NS1881 Nursing Practice Mock Examination
Comprehensive Clinical Competency Readiness Assessment | 2026/2027
75 Questions | Select the BEST answer. Correct answers highlighted in teal.
Section I: Prioritization & Delegation
1. A nurse receives report on four patients. Which patient should the nurse assess FIRST?
A. A patient with type 2 diabetes requesting dietary B. A patient with pneumonia whose SpO2 has
education dropped from 95% to 88%
C. A patient post-appendectomy day 2 with a D. A patient with hypertension reporting a headache
temperature of 37.8°C
Correct Answer: B. A patient with pneumonia whose SpO2 has dropped from 95% to 88%
Rationale: Using the ABC framework, the patient with a declining SpO2 (88%) is the priority because this indicates
hypoxemia, a potentially life-threatening condition affecting the airway-breathing-circulation continuum. The other
patients have non-urgent needs that can be addressed after stabilizing the hypoxic patient.
2. Which task is MOST appropriate for the nurse to delegate to a UAP?
A. Assessing a postoperative patient's wound for B. Measuring intake and output for a stable patient
dehiscence
C. Evaluating a patient's response to a new D. Teaching a patient with heart failure about
antihypertensive sodium restriction
Correct Answer: B. Measuring intake and output for a stable patient
Rationale: Measuring intake and output is a standardized, repetitive task within UAP scope of practice. Assessment,
evaluation, and patient teaching require RN-level education and clinical judgment and cannot be delegated to
unlicensed assistive personnel.
3. A nurse is caring for multiple patients. Which patient is MOST stable and can be delegated to an
LPN/LVN?
A. A patient with new-onset atrial fibrillation with a B. A patient 1 day post-cholecystectomy with stable
heart rate of 142 vital signs
C. A patient with acute respiratory distress requiring D. A patient receiving a blood transfusion for the
BiPAP adjustment first time
Correct Answer: B. A patient 1 day post-cholecystectomy with stable vital signs
Rationale: An LPN/LVN can care for a stable post-cholecystectomy patient with predictable outcomes under RN
supervision. New-onset arrhythmias, patients requiring ventilator management or blood transfusion first-time
monitoring require RN-level assessment and clinical judgment.
4. Using Maslow's hierarchy, which need should the nurse address FIRST?
A. A patient expresses fear about an upcoming B. A patient reports difficulty breathing after
surgery ambulation
1
, C. A patient expresses concern about financial D. A patient wants to discuss advance directives
matters
Correct Answer: B. A patient reports difficulty breathing after ambulation
Rationale: Maslow's hierarchy prioritizes physiological needs before safety, love/belonging, esteem, and self-
actualization. Difficulty breathing is an oxygenation need (physiological) and takes priority over fear (safety), financial
concerns (security), or advance directives (self-actualization). Physiological needs must be met first.
5. A nurse is assigning care for the shift. Which action by the nurse demonstrates the MOST effective use of
the Five Rights of Delegation?
A. Delegating vital signs to a UAP for an unstable B. Delegating blood glucose monitoring to an LPN
postoperative patient for a newly diagnosed diabetic
C. Delegating admission assessment to a UAP while D. Delegating IV medication administration to an
the RN manages a crisis experienced UAP
Correct Answer: B. Delegating blood glucose monitoring to an LPN for a newly diagnosed diabetic
Rationale: The Five Rights of Delegation include right task, right circumstances, right person, right
direction/communication, and right supervision/evaluation. Blood glucose monitoring is within LPN scope for a stable
patient. Vital signs for an unstable patient and admission assessment require RN assessment. IV medication
administration is never within UAP scope.
6. A nurse receives change-of-shift report using I-PASS. The "S" component stands for:
A. Safety B. Situation C. Synthesis D. Symptoms
Correct Answer: C. Synthesis
Rationale: I-PASS stands for: Illness severity, Patient summary, Action list, Situation awareness and contingency
planning, and Synthesis by receiver. The "S" represents Situation awareness, where anticipated problems and
contingency plans are communicated. This structured handoff tool reduces communication errors and improves patient
safety.
7. A postoperative patient has a PCA pump with morphine. The nurse finds the patient drowsy with a
respiratory rate of 8 breaths per minute. What is the priority action?
A. Document findings and continue to monitor B. Administer naloxone per protocol and contact the
provider
C. Encourage the patient to take deep breaths D. Reduce the PCA dose by half
Correct Answer: B. Administer naloxone per protocol and contact the provider
Rationale: Opioid-induced respiratory depression (RR less than 8/min with altered consciousness) is a medical
emergency requiring immediate reversal with naloxone. The PCA should be stopped and the provider notified. Waiting
to document or simply encouraging deep breaths delays lifesaving intervention. The nurse cannot independently adjust
PCA dosing.
8. A nurse is providing SBAR communication to a provider about a patient with worsening heart failure.
Which statement belongs in the "A" (Assessment) component?
A. The patient has gained 3 kg in 2 days B. I think the patient may be experiencing fluid
overload
C. The patient was admitted 3 days ago with CHF D. Please order a chest x-ray and increase
exacerbation furosemide dose
Correct Answer: B. I think the patient may be experiencing fluid overload
2
, Rationale: The Assessment component of SBAR is where the nurse shares their clinical judgment about the situation. "I
think the patient may be experiencing fluid overload" represents the nurse's assessment. Weight gain is a finding
(Situation). Admission history is Background. Requesting orders is the Recommendation.
Section II: Medical-Surgical Nursing
9. A patient with STEMI arrives at the ED within 30 minutes of symptom onset. The 12-lead ECG shows ST
elevation in leads V1–V4. Which is the priority intervention?
A. Administer aspirin 325 mg chewable B. Prepare for emergent percutaneous coronary
intervention (PCI)
C. Obtain cardiac biomarkers (troponin, CK-MB) D. Administer sublingual nitroglycerin
Correct Answer: B. Prepare for emergent percutaneous coronary intervention (PCI)
Rationale: For STEMI presenting within the PCI-capable facility timeframe, emergent PCI is the gold standard
reperfusion strategy per AHA/ACC guidelines with a door-to-balloon time goal of less than 90 minutes. PCI is superior
to fibrinolytic therapy when available within the time window. While aspirin, nitroglycerin, and biomarkers are all
important, PCI is the priority life-saving intervention.
10. A patient with heart failure has crackles bilaterally, JVD, 3+ pitting edema, and weight gain of 4 kg in 3
days. Which medication should the nurse anticipate being prescribed FIRST?
A. Metoprolol B. Enalapril C. Furosemide IV D. Digoxin
Correct Answer: C. Furosemide IV
Rationale: The patient's findings indicate acute decompensated heart failure with volume overload. IV loop diuretics
(furosemide) are the first-line treatment to rapidly reduce fluid overload and relieve symptoms of congestion. Beta-
blockers and ACE inhibitors are long-term management but should not be initiated during acute decompensation.
Digoxin is not a first-line agent for acute management.
11. A patient with COPD has an ABG result: pH 7.34, PaCO2 56 mmHg, HCO3 30 mEq/L. Which
interpretation is correct?
A. Acute respiratory B. Partially compensated C. Metabolic alkalosis D. Respiratory alkalosis
acidosis respiratory acidosis
Correct Answer: B. Partially compensated respiratory acidosis
Rationale: The pH is below normal (acidemia), PaCO2 is elevated (respiratory acidosis), and HCO3 is elevated
(metabolic compensation). The kidneys have retained bicarbonate to compensate for the chronically elevated CO2 in
COPD. Because pH is still abnormal, it is partially compensated respiratory acidosis, consistent with chronic COPD.
12. A patient with a PE is started on heparin. Which finding requires IMMEDIATE provider notification?
A. aPTT of 62 seconds B. Platelet count of C. Heparin drip at 18 D. Minor bleeding at IV
78,000/mcL units/kg/hr site
Correct Answer: B. Platelet count of 78,000/mcL
Rationale: A platelet count of 78,000 (normal 150,000–400,000) suggests heparin-induced thrombocytopenia (HIT), a
potentially life-threatening complication that requires immediate discontinuation of heparin and switch to a direct
thrombin inhibitor (argatroban or bivalirudin). An aPTT of 62 seconds is within therapeutic range. Minor bleeding is
expected but should be monitored.
13. A patient with type 1 diabetes presents with blood glucose 520 mg/dL, pH 7.20, serum bicarbonate 10
mEq/L, and positive ketones. What is the priority intervention?
3
Comprehensive Clinical Competency Readiness Assessment | 2026/2027
75 Questions | Select the BEST answer. Correct answers highlighted in teal.
Section I: Prioritization & Delegation
1. A nurse receives report on four patients. Which patient should the nurse assess FIRST?
A. A patient with type 2 diabetes requesting dietary B. A patient with pneumonia whose SpO2 has
education dropped from 95% to 88%
C. A patient post-appendectomy day 2 with a D. A patient with hypertension reporting a headache
temperature of 37.8°C
Correct Answer: B. A patient with pneumonia whose SpO2 has dropped from 95% to 88%
Rationale: Using the ABC framework, the patient with a declining SpO2 (88%) is the priority because this indicates
hypoxemia, a potentially life-threatening condition affecting the airway-breathing-circulation continuum. The other
patients have non-urgent needs that can be addressed after stabilizing the hypoxic patient.
2. Which task is MOST appropriate for the nurse to delegate to a UAP?
A. Assessing a postoperative patient's wound for B. Measuring intake and output for a stable patient
dehiscence
C. Evaluating a patient's response to a new D. Teaching a patient with heart failure about
antihypertensive sodium restriction
Correct Answer: B. Measuring intake and output for a stable patient
Rationale: Measuring intake and output is a standardized, repetitive task within UAP scope of practice. Assessment,
evaluation, and patient teaching require RN-level education and clinical judgment and cannot be delegated to
unlicensed assistive personnel.
3. A nurse is caring for multiple patients. Which patient is MOST stable and can be delegated to an
LPN/LVN?
A. A patient with new-onset atrial fibrillation with a B. A patient 1 day post-cholecystectomy with stable
heart rate of 142 vital signs
C. A patient with acute respiratory distress requiring D. A patient receiving a blood transfusion for the
BiPAP adjustment first time
Correct Answer: B. A patient 1 day post-cholecystectomy with stable vital signs
Rationale: An LPN/LVN can care for a stable post-cholecystectomy patient with predictable outcomes under RN
supervision. New-onset arrhythmias, patients requiring ventilator management or blood transfusion first-time
monitoring require RN-level assessment and clinical judgment.
4. Using Maslow's hierarchy, which need should the nurse address FIRST?
A. A patient expresses fear about an upcoming B. A patient reports difficulty breathing after
surgery ambulation
1
, C. A patient expresses concern about financial D. A patient wants to discuss advance directives
matters
Correct Answer: B. A patient reports difficulty breathing after ambulation
Rationale: Maslow's hierarchy prioritizes physiological needs before safety, love/belonging, esteem, and self-
actualization. Difficulty breathing is an oxygenation need (physiological) and takes priority over fear (safety), financial
concerns (security), or advance directives (self-actualization). Physiological needs must be met first.
5. A nurse is assigning care for the shift. Which action by the nurse demonstrates the MOST effective use of
the Five Rights of Delegation?
A. Delegating vital signs to a UAP for an unstable B. Delegating blood glucose monitoring to an LPN
postoperative patient for a newly diagnosed diabetic
C. Delegating admission assessment to a UAP while D. Delegating IV medication administration to an
the RN manages a crisis experienced UAP
Correct Answer: B. Delegating blood glucose monitoring to an LPN for a newly diagnosed diabetic
Rationale: The Five Rights of Delegation include right task, right circumstances, right person, right
direction/communication, and right supervision/evaluation. Blood glucose monitoring is within LPN scope for a stable
patient. Vital signs for an unstable patient and admission assessment require RN assessment. IV medication
administration is never within UAP scope.
6. A nurse receives change-of-shift report using I-PASS. The "S" component stands for:
A. Safety B. Situation C. Synthesis D. Symptoms
Correct Answer: C. Synthesis
Rationale: I-PASS stands for: Illness severity, Patient summary, Action list, Situation awareness and contingency
planning, and Synthesis by receiver. The "S" represents Situation awareness, where anticipated problems and
contingency plans are communicated. This structured handoff tool reduces communication errors and improves patient
safety.
7. A postoperative patient has a PCA pump with morphine. The nurse finds the patient drowsy with a
respiratory rate of 8 breaths per minute. What is the priority action?
A. Document findings and continue to monitor B. Administer naloxone per protocol and contact the
provider
C. Encourage the patient to take deep breaths D. Reduce the PCA dose by half
Correct Answer: B. Administer naloxone per protocol and contact the provider
Rationale: Opioid-induced respiratory depression (RR less than 8/min with altered consciousness) is a medical
emergency requiring immediate reversal with naloxone. The PCA should be stopped and the provider notified. Waiting
to document or simply encouraging deep breaths delays lifesaving intervention. The nurse cannot independently adjust
PCA dosing.
8. A nurse is providing SBAR communication to a provider about a patient with worsening heart failure.
Which statement belongs in the "A" (Assessment) component?
A. The patient has gained 3 kg in 2 days B. I think the patient may be experiencing fluid
overload
C. The patient was admitted 3 days ago with CHF D. Please order a chest x-ray and increase
exacerbation furosemide dose
Correct Answer: B. I think the patient may be experiencing fluid overload
2
, Rationale: The Assessment component of SBAR is where the nurse shares their clinical judgment about the situation. "I
think the patient may be experiencing fluid overload" represents the nurse's assessment. Weight gain is a finding
(Situation). Admission history is Background. Requesting orders is the Recommendation.
Section II: Medical-Surgical Nursing
9. A patient with STEMI arrives at the ED within 30 minutes of symptom onset. The 12-lead ECG shows ST
elevation in leads V1–V4. Which is the priority intervention?
A. Administer aspirin 325 mg chewable B. Prepare for emergent percutaneous coronary
intervention (PCI)
C. Obtain cardiac biomarkers (troponin, CK-MB) D. Administer sublingual nitroglycerin
Correct Answer: B. Prepare for emergent percutaneous coronary intervention (PCI)
Rationale: For STEMI presenting within the PCI-capable facility timeframe, emergent PCI is the gold standard
reperfusion strategy per AHA/ACC guidelines with a door-to-balloon time goal of less than 90 minutes. PCI is superior
to fibrinolytic therapy when available within the time window. While aspirin, nitroglycerin, and biomarkers are all
important, PCI is the priority life-saving intervention.
10. A patient with heart failure has crackles bilaterally, JVD, 3+ pitting edema, and weight gain of 4 kg in 3
days. Which medication should the nurse anticipate being prescribed FIRST?
A. Metoprolol B. Enalapril C. Furosemide IV D. Digoxin
Correct Answer: C. Furosemide IV
Rationale: The patient's findings indicate acute decompensated heart failure with volume overload. IV loop diuretics
(furosemide) are the first-line treatment to rapidly reduce fluid overload and relieve symptoms of congestion. Beta-
blockers and ACE inhibitors are long-term management but should not be initiated during acute decompensation.
Digoxin is not a first-line agent for acute management.
11. A patient with COPD has an ABG result: pH 7.34, PaCO2 56 mmHg, HCO3 30 mEq/L. Which
interpretation is correct?
A. Acute respiratory B. Partially compensated C. Metabolic alkalosis D. Respiratory alkalosis
acidosis respiratory acidosis
Correct Answer: B. Partially compensated respiratory acidosis
Rationale: The pH is below normal (acidemia), PaCO2 is elevated (respiratory acidosis), and HCO3 is elevated
(metabolic compensation). The kidneys have retained bicarbonate to compensate for the chronically elevated CO2 in
COPD. Because pH is still abnormal, it is partially compensated respiratory acidosis, consistent with chronic COPD.
12. A patient with a PE is started on heparin. Which finding requires IMMEDIATE provider notification?
A. aPTT of 62 seconds B. Platelet count of C. Heparin drip at 18 D. Minor bleeding at IV
78,000/mcL units/kg/hr site
Correct Answer: B. Platelet count of 78,000/mcL
Rationale: A platelet count of 78,000 (normal 150,000–400,000) suggests heparin-induced thrombocytopenia (HIT), a
potentially life-threatening complication that requires immediate discontinuation of heparin and switch to a direct
thrombin inhibitor (argatroban or bivalirudin). An aPTT of 62 seconds is within therapeutic range. Minor bleeding is
expected but should be monitored.
13. A patient with type 1 diabetes presents with blood glucose 520 mg/dL, pH 7.20, serum bicarbonate 10
mEq/L, and positive ketones. What is the priority intervention?
3
