BSN 346 | BSN346 Exam 4: Concepts of Nursing III -
Nightingale College Updated and Latest Questions
and Correct Answers with Rationale
1. A registered nurse (RN) is supervising a team consisting of an LPN and a UAP. Which task is
most appropriate to delegate to the LPN?
A. Administration of a scheduled subcutaneous insulin injection
B. Initial assessment of a patient admitted with chest pain
C. Developing the discharge plan for a patient following a hip replacement
D. Providing education to a patient about a new prescription for warfarin
Correct Answer: A
Expert Explanation: Administering routine medications like insulin is within the scope of
practice for an LPN. The RN is responsible for initial assessments and complex teaching,
which makes options A and D inappropriate for an LPN. Discharge planning is a nursing
process function that requires the judgment and synthesis of an RN. Delegating stable
medication tasks allows the RN to focus on more complex clinical decisions. Understanding
the specific scope of practice for each team member is essential for ensuring patient safety
and effective leadership.
2. A nurse receives report on four patients. Which patient should the nurse assess first?
A. A patient with COPD whose oxygen saturation is 90% on 2 liters
B. A patient who is 2 hours post-thyroidectomy and has a hoarse voice
C. A patient with diabetes who has a fasting blood glucose of 140 mg/dL
D. A patient reporting level 6 abdominal pain after a laparoscopic surgery
Correct Answer: B
Expert Explanation: A hoarse voice following a thyroidectomy can indicate laryngeal
nerve damage or impending airway obstruction due to swelling. This patient presents the
highest risk to life and airway patency, requiring immediate evaluation. While a saturation
of 90% in COPD is relatively normal and 140 glucose is stable, the airway must take
precedence. Pain management for the surgical patient is important but comes after
stabilizing life-threatening respiratory issues. Prioritization in nursing always utilizes the
ABC (Airway, Breathing, Circulation) framework to determine the first intervention.
3. The nurse manager is dealing with a conflict between two staff nurses regarding the
holiday schedule. Which approach demonstrates the most effective leadership style?
A. Ignoring the conflict and letting the staff resolve it themselves
,B. Facilitating a meeting where both nurses can voice their concerns and seek a
compromise
C. Telling the nurses exactly how the schedule will be without their input
D. Asking the nursing director to make the decision for the unit
Correct Answer: B
Expert Explanation: Facilitating communication and seeking compromise aligns with
democratic or transformational leadership styles which foster a collaborative environment.
Conflict resolution is a vital management skill that prevents unit morale from declining.
Avoiding the conflict or being overly autocratic can lead to long-term resentment among
the staff. By involving the nurses in the solution, the manager encourages professional
growth and accountability. Leadership requires addressing interpersonal issues directly to
maintain a safe and productive work culture.
4. A UAP reports to the nurse that a patient’s blood pressure is 82/40 mmHg. What is the
nurse’s priority action?
A. Instruct the UAP to re-check the blood pressure in 15 minutes
B. Call the physician to obtain an order for a fluid bolus
C. Immediately go to the patient’s room to assess for signs of shock
D. Document the blood pressure in the electronic health record
Correct Answer: C
Expert Explanation: The nurse must personally assess the patient to validate the UAP’s
findings and determine the clinical status. Hypotension is a critical sign that could indicate
hemorrhage, sepsis, or cardiac failure. The RN should not rely on a re-check by the UAP
when the initial finding is significantly outside the normal range. Calling the physician
should only occur after the nurse has gathered objective data to report. Immediate clinical
assessment is the hallmark of the ‘Assess’ phase in the nursing process when unexpected
data is presented.
5. Which action by the nurse is a primary example of quality improvement at the bedside?
A. Participating in a unit-based committee to track the incidence of falls
B. Administering medications at the exact times they are scheduled
C. Providing a warm blanket to a patient who is feeling cold
D. Completing an incident report after a medication error occurred
Correct Answer: A
Expert Explanation: Quality improvement involves the systematic analysis of data to
improve patient outcomes and system processes. Participating in a committee to track falls
, is an active role in identifying trends and implementing changes. While incident reports are
part of safety, they are reactive rather than proactive system-wide improvements.
Administering medications is a standard of practice but not necessarily a QI initiative.
Engaging in QI helps transition nursing from individual task completion to systemic
healthcare excellence.
6. A nurse is caring for a patient who refuses to take a life-saving medication due to religious
beliefs. What is the nurse’s best action?
A. Administer the medication anyway because it is in the patient’s best interest
B. Respect the patient’s decision and document the refusal
C. Tell the patient that they will die if they do not take the medication
D. Wait until the family arrives and ask them to convince the patient
Correct Answer: B
Expert Explanation: Autonomy is the ethical principle that ensures a competent patient’s
right to refuse treatment. Forcing treatment would be a violation of the patient’s rights and
could lead to legal action for battery. The nurse’s role is to provide information and support
while honoring the patient’s values. Coercion or involving family to bypass the patient’s
will is ethically inappropriate. Documentation of the refusal and the education provided
ensures the healthcare team is aware of the patient’s stance.
7. A nurse is preparing to delegate tasks to a UAP for a patient with a fresh post-operative
wound. Which task can be delegated?
A. Assessing the wound for signs of infection
B. Applying a sterile dressing to the surgical site
C. Emptying the surgical drain and recording the output
D. Teaching the patient how to splint the incision
Correct Answer: C
Expert Explanation: Emptying a drain and recording volume is a technical task that does
not require clinical judgment or interpretation. Assessment, sterile dressing changes, and
education are the responsibility of the licensed nurse. The RN must always ensure the UAP
is competent in the task before delegating it. Recording output is essential for monitoring
fluid balance but the interpretation of that output belongs to the RN. Clear delegation
protocols protect the patient and maximize the efficiency of the healthcare team.
8. A patient with a history of heart failure is admitted with shortness of breath. Which
assessment finding requires the most immediate intervention?
A. Fine crackles heard in the lung bases
B. Weight gain of 2 pounds over the last 24 hours
Nightingale College Updated and Latest Questions
and Correct Answers with Rationale
1. A registered nurse (RN) is supervising a team consisting of an LPN and a UAP. Which task is
most appropriate to delegate to the LPN?
A. Administration of a scheduled subcutaneous insulin injection
B. Initial assessment of a patient admitted with chest pain
C. Developing the discharge plan for a patient following a hip replacement
D. Providing education to a patient about a new prescription for warfarin
Correct Answer: A
Expert Explanation: Administering routine medications like insulin is within the scope of
practice for an LPN. The RN is responsible for initial assessments and complex teaching,
which makes options A and D inappropriate for an LPN. Discharge planning is a nursing
process function that requires the judgment and synthesis of an RN. Delegating stable
medication tasks allows the RN to focus on more complex clinical decisions. Understanding
the specific scope of practice for each team member is essential for ensuring patient safety
and effective leadership.
2. A nurse receives report on four patients. Which patient should the nurse assess first?
A. A patient with COPD whose oxygen saturation is 90% on 2 liters
B. A patient who is 2 hours post-thyroidectomy and has a hoarse voice
C. A patient with diabetes who has a fasting blood glucose of 140 mg/dL
D. A patient reporting level 6 abdominal pain after a laparoscopic surgery
Correct Answer: B
Expert Explanation: A hoarse voice following a thyroidectomy can indicate laryngeal
nerve damage or impending airway obstruction due to swelling. This patient presents the
highest risk to life and airway patency, requiring immediate evaluation. While a saturation
of 90% in COPD is relatively normal and 140 glucose is stable, the airway must take
precedence. Pain management for the surgical patient is important but comes after
stabilizing life-threatening respiratory issues. Prioritization in nursing always utilizes the
ABC (Airway, Breathing, Circulation) framework to determine the first intervention.
3. The nurse manager is dealing with a conflict between two staff nurses regarding the
holiday schedule. Which approach demonstrates the most effective leadership style?
A. Ignoring the conflict and letting the staff resolve it themselves
,B. Facilitating a meeting where both nurses can voice their concerns and seek a
compromise
C. Telling the nurses exactly how the schedule will be without their input
D. Asking the nursing director to make the decision for the unit
Correct Answer: B
Expert Explanation: Facilitating communication and seeking compromise aligns with
democratic or transformational leadership styles which foster a collaborative environment.
Conflict resolution is a vital management skill that prevents unit morale from declining.
Avoiding the conflict or being overly autocratic can lead to long-term resentment among
the staff. By involving the nurses in the solution, the manager encourages professional
growth and accountability. Leadership requires addressing interpersonal issues directly to
maintain a safe and productive work culture.
4. A UAP reports to the nurse that a patient’s blood pressure is 82/40 mmHg. What is the
nurse’s priority action?
A. Instruct the UAP to re-check the blood pressure in 15 minutes
B. Call the physician to obtain an order for a fluid bolus
C. Immediately go to the patient’s room to assess for signs of shock
D. Document the blood pressure in the electronic health record
Correct Answer: C
Expert Explanation: The nurse must personally assess the patient to validate the UAP’s
findings and determine the clinical status. Hypotension is a critical sign that could indicate
hemorrhage, sepsis, or cardiac failure. The RN should not rely on a re-check by the UAP
when the initial finding is significantly outside the normal range. Calling the physician
should only occur after the nurse has gathered objective data to report. Immediate clinical
assessment is the hallmark of the ‘Assess’ phase in the nursing process when unexpected
data is presented.
5. Which action by the nurse is a primary example of quality improvement at the bedside?
A. Participating in a unit-based committee to track the incidence of falls
B. Administering medications at the exact times they are scheduled
C. Providing a warm blanket to a patient who is feeling cold
D. Completing an incident report after a medication error occurred
Correct Answer: A
Expert Explanation: Quality improvement involves the systematic analysis of data to
improve patient outcomes and system processes. Participating in a committee to track falls
, is an active role in identifying trends and implementing changes. While incident reports are
part of safety, they are reactive rather than proactive system-wide improvements.
Administering medications is a standard of practice but not necessarily a QI initiative.
Engaging in QI helps transition nursing from individual task completion to systemic
healthcare excellence.
6. A nurse is caring for a patient who refuses to take a life-saving medication due to religious
beliefs. What is the nurse’s best action?
A. Administer the medication anyway because it is in the patient’s best interest
B. Respect the patient’s decision and document the refusal
C. Tell the patient that they will die if they do not take the medication
D. Wait until the family arrives and ask them to convince the patient
Correct Answer: B
Expert Explanation: Autonomy is the ethical principle that ensures a competent patient’s
right to refuse treatment. Forcing treatment would be a violation of the patient’s rights and
could lead to legal action for battery. The nurse’s role is to provide information and support
while honoring the patient’s values. Coercion or involving family to bypass the patient’s
will is ethically inappropriate. Documentation of the refusal and the education provided
ensures the healthcare team is aware of the patient’s stance.
7. A nurse is preparing to delegate tasks to a UAP for a patient with a fresh post-operative
wound. Which task can be delegated?
A. Assessing the wound for signs of infection
B. Applying a sterile dressing to the surgical site
C. Emptying the surgical drain and recording the output
D. Teaching the patient how to splint the incision
Correct Answer: C
Expert Explanation: Emptying a drain and recording volume is a technical task that does
not require clinical judgment or interpretation. Assessment, sterile dressing changes, and
education are the responsibility of the licensed nurse. The RN must always ensure the UAP
is competent in the task before delegating it. Recording output is essential for monitoring
fluid balance but the interpretation of that output belongs to the RN. Clear delegation
protocols protect the patient and maximize the efficiency of the healthcare team.
8. A patient with a history of heart failure is admitted with shortness of breath. Which
assessment finding requires the most immediate intervention?
A. Fine crackles heard in the lung bases
B. Weight gain of 2 pounds over the last 24 hours
