PNR 207/PNR207 Exam 3 V1 | Transition to
PN Practice - Capstone Q&A with
Rationale | Fortis College
1. A Practical Nurse (PN) is reviewing the priority of care for a group of clients at the start of a
shift. Which client should the nurse assess first?
A. A client with a new diagnosis of pneumonia who is experiencing increased confusion and
restlessness.
B. A client with a history of heart failure who has 2+ pitting edema in the lower extremities.
C. A client who is requesting PRN pain medication for chronic back pain rated at 6/10.
D. A client who underwent an appendectomy yesterday and has not yet ambulated today.
Correct Answer: A
Expert Explanation: Increased confusion and restlessness in a client with pneumonia are
early signs of hypoxia. This reflects a priority issue based on the ABC (Airway, Breathing,
Circulation) framework as it indicates declining respiratory status. Addressing this client
immediately is essential to prevent respiratory failure or arrest.
2. A PN is preparing to delegate tasks to an Unlicensed Assistive Personnel (UAP). Which task
is appropriate to delegate to the UAP?
A. Feeding a client who has a high risk for aspiration and dysphagia.
B. Assessing the skin integrity of a client who is bedbound.
,C. Recording the intake and output for a client with a history of renal failure.
D. Providing discharge instructions to a client who just had a cast applied.
Correct Answer: C
Expert Explanation: The recording of intake and output is a routine, non-invasive task
that falls within the scope of a UAP’s role. Assessments and teaching are strictly reserved
for licensed nursing personnel because they require clinical judgment. Ensuring tasks are
delegated to the correct level of staff is vital for safe and effective care delivery.
3. A client with terminal cancer expresses a desire to stop all curative treatments and move
to hospice care. The family disagrees with this decision. Which ethical principle is the nurse
upholding by supporting the client?
A. Beneficence
B. Justice
C. Autonomy
D. Fidelity
Correct Answer: C
Expert Explanation: Autonomy refers to the right of a competent individual to make their
own decisions regarding their healthcare. The nurse must respect the client’s self-
determination even when it conflicts with the wishes of the family or healthcare team. This
principle is a cornerstone of ethical nursing practice and patient-centered care.
, 4. A nurse is documenting in a client’s electronic health record. Which entry is the most
objective and accurate?
A. The client seems very angry and was yelling at the staff this morning.
B. Client’s surgical dressing is saturated with 5 cm of bright red drainage.
C. The client appears to be in a lot of pain because they are moaning.
D. The client ate a good portion of their breakfast tray today.
Correct Answer: B
Expert Explanation: Objective documentation should focus on measurable and observable
data rather than interpretations or vague adjectives. Describing the specific size and color
of drainage provides a clear clinical picture for other healthcare providers. Accurate
documentation is essential for continuity of care and legal protection.
5. Which action by the PN demonstrates adherence to the Health Insurance Portability and
Accountability Act (HIPAA)?
A. Discussing a client’s labs with a nurse from another unit in the hospital cafeteria.
B. Giving a telephone update on a client’s condition to an individual who provided the
correct security code.
C. Leaving a printed laboratory report on the counter at the nursing station.
D. Sharing a computer password with a nursing student to facilitate charting.
Correct Answer: B
PN Practice - Capstone Q&A with
Rationale | Fortis College
1. A Practical Nurse (PN) is reviewing the priority of care for a group of clients at the start of a
shift. Which client should the nurse assess first?
A. A client with a new diagnosis of pneumonia who is experiencing increased confusion and
restlessness.
B. A client with a history of heart failure who has 2+ pitting edema in the lower extremities.
C. A client who is requesting PRN pain medication for chronic back pain rated at 6/10.
D. A client who underwent an appendectomy yesterday and has not yet ambulated today.
Correct Answer: A
Expert Explanation: Increased confusion and restlessness in a client with pneumonia are
early signs of hypoxia. This reflects a priority issue based on the ABC (Airway, Breathing,
Circulation) framework as it indicates declining respiratory status. Addressing this client
immediately is essential to prevent respiratory failure or arrest.
2. A PN is preparing to delegate tasks to an Unlicensed Assistive Personnel (UAP). Which task
is appropriate to delegate to the UAP?
A. Feeding a client who has a high risk for aspiration and dysphagia.
B. Assessing the skin integrity of a client who is bedbound.
,C. Recording the intake and output for a client with a history of renal failure.
D. Providing discharge instructions to a client who just had a cast applied.
Correct Answer: C
Expert Explanation: The recording of intake and output is a routine, non-invasive task
that falls within the scope of a UAP’s role. Assessments and teaching are strictly reserved
for licensed nursing personnel because they require clinical judgment. Ensuring tasks are
delegated to the correct level of staff is vital for safe and effective care delivery.
3. A client with terminal cancer expresses a desire to stop all curative treatments and move
to hospice care. The family disagrees with this decision. Which ethical principle is the nurse
upholding by supporting the client?
A. Beneficence
B. Justice
C. Autonomy
D. Fidelity
Correct Answer: C
Expert Explanation: Autonomy refers to the right of a competent individual to make their
own decisions regarding their healthcare. The nurse must respect the client’s self-
determination even when it conflicts with the wishes of the family or healthcare team. This
principle is a cornerstone of ethical nursing practice and patient-centered care.
, 4. A nurse is documenting in a client’s electronic health record. Which entry is the most
objective and accurate?
A. The client seems very angry and was yelling at the staff this morning.
B. Client’s surgical dressing is saturated with 5 cm of bright red drainage.
C. The client appears to be in a lot of pain because they are moaning.
D. The client ate a good portion of their breakfast tray today.
Correct Answer: B
Expert Explanation: Objective documentation should focus on measurable and observable
data rather than interpretations or vague adjectives. Describing the specific size and color
of drainage provides a clear clinical picture for other healthcare providers. Accurate
documentation is essential for continuity of care and legal protection.
5. Which action by the PN demonstrates adherence to the Health Insurance Portability and
Accountability Act (HIPAA)?
A. Discussing a client’s labs with a nurse from another unit in the hospital cafeteria.
B. Giving a telephone update on a client’s condition to an individual who provided the
correct security code.
C. Leaving a printed laboratory report on the counter at the nursing station.
D. Sharing a computer password with a nursing student to facilitate charting.
Correct Answer: B
