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Blueprint/areas of focus | 2026 Update
Complete.
1. Which personal protective equipment (PPE) is required?
a) Surgical mask and gloves
b) N95 respirator, gown, gloves
c) Gown and gloves only
d) Gloves only
Answer: c) Gown and gloves only
*Rationale: C. diff requires contact precautions: gown and
gloves. Alcohol hand sanitizer is ineffective; wash with soap and
water. N95 is for airborne (TB, COVID-19 with aerosolizing
procedures).*
2. The nurse must ensure that the patient’s environment is
cleaned with:
a) 70% isopropyl alcohol
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b) Chlorine-based disinfectant (e.g., bleach)
c) Quaternary ammonium compound
d) Hydrogen peroxide wipes only
Answer: b) Chlorine-based disinfectant
*Rationale: C. diff spores are resistant to alcohol and quaternary
ammonium. Bleach (1:10 dilution or EPA-approved sporicidal
agent) is required.*
3. A nurse accidentally sustains a needlestick from a patient
with hepatitis B. The first action is:
a) Report to employee health within 24 hours
b) Wash the site with soap and water
c) Start hepatitis B immune globulin (HBIG)
d) Check patient’s HBsAg status
Answer: b) Wash the site with soap and water
Rationale: Immediate first aid: wash needlestick site with soap and
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water; do not squeeze or use bleach. Then report and initiate post-
exposure prophylaxis based on patient’s status.
4. Which patient requires airborne precautions?
a) 5-year-old with chickenpox (varicella)
b) Adult with MRSA pneumonia
c) Infant with RSV bronchiolitis
d) Elderly with norovirus diarrhea
Answer: a) Chickenpox (varicella)
Rationale: Airborne: measles, varicella (chickenpox/shingles
disseminated), tuberculosis. MRSA = contact; RSV =
contact/droplet; norovirus = contact.
5. A patient on a ventilator has a endotracheal tube cuff
pressure of 32 cmH₂O. The nurse should:
a) Document as normal
b) Deflate the cuff immediately
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c) Reduce pressure to 20–25 cmH₂O
d) Increase pressure to 35 cmH₂O
Answer: c) Reduce to 20–25 cmH₂O
*Rationale: Normal cuff pressure 20–30 cmH₂O (usually 25-30).
>30 increases risk of tracheal necrosis. 32 is too high; aspirate
air to lower.*
(Continue to Q25 with additional safety topics: fall prevention, fire
safety, medication reconciliation, etc.)
SECTION 2: PHARMACOLOGY & MEDICATION
ADMINISTRATION (Questions 26–50)
Scenario 2: A patient is prescribed digoxin 0.25 mg IV push. The
apical pulse is 52 bpm.
26. The nurse should:
a) Administer the digoxin as ordered
Blueprint/areas of focus | 2026 Update
Complete.
1. Which personal protective equipment (PPE) is required?
a) Surgical mask and gloves
b) N95 respirator, gown, gloves
c) Gown and gloves only
d) Gloves only
Answer: c) Gown and gloves only
*Rationale: C. diff requires contact precautions: gown and
gloves. Alcohol hand sanitizer is ineffective; wash with soap and
water. N95 is for airborne (TB, COVID-19 with aerosolizing
procedures).*
2. The nurse must ensure that the patient’s environment is
cleaned with:
a) 70% isopropyl alcohol
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b) Chlorine-based disinfectant (e.g., bleach)
c) Quaternary ammonium compound
d) Hydrogen peroxide wipes only
Answer: b) Chlorine-based disinfectant
*Rationale: C. diff spores are resistant to alcohol and quaternary
ammonium. Bleach (1:10 dilution or EPA-approved sporicidal
agent) is required.*
3. A nurse accidentally sustains a needlestick from a patient
with hepatitis B. The first action is:
a) Report to employee health within 24 hours
b) Wash the site with soap and water
c) Start hepatitis B immune globulin (HBIG)
d) Check patient’s HBsAg status
Answer: b) Wash the site with soap and water
Rationale: Immediate first aid: wash needlestick site with soap and
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water; do not squeeze or use bleach. Then report and initiate post-
exposure prophylaxis based on patient’s status.
4. Which patient requires airborne precautions?
a) 5-year-old with chickenpox (varicella)
b) Adult with MRSA pneumonia
c) Infant with RSV bronchiolitis
d) Elderly with norovirus diarrhea
Answer: a) Chickenpox (varicella)
Rationale: Airborne: measles, varicella (chickenpox/shingles
disseminated), tuberculosis. MRSA = contact; RSV =
contact/droplet; norovirus = contact.
5. A patient on a ventilator has a endotracheal tube cuff
pressure of 32 cmH₂O. The nurse should:
a) Document as normal
b) Deflate the cuff immediately
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c) Reduce pressure to 20–25 cmH₂O
d) Increase pressure to 35 cmH₂O
Answer: c) Reduce to 20–25 cmH₂O
*Rationale: Normal cuff pressure 20–30 cmH₂O (usually 25-30).
>30 increases risk of tracheal necrosis. 32 is too high; aspirate
air to lower.*
(Continue to Q25 with additional safety topics: fall prevention, fire
safety, medication reconciliation, etc.)
SECTION 2: PHARMACOLOGY & MEDICATION
ADMINISTRATION (Questions 26–50)
Scenario 2: A patient is prescribed digoxin 0.25 mg IV push. The
apical pulse is 52 bpm.
26. The nurse should:
a) Administer the digoxin as ordered
