infusion and apply pressure to the IV site
CORRECT ANSWER: C
RATIONALE: An aPTT of 90 seconds indicates supratherapeutic anticoagulation. Per Canadian
nursing standards and heparin protocols, the nurse should reduce the infusion rate and recheck
the aPTT in 4 hours. Protamine sulfate is reserved for life-threatening bleeding, not merely
elevated aPTT.
QUESTION 8:
Which CNO practice standard emphasizes the nurse's responsibility to maintain competence
through ongoing learning and self-reflection? A) Professional Standards
B) Ethics
C) Therapeutic Nurse-Client Relationship
D) Medication
CORRECT ANSWER: A
RATIONALE: The CNO Professional Standards outline the expectation that nurses maintain and
enhance their competence through ongoing learning, self-reflection, and integration of new
knowledge into practice. This standard encompasses accountability, continuing competence,
and professional growth.
QUESTION 9:
A client with chronic obstructive pulmonary disease (COPD) has an oxygen saturation of 88% on
room air. What is the most appropriate initial oxygen delivery method? A) Non-rebreather mask
at 15 L/min
B) Nasal cannula at 1-2 L/min
C) Venturi mask at 40% FiO2
D) High-flow nasal cannula at 40 L/min
CORRECT ANSWER: B
, 4
RATIONALE: Clients with COPD are at risk for CO2 retention. The initial oxygen delivery should
be low-flow via nasal cannula at 1-2 L/min, titrated to maintain SpO2 between 88-92% per
Canadian Thoracic Society guidelines. High-flow oxygen can suppress the hypoxic drive.
QUESTION 10:
A practical nurse is preparing to administer digoxin 0.25 mg PO. The client's apical pulse is 52
bpm. What is the appropriate action? A) Administer the medication as ordered
B) Hold the dose and notify the physician
C) Check the radial pulse instead
D) Administer half the dose and reassess in 1 hour
CORRECT ANSWER: B
RATIONALE: Digoxin is contraindicated when the apical pulse is below 60 bpm due to risk of
bradycardia and heart block. The nurse must hold the dose and notify the physician
immediately. This follows CNO Medication standards and cardiac medication safety protocols
taught in Seneca PNR300.
QUESTION 11:
Which documentation principle aligns with CNO Documentation standards? A) Document only
abnormal findings to save time
B) Use abbreviations approved by the facility and avoid subjective statements
C) Record entries before providing care to ensure completeness
D) Leave blank spaces in the chart for later additions
CORRECT ANSWER: B
RATIONALE: CNO Documentation standards require the use of approved abbreviations,
objective and factual recording, and timely documentation. Subjective statements and
unapproved abbreviations compromise legal defensibility and continuity of care.
QUESTION 12:
A client with heart failure has a daily weight gain of 2.5 kg over 2 days. What is the priority
nursing intervention? A) Restrict fluid intake to 500 mL per day
B) Notify the physician and assess for signs of fluid overload
C) Administer a diuretic immediately without consulting
D) Encourage increased ambulation to mobilize fluid
CORRECT ANSWER: B
RATIONALE: A weight gain of 2.5 kg in 2 days indicates approximately 2.5 L of fluid retention,
signaling acute decompensated heart failure. The nurse must notify the physician and assess for
pulmonary edema, jugular venous distension, and peripheral edema per Canadian
cardiovascular nursing guidelines.
Seneca College – PNR300 Final Exam Review
| Practice Questions and Verified Answers
QUESTION 1:
According to the CNO (College of Nurses of Ontario), what is the primary purpose of the
Therapeutic Nurse-Client Relationship standard? A) To establish boundaries that protect nurses
from legal liability
B) To promote client autonomy, dignity, and safe, ethical care
C) To document all nurse-client interactions for regulatory review
D) To limit physical contact between nurses and clients
CORRECT ANSWER: B
RATIONALE: The CNO Therapeutic Nurse-Client Relationship standard exists to promote client
autonomy, dignity, and the provision of safe, competent, and ethical care. It establishes
professional boundaries while prioritizing the client's needs and well-being within the
therapeutic relationship.
QUESTION 2:
A practical nurse discovers a medication error was made on the previous shift. The client is
stable with no adverse effects. What is the PN's FIRST action according to CNO standards? A)
Complete an incident report and place it in the client's chart
B) Notify the client's family before documenting the error
C) Report the error to the supervising RN or physician immediately
D) Do nothing since the client is stable and no harm occurred
CORRECT ANSWER: C
RATIONALE: CNO standards require immediate reporting of medication errors to the
appropriate supervisor (RN or physician) regardless of client outcome. Timely reporting allows
for assessment of potential delayed effects and demonstrates accountability and transparency
in nursing practice.
QUESTION 3:
A client with type 2 diabetes has a fasting blood glucose of 3.8 mmol/L and is alert but
diaphoretic. What is the priority nursing intervention? A) Administer 15g of fast-acting
carbohydrate (e.g., 150 mL juice)
B) Administer glucagon intramuscularly immediately
C) Recheck blood glucose in 15 minutes without intervention
,2
D) Provide a full meal with protein and complex carbohydrates
CORRECT ANSWER: A
RATIONALE: A blood glucose of 3.8 mmol/L indicates hypoglycemia in a conscious, alert client.
The priority is 15g of fast-acting carbohydrate (oral glucose, juice, regular soda) followed by
rechecking in 15 minutes. Glucagon is reserved for unconscious clients or those unable to
swallow safely.
QUESTION 4:
Which of the following is an example of a CNO-controlled act authorized to practical nurses in
Ontario? A) Performing a comprehensive health assessment independently
B) Administering medications by inhalation or intradermal, intramuscular, subcutaneous, or
topical routes
C) Ordering diagnostic laboratory tests without physician delegation
D) Performing surgical procedures under local anesthesia
CORRECT ANSWER: B
RATIONALE: Under Ontario's Regulated Health Professions Act, practical nurses are authorized
to administer medications by inhalation, intradermal, intramuscular, subcutaneous, and topical
routes. Comprehensive assessments and test ordering are not within the PN scope without
additional authorization.
QUESTION 5:
A postpartum client reports a gush of blood and a firm, contracted uterus. The perineal pad is
saturated with bright red blood. What is the most likely cause? A) Uterine atony
B) Retained placental fragments
C) Vaginal hematoma
D) Normal lochia rubra
CORRECT ANSWER: B
RATIONALE: A firm, contracted uterus with bright red bleeding and gush of blood suggests
retained placental fragments. Uterine atony would present with a boggy uterus. Normal lochia
rubra should not saturate a pad rapidly. Vaginal hematoma typically presents with severe pain
and bulging.
QUESTION 6:
A practical nurse is caring for a client with dementia who becomes agitated and attempts to
leave the unit. Which de-escalation technique is most appropriate FIRST? A) Apply soft wrist
restraints to prevent elopement
B) Administer PRN lorazepam as ordered for agitation
C) Redirect the client to a preferred activity using a calm, reassuring voice
,3
D) Call security to physically block the exit door
CORRECT ANSWER: C
RATIONALE: The least-restrictive approach is redirection using a calm, reassuring voice and
engaging the client in a preferred activity. Restraints and chemical sedation are last resorts after
non-pharmacological interventions fail. Physical blocking may escalate agitation further.
QUESTION 7:
A client receiving IV heparin has an aPTT of 90 seconds (normal 25-35 seconds). What is the
priority nursing action? A) Continue the infusion at the current rate and monitor
B) Notify the physician immediately and prepare to administer protamine sulfate
C) Reduce the infusion rate per protocol and recheck aPTT in 4 hours
D) Stop the infusion and apply pressure to the IV site
CORRECT ANSWER: C
RATIONALE: An aPTT of 90 seconds indicates supratherapeutic anticoagulation. Per Canadian
nursing standards and heparin protocols, the nurse should reduce the infusion rate and recheck
the aPTT in 4 hours. Protamine sulfate is reserved for life-threatening bleeding, not merely
elevated aPTT.
QUESTION 8:
Which CNO practice standard emphasizes the nurse's responsibility to maintain competence
through ongoing learning and self-reflection? A) Professional Standards
B) Ethics
C) Therapeutic Nurse-Client Relationship
D) Medication
CORRECT ANSWER: A
RATIONALE: The CNO Professional Standards outline the expectation that nurses maintain and
enhance their competence through ongoing learning, self-reflection, and integration of new
knowledge into practice. This standard encompasses accountability, continuing competence,
and professional growth.
QUESTION 9:
A client with chronic obstructive pulmonary disease (COPD) has an oxygen saturation of 88% on
room air. What is the most appropriate initial oxygen delivery method? A) Non-rebreather mask
at 15 L/min
B) Nasal cannula at 1-2 L/min
C) Venturi mask at 40% FiO2
D) High-flow nasal cannula at 40 L/min
CORRECT ANSWER: B
, 4
RATIONALE: Clients with COPD are at risk for CO2 retention. The initial oxygen delivery should
be low-flow via nasal cannula at 1-2 L/min, titrated to maintain SpO2 between 88-92% per
Canadian Thoracic Society guidelines. High-flow oxygen can suppress the hypoxic drive.
QUESTION 10:
A practical nurse is preparing to administer digoxin 0.25 mg PO. The client's apical pulse is 52
bpm. What is the appropriate action? A) Administer the medication as ordered
B) Hold the dose and notify the physician
C) Check the radial pulse instead
D) Administer half the dose and reassess in 1 hour
CORRECT ANSWER: B
RATIONALE: Digoxin is contraindicated when the apical pulse is below 60 bpm due to risk of
bradycardia and heart block. The nurse must hold the dose and notify the physician
immediately. This follows CNO Medication standards and cardiac medication safety protocols
taught in Seneca PNR300.
QUESTION 11:
Which documentation principle aligns with CNO Documentation standards? A) Document only
abnormal findings to save time
B) Use abbreviations approved by the facility and avoid subjective statements
C) Record entries before providing care to ensure completeness
D) Leave blank spaces in the chart for later additions
CORRECT ANSWER: B
RATIONALE: CNO Documentation standards require the use of approved abbreviations,
objective and factual recording, and timely documentation. Subjective statements and
unapproved abbreviations compromise legal defensibility and continuity of care.
QUESTION 12:
A client with heart failure has a daily weight gain of 2.5 kg over 2 days. What is the priority
nursing intervention? A) Restrict fluid intake to 500 mL per day
B) Notify the physician and assess for signs of fluid overload
C) Administer a diuretic immediately without consulting
D) Encourage increased ambulation to mobilize fluid
CORRECT ANSWER: B
RATIONALE: A weight gain of 2.5 kg in 2 days indicates approximately 2.5 L of fluid retention,
signaling acute decompensated heart failure. The nurse must notify the physician and assess for
pulmonary edema, jugular venous distension, and peripheral edema per Canadian
cardiovascular nursing guidelines.
