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Section 1: Safe & Effective Care Environment (Q1-85)
Subsection 1A: Management of Care - Delegation, Prioritization, Assignment (Q1-50)
Q1. The registered nurse (RN) is planning care for four patients. Which task is most
appropriate to delegate to a licensed practical nurse (LPN)?
A. Developing a plan of care for a newly admitted patient with heart failure
B. Administering an oral antibiotic to a stable patient with pneumonia
C. Performing the initial admission assessment on a postoperative patient
D. Teaching a patient with diabetes how to administer insulin
Correct Answer: B. Administering an oral antibiotic to a stable patient with pneumonia
[CORRECT]
Rationale: LPNs can administer oral medications to stable patients; RNs must perform
initial assessments, develop care plans, and teach insulin administration per scope of
practice.
Q2. A nursing assistant (UAP) has four assigned patients. Which task should the RN
refrain from delegating to the UAP?
A. Assisting an independent patient with ambulation to the bathroom
B. Measuring and recording intake and output for a patient with a Foley catheter
C. Evaluating the effectiveness of pain medication given 30 minutes ago
D. Providing a bed bath for a patient on bed rest
Correct Answer: C. Evaluating the effectiveness of pain medication given 30 minutes
ago [CORRECT]
Rationale: Evaluation of patient responses to interventions requires nursing judgment
and cannot be delegated to UAPs; UAPs can assist with hygiene, ambulation, and data
collection but not clinical evaluation.
,Q3. The charge nurse is making assignments for the shift. Which patient is most
appropriate for a float RN from the medical-surgical unit to care for?
A. A patient in the intensive care unit on a ventilator requiring multiple vasopressors
B. A stable patient admitted 2 days ago for community-acquired pneumonia awaiting
discharge
C. A patient who had a craniotomy 6 hours ago with an external ventricular drain
D. A patient with a new tracheostomy requiring frequent suctioning and weaning
Correct Answer: B. A stable patient admitted 2 days ago for community-acquired
pneumonia awaiting discharge [CORRECT]
Rationale: Float staff should receive assignments matching their competency level;
stable patients awaiting discharge are appropriate, whereas ICU-level, neurosurgical, or
complex respiratory patients require specialized care.
Q4. Which action by the RN violates the Health Insurance Portability and Accountability
Act (HIPAA)?
A. Discussing a patient's condition with the physical therapist involved in the patient's
care
B. Reviewing a patient's medical record to prepare for an upcoming shift
C. Sharing a patient's laboratory results with a neighbor who asks how the patient is
doing
D. Faxing a discharge summary to the patient's primary care provider with a cover sheet
Correct Answer: C. Sharing a patient's laboratory results with a neighbor who asks how
the patient is doing [CORRECT]
Rationale: HIPAA prohibits disclosure of protected health information to unauthorized
individuals; the neighbor is not involved in the patient's care, making this a violation.
Q5. A patient is scheduled for an elective cholecystectomy. Who is responsible for
obtaining the informed consent for the surgical procedure?
A. The circulating nurse
B. The surgeon performing the procedure
C. The anesthesiologist
D. The unit secretary
Correct Answer: B. The surgeon performing the procedure [CORRECT]
,Rationale: The provider performing the invasive procedure is legally responsible for
obtaining informed consent; nurses may witness the signature but do not obtain
surgical consent.
Q6. A patient with decision-making capacity refuses a blood transfusion based on
religious beliefs. What is the nurse's most appropriate action?
A. Notify the provider and document the refusal; respect the patient's autonomy
B. Convince the patient that the transfusion is necessary for survival
C. Administer the transfusion because it is a life-saving intervention
D. Ask the patient's family to override the patient's decision
Correct Answer: A. Notify the provider and document the refusal; respect the patient's
autonomy [CORRECT]
Rationale: Competent patients have the right to refuse treatment; the nurse must notify
the provider, document thoroughly, and advocate for the patient's autonomy while
ensuring the patient understands consequences.
Q7. An advance directive is best described as:
A. A legal document that designates a healthcare proxy and outlines treatment
preferences
B. A physician order that mandates resuscitation in all circumstances
C. A nursing care plan developed at the time of hospital admission
D. An insurance authorization form for surgical procedures
Correct Answer: A. A legal document that designates a healthcare proxy and outlines
treatment preferences [CORRECT]
Rationale: Advance directives allow patients to specify healthcare preferences and
appoint surrogates; they guide care when patients cannot speak for themselves and
must be honored per federal law.
Q8. A medication error occurs when a nurse administers a patient's morning dose of
metoprolol to the wrong patient. After ensuring the wrong patient is stable, the nurse's
next priority is to:
A. Complete an incident report and notify the nurse manager
B. Document the error in the patient's medical record with objective facts
C. Notify the provider and implement any ordered corrective measures
, D. Hide the error to prevent disciplinary action
Correct Answer: C. Notify the provider and implement any ordered corrective measures
[CORRECT]
Rationale: Patient safety is the immediate priority; the provider must be notified to
assess for harm, followed by documentation and completion of the incident report for
quality improvement.
Q9. A patient arrives in the emergency department with a gunshot wound and is
unconscious. No family members are present. Emergency surgery is required to save
the patient's life. Which statement best describes the legal basis for proceeding with
treatment?
A. The physician must wait for a court order before operating
B. Implied consent permits emergency treatment when immediate intervention is
necessary to prevent death
C. The nurse can provide consent because the patient is on hospital property
D. Consent is not required for any patient who arrives via ambulance
Correct Answer: B. Implied consent permits emergency treatment when immediate
intervention is necessary to prevent death [CORRECT]
Rationale: Implied consent applies when a patient cannot consent and no proxy is
available in a life-threatening emergency; delaying care to obtain court orders would
violate duty to act.
Q10. The RN is caring for four patients. Which patient should the RN assess first?
A. A patient requesting a PRN stool softener for constipation
B. A patient with a blood pressure of 198/102 who is asymptomatic and scheduled for
discharge
C. A patient with a respiratory rate of 8/minute and oxygen saturation of 84% on room
air
D. A patient with a stable heart rate of 88 bpm awaiting physical therapy
Correct Answer: C. A patient with a respiratory rate of 8/minute and oxygen saturation
of 84% on room air [CORRECT]