PNR 207/PNR207 Final Exam V3 |
Transition to PN Practice - Capstone Q&A
with Rationale | Fortis College
1. A Licensed Practical Nurse (LPN) is planning the client assignments for the upcoming shift.
Which client should be assigned to the most experienced Unlicensed Assistive Personnel
(UAP)?
A. A client who requires a sterile dressing change on a stage 3 pressure ulcer.
B. A stable client who requires assistance with ambulation and range-of-motion exercises.
C. A client with a new tracheostomy who requires frequent suctioning.
D. A client receiving a continuous IV infusion of heparin for deep vein thrombosis.
Correct Answer: B
Expert Explanation: Delegation to UAP must involve tasks that are routine and do not
require clinical judgment or assessment. Assisting with ambulation and range-of-motion
for a stable client falls within the scope of practice for a UAP. Sterile dressing changes and
monitoring IV infusions or tracheostomies require the specialized skills of a licensed nurse.
2. A nurse is caring for a client who is scheduled for surgery. The client expresses doubt about
the procedure and states, ‘I don’t think I want to do this anymore.’ Which action should the
nurse take first?
A. Notify the surgeon that the client is refusing the procedure.
,B. Ask the client to explain their concerns and feelings about the surgery.
C. Administer the preoperative sedative as ordered to calm the client.
D. Reassure the client that the surgeon is highly skilled and successful.
Correct Answer: B
Expert Explanation: The nurse’s first responsibility is to assess the client’s concerns
through therapeutic communication. Exploring the client’s feelings allows the nurse to
identify the specific source of anxiety or misinformation. Once assessment is complete, the
nurse can then facilitate communication between the client and the surgeon if needed.
3. During a disaster triage, which client should the nurse assign a ‘Red’ tag (Immediate
priority)?
A. A client with multiple fractures who is conscious and stable.
B. A client with a sucking chest wound and significant respiratory distress.
C. A client with a minor laceration to the forearm.
D. A client who is pulseless and non-breathing with a head injury.
Correct Answer: B
Expert Explanation: Red tags are assigned to clients with life-threatening injuries who
have a high chance of survival if treated immediately. A sucking chest wound is a critical
respiratory emergency that requires rapid intervention. Clients who are pulseless are
, typically tagged black (expectant) in a mass casualty event to prioritize resources for those
who can be saved.
4. The nurse is preparing to administer medication to a client. Which of the following actions
represents the best practice for client identification?
A. Calling the client by the name listed on the chart.
B. Checking the client’s room number against the medication administration record (MAR).
C. Verifying the client’s identity with a family member in the room.
D. Asking the client to state their name and date of birth.
Correct Answer: D
Expert Explanation: Joint Commission standards require the use of at least two unique
identifiers before administering medications. Asking the client to state their name and date
of birth is an active identification process. Room numbers are never used as identifiers
because clients can be moved between rooms frequently.
5. A nurse is teaching a new LPN about the principles of beneficence. Which action by the LPN
demonstrates this principle?
A. Allowing a client to choose which arm to use for an injection.
B. Providing the same level of care to all clients regardless of their background.
C. Fulfilling a promise to return to a client’s room in ten minutes.
D. Administering pain medication to a client who is in post-operative distress.
Transition to PN Practice - Capstone Q&A
with Rationale | Fortis College
1. A Licensed Practical Nurse (LPN) is planning the client assignments for the upcoming shift.
Which client should be assigned to the most experienced Unlicensed Assistive Personnel
(UAP)?
A. A client who requires a sterile dressing change on a stage 3 pressure ulcer.
B. A stable client who requires assistance with ambulation and range-of-motion exercises.
C. A client with a new tracheostomy who requires frequent suctioning.
D. A client receiving a continuous IV infusion of heparin for deep vein thrombosis.
Correct Answer: B
Expert Explanation: Delegation to UAP must involve tasks that are routine and do not
require clinical judgment or assessment. Assisting with ambulation and range-of-motion
for a stable client falls within the scope of practice for a UAP. Sterile dressing changes and
monitoring IV infusions or tracheostomies require the specialized skills of a licensed nurse.
2. A nurse is caring for a client who is scheduled for surgery. The client expresses doubt about
the procedure and states, ‘I don’t think I want to do this anymore.’ Which action should the
nurse take first?
A. Notify the surgeon that the client is refusing the procedure.
,B. Ask the client to explain their concerns and feelings about the surgery.
C. Administer the preoperative sedative as ordered to calm the client.
D. Reassure the client that the surgeon is highly skilled and successful.
Correct Answer: B
Expert Explanation: The nurse’s first responsibility is to assess the client’s concerns
through therapeutic communication. Exploring the client’s feelings allows the nurse to
identify the specific source of anxiety or misinformation. Once assessment is complete, the
nurse can then facilitate communication between the client and the surgeon if needed.
3. During a disaster triage, which client should the nurse assign a ‘Red’ tag (Immediate
priority)?
A. A client with multiple fractures who is conscious and stable.
B. A client with a sucking chest wound and significant respiratory distress.
C. A client with a minor laceration to the forearm.
D. A client who is pulseless and non-breathing with a head injury.
Correct Answer: B
Expert Explanation: Red tags are assigned to clients with life-threatening injuries who
have a high chance of survival if treated immediately. A sucking chest wound is a critical
respiratory emergency that requires rapid intervention. Clients who are pulseless are
, typically tagged black (expectant) in a mass casualty event to prioritize resources for those
who can be saved.
4. The nurse is preparing to administer medication to a client. Which of the following actions
represents the best practice for client identification?
A. Calling the client by the name listed on the chart.
B. Checking the client’s room number against the medication administration record (MAR).
C. Verifying the client’s identity with a family member in the room.
D. Asking the client to state their name and date of birth.
Correct Answer: D
Expert Explanation: Joint Commission standards require the use of at least two unique
identifiers before administering medications. Asking the client to state their name and date
of birth is an active identification process. Room numbers are never used as identifiers
because clients can be moved between rooms frequently.
5. A nurse is teaching a new LPN about the principles of beneficence. Which action by the LPN
demonstrates this principle?
A. Allowing a client to choose which arm to use for an injection.
B. Providing the same level of care to all clients regardless of their background.
C. Fulfilling a promise to return to a client’s room in ten minutes.
D. Administering pain medication to a client who is in post-operative distress.
