Canadian English Language Benchmark Assessment for Nurses (CELBAN) — Questions and Answers

Question 1: A medication administration record (MAR) lists: 'Metoprolol 25 mg PO BID.' How should this medication be administered?

25 mg by mouth once daily at bedtime
25 mg intravenously twice daily
25 mg by injection twice daily
25 mg by mouth twice daily (Correct answer)

Correct answer: 25 mg by mouth twice daily

PO means 'per os' (by mouth) and BID means 'bis in die' (twice a day).

Question 2: A nurse caring for a terminally ill patient learns the family wants to withhold the diagnosis from the patient. How should the nurse respond?

Honor the family's wishes and avoid all discussions of diagnosis with the patient
Refuse to care for the patient until the situation is resolved
Immediately tell the patient their diagnosis without consulting the team
Acknowledge the family's concerns, explain the patient's right to information, and collaborate with the team on an ethical approach (Correct answer)

Correct answer: Acknowledge the family's concerns, explain the patient's right to information, and collaborate with the team on an ethical approach

Patients have the right to know their diagnosis; the nurse must balance family concerns with patient autonomy through an ethical, team-based approach.

Question 3: In a CELBAN speaking task simulating a triage scenario, a patient describes chest pain that started 20 minutes ago. What is the most important verbal action the nurse should take first?

Immediately notify the charge nurse or physician while keeping the patient calm and asking them to remain seated. (Correct answer)
Offer the patient a glass of water and reassure them it is probably heartburn.
Ask the patient to complete a paper triage form.
Tell the patient to wait in the waiting room until their name is called.

Correct answer: Immediately notify the charge nurse or physician while keeping the patient calm and asking them to remain seated.

Acute chest pain is a potential cardiac emergency requiring immediate escalation while keeping the patient calm and stationary.

Question 4: A nurse is reviewing the following entry in a patient's chart: 'Pt. c/o sharp, stabbing pain to RUQ, rated 8/10. Skin is diaphoretic and clammy. V/S: BP 150/90, HR 110, RR 22, T 37.8 C. NPO since midnight. Awaiting ultrasound.' Which of the following is the most accurate summary of the patient's condition?

The patient is experiencing significant pain and showing signs of distress, requiring further investigation. (Correct answer)
The patient is dehydrated and needs immediate fluid replacement before any diagnostic tests.
The patient is stable with minor abdominal discomfort and will be discharged soon.
The patient has a low-grade fever and is being kept without food or drink as a precaution.

Correct answer: The patient is experiencing significant pain and showing signs of distress, requiring further investigation.

The correct answer accurately synthesizes all the key information. The patient's complaint ('c/o') of 'sharp, stabbing pain' rated 8/10 indicates severe pain, not minor discomfort. The vital signs (V/S) are elevated (hypertension, tachycardia, tachypnea), and the skin is 'diaphoretic and clammy,' which are signs of distress. The patient is being kept 'NPO' (nothing by mouth) and is 'awaiting ultrasound,' which points to the need for further diagnostic investigation.

Question 5: A patient from a collectivist culture insists that all medical decisions be made by the family elder, not themselves. What is the most culturally competent nursing response?

Transfer care to another nurse who shares the patient's background
Respect the patient's cultural preference and include the family elder in discussions with the patient's consent (Correct answer)
Insist the patient make their own decisions as required by law
Document that the patient is incapable of consent and proceed without the family

Correct answer: Respect the patient's cultural preference and include the family elder in discussions with the patient's consent

Respecting a patient's cultural value of collective decision-making, while ensuring the patient consents to this arrangement, honors both autonomy and cultural competency.

Question 6: A nurse notices that a peer is consistently cutting corners in documentation. The MOST appropriate action is to:

Ignore it since it is not your responsibility
Report it anonymously to hospital administration immediately
Address the concern with the peer directly, then escalate to the charge nurse if it continues (Correct answer)
Complete the missing documentation yourself to protect patients

Correct answer: Address the concern with the peer directly, then escalate to the charge nurse if it continues

Professional accountability involves addressing concerns collegially first, then escalating through proper channels if behavior does not change.

Question 7: Which language feature is most likely to negatively impact a nurse's CELBAN Speaking score when explaining post-operative care?

Repeating key instructions for emphasis
Using clear signposting words like 'first,' 'next,' and 'finally'
Pausing briefly to allow the patient to ask questions
Heavy use of unexplained medical jargon with a non-medical patient (Correct answer)

Correct answer: Heavy use of unexplained medical jargon with a non-medical patient

Using unexplained technical terminology with a patient reduces comprehension and demonstrates poor lexical appropriateness, lowering the Speaking score.

Question 8: During a CELBAN speaking role-play, a patient says they are confused about why they need to take a medication. What is the best opening response to address their concern?

Advise them to ask the pharmacist when they get home.
Acknowledge their concern and offer to explain the medication's purpose clearly. (Correct answer)
Reassure them it is a routine medication and nothing to worry about.
Tell them the doctor ordered it and they must comply.

Correct answer: Acknowledge their concern and offer to explain the medication's purpose clearly.

Acknowledging the patient's concern first demonstrates therapeutic communication, a key criterion in the CELBAN speaking assessment.

Question 9: In the CELBAN Speaking section, which task type requires you to listen to a recorded scenario and then respond as if speaking directly to a patient or colleague?

Reading aloud task
Picture description task
Role-play task (Correct answer)
Monologue task

Correct answer: Role-play task

The role-play task in CELBAN Speaking presents a recorded prompt to which candidates respond as they would in a real clinical situation.

Question 10: You hear a nurse giving instructions to a patient: "Please take this medication after meals, twice a day." What should the patient do?

Take the medication after meals. (Correct answer)
Take the medication before meals.
Take the medication with meals.
Take the medication only once a day.

Correct answer: Take the medication after meals.

The nurse's instruction, "Please take this medication after meals," directly specifies the timing for the medication. This means the patient should consume food first, then take the medicine, not before or with meals.

Question 11: A nurse listens to a patient explain their pain to a resident physician: 'It's not really pain — it's more like pressure, right here, and it goes up into my jaw.' The resident documents 'patient denies pain.' What is the nursing concern?

The nurse should not intervene in physician documentation
The resident may have missed a potential cardiac symptom by interpreting 'not pain' too literally (Correct answer)
The resident correctly documented the patient's exact words
The patient needs to be coached to use the word 'pain' for accurate charting

Correct answer: The resident may have missed a potential cardiac symptom by interpreting 'not pain' too literally

Pressure radiating to the jaw is a classic anginal equivalent; the nurse must alert the team that the symptom requires cardiac evaluation regardless of the patient's word choice.

Question 12: You hear an announcement: "Code Blue in Room 305." What does this mean?

The patient needs immediate assistance. (Correct answer)
A staff meeting is scheduled in Room 305.
The room requires cleaning.
Visitors are allowed in Room 305.

Correct answer: The patient needs immediate assistance.

In a hospital setting, a "Code Blue" is a universally recognized emergency code indicating a medical emergency, typically a cardiac arrest or respiratory arrest. This signals that a patient requires immediate resuscitation or critical medical intervention. Therefore, it means the patient needs immediate assistance.

Question 13: A nurse says, "Elevate your leg to reduce swelling." What should the patient do?

Raise the leg higher than the body. (Correct answer)
Massage the leg.
Keep the leg flat.
Place the leg in cold water.

Correct answer: Raise the leg higher than the body.

To "elevate" a body part means to raise it to a higher position. In a medical context, elevating a leg above the level of the heart helps to promote venous return and lymphatic drainage, which effectively reduces swelling. Keeping the leg flat or massaging it would not achieve this specific outcome.

Question 14: When preparing to speak in a CELBAN role-play, a key strategy for improving coherence is to:

Use discourse markers such as 'first,' 'however,' 'as a result,' and 'in addition' to link ideas. (Correct answer)
Speak without pausing to demonstrate fluency.
Repeat the same sentence in different words to fill the time.
Focus solely on pronunciation and ignore logical flow.

Correct answer: Use discourse markers such as 'first,' 'however,' 'as a result,' and 'in addition' to link ideas.

Discourse markers help organize spoken information logically, which directly improves the coherence score on CELBAN Speaking.

Question 15: Why should a nurse avoid using abbreviations in an incident report?

Abbreviations can be misinterpreted and reduce clarity for reviewers unfamiliar with the terms. (Correct answer)
Abbreviations make the report look unprofessional.
Abbreviations take up too much space on the form.
Most incident report forms do not have enough room for abbreviations.

Correct answer: Abbreviations can be misinterpreted and reduce clarity for reviewers unfamiliar with the terms.

Abbreviations can be ambiguous and cause confusion for risk managers, legal teams, or reviewers from other departments.

Question 16: A pharmacist leaves a voicemail for a nurse: 'Just a heads-up — we're out of IV vancomycin until the morning delivery. The patient in 306 has their next dose due at 2100. Please call the on-call physician to discuss an alternative.' What action does the pharmacist expect the nurse to take?

Administer the vancomycin from a different floor's supply without notifying anyone
Delay the patient's antibiotic dose until the next morning without informing anyone
Ask the patient's family to bring vancomycin from another hospital
Contact the on-call physician to arrange an alternative antibiotic since IV vancomycin is temporarily unavailable (Correct answer)

Correct answer: Contact the on-call physician to arrange an alternative antibiotic since IV vancomycin is temporarily unavailable

The pharmacist explicitly instructs the nurse to call the on-call physician to discuss an alternative due to the supply shortage before the patient's scheduled 2100 dose.

Question 17: The incident report should be filed:

Attached to the patient discharge summary
Inside the patient's permanent health record
Separately from the patient's chart, in the risk management system (Correct answer)
In the nursing station's shared log only

Correct answer: Separately from the patient's chart, in the risk management system

Incident reports are confidential quality improvement documents kept separate from the patient's medical record.

Question 18: "I apologize, but it appears that I am unclear. Would you kindly clarify your problem for me again?"

Probing question
Revalidation phrase (Correct answer)
Set appropriate expectations
Examples of clarifying questions are:

Correct answer: Revalidation phrase

Apologizing for being unclear and asking the patient to re-explain their problem is a revalidation phrase, used to confirm or correct your understanding of what was communicated. It is not a probing or clarifying question, both of which gather new information rather than re-confirming existing information.

Question 19: Globally, the coronavirus infection is beginning to spread in another form. The WHO called the mutation "Omicon," sticking to the Greek letters. Additionally, on November 9th, Botswana received the first report of this virus. Following the eighteen-day period, it was discovered in South Africa and labeled as a "virus of concern." Cases have since been recorded from Israel, Madagascar, Belgium, and Hong Kong. Epidemiologists have cautioned that this new strain may be very contagious and may be able to avoid the defenses provided by our present vaccinations. As a result, several nations have reinstated their restrictions on ravels. In spite of this, the Czech Republic, the UK, and Germany have all effectively reported new cases. Researchers have identified 50 genetic alterations in the DNA that affect the spikes that may make the virus more virulent, more transmissible, and potentially more resistant to vaccinations. These variations are being investigated by scientists in an effort to evaluate the potential risks that Omicron may offer. According to scientists, it can take a few weeks to ascertain how well our vaccinations work against Omicron. "When you've got a virus that's showing this degree of transmissibility, and you're having travel-related cases, it virtually invariably is getting to go everywhere [the world]," the chief medical advisor to the White House has issued a warning. What is Omicron being flagged as?

a virus of concern (Correct answer)
extremely deadly virus
a warning
a worry

Correct answer: a virus of concern

The passage directly states that after discovery in South Africa, the variant 'was labeled as a "virus of concern."' 'A warning' and 'a worry' are close synonyms but are not the exact phrase used. 'Extremely deadly virus' is not mentioned anywhere in the text.

Question 20: A charge nurse overhears a new nurse tell a patient: 'Your surgery is tomorrow morning, so you can't eat after midnight.' The patient's surgery is actually scheduled for the afternoon. What should the charge nurse do first?

Ask the patient to confirm the time with the surgeon directly
Immediately clarify the fasting instructions with the patient to prevent unnecessary prolonged fasting (Correct answer)
Correct the new nurse privately later during the shift
Document the communication error in the incident report first

Correct answer: Immediately clarify the fasting instructions with the patient to prevent unnecessary prolonged fasting

Prolonged unnecessary fasting can cause patient discomfort and dehydration; immediate correction of the instruction to the patient is the priority.

Question 21: Which sentence correctly uses a conditional structure appropriate for patient teaching?

If you experience chest pain, you should call for assistance immediately. (Correct answer)
If you experienced chest pain, you should call for assistance immediately.
If you will experience chest pain, you should call for assistance immediately.
If you would experience chest pain, you should call for assistance immediately.

Correct answer: If you experience chest pain, you should call for assistance immediately.

A first conditional uses 'if + simple present' in the condition clause and 'will/should + base verb' in the result clause for real, possible situations.

Question 22: A chart contains a physician's note: 'Suspect PE; order CTPA stat, initiate anticoagulation per protocol.' What does PE stand for in this context?

Pericardial effusion
Peripheral edema
Pleural effusion
Pulmonary embolism (Correct answer)

Correct answer: Pulmonary embolism

PE in the context of CTPA (CT pulmonary angiography) and anticoagulation clearly refers to pulmonary embolism, a life-threatening blockage of lung blood vessels.

Question 23: The physician's orders in a patient's chart state: 'Administer Gravol 50 mg IM q6h PRN for N/V.' How should the nurse interpret this order?

Give 50 mg of Gravol by mouth every 6 hours continuously for nausea and vomiting.
Apply a 50 mg Gravol patch to the skin every 6 hours to prevent nausea.
Administer 50 mg of Gravol into the muscle every 6 hours only if the patient complains of nausea or vomiting. (Correct answer)
Give 50 mg of Gravol intravenously every 6 hours as needed for pain.

Correct answer: Administer 50 mg of Gravol into the muscle every 6 hours only if the patient complains of nausea or vomiting.

This answer correctly decodes all the abbreviations. 'IM' stands for intramuscular (into the muscle). 'q6h' means every 6 hours. 'PRN' means 'pro re nata' or as needed. 'N/V' stands for nausea and vomiting. Therefore, the nurse should give the medication via injection into the muscle, only when the patient experiences nausea or vomiting, and no more frequently than every 6 hours.

Question 24: A nurse listens to a patient education audio clip: 'Take your lisinopril every morning with or without food, but avoid potassium supplements and salt substitutes unless your doctor approves them.' What is a key dietary restriction mentioned?

The patient must follow a strict low-sodium diet and avoid all fruits
The patient should stop lisinopril if they feel dizzy
The patient must take lisinopril only with a high-fat meal
The patient should avoid potassium supplements and salt substitutes without physician approval (Correct answer)

Correct answer: The patient should avoid potassium supplements and salt substitutes without physician approval

Lisinopril (an ACE inhibitor) can raise potassium levels, so the instruction warns against potassium supplements and potassium-containing salt substitutes without approval.

Question 25: "Would you kindly remember if this had occurred previously?"

Once you have a good understanding of the patient's needs, let them know when they can expect to have their symptoms resolved. This can be as simple as saying:
Examples of clarifying questions are:
Better Probing question
You can also ask probing questions that will help you obtain more information such as: (Correct answer)

Correct answer: You can also ask probing questions that will help you obtain more information such as:

Asking 'Would you kindly remember if this had occurred previously?' is a probing question because it digs deeper into the patient's history to gather more relevant details about their condition. Probing questions go beyond surface-level facts to uncover context, unlike clarifying questions which resolve misunderstandings or expectation-setting statements.

Question 26: A nursing textbook passage states: 'The Glasgow Coma Scale (GCS) assesses three areas: eye opening (scored 1–4), verbal response (scored 1–5), and motor response (scored 1–6). A total score of 15 indicates full consciousness, while a score of 8 or below indicates severe impairment requiring airway protection.' A patient scores: eyes open to voice (3), confused verbal response (4), localizes pain (5). What is this patient's GCS score?

13
10
11
12 (Correct answer)

Correct answer: 12

Eyes to voice = 3, confused speech = 4, localizes pain = 5; total GCS = 3 + 4 + 5 = 12.

Question 27: A consent form preamble reads: 'Informed consent requires that patients receive information in a language and format they understand, have the capacity to make decisions, and provide voluntary agreement free from coercion.' A patient who speaks limited English is presented a consent form for surgery by a surgeon in a hurry, with the family member translating. What is the PRIMARY concern?

The patient's limited English means they cannot legally consent to surgery
The surgeon should not be present during the consent process
Family translation may not be accurate and does not ensure patient understanding or voluntary consent (Correct answer)
The consent form should be signed only by the family member

Correct answer: Family translation may not be accurate and does not ensure patient understanding or voluntary consent

Family members may omit, alter, or distort information and may introduce pressure; a certified medical interpreter should be used to meet informed consent standards.

Question 28: A shift handover report reads: 'Mr. Chen in Room 14 is post-op day 2 following bowel resection. He has a nasogastric tube to low intermittent suction, is NPO, and receiving TPN. His abdomen remains distended and he has not passed flatus.' What does 'not passed flatus' indicate in this context?

The patient's bowel sounds are absent, requiring urgent intervention
TPN is causing bloating and should be discontinued
Postoperative ileus may be present as bowel motility has not returned (Correct answer)
The nasogastric tube is incorrectly placed and needs repositioning

Correct answer: Postoperative ileus may be present as bowel motility has not returned

Absence of flatus after bowel resection suggests postoperative ileus — the bowel has not yet regained peristaltic function.

Question 29: After completing a telephone consultation using SBAR, the nurse receives a new order. What is the nurse's final required step before ending the call?

Read back the order to confirm accuracy and ask the physician to acknowledge it (Correct answer)
Say goodbye and hang up
Page the charge nurse to also receive the order
Email the order to the physician for their records

Correct answer: Read back the order to confirm accuracy and ask the physician to acknowledge it

Reading back the order and receiving verbal acknowledgement closes the communication loop and prevents errors from misheard or misunderstood instructions.

Question 30: A patient's lab results section shows: 'Hgb 95 g/L'. The normal range for an adult male is 135-175 g/L. Based on this result, which of the following conditions should the nurse be most concerned about?

Dehydration
Anemia (Correct answer)
Infection
Hyperglycemia

Correct answer: Anemia

Hgb stands for Hemoglobin. A result of 95 g/L is significantly below the normal range of 135-175 g/L for an adult male. Low hemoglobin is the primary indicator of anemia, a condition characterized by a deficiency of red blood cells or hemoglobin in the blood.

Question 31: During a code blue, a nurse notices chest compressions being performed incorrectly. What is the correct response?

Remain silent to avoid embarrassing the rescuer
Stop the resuscitation to hold a training session
Calmly and clearly correct the technique or offer to take over compressions (Correct answer)
Report the error after the patient has been stabilized

Correct answer: Calmly and clearly correct the technique or offer to take over compressions

During a code, real-time correction of technique is critical to patient survival and must be done without delay.

Question 32: "This is a bit complicated. I should be able to let you know how we can work on this _______."

Revalidation phrase
Better probing question
Level setting of expectations with empathy (Correct answer)
Set appropriate expectations

Correct answer: Level setting of expectations with empathy

The phrase acknowledges the situation is complicated (showing empathy and honesty) while committing to a future update with a time placeholder, which is the hallmark of level setting expectations with empathy. Plain 'set appropriate expectations' lacks the empathetic tone, and a revalidation phrase would confirm what was heard rather than project forward.

Question 33: A patient's daughter says to the nurse: 'My mother doesn't speak much English — she mostly understands Tagalog. Can you explain her discharge instructions in a way she can understand?' What is the nurse's most appropriate response in this scenario?

Ask the daughter to translate all discharge instructions on the nurse's behalf without professional review
Provide written English handouts and assume the patient will translate them independently
Postpone discharge until the patient learns enough English to understand instructions
Arrange for a qualified interpreter to provide discharge education in Tagalog to ensure accurate understanding (Correct answer)

Correct answer: Arrange for a qualified interpreter to provide discharge education in Tagalog to ensure accurate understanding

Using a qualified interpreter ensures accurate, unbiased communication of critical discharge information and meets patient rights and safety standards.

Question 34: During a CELBAN speaking scenario, you must explain the purpose of a blood pressure cuff to a patient who has never used one before. The best approach is to use:

Avoid any explanation and just proceed with the measurement.
Simple language and a brief analogy, such as 'This cuff gently squeezes your arm to measure the force of your blood flow.' (Correct answer)
A technical explanation using advanced cardiovascular terminology.
Medical abbreviations like 'BP cuff for recording systolic and diastolic readings.'

Correct answer: Simple language and a brief analogy, such as 'This cuff gently squeezes your arm to measure the force of your blood flow.'

Simple language with a relatable analogy makes medical equipment less intimidating and supports patient health literacy.

Question 35: Which speaking strategy helps a CELBAN candidate avoid long, awkward silences when they need a moment to think during a role-play?

Switching topics to something you are more comfortable with
Using natural fillers and stalling phrases such as 'That's a great question. Let me make sure I explain this clearly...' (Correct answer)
Repeating the question word for word three times before answering
Staring silently at the examiner for up to 30 seconds

Correct answer: Using natural fillers and stalling phrases such as 'That's a great question. Let me make sure I explain this clearly...'

Natural stalling phrases maintain conversational flow and demonstrate composure while the speaker formulates a thoughtful clinical response.

Question 36: A nurse is speaking with an elderly patient who is hard of hearing. Which communication strategy is most appropriate for the CELBAN Speaking scenario?

Face the patient, speak clearly, and use simple sentences at a moderate pace. (Correct answer)
Shout loudly to ensure the patient hears every word.
Ask a family member to relay all information to the patient.
Speak as fast as possible to save time.

Correct answer: Face the patient, speak clearly, and use simple sentences at a moderate pace.

Facing the patient, speaking clearly and slowly, and using plain language are best practices for communicating with hearing-impaired patients.

Question 37: A patient receiving blood thinner injections at home asks, 'What do I do if I miss a dose?' What is the most appropriate nursing response?

'Stop the medication and return to hospital.'
'Take a double dose to make up for it.'
'Contact your healthcare provider for guidance.' (Correct answer)
'Do not take the missed dose; skip it and resume your normal schedule.'

Correct answer: 'Contact your healthcare provider for guidance.'

Missed anticoagulant dose guidance depends on the specific drug and patient factors, so the healthcare provider must be consulted.

Question 38: An incident report for a patient elopement should be submitted:

Only if the patient is found and returned safely
After the family has been notified and consents to the report
As soon as possible, ideally within the same shift the event occurred (Correct answer)
Within one week after a full investigation is complete

Correct answer: As soon as possible, ideally within the same shift the event occurred

Incident reports must be filed promptly, typically within the same shift, to ensure accuracy and timely intervention.

Question 39: A nurse is administering blood and the patient develops a rash, fever, and chills fifteen minutes into the transfusion. What is the priority action?

Complete the transfusion as the reaction may resolve
Stop the transfusion immediately, keep the IV line open with normal saline, and notify the physician (Correct answer)
Slow the transfusion rate and monitor the patient
Give the patient an antihistamine and continue the transfusion

Correct answer: Stop the transfusion immediately, keep the IV line open with normal saline, and notify the physician

Signs of a transfusion reaction require immediate cessation of the blood product and physician notification to prevent life-threatening complications.

Question 40: A chart notation reads: 'PRN Acetaminophen 650 mg PO q4-6h for pain rated >4/10.' When should the nurse administer this medication?

Only at bedtime when pain is at its worst
Every 4 to 6 hours regardless of pain level
Every 4 hours when the patient reports any pain
Only when the patient reports pain at a score greater than 4 out of 10 (Correct answer)

Correct answer: Only when the patient reports pain at a score greater than 4 out of 10

PRN means 'as needed' and the condition specified is pain rated greater than 4 on a 10-point scale.

Question 41: During a CELBAN speaking task, a patient mentions they have been taking a herbal supplement and asks if it is safe with their prescribed blood thinner. The best nurse response is:

'That is the pharmacist's job, not mine.'
'I'm glad you told me. Some herbal supplements can interact with blood thinners, so I'll note this and make sure the doctor or pharmacist reviews it with you.' (Correct answer)
'Herbal supplements are natural, so they are definitely safe.'
'Stop taking the supplement immediately until we figure this out.'

Correct answer: 'I'm glad you told me. Some herbal supplements can interact with blood thinners, so I'll note this and make sure the doctor or pharmacist reviews it with you.'

Acknowledging the patient's disclosure, noting the potential for interactions, and escalating to the appropriate professional is the correct nursing response.

Question 42: A chart entry reads: 'PT/INR: 3.8. Patient on warfarin.' What action should the nurse anticipate?

Increase the warfarin dose as the level is therapeutic
Administer vitamin K immediately without physician order
Document the finding and continue current warfarin dose
Notify the physician as the INR is above the typical therapeutic range of 2.0–3.0 (Correct answer)

Correct answer: Notify the physician as the INR is above the typical therapeutic range of 2.0–3.0

An INR of 3.8 is above the typical therapeutic range of 2.0–3.0 for most indications, increasing the patient's risk of bleeding and requiring physician notification.

Question 43: A nurse is documenting a patient encounter in which cultural factors significantly influenced the care plan. What should the nurse include in the documentation?

Specific cultural factors discussed, accommodations made, and the patient's response to the care plan (Correct answer)
Only the medical interventions, as cultural factors are not clinically relevant
A summary of the nurse's own cultural background for context
Personal opinions about the patient's cultural practices

Correct answer: Specific cultural factors discussed, accommodations made, and the patient's response to the care plan

Documenting specific cultural accommodations and patient responses ensures continuity of culturally competent care across the healthcare team.

Question 44: A patient in a CELBAN speaking role-play asks: 'What happens if I don't take my blood thinners?' The best nurse response is:

'You'll probably be fine; lots of people stop taking medications.'
'That is a very risky question to even ask.'
'You could develop a dangerous blood clot, which might block blood flow to your heart or brain. It's important we understand your concerns about the medication.' (Correct answer)
'That's not really my area — ask your doctor.'

Correct answer: 'You could develop a dangerous blood clot, which might block blood flow to your heart or brain. It's important we understand your concerns about the medication.'

The nurse should clearly explain the clinical risks of non-adherence and explore the patient's underlying concerns in a non-judgmental way.

Question 45: A nurse overhears two nurses at the station discussing a patient's HIV status by name in front of visitors in the hallway. What is the immediate concern?

This is a breach of patient confidentiality and privacy that must be addressed immediately (Correct answer)
The visitors likely do not understand medical terminology, so no harm has occurred
The conversation should be allowed to continue if it is clinically relevant
The nurses may have incorrect information about the patient's diagnosis

Correct answer: This is a breach of patient confidentiality and privacy that must be addressed immediately

Discussing a patient's sensitive diagnosis by name in a public area violates confidentiality and must be stopped and addressed according to facility policy.

Question 46: A CELBAN speaking scenario asks you to explain a procedure to an anxious patient. Which element is LEAST important in your initial response?

Detailing the full medical history of previous patients who had the same procedure (Correct answer)
Asking the patient if they have questions
Explaining each step of the procedure in simple terms
Acknowledging the patient's anxiety

Correct answer: Detailing the full medical history of previous patients who had the same procedure

Sharing other patients' medical histories is irrelevant and violates confidentiality; it has no place in patient education.

Question 47: During bedside handover, the patient says, 'No one told me I was going for a scan tomorrow.' What is the nurse's best response?

That's not my problem — ask the day nurse.
I'll leave a note for the next shift to deal with it.
You must have forgotten; it was definitely explained.
I'm sorry for the confusion. Let me check the orders and explain what the scan involves. (Correct answer)

Correct answer: I'm sorry for the confusion. Let me check the orders and explain what the scan involves.

Acknowledging the patient's concern, apologizing for any communication gap, and immediately providing information demonstrates patient-centered care.

Question 48: A nurse hears a patient with heart failure tell their adult child: 'My ankles have been swelling for three days but I didn't want to call — I thought it would go away.' What does this statement indicate?

The patient needs a referral for cognitive assessment
The patient has good insight into when symptoms are self-limiting
The patient was afraid of hospital admission and made a rational risk decision
The patient may not understand that ankle swelling is a warning sign requiring prompt reporting in heart failure (Correct answer)

Correct answer: The patient may not understand that ankle swelling is a warning sign requiring prompt reporting in heart failure

Ankle edema is a key symptom of decompensating heart failure; patient education should reinforce that this symptom must be reported promptly.

Question 49: Which sentence is most appropriate when handing over a patient with a new concern at the end of a shift?

He seemed a bit off, I didn't check.
I think he's okay but maybe watch him.
Someone should probably look at him.
His BP dropped to 90/60 at 14:00; I notified Dr. Patel and the order for IV fluids is in the chart. (Correct answer)

Correct answer: His BP dropped to 90/60 at 14:00; I notified Dr. Patel and the order for IV fluids is in the chart.

Effective handover communication includes specific vital sign values, the time of the change, actions taken, and follow-up orders documented.

Question 50: "What is the duration of this occurrence?"

Probing question (Correct answer)
Revalidation phrase
Level setting of expectations with empathy
examples of clarifying questions are:

Correct answer: Probing question

Asking how long the occurrence lasts is a probing question because it digs deeper into the timeline and persistence of the symptom to elicit more specific information. It is not expectation-setting, a revalidation phrase, or a generic clarifying question.

Question 51: Globally, the coronavirus infection is beginning to spread in another form. The WHO called the mutation "Omicon," sticking to the Greek letters. Additionally, on November 9th, Botswana received the first report of this virus. Following the eighteen-day period, it was discovered in South Africa and labeled as a "virus of concern." Cases have since been recorded from Israel, Madagascar, Belgium, and Hong Kong. Epidemiologists have cautioned that this new strain may be very contagious and may be able to avoid the defenses provided by our present vaccinations. As a result, several nations have reinstated their restrictions on ravels. In spite of this, the Czech Republic, the UK, and Germany have all effectively reported new cases. Researchers have identified 50 genetic alterations in the DNA that affect the spikes that may make the virus more virulent, more transmissible, and potentially more resistant to vaccinations. These variations are being investigated by scientists in an effort to evaluate the potential risks that Omicron may offer. According to scientists, it can take a few weeks to ascertain how well our vaccinations work against Omicron. "When you've got a virus that's showing this degree of transmissibility, and you're having travel-related cases, it virtually invariably is getting to go everywhere [the world]," the chief medical advisor to the White House has issued a warning. Who named the new variant Omicron?

South Africa's government
South Korea's government
The WHO (Correct answer)
The Geek Alphabet Association

Correct answer: The WHO

The passage states explicitly: 'The WHO called the mutation "Omicron," sticking to the Greek letters.' No other organization is credited with naming the variant. The other options — a Greek Alphabet Association (fictional), South Korea, or South Africa — are not mentioned in this role.

Question 52: A chart reads: 'Hx of HTN, DM Type 2, and CKD Stage 3.' What does this mean about the patient's medical background?

Hypotension, diabetes insipidus, and congenital kidney defect stage 3
History of hypertension, diabetes mellitus type 2, and chronic kidney disease stage 3 (Correct answer)
Hypertension, diabetic neuropathy, and coronary kidney disease stage 3
History of heart transplant, diabetes mellitus type 2, and chronic knee disease stage 3

Correct answer: History of hypertension, diabetes mellitus type 2, and chronic kidney disease stage 3

Hx = history, HTN = hypertension, DM = diabetes mellitus, CKD = chronic kidney disease.

Question 53: A CELBAN speaking scenario involves a patient who is tearful about a recent cancer diagnosis. After the role-play, an examiner notes the candidate 'failed to demonstrate empathy.' Which response illustrates the missed empathetic language?

'Let's focus on what your treatment options are right now.'
'That must be incredibly difficult news to receive. I'm here with you, and we'll work through this together.' (Correct answer)
'The doctor will explain everything; I'm just the nurse.'
'Many people survive cancer these days, so try to stay positive.'

Correct answer: 'That must be incredibly difficult news to receive. I'm here with you, and we'll work through this together.'

Explicitly naming the patient's emotional experience and offering presence and partnership is the hallmark of empathetic clinical communication.

Question 54: A physiotherapist says during an interdisciplinary meeting: 'Mrs. Lam is weight-bearing as tolerated on the right hip — she managed eight metres with the walker this morning but fatigues quickly and needs stand-by assist for safety.' What does this report tell the nursing team?

Mrs. Lam is non-weight-bearing and must remain in bed
Mrs. Lam is fully independent with mobility and needs no nursing support
Mrs. Lam refused physiotherapy and did not attempt walking
Mrs. Lam can walk short distances with a walker but tires easily and still requires a nurse nearby for safety (Correct answer)

Correct answer: Mrs. Lam can walk short distances with a walker but tires easily and still requires a nurse nearby for safety

The physiotherapist reports the patient walked 8 metres with a walker (weight-bearing as tolerated) but fatigues quickly and needs stand-by assistance, meaning nursing supervision is still required.

Question 55: A CELBAN listening section features a pharmacist counselling a patient: 'This antibiotic needs to be taken with a full glass of water and you should remain upright for at least 30 minutes afterward — it can cause esophageal irritation if you lie down too soon.' Which antibiotic class is most likely being described?

Bisphosphonates — wait, this is a tetracycline or doxycycline, which causes esophageal irritation when the patient reclines after dosing (Correct answer)
Penicillins, which require refrigeration to maintain stability
Macrolides, which must always be taken on an empty stomach
Fluoroquinolones, which should be taken with antacids for best absorption

Correct answer: Bisphosphonates — wait, this is a tetracycline or doxycycline, which causes esophageal irritation when the patient reclines after dosing

The instruction to stay upright for 30 minutes and use a full glass of water is a hallmark counselling point for tetracyclines (especially doxycycline) to prevent pill-induced esophagitis.

Question 56: During a CELBAN listening simulation, a patient says: 'The nurse last night told me I could have something for pain if I needed it, but I didn't want to bother anyone.' Which issue does this statement most directly reveal?

The patient is hesitant to request PRN pain medication due to concern about disturbing staff, suggesting a pain management communication gap (Correct answer)
The night nurse administered the wrong medication
The patient is satisfied with pain control and no follow-up is needed
The night nurse failed to document the PRN analgesic order

Correct answer: The patient is hesitant to request PRN pain medication due to concern about disturbing staff, suggesting a pain management communication gap

The patient's reluctance to 'bother anyone' indicates a barrier to self-reporting pain and requesting PRN medication, which can lead to undertreated pain.

Question 57: In the CELBAN Speaking section, candidates are scored on several criteria. Which of the following is NOT one of the main scoring dimensions?

Pronunciation
Fluency and coherence
Lexical resource (vocabulary range)
Spelling accuracy (Correct answer)

Correct answer: Spelling accuracy

CELBAN Speaking is scored on fluency, coherence, vocabulary, grammar, and pronunciation — spelling is assessed in the Writing section, not Speaking.

Question 58: A chart consultation note states: 'Recommend strict I&O monitoring and daily weights for fluid management.' Why would daily weights be ordered alongside I&O monitoring?

To calculate the correct medication dosage based on body weight
To monitor nutritional status and caloric intake
To assess the patient's mobility and ability to stand
To detect fluid retention or loss more accurately than I&O alone (Correct answer)

Correct answer: To detect fluid retention or loss more accurately than I&O alone

Daily weights provide an objective measure of total body fluid changes, as 1 kg of body weight change approximately equals 1 liter of fluid retained or lost.

Question 59: In a CELBAN speaking scenario, a family member asks you for the patient's confidential diagnosis without the patient's consent present. The correct response is:

Refer them to the hospital website's privacy policy.
'I'm sorry, I can only discuss your family member's health information with their permission.' (Correct answer)
Tell the family member to wait in the hall and then share all details.
Share the information briefly since family members always have the right to know.

Correct answer: 'I'm sorry, I can only discuss your family member's health information with their permission.'

Patient confidentiality must be maintained; health information cannot be shared with family members without explicit patient consent.

Question 60: A patient doesn’t speak your language fluently and struggles to communicate. What should you do?

Use gestures or pictures to aid communication. (Correct answer)
Ignore their attempts to explain.
Insist they try harder to speak your language.
Ask another patient to translate.

Correct answer: Use gestures or pictures to aid communication.

When a patient struggles with language, using visual aids like gestures or pictures is a practical and immediate way to bridge the communication gap. This approach demonstrates resourcefulness and ensures the patient's needs are understood and addressed, promoting effective care.

Question 61: During a care conference, a family member states: 'We want everything done — we can't just let him go.' The patient previously told a nurse he did not want aggressive interventions. What should the nurse do?

Follow the family's wishes since they are the legal decision-makers
Ask the family to leave the conference so the team can decide independently
Defer entirely to the attending physician without contributing to the discussion
Advocate for the patient's expressed wishes and raise the need to clarify goals of care (Correct answer)

Correct answer: Advocate for the patient's expressed wishes and raise the need to clarify goals of care

Nurses are obligated to advocate for the patient's expressed wishes and facilitate a goals-of-care conversation that honors patient autonomy.

Question 62: A patient tells an interpreter during a translated consultation: 'I don't want to tell the doctor everything because I'm afraid they will judge me.' The interpreter relays this verbatim. How should the nurse respond?

Proceed with the assessment using only the information the patient volunteers
Acknowledge the patient's concern and reassure them that disclosures are confidential and non-judgmental (Correct answer)
Document that the patient is withholding information and flag for psychiatric review
Ask the interpreter to encourage the patient to be more open

Correct answer: Acknowledge the patient's concern and reassure them that disclosures are confidential and non-judgmental

Building trust by validating the patient's fear and affirming confidentiality encourages open disclosure and supports accurate assessment.

Question 63: Everyone knows that getting into bed early has a significant impact on our fitness. Researchers claim to have found the best time of day to go to bed. British researchers. The ideal bedtime, according to Biobank, is between 10 and 11 p.m. People who sleep between these hours are said to be less likely to develop heart disease. The researchers collected information on the sleeping habits of eighty thousand individuals six years ago. For seven days, the volunteers were required to wear a unique watch that allowed the researchers to record their sleeping and waking hours. The volunteers' level of fitness was then observed by the investigators. Approximately 3,000 volunteers experienced cardiac issues. They either went to bed before or after the "healthy" 10 o'clock or 11 o'clock period. Dr. David Plans, one of the study's authors, made observations about the effects of sleep patterns on heart health in his research. He said, "Although our study does not allow us to conclude on causality, the results suggest that early or late bedtimes may disrupt the body clock, with [negative] outcomes for cardiovascular fitness." However, he added, "Changing into is able to reduce the probability of seeing morning light, which resets the body clock." If our body clock isn't always reset correctly, we run the risk of developing cardiovascular disease. When is the healthiest sleeping time?

between 10 pm and 11 pm (Correct answer)
7:00 PM
after lunch
after dinner

Correct answer: between 10 pm and 11 pm

The passage states: 'The ideal bedtime, according to Biobank, is between 10 and 11 p.m.' This is a specific, research-backed window. The other options — after dinner, after lunch, and 7:00 PM — are vague or simply not supported by anything in the text.

Question 64: A patient newly diagnosed with Type 2 diabetes tells her husband during your assessment: 'I guess I just have to give up everything I enjoy eating.' What does this statement suggest to the nurse?

The patient's cultural food preferences conflict with medical guidelines
The patient is in denial and not ready to engage with her care plan
The patient has already received thorough dietary counseling
The patient holds a misconception about diabetes management that requires education (Correct answer)

Correct answer: The patient holds a misconception about diabetes management that requires education

The patient's all-or-nothing thinking suggests a misconception; a dietitian referral and education about balanced meal planning are indicated.

Question 65: Everyone knows that getting into bed early has a significant impact on our fitness. Researchers claim to have found the best time of day to go to bed. British researchers. The ideal bedtime, according to Biobank, is between 10 and 11 p.m. People who sleep between these hours are said to be less likely to develop heart disease. The researchers collected information on the sleeping habits of eighty thousand individuals six years ago. For seven days, the volunteers were required to wear a unique watch that allowed the researchers to record their sleeping and waking hours. The volunteers' level of fitness was then observed by the investigators. Approximately 3,000 volunteers experienced cardiac issues. They either went to bed before or after the "healthy" 10 o'clock or 11 o'clock period. Dr. David Plans, one of the study's authors, made observations about the effects of sleep patterns on heart health in his research. He said, "Although our study does not allow us to conclude on causality, the results suggest that early or late bedtimes may disrupt the body clock, with [negative] outcomes for cardiovascular fitness." However, he added, "Changing into is able to reduce the probability of seeing morning light, which resets the body clock." If our body clock isn't always reset correctly, we run the risk of developing cardiovascular disease. Who does the article say knows that going to bed early is good for us?

doctors
students
everyone (Correct answer)
volunteers

Correct answer: everyone

The very first sentence of the article states: 'Everyone knows that getting into bed early has a significant impact on our fitness.' The word 'everyone' is a broad general claim, making it the correct answer. Doctors, students, and volunteers are specific groups mentioned later in the article but are not what the opening sentence refers to.

Question 66: A nurse reads in a patient's progress note: 'Wound site shows erythema, warmth, and purulent discharge.' What condition does this describe?

A wound infection (Correct answer)
Wound dehiscence
An allergic reaction to dressing material
Normal wound healing

Correct answer: A wound infection

Erythema (redness), warmth, and purulent (pus-containing) discharge are classic signs of a wound infection.

Question 67: A patient's family member tells the nurse over the phone: 'She mentioned her chest feels tight and she's sweating a lot — she said it started about an hour ago. She didn't want me to call but I was worried.' What is the most clinically significant information in this message?

The family member called without the patient's permission
The family member is requesting a callback in the morning
The patient is non-compliant with her discharge instructions
The patient has had chest tightness and diaphoresis for approximately one hour, which could indicate a cardiac event (Correct answer)

Correct answer: The patient has had chest tightness and diaphoresis for approximately one hour, which could indicate a cardiac event

Chest tightness and diaphoresis lasting an hour are classic warning signs of acute myocardial infarction and require immediate clinical assessment.

Question 68: You are reviewing a patient's medication administration record (MAR). Which of the following entries requires immediate clarification from the prescriber?

Digoxin .125 mg PO daily. Hold for HR < 60. (Correct answer)
Furosemide 20 mg PO daily
Tylenol 650 mg PO q4h PRN pain
Insulin Sliding Scale ac hs

Correct answer: Digoxin .125 mg PO daily. Hold for HR < 60.

The order 'Digoxin .125 mg PO daily. Hold for HR < 60.' contains a trailing zero and a leading decimal, which are on the 'Do Not Use' list of abbreviations by organizations like ISMP Canada to prevent medication errors. The correct way to write this is 'Digoxin 0.125 mg...'. The period before the number could be missed, leading to an overdose. The other orders use standard and safe abbreviations.

Question 69: A clinical protocol for blood transfusion reads: 'Vital signs must be obtained before transfusion, at 15 minutes, and at completion. The transfusion must be completed within 4 hours of issue from the blood bank. If a transfusion reaction is suspected, STOP the transfusion immediately and notify the physician.' At 20 minutes into a transfusion, a patient develops hives and pruritus. What is the FIRST action?

Administer diphenhydramine and complete the transfusion
Check vital signs and document the reaction in the chart
Slow the infusion rate and continue monitoring
Stop the transfusion and notify the physician (Correct answer)

Correct answer: Stop the transfusion and notify the physician

The protocol explicitly states to stop the transfusion immediately if a reaction is suspected, before any other interventions.

Question 70: During a shift, a patient asks their roommate loudly: 'Do you know what NPO means? They told me I can't eat but didn't explain why.' What is the nurse's most appropriate response when they overhear this?

Allow the roommate to explain so the patient feels comfortable asking peers
Approach the patient and explain that NPO means nothing by mouth, then clarify the reason related to their care (Correct answer)
Inform the charge nurse that the patient is confused about their care plan
Document that patient education was provided by peer support

Correct answer: Approach the patient and explain that NPO means nothing by mouth, then clarify the reason related to their care

The nurse should directly educate the patient about NPO status and the clinical rationale, as patient understanding supports safety and compliance.

Question 71: A statement of urgency

Let the patient know that you are aware of the urgency/complexity of the issue. It is often reassuring to the patients when you communicate an understanding of the importance of their issue/situation. When it is an urgent matter, reassure them that you know it is. You can say:
"In this case, time is of the essence. I am going to speak with Dr. Brown or my Nurse Supervisor to help me expedite this issue." (Correct answer)
You can also ask probing questions that will help you obtain more information such as:
Once you have a good understanding of the patient's needs, let them know when they can expect to have their symptoms resolved. This can be as simple as saying:

Correct answer: "In this case, time is of the essence. I am going to speak with Dr. Brown or my Nurse Supervisor to help me expedite this issue."

This statement is a statement of urgency because it both acknowledges that time is critical and states a clear plan of action — escalating to Dr. Brown or the Nurse Supervisor to expedite the issue. The other options only express empathy, ask probing questions, or set resolution expectations without combining urgency with a concrete next step.

Question 72: A CELBAN speaking task asks you to explain NPO (nothing by mouth) instructions to a patient before a morning procedure. Which explanation is most appropriate?

'Don't eat or drink anything, including water, after midnight. This keeps your stomach empty so the anesthesia is safer.' (Correct answer)
'The doctor says no eating. Just follow the rules.'
'You can have clear fluids up until your procedure begins.'
'You are NPO from midnight — no food or drink, including water.'

Correct answer: 'Don't eat or drink anything, including water, after midnight. This keeps your stomach empty so the anesthesia is safer.'

Giving the instruction in plain language and briefly explaining the reason increases patient understanding and compliance.

Question 73: A patient appears anxious before a procedure. Which therapeutic communication technique is MOST appropriate to use first?

Give detailed statistics about procedure risks
Reassure the patient by saying 'Everything will be fine'
Redirect the conversation to the procedure steps
Use open-ended questions to invite the patient to express concerns (Correct answer)

Correct answer: Use open-ended questions to invite the patient to express concerns

Open-ended questions encourage patients to verbalize fears, allowing the nurse to address specific concerns rather than making empty reassurances.

Question 74: During a recorded medical dialogue used in a CELBAN practice task, a surgeon says: 'We'll book her for an elective laparoscopic cholecystectomy once the acute inflammation settles — probably in six to eight weeks.' What does the patient need to understand?

She needs to return to the emergency department within 24 hours
The surgeon is recommending conservative management with no surgery
Her gallbladder surgery will be scheduled in approximately six to eight weeks after inflammation resolves (Correct answer)
She will have emergency gallbladder surgery today

Correct answer: Her gallbladder surgery will be scheduled in approximately six to eight weeks after inflammation resolves

The surgeon's statement indicates a planned (elective) minimally invasive gallbladder removal after the current inflammation subsides, with a 6–8 week timeline.

Question 75: A patient's son says during a visit: 'My mother keeps saying her pain is a 3 out of 10, but she's clearly grimacing and barely moving. Should I be worried?' What does this dialogue indicate?

There may be a discrepancy between the patient's self-report and observable pain cues (Correct answer)
The numeric pain scale is the most reliable measure available
The family member is over-interpreting normal post-operative behavior
The patient is exaggerating her discomfort to her family

Correct answer: There may be a discrepancy between the patient's self-report and observable pain cues

When verbal self-report and non-verbal cues conflict, nurses must assess both and investigate possible reasons such as stoicism or fear of medication.

Question 76: An elderly patient with dementia repeatedly pulls out their IV line. What is the most appropriate nursing response?

Ignore the behavior as it is expected with dementia
Discharge the patient's IV and discontinue treatment
Discuss with the care team and explore alternatives such as mittens or distraction techniques before considering restraints (Correct answer)
Physically restrain the patient without a physician order

Correct answer: Discuss with the care team and explore alternatives such as mittens or distraction techniques before considering restraints

Least-restrictive interventions must be explored with the interdisciplinary team before any form of restraint is applied.

Question 77: A patient with limited English says 'I have sugar' when describing a chronic condition. What should the nurse do first?

Request a professional interpreter before continuing
Proceed with the physical assessment
Ask a clarifying question to confirm the meaning (Correct answer)
Document 'diabetes mellitus' immediately

Correct answer: Ask a clarifying question to confirm the meaning

Asking a clarifying question (e.g., 'Do you mean diabetes?') confirms the patient's meaning before documenting, preventing a potentially inaccurate medical record.

Question 78: After completing an incident report, a supervisor asks a nurse to remove a detail that reflects poorly on the unit. The nurse should:

Remove the detail to maintain team harmony
Refuse to alter factual information, as falsifying a report is unethical and potentially illegal (Correct answer)
Submit two versions of the report
Rewrite the entire report in vague terms

Correct answer: Refuse to alter factual information, as falsifying a report is unethical and potentially illegal

Altering incident reports to conceal facts is a serious breach of professional ethics and may constitute falsification of records.

Question 79: A CELBAN speaking task involves explaining an insulin injection technique to a newly diagnosed diabetic patient. Which phrase best checks patient readiness to learn?

'Your doctor told me you need to know this.'
'You need to learn this today before you go home.'
'I'll show you this quickly so we can get it done.'
'Is this a good time for us to go over how to give yourself your insulin injection?' (Correct answer)

Correct answer: 'Is this a good time for us to go over how to give yourself your insulin injection?'

Asking whether the patient is ready respects their autonomy and ensures they are in the right mindset to receive new information.

Question 80: An elderly patient says quietly to a nurse during bathing: 'My daughter-in-law controls all my money and I'm not allowed to call anyone.' What type of concern does this statement raise?

This may indicate financial abuse and/or social isolation requiring a safeguarding assessment (Correct answer)
The patient is experiencing normal family conflict
The patient needs a social work referral for caregiver respite only
The nurse should encourage the patient to resolve family issues independently

Correct answer: This may indicate financial abuse and/or social isolation requiring a safeguarding assessment

Statements suggesting financial control and restricted communication are red flags for elder abuse that mandate a safeguarding assessment.

Question 81: A patient refuses to listen to discharge instructions, saying 'I'll figure it out at home.' What is the nurse's best response?

Explore the patient's concerns before attempting to re-engage (Correct answer)
Document refusal and proceed with discharge
Call security to delay the discharge
Force the patient to listen by hospital policy

Correct answer: Explore the patient's concerns before attempting to re-engage

Understanding the reason for refusal allows the nurse to address barriers and motivate the patient to engage.

Question 82: A nurse reads the following in a patient's chart: 'Advance diet as tolerated from clear liquids to full liquids, then soft diet.' What does this order require from the nursing staff?

Give the patient a full diet immediately
Keep the patient on clear liquids for the full hospital stay
Progress the diet stepwise based on the patient's ability to tolerate each stage without complications (Correct answer)
Consult dietary before making any diet changes

Correct answer: Progress the diet stepwise based on the patient's ability to tolerate each stage without complications

An 'advance as tolerated' order means the nurse assesses the patient's ability to tolerate each diet stage before progressing to the next level.

Question 83: During a CELBAN role-play, a patient refuses a recommended treatment. As the nurse, your most appropriate action is to:

Argue persistently until the patient agrees.
Respect the refusal, explain the potential consequences, and document the discussion. (Correct answer)
Tell the patient their insurance will not cover future problems if they refuse.
Proceed with the treatment anyway to ensure patient safety.

Correct answer: Respect the refusal, explain the potential consequences, and document the discussion.

Nurses must respect patient autonomy, inform them of consequences of refusal, and document the conversation appropriately.

Question 84: A nurse notices that a patient's dietary restrictions based on religious practice conflict with the prescribed hospital diet. The most appropriate action is to:

Ask the patient to suspend their dietary practices during hospitalization
Notify the dietitian and work to accommodate religious dietary needs within medical parameters (Correct answer)
Document the conflict and take no action
Override the restriction since medical nutrition takes priority

Correct answer: Notify the dietitian and work to accommodate religious dietary needs within medical parameters

Collaborating with dietitians to honor religious dietary restrictions while meeting medical nutritional needs reflects culturally competent, patient-centered care.

Question 85: A nurse disagrees with a physician's order. The MOST professional action is to:

Refuse to carry out the order and document personal disagreement
Administer the order without comment to avoid conflict
Complain about the order to other nursing staff
Clarify the concern directly with the physician using assertive, respectful communication (Correct answer)

Correct answer: Clarify the concern directly with the physician using assertive, respectful communication

Assertive professional communication with the ordering provider is the appropriate first step when a nurse questions an order's safety or appropriateness.

Question 86: During a medication teaching session, a patient says: 'My last pharmacist said this drug was dangerous, so I looked it up online and now I'm scared to take it.' What is the nurse's most effective first response?

Explore the specific concerns the patient read about and address them with accurate, evidence-based information (Correct answer)
Dismiss the online information as unreliable and reinforce the prescription
Advise the patient to call the pharmacist directly rather than using the internet
Contact the prescribing physician to consider switching the medication

Correct answer: Explore the specific concerns the patient read about and address them with accurate, evidence-based information

Acknowledging the patient's concern and addressing the specific information they found builds trust and supports informed medication adherence.

Question 87: Globally, the coronavirus infection is beginning to spread in another form. The WHO called the mutation "Omicron," sticking to the Greek letters. Additionally, on November 9th, Botswana received the first report of this virus. Following the eighteen-day period, it was discovered in South Africa and labeled as a "virus of concern." Cases have since been recorded from Israel, Madagascar, Belgium, and Hong Kong. Epidemiologists have cautioned that this new strain may be very contagious and may be able to avoid the defenses provided by our present vaccinations. As a result, several nations have reinstated their restrictions on ravels. In spite of this, the Czech Republic, the UK, and Germany have all effectively reported new cases. Researchers have identified 50 genetic alterations in the DNA that affect the spikes that may make the virus more virulent, more transmissible, and potentially more resistant to vaccinations. These variations are being investigated by scientists in an effort to evaluate the potential risks that Omicron may offer. According to scientists, it can take a few weeks to ascertain how well our vaccinations work against Omicron. "When you've got a virus that's showing this degree of transmissibility, and you're having travel-related cases, it virtually invariably is getting to go everywhere [the world]," the chief medical advisor to the White House has issued a warning. How long might it take scientists to find out how dangerous Omicron is?

months
years
hours
a few weeks (Correct answer)

Correct answer: a few weeks

The passage states: 'it can take a few weeks to ascertain how well our vaccinations work against Omicron.' Months, years, and hours are all mentioned nowhere in the text — 'a few weeks' is the specific timeframe given by scientists.

Question 88: During a team huddle a physician says: 'We'll hold the metformin today — her creatinine came back at 180 and we're sending her for a contrast CT this afternoon.' What is the reason for withholding the medication?

The patient is allergic to metformin
Elevated creatinine and upcoming contrast imaging increase the risk of lactic acidosis with metformin (Correct answer)
The patient refused to take oral medications this morning
The CT scan requires the patient to be NPO including all medications

Correct answer: Elevated creatinine and upcoming contrast imaging increase the risk of lactic acidosis with metformin

Metformin is held before contrast CT in patients with elevated creatinine to prevent contrast-induced nephropathy and metformin-associated lactic acidosis.

Question 89: "Could you describe your exact actions at the beginning of the symptoms?"

Set appropriate expectations
Examples of clarifying questions are:
Better Probing question (Correct answer)
Revalidation phrase

Correct answer: Better Probing question

Asking the patient to describe their exact actions at the onset of symptoms is a better probing question because it requests a detailed account of the surrounding circumstances rather than a simple 'when' or 'how long.' This depth of inquiry makes it more effective than the expectation-setting, clarifying, or revalidation options.

Question 90: A colleague is explaining a procedure, but a patient doesn’t seem to understand. What should you do?

Interrupt and explain it yourself.
Ignore it and assume the patient understands.
Wait until your colleague is finished and then clarify for the patient. (Correct answer)
Ask the patient if they have any questions while your colleague is explaining.

Correct answer: Wait until your colleague is finished and then clarify for the patient.

Interrupting a colleague can be disruptive and undermine their authority and the patient's trust in them. Waiting until they finish allows for a respectful interaction, after which you can offer clarification to the patient, ensuring they fully understand without causing awkwardness or disrespect.

Question 91: A nursing research article states: 'A randomized controlled trial (RCT) is considered the gold standard for evaluating clinical interventions. Unlike cohort studies, RCTs use random allocation to minimize selection bias and confounding variables.' A nurse is evaluating two studies: one RCT and one retrospective chart review on the same topic. Which provides stronger evidence for practice change?

The RCT because random allocation reduces bias and strengthens causal inference (Correct answer)
Both are equal if they have the same sample size
The retrospective study because it covers a longer time period
The retrospective chart review because it uses real patient data

Correct answer: The RCT because random allocation reduces bias and strengthens causal inference

RCTs are the gold standard for evaluating interventions because randomization minimizes confounding and selection bias, providing stronger causal evidence.

Question 92: A CELBAN listening passage describes a nurse saying: 'I noticed the patient's wound drainage has changed from serous to seropurulent over the past 24 hours, and there's some surrounding erythema.' What change is being described?

The patient's wound is fully closed and no further monitoring is needed
The wound drainage has changed from clear/straw-coloured to cloudy with pus, and redness has appeared around the wound, suggesting possible infection (Correct answer)
The wound is healing faster than expected with no concerns
The wound dressing needs to be changed to a waterproof type

Correct answer: The wound drainage has changed from clear/straw-coloured to cloudy with pus, and redness has appeared around the wound, suggesting possible infection

Seropurulent drainage (cloudy, mixed with pus) replacing serous drainage, combined with erythema, are classic early signs of wound infection requiring prompt assessment.

Question 93: Globally, the coronavirus infection is beginning to spread in another form. The WHO called the mutation "Omicon," sticking to the Greek letters. Additionally, on November 9th, Botswana received the first report of this virus. Following the eighteen-day period, it was discovered in South Africa and labeled as a "virus of concern." Cases have since been recorded from Israel, Madagascar, Belgium, and Hong Kong. Epidemiologists have cautioned that this new strain may be very contagious and may be able to avoid the defenses provided by our present vaccinations. As a result, several nations have reinstated their restrictions on ravels. In spite of this, the Czech Republic, the UK, and Germany have all effectively reported new cases. Researchers have identified 50 genetic alterations in the DNA that affect the spikes that may make the virus more virulent, more transmissible, and potentially more resistant to vaccinations. These variations are being investigated by scientists in an effort to evaluate the potential risks that Omicron may offer. According to scientists, it can take a few weeks to ascertain how well our vaccinations work against Omicron. "When you've got a virus that's showing this degree of transmissibility, and you're having travel-related cases, it virtually invariably is getting to go everywhere [the world]," the chief medical advisor to the White House has issued a warning. How many genetic changes in Omicron have scientists discovered?

70
50 (Correct answer)
40
60

Correct answer: 50

The passage explicitly states: 'Researchers have identified 50 genetic alterations in the DNA that affect the spikes.' The other numbers — 40, 60, and 70 — do not appear in the text and are designed to test whether you read carefully.

Question 94: A nurse on a busy medical unit is informed of four patient requests simultaneously. Which of the following situations requires the nurse's most immediate assessment?

A patient with a history of heart failure reports new-onset shortness of breath. (Correct answer)
A family member is asking for an update on a patient's lab results.
A post-operative patient rated their incisional pain as 7/10.
A patient who is NPO for a procedure is asking for a drink of water.

Correct answer: A patient with a history of heart failure reports new-onset shortness of breath.

According to the ABC (Airway, Breathing, Circulation) framework for prioritization, new-onset shortness of breath is a critical sign of a potentially life-threatening breathing problem that must be assessed immediately.

Question 95: A physician's telephone order is heard as: 'Give 40 mg of furosemide IV push now and reassess fluid status in two hours.' What does the nurse need to confirm before administering this order?

Whether the patient prefers an oral or IV route
The patient's dietary preferences for the morning meal
Whether the family has consented to IV medications
The patient's current fluid status, renal function, and any known allergies, and ensure the verbal order is correctly transcribed (Correct answer)

Correct answer: The patient's current fluid status, renal function, and any known allergies, and ensure the verbal order is correctly transcribed

Before administering any telephone order, the nurse must repeat back the order, verify patient identity and allergies, check renal function relevant to furosemide, and document accurately.

Question 96: When giving discharge instructions during a CELBAN speaking task, what is the most effective technique to verify patient understanding?

Tell the patient to call if they have questions later.
Hand the patient a brochure with written instructions.
Ask the patient to sign a consent form.
Use the teach-back method by asking the patient to repeat the instructions in their own words. (Correct answer)

Correct answer: Use the teach-back method by asking the patient to repeat the instructions in their own words.

The teach-back method is widely recognized as the most reliable way to confirm patient comprehension during discharge education.

Question 97: A patient explains they prefer a same-gender nurse for physical examinations due to religious beliefs. The nurse should:

Ask the patient to justify their religious reasoning before making changes
Accommodate the request when possible by arranging a same-gender nurse (Correct answer)
Explain that nursing assignments cannot be changed based on personal preferences
Note the preference as medically irrelevant in the chart

Correct answer: Accommodate the request when possible by arranging a same-gender nurse

Accommodating gender preferences for religious or cultural reasons is an important aspect of patient-centered, culturally competent care.

Question 98: "Our resident physician, Mr. McAvinue, is presently analyzing your MRI to see whether you require any additional testing. You should expect to wait for at least thirty minutes, and then he will meet with you to go over the results and any other testing that may be required."

Let the patient know that you are aware of the urgency/complexity of the issue. It is often reassuring to the patients when you communicate an understanding of the importance of their issue/situation. When it is an urgent matter, reassure them that you know it is. You can say:
Once you start working on the issue, keep the patient informed about your progress. Let them know what you are doing and why you are doing it. Also, let them know how much longer they can expect to wait. (Correct answer)
Keep the patient informed about the progress
Once you have a good understanding of the patient's needs, let them know when they can expect to have their symptoms resolved. This can be as simple as saying:

Correct answer: Once you start working on the issue, keep the patient informed about your progress. Let them know what you are doing and why you are doing it. Also, let them know how much longer they can expect to wait.

This statement keeps the patient informed of progress: it explains what is being done (the resident is reviewing the MRI), why, and how long the wait will be, which is best practice during waiting periods. The other options focus only on setting resolution expectations or acknowledging urgency rather than giving an ongoing progress update.

Question 99: A passage about therapeutic communication reads: 'Therapeutic communication techniques include active listening, open-ended questions, silence, and clarification. Non-therapeutic techniques such as false reassurance, giving advice, and changing the subject can hinder the nurse-patient relationship.' A patient says: 'I'm terrified about my surgery tomorrow.' The nurse responds: 'Don't worry — everything will be just fine!' What technique does this represent?

False reassurance (Correct answer)
Active listening
Open-ended questioning
Clarification

Correct answer: False reassurance

Telling a patient not to worry and that everything will be fine dismisses their feelings and offers unfounded guarantees — a classic example of false reassurance.

Question 100: Globally, the coronavirus infection is beginning to spread in another form. The WHO called the mutation "Omicron," sticking to the Greek letters. Additionally, on November 9th, Botswana received the first report of this virus. Following the eighteen-day period, it was discovered in South Africa and labeled as a "virus of concern." Cases have since been recorded from Israel, Madagascar, Belgium, and Hong Kong. Epidemiologists have cautioned that this new strain may be very contagious and may be able to avoid the defenses provided by our present vaccinations. As a result, several nations have reinstated their restrictions on ravels. In spite of this, the Czech Republic, the UK, and Germany have all effectively reported new cases. Researchers have identified 50 genetic alterations in the DNA that affect the spikes that may make the virus more virulent, more transmissible, and potentially more resistant to vaccinations. These variations are being investigated by scientists in an effort to evaluate the potential risks that Omicron may offer. According to scientists, it can take a few weeks to ascertain how well our vaccinations work against Omicron. "When you've got a virus that's showing this degree of transmissibility, and you're having travel-related cases, it virtually invariably is getting to go everywhere [the world]," the chief medical advisor to the White House has issued a warning. Which member of the White House staff commented on Omicron?

the special advisor to vaccines
the chief of staff
the chief medical adviser (Correct answer)
the senior advisor to the President

Correct answer: the chief medical adviser

The final sentence of the passage attributes the quoted warning to 'the chief medical advisor to the White House.' The chief of staff, senior advisor to the President, and special advisor to vaccines are all plausible-sounding titles but are not mentioned in the text.

Canadian English Language Benchmark Assessment for Nurses (CELBAN)

CELBAN assesses the English language proficiency of internationally educated nurses (IENs) who wish to practice nursing in Canada.

100

Questions

180 min

Time Limit

70%

To Pass

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