CNO College of Nurses of Ontario Exam — Questions and Answers

Question 1: A nurse makes an error in a client's electronic health record by documenting on the wrong chart. Which of the following actions is the most appropriate and legally sound way to correct this error according to CNO's Documentation practice standard?

Copy the entry to the correct chart and then delete the original incorrect entry.
Delete the incorrect entry completely to avoid any future confusion.
Leave the incorrect entry as is, but add a new, separate note explaining the error.
Document that the entry was made in error, ensuring the original entry remains visible, and then make the correct entry in the appropriate chart. (Correct answer)

Correct answer: Document that the entry was made in error, ensuring the original entry remains visible, and then make the correct entry in the appropriate chart.

The CNO's Documentation practice standard emphasizes that a health record is a legal document and original entries should never be deleted or obliterated. [12, 15] When an error is made, the correct procedure is to clearly indicate that the entry is an error (e.g., using a strikethrough for paper or a 'mistaken entry' function in an EHR) while ensuring the original information remains visible or retrievable. [12, 21] The nurse should then create a new, correct entry. This maintains the integrity and legal standing of the health record.

Question 2: While reviewing a client's electronic chart, a nurse notices an incorrect medication dosage was documented by a colleague on a previous shift. The client did not suffer any adverse effects. What is the nurse's most appropriate initial action?

Add a new entry to the chart clarifying the error and the correct information.
Delete the incorrect entry to prevent future confusion for the healthcare team.
Report the error immediately to the unit manager for disciplinary action.
Discuss the error with the colleague who made the entry and instruct them on how to correct it. (Correct answer)

Correct answer: Discuss the error with the colleague who made the entry and instruct them on how to correct it.

Professional accountability involves addressing issues directly and collegially when appropriate. The first step is to speak with the colleague who made the error, as they are accountable for their own documentation and should be the one to correct it according to facility policy. Deleting the entry is improper alteration of a legal record. Reporting to the manager may be necessary if the colleague is unresponsive or if there is a pattern of errors, but it is not the most appropriate initial action. Adding a new entry is not ideal as the original author should make the correction if possible.

Question 3: Under the Health Care Consent Act, how is capacity to consent assessed for a client with dementia who requires multiple procedures?

Specifically for each treatment decision being made (Correct answer)
Once upon admission, applying to all future treatments
Only by a physician or psychiatrist
Globally for all decisions at the same time

Correct answer: Specifically for each treatment decision being made

Capacity is decision-specific under the HCCA; a person may be capable of consenting to some treatments but incapable of consenting to others.

Question 4: A nurse notices a colleague consistently failing to perform required safety checks before administering high-risk medications. The nurse has informally spoken to the colleague, but the behaviour continues. What is the nurse's most appropriate next step to demonstrate professional accountability?

Confront the colleague again in the presence of another nurse.
Continue monitoring the colleague and documenting their errors for a future report.
Report the colleague's behaviour to the nursing unit manager or appropriate authority. (Correct answer)
Anonymously report the issue to the CNO's professional conduct department.

Correct answer: Report the colleague's behaviour to the nursing unit manager or appropriate authority.

Nurses have a professional and ethical responsibility to take action when they witness unsafe practice that could jeopardize client safety. After an initial attempt to address the issue directly with the colleague has failed, the nurse is accountable for escalating the concern to the appropriate authority, such as the nurse manager, to ensure client safety is protected through formal channels.

Question 5: A physician gives a nurse a telephone order for a new medication. To comply with the CNO's Medication practice standard, what is the most critical action the nurse must take after transcribing the order?

Ask a colleague to review the transcribed order.
Administer the medication immediately to ensure timely care.
Read the order back to the prescriber for verification. (Correct answer)
Wait for the prescriber to sign the order before administering the medication.

Correct answer: Read the order back to the prescriber for verification.

The CNO's standards emphasize clear communication to ensure safety. When taking verbal or telephone orders, the nurse is accountable for accurately recording the information and must read it back to the prescriber to verify its correctness and prevent errors. While having a colleague review it is good practice, the direct confirmation with the prescriber is the most critical step.

Question 6: An RN is delegating the task of obtaining a routine capillary blood glucose reading to an Unregulated Care Provider (UCP). To meet the CNO standards for delegation and leadership, which instruction is most critical for the RN to provide?

"Let me know what the result is when you get it."
"Please check Mrs. Smith's blood sugar now."
"Check Mrs. Smith's blood sugar before her lunch. Please report the result to me immediately, and also let me know if she reports feeling dizzy or sweaty." (Correct answer)
"You've done this before, just check her sugar and document it in the chart."

Correct answer: "Check Mrs. Smith's blood sugar before her lunch. Please report the result to me immediately, and also let me know if she reports feeling dizzy or sweaty."

Effective delegation requires clear and complete communication, including the specific parameters of the task, the timeline, and what, when, and how to report back. This instruction is comprehensive, providing specific patient-centered directions and outlining critical findings to report, which aligns with the 'Right Communication' and 'Right Supervision' principles of delegation.

Question 7: When assessing a client's skin turgor, the nurse pinches the skin on the back of the hand and notes it returns slowly. This finding suggests:

Allergic reaction
Fluid overload
Dehydration or decreased skin elasticity (Correct answer)
Normal hydration status

Correct answer: Dehydration or decreased skin elasticity

Slow skin turgor return indicates decreased tissue fluid, which can be caused by dehydration or, in older adults, by reduced skin elasticity.

Question 8: A capable 16-year-old refuses a blood transfusion on religious grounds. How should the nurse respond?

Respect the capable minor's refusal and escalate to the healthcare team (Correct answer)
Obtain consent from the parents, who have authority over all minors in Ontario
Contact child protective services immediately
Proceed with the transfusion because it is life-saving

Correct answer: Respect the capable minor's refusal and escalate to the healthcare team

Ontario's HCCA sets no minimum age for capacity; any person capable of understanding a treatment decision — including minors — has the right to consent or refuse.

Question 9: A father expresses concerns about his son’s upcoming surgery. The nurse listens to the father's concerns and validates his feelings. What component of the nurse-client relationship is the nurse demonstrating?

Empathy (Correct answer)
Professional intimacy
Trust
Respect

Correct answer: Empathy

Explanation: Empathy involves the ability to understand and share the feelings of another person, in this case, the father's concerns about his son's surgery. By actively listening and validating the father's feelings, the nurse is showing empathy, which is an essential component of building a therapeutic nurse-client relationship.

Question 10: When performing a nutritional assessment on an older adult client, which tool is commonly used to screen for malnutrition risk?

APGAR score
Mini Nutritional Assessment (MNA) (Correct answer)
CAGE questionnaire
Braden Scale

Correct answer: Mini Nutritional Assessment (MNA)

The Mini Nutritional Assessment (MNA) is a validated screening tool specifically designed to identify malnutrition risk in older adults.

Question 11: The RN in our family health clinic forgot to sign for a narcotic wastage prior to leaving for the day. The oncoming RPN discovered the partially used ampule during the evening shift. Can the evening shift nurse sign for the RN’s wastage?

No. The RPN cannot sign for the other nurse’s wastage. (Correct answer)
No. The RPN can lock up the wastage until the RN is available to sign.
Yes. The RPN can sign for the RN’s wastage as a fellow team member.
Yes. The RPN can sign as long as another registered staff is a witness.

Correct answer: No. The RPN cannot sign for the other nurse’s wastage.

Explanation: The RPN cannot sign for the other nurse’s wastage. In medication management, it's essential to adhere to strict protocols and ensure accurate documentation, especially when handling controlled substances like narcotics. Only the individual who administered or wasted the medication should sign for the wastage to maintain accountability and legal compliance. Therefore, it is not appropriate for the evening shift nurse (RPN) to sign for the RN's wastage.

Question 12: Actively supporting a right and good cause; supporting others for speaking for themselves or speaking on behalf of those who cannot speak for themselves.

Client
Advocate (Correct answer)
Accountability
Collaborate

Correct answer: Advocate

Explanation: Advocacy in nursing involves actively supporting a right and good cause, whether it's advocating for individual clients to ensure their needs are met, advocating for improvements in healthcare systems or policies, or speaking up for those who cannot speak for themselves. Nurses serve as advocates for their clients, empowering them to speak for themselves and advocating on their behalf when necessary.

Question 13: Which of the following actions best demonstrates a nurse's commitment to the principle of 'acting with integrity in the client's best interest' as outlined in the CNO Code of Conduct?

Sharing details of a client's interesting case with a colleague in the cafeteria.
Accepting a valuable gift from a grateful client after their discharge.
Ensuring a client's personal health information is protected and only shared for therapeutic reasons. (Correct answer)
Performing a procedure without full consent because the nurse believes it is necessary.

Correct answer: Ensuring a client's personal health information is protected and only shared for therapeutic reasons.

Acting with integrity includes protecting client privacy and confidentiality. The CNO Code of Conduct states that nurses must protect the privacy and confidentiality of clients' personal health information. Sharing information without a therapeutic reason, accepting significant gifts that could influence care, and proceeding without informed consent all violate this principle.

Question 14: The CNO standards identify empathy as a key component of the therapeutic nurse-client relationship. How is empathy best described in this context?

Feeling pity or sorrow for the client's unfortunate circumstances.
Understanding the client's perspective and communicating that understanding back to them. (Correct answer)
Sharing the client's feelings and experiencing the same emotions.
Maintaining a detached and purely objective professional distance from the client.

Correct answer: Understanding the client's perspective and communicating that understanding back to them.

Empathy is the ability to understand what the client is experiencing from their point of view and to reflect that understanding back to them. This validates the client's feelings without the nurse taking on those feelings, which would be sympathy.

Question 15: During a mental status examination, which assessment tool is commonly used to screen for cognitive impairment in older adults?

PHQ-9
AUDIT-C
MMSE (Mini-Mental State Examination) (Correct answer)
GAD-7

Correct answer: MMSE (Mini-Mental State Examination)

The Mini-Mental State Examination (MMSE) is a widely used standardized tool to screen for cognitive impairment and dementia in older adults.

Question 16: Under the Regulated Health Professions Act, when is a nurse legally required to self-report to the CNO?

When their employment is terminated for any reason.
Only after being found guilty of a criminal offence.
When they are named in a civil lawsuit, regardless of the reason.
Within 30 days of being charged with any offence. (Correct answer)

Correct answer: Within 30 days of being charged with any offence.

The CNO requires nurses to self-report specific information to maintain public trust and safety. A nurse must self-report if they have been charged with any offence, found guilty of an offence, have a finding of professional negligence, or a finding of misconduct in another profession. This report must be made as soon as possible, but no later than 30 days from the event.

Question 17: A nurse is performing a Glasgow Coma Scale (GCS) assessment. Which three components are evaluated?

Heart rate, blood pressure, and respiratory rate
Pupil reaction, motor strength, and reflexes
Eye opening, verbal response, and motor response (Correct answer)
Orientation, memory, and judgment

Correct answer: Eye opening, verbal response, and motor response

The GCS assesses eye opening, verbal response, and motor response, with a maximum score of 15 indicating full consciousness.

Question 18: A client is hesitant to ask questions about their diagnosis, stating, "You're the expert, I don't want to bother you." How should the nurse best respond to address the inherent power imbalance in this therapeutic relationship?

Tell the client that it's their right to be informed and they must ask questions.
Provide the client with a pamphlet about their diagnosis to read on their own time.
Acknowledge the client's feelings and create a safe, collaborative environment for them to ask questions. (Correct answer)
Document in the chart that the client is non-participatory in their care planning.

Correct answer: Acknowledge the client's feelings and create a safe, collaborative environment for them to ask questions.

The nurse-client relationship has an unequal power dynamic. The nurse's role is to empower the client and promote a partnership. Acknowledging the client's feelings validates their concern, while explicitly inviting questions creates a safe space for collaboration and shared decision-making, thereby reducing the power imbalance.

Question 19: A nurse in a hospital isn't paying attention and gives a patient a lethal dose of medication.

Public Law
Civil Law
Criminal Law (Correct answer)
None of the above.

Correct answer: Criminal Law

Explanation: In this scenario, the nurse's action of administering a lethal dose of medication due to not paying attention may result in criminal liability. Criminal law deals with actions or omissions that are deemed harmful or threatening to society, and administering a lethal dose of medication negligently falls under this category. It's considered a criminal offense because it involves the potential harm or death of an individual due to the nurse's negligence or recklessness. Therefore, the nurse may face criminal charges and legal consequences for such actions.

Question 20: A nurse discovers they administered a medication to the wrong client. After assessing the client and ensuring their immediate safety, what is the nurse's next accountability according to the CNO's standards?

Document the error only in the client's chart.
Notify the prescriber and the nursing manager of the error. (Correct answer)
Ask the client not to mention the mistake to anyone.
Complete the incident report to fulfill organizational requirements.

Correct answer: Notify the prescriber and the nursing manager of the error.

After ensuring client safety, the nurse's accountability is to report the medication error to the appropriate individuals, which includes the prescriber and the nurse's manager. This facilitates timely intervention and management of the client's health and initiates the necessary follow-up and quality improvement processes. Documentation and incident reports are also required but follow notification.

Question 21: A nurse assesses a client's pedal pulses and rates them as 1+. What does this indicate?

Normal pulse strength
Bounding, strong pulses
Diminished pulses that are weak and barely palpable (Correct answer)
Absent pulses

Correct answer: Diminished pulses that are weak and barely palpable

A 1+ pulse rating indicates a weak, barely palpable pulse, suggesting reduced peripheral arterial perfusion.

Question 22: Under which specific circumstance may treatment be provided to an incapable person WITHOUT substitute consent under the Health Care Consent Act?

When the healthcare team unanimously agrees the treatment is medically necessary
In an emergency where there is immediate risk of death or serious bodily harm and no time to obtain consent (Correct answer)
When the person's adult family members provide verbal agreement to proceed
When the person has been found incapable by a physician and treatment is recommended

Correct answer: In an emergency where there is immediate risk of death or serious bodily harm and no time to obtain consent

The HCCA permits emergency treatment without consent only when the person is incapable, there is an immediate risk of death or serious bodily harm, and the urgency does not allow time to obtain consent.

Question 23: The obligation to answer for the professional, ethical, and legal responsibilities of one's activities and duties.

Client
Accountability (Correct answer)
Advocate
Boundary

Correct answer: Accountability

Explanation: Accountability refers to the obligation of healthcare professionals, including nurses, to answer for their actions, decisions, and responsibilities related to their practice. It encompasses being answerable for the professional, ethical, and legal aspects of one's activities and duties. Nurses are expected to uphold high standards of accountability in their practice to ensure safe and effective care for their clients.

Question 24: A nurse is caring for a client who speaks limited English. How should the nurse best conduct the health assessment?

Ask a family member to translate all clinical questions
Use a trained professional interpreter to ensure accurate communication (Correct answer)
Skip the subjective assessment and rely only on objective data
Use medical jargon and assume the client understands

Correct answer: Use a trained professional interpreter to ensure accurate communication

A trained professional interpreter ensures accurate, confidential, and culturally appropriate communication during assessments.

Question 25: Which of the following actions by a nurse best exemplifies the competency of 'role clarification' within an interprofessional healthcare team?

Focusing exclusively on nursing tasks and directing other team members to stay within their own professional domains.
Assuming the lead on all aspects of the client's care plan to ensure efficiency.
Actively listening to the physiotherapist's assessment and explaining the nursing role in mobility to create a shared plan. (Correct answer)
Waiting for the physician to assign specific tasks to each member of the healthcare team.

Correct answer: Actively listening to the physiotherapist's assessment and explaining the nursing role in mobility to create a shared plan.

Role clarification involves understanding your own role and the roles of others to achieve optimal client outcomes. Actively listening and explaining one's own professional contributions to achieve a shared goal is a core component of this competency. The other options reflect hierarchical, siloed, or passive approaches rather than a collaborative one.

Question 26: A nurse notices a colleague consistently failing to perform required safety checks before administering medication. The nurse has informally mentioned it to the colleague, but the behavior continues. According to the CNO Code of Conduct, what is the nurse's next most appropriate action?

Report the unsafe behavior to the appropriate authority, such as the nurse manager or employer. (Correct answer)
Continue to monitor the colleague and gather more evidence before acting.
Confront the colleague again, but this time in a more forceful manner.
Assume the colleague is just busy and offer to help them with their workload.

Correct answer: Report the unsafe behavior to the appropriate authority, such as the nurse manager or employer.

Principle 6 of the CNO Code of Conduct, 'Nurses maintain public confidence in the nursing profession,' requires nurses to report any error, unsafe behaviour, or unethical conduct to the relevant individuals, such as an employer or CNO, to protect client safety. Ignoring the issue or only addressing it informally is not sufficient when client safety is at risk.

Question 27: A nurse is preparing to insert a urinary catheter. Which action is most important in preventing catheter-associated urinary tract infections (CAUTIs)?

Use the largest catheter size available
Maintain strict aseptic technique throughout the insertion procedure (Correct answer)
Irrigate the catheter every shift
Leave the drainage bag on the floor for easy access

Correct answer: Maintain strict aseptic technique throughout the insertion procedure

Strict aseptic technique during catheter insertion is the most effective measure to prevent introduction of pathogens and reduce CAUTI risk.

Question 28: A charge nurse observes that staff members are reluctant to report near-miss medication errors for fear of disciplinary action. To foster a culture of safety, what is the most effective leadership strategy the charge nurse should implement?

Require nurses to sign a document acknowledging their individual accountability for any errors they make.
Designate one senior nurse per shift to be solely responsible for reporting all incidents, removing the burden from others.
Thank a nurse who reports a near miss in a team meeting, and facilitate a non-punitive discussion about system factors that may have contributed. (Correct answer)
Implement a strict, zero-tolerance policy for all medication errors, including near misses.

Correct answer: Thank a nurse who reports a near miss in a team meeting, and facilitate a non-punitive discussion about system factors that may have contributed.

According to CNO resources, a culture of safety is fostered when leaders create a blame-free environment where staff feel safe to speak up. Framing near misses as learning opportunities for system improvement, rather than individual failures, encourages reporting and ultimately enhances client safety. Punitive measures or focusing solely on individual accountability discourages reporting.

Question 29: Which of the following best describes the purpose of a root cause analysis (RCA) following a critical incident?

To create a legal record for litigation purposes
To identify underlying systemic factors that contributed to the incident and prevent recurrence (Correct answer)
To determine which nurse is at fault and assign discipline
To compare incident rates across hospitals

Correct answer: To identify underlying systemic factors that contributed to the incident and prevent recurrence

RCA is a structured process for identifying contributing systemic factors — not individual blame — so that processes can be improved to prevent future incidents.

Question 30: A nurse is completing their annual self-assessment as part of the CNO's Quality Assurance (QA) Program. This mandatory process, referred to as 'QA Every Day', consists of which two core components?

A skills demonstration and a review of performance metrics.
Peer feedback review and a jurisprudence exam.
Practice Reflection and development of a Learning Plan. (Correct answer)
Attending a mandatory workshop and completing a knowledge quiz.

Correct answer: Practice Reflection and development of a Learning Plan.

The foundation of the CNO's annual QA Program for all nurses is 'QA Every Day', which requires nurses to engage in Practice Reflection to identify learning needs and then create a Learning Plan with goals to address those needs.

Question 31: A staff nurse identifies a recurring issue with the availability of translation services, which is negatively impacting informed consent for clients with language barriers. As a nurse leader, what is the most professional and effective first step to advocate for systemic change?

Refuse to care for clients with language barriers until the problem is resolved.
Create a petition and ask colleagues on the unit to sign it.
Advise affected clients to file formal complaints with the hospital's patient advocate.
Collect specific examples and data on the frequency of the issue and its impact on client care to present to the unit manager. (Correct answer)

Correct answer: Collect specific examples and data on the frequency of the issue and its impact on client care to present to the unit manager.

Effective leadership and advocacy are grounded in evidence. Collecting data and specific examples provides a strong, professional basis for a discussion with management about a systemic problem. This approach is constructive and solution-oriented. The other options are either unprofessional, less effective, or shift the responsibility inappropriately.

Question 32: According to CNO principles, which factor most significantly contributes to medication errors in nursing practice?

Over-reliance on electronic health records
Interruptions during medication preparation and administration (Correct answer)
Excessive staffing on nursing units
Clients who ask too many questions

Correct answer: Interruptions during medication preparation and administration

Research consistently identifies interruptions during medication preparation as a leading contributing factor to nursing medication errors.

Question 33: What is the purpose of a Safety Data Sheet (SDS) in a clinical nursing environment?

To record client vital signs
To provide information about hazardous materials including handling, storage, and emergency procedures (Correct answer)
To schedule client procedures
To document nursing diagnoses

Correct answer: To provide information about hazardous materials including handling, storage, and emergency procedures

Safety Data Sheets provide critical information on handling, exposure risks, and emergency response for hazardous substances used in clinical settings.

Question 34: Which of the following is a mandatory component of the CNO's Quality Assurance (QA) Program for all nurses in the General and Extended classes?

Completing a peer performance review with a colleague each year.
Engaging in practice reflection and developing a Learning Plan annually. (Correct answer)
Attending a minimum of two professional development workshops annually.
Submitting a portfolio of clinical exemplars for review by the CNO.

Correct answer: Engaging in practice reflection and developing a Learning Plan annually.

The Regulated Health Professions Act, 1991, requires the CNO to have a QA Program. A core requirement for all members in the General and Extended classes is to perform a self-assessment, which includes reflecting on their practice and developing a Learning Plan each year to maintain and enhance their competence.

Question 35: A nurse develops a Learning Plan with two specific goals. Halfway through the year, the nurse's role changes, introducing new responsibilities and learning needs. Which of the following actions is most consistent with the principles of the QA Program?

Completing the original goals and waiting until next year to address the new needs.
Reviewing and updating the Learning Plan to reflect the new learning needs. (Correct answer)
Requesting an exemption from the QA Program for the year due to the role change.
Sticking to the original Learning Plan to demonstrate commitment.

Correct answer: Reviewing and updating the Learning Plan to reflect the new learning needs.

A Learning Plan is a dynamic document. The CNO encourages nurses to review their plan regularly and make adjustments to goals and activities as needed. The QA program is a continuous process, and the Learning Plan should evolve with the nurse's practice.

Question 36: The practical nurse has determined that a situation involving a patient has become an ethical dilemma. What is the critical first step in resolving an ethical dilemma?

Gather all relevant information regarding the ethical dilemma. (Correct answer)
List the ethical principles that relate to the ethical dilemma.
Ensure that the attending physician has written an order to support the ethics process.
Consult a professional ethicist to ensure that the steps of resolving an ethical dilemma are followed correctly.

Correct answer: Gather all relevant information regarding the ethical dilemma.

Explanation: Before any action can be taken to address an ethical dilemma, it is essential to gather all pertinent information about the situation. This includes understanding the facts, perspectives of stakeholders, and relevant ethical principles involved. Once all relevant information is gathered, the nurse can then proceed to analyze the situation, identify possible courses of action, and make an informed decision based on ethical principles and professional standards.

Question 37: Defining lines that separate the therapeutic behavior's of an RPN from any behavior's that, well-intentioned or not, could reduce the benefit of nursing care to clients, families, or communities.

Community
Accountability
Boundary (Correct answer)
Advocate

Correct answer: Boundary

Explanation: Boundaries in nursing refer to the defining lines that separate therapeutic behaviors from any behaviors that, regardless of intentions, could potentially reduce the benefit of nursing care to clients, families, or communities. Maintaining professional boundaries is essential for providing safe, effective, and ethical nursing care.

Question 38: A nurse is documenting the administration of a PRN (as needed) dose of morphine for a client's post-operative pain. In addition to the date, time, drug, dose, and route, what other information is essential to include in the client's record to meet CNO documentation standards?

The pre-administration pain assessment and the post-administration evaluation of the medication's effectiveness. (Correct answer)
The client's expected discharge date.
The name of the pharmacist who dispensed the medication.
The time the client's family was notified.

Correct answer: The pre-administration pain assessment and the post-administration evaluation of the medication's effectiveness.

CNO's Documentation standard requires a clear, complete, and accurate record of the care provided. For PRN medications, this includes not only the details of administration but also the nursing assessment that justified giving the dose (the 'right reason') and the evaluation of its outcome (the 'right evaluation'), which demonstrates the nurse's application of the nursing process.

Question 39: An RN in a public hospital independently decides to insert a finger beyond the anal verge to assess for fecal impaction, which is a controlled act. In this setting, the nurse requires which of the following to perform this act?

Confirmation of their own competence and the client's consent.
Verbal permission from the charge nurse.
A direct order from a physician or Nurse Practitioner. (Correct answer)
A personal liability insurance policy.

Correct answer: A direct order from a physician or Nurse Practitioner.

While RNs and RPNs can initiate certain controlled acts in some settings, the Public Hospitals Act restricts this authority. In a hospital, an order from an authorized provider (like a physician or NP) is required for a nurse to perform most controlled acts, including putting a finger beyond the anal verge.

Question 40: According to the CNO's Code of Conduct, what is the primary accountability of a nurse when they identify a conflict between their personal beliefs and a client's care plan?

To inform the client about the personal conflict and offer alternative care options.
To transfer care of the client to another nurse immediately.
To provide safe, compassionate, and timely care until other arrangements are made. (Correct answer)
To document the conflict in the client's chart and seek guidance from the ethics committee.

Correct answer: To provide safe, compassionate, and timely care until other arrangements are made.

The CNO's Code of Conduct stipulates that nurses must prioritize the client's well-being. If a personal belief conflicts with the client's care plan, the nurse's immediate responsibility is to continue providing safe and compassionate care to ensure there is no gap in service or harm to the client, while arrangements for an alternative caregiver are established.

Question 41: At every stage of life, health is determined by complex interactions among social and economic factors, the physical environment, and individual behaviour. They do not exist in isolation from each other. These determinants, in combination, influence health status.

Determinants of health (Correct answer)
Population
Competence
Evidence-informed practice

Correct answer: Determinants of health

Explanation: The passage describes how health is influenced by various factors, including social and economic factors, the physical environment, and individual behavior. These factors collectively shape an individual's health status and are known as determinants of health.

Question 42: A nurse is preparing to administer an intramuscular injection. According to the principles of Routine Practices, what is the minimum Personal Protective Equipment (PPE) the nurse should wear?

No PPE is required as injections are a sterile procedure.
Gloves only. (Correct answer)
A surgical mask and eye protection.
A gown and gloves.

Correct answer: Gloves only.

Routine Practices are based on a point-of-care risk assessment (PCRA). When performing a procedure like an intramuscular injection, there is a risk of exposure to blood or body fluids, even if minimal. Therefore, wearing gloves is the minimum required PPE to protect the nurse from potential exposure at the injection site.

Question 43: When documenting a health assessment finding as 'WNL,' what does this abbreviation mean?

Well-Nourished Level
Within Normal Limits (Correct answer)
Without Neurological Loss
Wound Noted on Left

Correct answer: Within Normal Limits

'WNL' stands for Within Normal Limits and is used in nursing documentation to indicate that a finding is within expected parameters.

Question 44: The '5 Rights of Medication Administration' include the right client, right drug, right dose, right route, and:

Right hospital
Right diagnosis
Right time (Correct answer)
Right nurse

Correct answer: Right time

The 5 Rights are client, drug, dose, route, and time — foundational checks to prevent medication errors.

Question 45: A client who is confused attempts to remove their IV line. What is the least restrictive intervention a nurse should try first?

Discharge the client
Apply wrist restraints immediately
Reorient the client, involve family, and explore alternatives such as distraction or IV line camouflage (Correct answer)
Administer sedation

Correct answer: Reorient the client, involve family, and explore alternatives such as distraction or IV line camouflage

Least-restrictive alternatives such as reorientation, family engagement, and environmental strategies should always be tried before physical restraints.

Question 46: A nurse is caring for a client newly diagnosed with a chronic illness who expresses feeling overwhelmed and alone. The nurse also has the same chronic illness. When considering the use of self-disclosure, what is the nurse's primary consideration?

Whether the disclosure will make the nurse feel more connected to the client.
How much personal detail the nurse is comfortable sharing with the client.
Whether the disclosure will serve a therapeutic purpose for the client. (Correct answer)
If the nurse's manager would approve of sharing personal health information.

Correct answer: Whether the disclosure will serve a therapeutic purpose for the client.

The CNO standards emphasize that self-disclosure should be used cautiously and only when it serves the client's therapeutic needs. The primary goal is to benefit the client by, for example, instilling hope or normalizing their experience, not to meet the nurse's own needs for connection or validation.

Question 47: An RPN orders an RPN colleague to insert a urethral catheter into a newly admitted client. What should the RPN colleague do?

Decline to accept the order (Correct answer)
Accept the order and proceed with the intervention
Consult with an RN before proceeding with the intervention
Confirm the order with a physician before proceeding with the intervention

Correct answer: Decline to accept the order

Explanation: This scenario involves a situation where an RPN is being asked to perform a procedure that may be beyond their scope of practice. To ensure safe and effective care, the RPN colleague should decline to accept the order. RPNs are required to work within their scope of practice and should not perform tasks for which they are not qualified or authorized. Consulting with an RN or confirming the order with a physician may be appropriate steps if there is uncertainty about the order or if clarification is needed regarding the client's care plan. However, the primary action should be to decline the order to ensure patient safety and adhere to professional standards.

Question 48: In clinical decision making, which action best reflects evidence-based practice as required by CNO standards?

Applying the same intervention to all clients with similar diagnoses
Using validated research evidence combined with clinical expertise and client preferences (Correct answer)
Following only physician orders without independent nursing judgment
Relying solely on personal experience when making care decisions

Correct answer: Using validated research evidence combined with clinical expertise and client preferences

Evidence-based practice requires integrating best available research, clinical expertise, and client preferences to guide nursing decisions.

Question 49: A competent client with a history of hypertension refuses their scheduled dose of metoprolol, stating, "I feel fine today and I don't want to take it." Which action by the nurse demonstrates accountability and respect for the client's right to refuse?

Insisting the client take the medication by explaining the risks of a hypertensive crisis.
Telling the client they cannot be responsible for what happens if they don't take the medication.
Hiding the medication in the client's food to ensure they receive the dose.
Documenting the refusal on the MAR and notifying the prescriber of the missed dose. (Correct answer)

Correct answer: Documenting the refusal on the MAR and notifying the prescriber of the missed dose.

According to the CNO standards and the 10 Rights of Medication Administration, clients have the right to refuse medication. The nurse's professional accountability is to respect the competent client's decision, withhold the medication, document the refusal accurately, and inform the prescriber. This ensures the care team is aware of the situation and can make any necessary adjustments to the plan of care.

Question 50: A nurse is caring for a client on contact precautions. Which personal protective equipment (PPE) must be donned before entering the client's room?

Only gloves are required for contact precautions
Gloves and gown at minimum before room entry (Correct answer)
Mask and goggles only
Full PPE including N95 respirator is always required

Correct answer: Gloves and gown at minimum before room entry

Contact precautions require gloves and a gown to be donned before entering the client's room to prevent transmission of pathogens via direct or indirect contact.

Question 51: A nurse is caring for a client who has decided to refuse a life-sustaining treatment. The client's family is distressed and asks the nurse to persuade the client to change their mind. According to the CNO's ethical values, what is the nurse's primary responsibility in this situation?

To respect the client's autonomous choice, even if it conflicts with personal or family values. (Correct answer)
To respect the family's wishes and attempt to influence the client's decision.
To document the client's decision and withdraw from their care.
To request an ethics committee consultation to make the final decision.

Correct answer: To respect the client's autonomous choice, even if it conflicts with personal or family values.

The CNO's ethical framework emphasizes the value of client choice. A nurse's primary responsibility is to respect a capable client's autonomous decision, even if it conflicts with their own values or the family's wishes. The nurse should ensure the client is fully informed and their decision is voluntary, but ultimately must uphold the client's right to self-determination.

Question 52: A client in a long-term care facility asks a nurse for their personal social media profile to connect online. What is the nurse's most appropriate initial action to maintain professional boundaries?

Report the client's request to the manager as an example of inappropriate behaviour.
Accept the request to avoid hurting the client's feelings but limit interactions online.
Gently explain that their relationship is professional, not personal, and therefore decline the request. (Correct answer)
Ignore the request and change the subject to a different topic to avoid confrontation.

Correct answer: Gently explain that their relationship is professional, not personal, and therefore decline the request.

Maintaining professional boundaries is the nurse's responsibility. This response is direct, respectful, and clearly reinforces the professional nature of the relationship without being punitive. It educates the client on the boundaries of the therapeutic relationship while protecting the nurse's privacy and professional integrity.

Question 53: A client writes to the College of Nurses of Ontario (CNO) stating that a nurse assaulted him during care. What action may CNO take in this situation?

Refer the complaint to local law enforcement
Request that the nurse's employment be terminated
Report the nurse to the employer
Investigate the allegation (Correct answer)

Correct answer: Investigate the allegation

Explanation: When a client reports an allegation of assault by a nurse, the appropriate action for the College of Nurses of Ontario (CNO) is to investigate the allegation. The CNO is responsible for investigating complaints against nurses to ensure the safety and well-being of the public. This investigation process involves gathering information, interviewing relevant parties, and determining whether disciplinary action or further steps are necessary to address the complaint. Referring the complaint to the nurse's employer, requesting employment termination, or involving law enforcement may occur depending on the outcome of the investigation and the severity of the allegation, but the initial step is to investigate the allegation internally.

Question 54: Under Ontario's Health Care Consent Act, who is ultimately responsible for obtaining informed consent for a proposed treatment?

The regulated health professional proposing the treatment (Correct answer)
The hospital administrator
The charge nurse on duty
The registered nurse administering the treatment

Correct answer: The regulated health professional proposing the treatment

Under the HCCA, the health professional proposing a treatment bears responsibility for obtaining informed consent before proceeding.

Question 55: Which of the following elements is NOT required for consent to be considered informed under Ontario's Health Care Consent Act?

The expected benefits of the treatment
The material risks of the treatment
The nature of the treatment
The cost of the treatment (Correct answer)

Correct answer: The cost of the treatment

Informed consent requires disclosure of the nature, expected benefits, material risks, side effects, and alternatives — cost is not a legislated requirement.

Question 56: Under the Health Care Consent Act, which TWO criteria must BOTH be met to find a person incapable of making a treatment decision?

Diagnosis of mental illness AND refusal of recommended treatment
Inability to communicate verbally AND absence of a substitute decision maker
Age over 65 and presence of a cognitive diagnosis
Unable to understand relevant information AND unable to appreciate the consequences (Correct answer)

Correct answer: Unable to understand relevant information AND unable to appreciate the consequences

Incapacity under the HCCA requires that the person cannot understand information relevant to the decision AND cannot appreciate the reasonably foreseeable consequences of consenting or refusing.

Question 57: When assessing a client's lung sounds, the nurse hears crackles in the lower lobes bilaterally. This finding is most consistent with which condition?

Asthma
Fluid accumulation such as pulmonary edema or pneumonia (Correct answer)
Pulmonary embolism
Pleural effusion without fluid

Correct answer: Fluid accumulation such as pulmonary edema or pneumonia

Bilateral basal crackles are commonly associated with fluid in the alveoli, as seen in pulmonary edema or pneumonia.

Question 58: A community health nurse has provided care to a client for several months. The client's health goals have been met, and services are being discontinued. According to the CNO's Therapeutic Nurse-Client Relationship standard, which action is essential during the termination phase of the relationship?

Promising the client that the nurse will visit them as a friend in the future.
Reviewing the client's progress and summarizing the goals achieved together. (Correct answer)
Exchanging personal phone numbers to stay in touch socially.
Abruptly stopping all communication to encourage client independence.

Correct answer: Reviewing the client's progress and summarizing the goals achieved together.

The termination phase is a planned and professional conclusion to the nurse-client relationship. It involves summarizing the client's progress, evaluating the achievement of goals, and ensuring a smooth transition to other services or to self-care. This provides closure and reinforces the client's accomplishments.

Question 59: To determine if performing a specific activity is within their scope of practice, a nurse must consider three essential components. These are:

Client Preference, Team Consensus, and Time Availability.
Orders, Experience, and Facility Policy.
Risk Assessment, Documentation, and Peer Review.
Authority, Context, and Competence. (Correct answer)

Correct answer: Authority, Context, and Competence.

The CNO's Scope of Practice standard is structured around three key concepts that a nurse must consider before performing any activity: Authority (do I have the legal right?), Context (is it appropriate in this setting?), and Competence (do I have the knowledge, skill, and judgment?).

Question 60: A nurse assesses a client and identifies a nursing diagnosis of 'impaired gas exchange.' Which finding most directly supports this diagnosis?

Client is unable to ambulate independently
SpO2 of 88% on room air with altered mental status (Correct answer)
Client reports feeling anxious
Blood pressure of 145/90 mmHg

Correct answer: SpO2 of 88% on room air with altered mental status

An SpO2 of 88% with associated altered mental status provides objective evidence of impaired gas exchange.

Question 61: Which of the following best describes a 'near-miss' in clinical safety terminology?

A minor medication side effect that was expected
An event that could have caused harm but was intercepted before reaching the client (Correct answer)
A complaint filed by a client about nursing care
An event that caused significant client harm

Correct answer: An event that could have caused harm but was intercepted before reaching the client

A near-miss is an unplanned event that did not cause harm because it was caught in time, but reveals an existing safety gap that needs attention.

Question 62: When using the SBAR communication tool during client handover, what does the 'R' stand for?

Reassessment
Recommendation (Correct answer)
Risk
Referral

Correct answer: Recommendation

In SBAR (Situation, Background, Assessment, Recommendation), 'R' stands for Recommendation — what action the nurse is requesting.

Question 63: Which of the following responsibilities falls exclusively under the mandate of the College of Nurses of Ontario (CNO)?

Advocating for better salaries and working conditions for nurses.
Offering professional liability protection to members.
Negotiating collective bargaining agreements with employers.
Establishing requirements for entry to practice to ensure public safety. (Correct answer)

Correct answer: Establishing requirements for entry to practice to ensure public safety.

The CNO's primary mandate, as dictated by provincial legislation, is to protect the public. [29] This is achieved by regulating the nursing profession, which includes setting the standards and requirements for individuals to enter the profession. [4, 29] Advocating for nurses' working conditions and negotiating salaries are roles of a union, like the Ontario Nurses' Association (ONA), while offering liability protection and other professional development are often functions of a professional association, like the RNAO. [29, 32]

Question 64: A client offers a nurse a significant monetary gift as a thank-you for excellent care. To maintain professional boundaries as outlined by the CNO, what is the nurse's most appropriate action?

Politely decline the gift, explaining the professional boundary guidelines. (Correct answer)
Accept the gift but donate it to a charity on behalf of the unit.
Accept the gift, as declining could harm the nurse-client relationship.
Suggest the client make a donation to the hospital's foundation instead.

Correct answer: Politely decline the gift, explaining the professional boundary guidelines.

The CNO's 'Professional Boundaries and Nurse-Client Relationships' standard requires nurses to maintain boundaries to protect the therapeutic relationship. Accepting gifts can blur these lines and create a perceived or actual conflict of interest. The most professional response is to graciously refuse the gift and explain that their good care is part of their professional role and they cannot accept personal gifts.

Question 65: A nurse auscultates a client's abdomen before and after administering a nasogastric tube feeding. What is the purpose of this assessment?

To detect cardiac arrhythmias
To confirm tube placement and assess bowel sounds indicating gut motility (Correct answer)
To measure the client's pain level
To evaluate respiratory function

Correct answer: To confirm tube placement and assess bowel sounds indicating gut motility

Abdominal auscultation before tube feeding helps confirm bowel sounds are present and assesses gut motility, supporting safe enteral nutrition delivery.

Question 66: While attending to a regular client during a home visit, the nurse casually tells the client that he can’t afford his wife’s school expenses. The client offers to write the nurse a cheque.

It is not acceptable to accept this kind of gift from a client because it crosses the boundary in a nurse-client relationship. (Correct answer)
It’s OK to accept a gift from the client as long as the nurse hasn’t asked for it.
It might be appropriate to accept the gift if you consider the cultural values of the client.
It is acceptable as long as the nurse writes a promissory note to repay the money when he is able.

Correct answer: It is not acceptable to accept this kind of gift from a client because it crosses the boundary in a nurse-client relationship.

Explanation: Accepting monetary gifts from clients can compromise the professional boundaries of the nurse-client relationship and raise ethical concerns. Nurses have a duty to maintain professional boundaries and avoid situations that may influence their objectivity or create conflicts of interest. Accepting gifts of monetary value from clients can create an imbalance of power and may lead to perceptions of favoritism or exploitation. Therefore, it is generally not acceptable for nurses to accept monetary gifts from clients, regardless of whether they have solicited the gift or not.

Question 67: According to the Nursing Act, 1991, who is legally permitted to use the professional title "nurse" in Ontario?

Retired nurses who maintain their knowledge through continuing education.
Graduates of an accredited nursing program who are awaiting their registration exam results.
Any individual employed in a healthcare setting to provide direct patient care.
Only members of the College of Nurses of Ontario (CNO). (Correct answer)

Correct answer: Only members of the College of Nurses of Ontario (CNO).

The Nursing Act, 1991, protects professional titles to ensure the public can identify qualified and regulated practitioners. [4, 5] The Act explicitly states that only members of the College of Nurses of Ontario (CNO) are legally permitted to use titles such as "nurse," "Registered Nurse," or "Registered Practical Nurse." [2, 6, 11] Using the title without being a CNO member is considered an illegal practice. [4, 11]

Question 68: A client asks 'What is this medication for?' before the nurse administers it. What is the nurse's primary obligation?

Provide clear information about the medication to support ongoing informed consent (Correct answer)
Document that the client is being non-compliant with the treatment plan
Refer all medication questions to the prescribing physician before proceeding
Administer the medication as ordered without detailed explanation

Correct answer: Provide clear information about the medication to support ongoing informed consent

Nurses have a professional obligation to provide clients with information about medications and treatments to support ongoing, meaningful informed consent throughout care.

Question 69: Under Ontario's Personal Health Information Protection Act, 2004 (PHIPA), a nurse understands that they are a 'health information custodian'. This role primarily obligates the nurse to:

Obtain express written consent before sharing any information with other members of the direct care team.
Ensure all personal health information is permanently deleted upon the client's discharge.
Safeguard client information, ensuring it is collected, used, and disclosed only as permitted by law. (Correct answer)
Allow any family member to access a client's health record upon verbal request.

Correct answer: Safeguard client information, ensuring it is collected, used, and disclosed only as permitted by law.

PHIPA governs how personal health information is managed in Ontario. As health information custodians, nurses have a legal and professional duty to protect the privacy and confidentiality of client information. This includes taking reasonable steps to safeguard it from theft, loss, and unauthorized use or disclosure. Consent to share information within the direct care team is often implied, not expressly written for every interaction. Records are not permanently deleted upon discharge, and access by others is strictly controlled and requires consent or legal authority.

Question 70: Two experienced RPNs on a unit have an ongoing personal conflict that is causing tension and leading to brief, clipped communication during handover. As the RN team leader, what is the most appropriate initial action?

Meet with each RPN privately to discuss the observed communication behaviours and remind them of their professional responsibility to collaborate effectively. (Correct answer)
Change the schedule to ensure the two RPNs never work the same shifts.
Report both RPNs to the unit manager for unprofessional conduct immediately.
Address the communication issue during the team huddle, without naming the individuals involved.

Correct answer: Meet with each RPN privately to discuss the observed communication behaviours and remind them of their professional responsibility to collaborate effectively.

The CNO's guidelines on conflict management emphasize addressing issues directly and professionally. Meeting with each nurse privately is the appropriate first step to understand their perspectives, address the impact of their behaviour on the team and client care, and reinforce professional expectations without public shaming. Escalating immediately or changing the schedule avoids addressing the root problem of unprofessional communication.

Question 71: A nurse documents an assessment at 10:00 but does not have time to enter it into the electronic health record (EHR) until 13:00. Which action is most appropriate for the nurse to take when documenting the assessment?

Document the current time (13:00) in the entry and state that the assessment was completed at 10:00. (Correct answer)
Ask a colleague who was free at 10:00 to enter and sign the assessment on their behalf.
Document the entry with a time of 10:00 and add a note in the comments about the delay.
Change the computer's time to 10:00 before making the entry to ensure chronological order.

Correct answer: Document the current time (13:00) in the entry and state that the assessment was completed at 10:00.

According to the CNO's Documentation standard, entries should be contemporaneous. When this is not possible, the nurse must make a 'late entry'. A late entry requires the nurse to document the time the entry is being made and to clearly state the time the event or care actually occurred. Back-dating is inappropriate and falsifying a record. Having another person document the care you provided is also incorrect.

Question 72: Which of the following situations would require a nurse to ensure a new consent is obtained before proceeding?

The treatment plan has changed significantly from what was originally consented to (Correct answer)
The client has recovered from an unrelated illness before the scheduled procedure
A different nurse will be administering the same treatment as originally planned
The procedure will be performed in a different room than originally planned

Correct answer: The treatment plan has changed significantly from what was originally consented to

A significant change to the nature, risks, or expected benefits of a proposed treatment constitutes a material change that requires re-consent.

Question 73: A nurse who has been selected for Part B (Practice Assessment) of the QA Assessment is required to submit their Learning Plan and complete a Code of Conduct practice activity. If the QA Peer Coach assesses the submission as unsatisfactory, what is a potential next step?

The nurse's license is automatically suspended.
The nurse may be directed to complete remedial support activities, such as meeting with a Peer Coach. (Correct answer)
The nurse must pay a fine and retake the jurisprudence exam.
The nurse is automatically enrolled in a multi-year, intensive practice review.

Correct answer: The nurse may be directed to complete remedial support activities, such as meeting with a Peer Coach.

The QA program is designed to be supportive. If a Peer Coach assesses a nurse's submission as unsatisfactory, the nurse may be directed to complete remedial support activities. This typically involves a mandatory meeting with a QA Peer Coach to discuss the practice reflection and ensure the nurse is practicing safely.

Question 74: Who holds the highest priority as a substitute decision maker (SDM) for an incapable adult under Ontario's Health Care Consent Act hierarchy?

Spouse or partner
Adult child of the incapable person
Court-appointed guardian of the person with treatment authority (Correct answer)
Attorney for personal care named in a power of attorney

Correct answer: Court-appointed guardian of the person with treatment authority

A court-appointed guardian of the person who has been granted authority to make treatment decisions ranks highest in the HCCA substitute decision maker hierarchy.

Question 75: According to CNO risk management principles, what is the nurse's role when a client refuses a prescribed treatment?

Document the refusal, ensure the client has received adequate information to make an informed decision, and notify the healthcare team (Correct answer)
Contact the client's family to override the decision
Discharge the client immediately
Proceed with the treatment anyway to ensure client safety

Correct answer: Document the refusal, ensure the client has received adequate information to make an informed decision, and notify the healthcare team

Clients have the right to refuse treatment; the nurse must document the refusal, confirm informed decision-making, and communicate with the team.

Question 76: A nurse is preparing to perform a procedure on a 75-year-old client who has been deemed incapable of making treatment decisions. The client has a spouse, two adult children, and a long-time friend who holds a valid power of attorney for personal care. According to the Health Care Consent Act, 1996, from whom must the nurse obtain consent?

The client's spouse, as they are the closest next of kin.
The physician in charge of the client's care.
The two adult children, by a majority decision.
The friend who holds the power of attorney for personal care. (Correct answer)

Correct answer: The friend who holds the power of attorney for personal care.

The Health Care Consent Act, 1996, establishes a specific hierarchy for substitute decision-makers (SDMs). [3, 7] A person named as an attorney for personal care in a power of attorney document ranks higher than family members such as a spouse or children. [8, 10] Therefore, the nurse must obtain consent from the friend who holds the power of attorney.

Question 77: Which of the following is a key principle of safe client handling and mobility (SCHM) to prevent musculoskeletal injury in nurses?

Use mechanical lifts and assistive devices for all dependent transfers (Correct answer)
Rely on client cooperation alone to perform transfers safely
Always use manual lifting techniques to build strength
Limit client ambulation to prevent falls

Correct answer: Use mechanical lifts and assistive devices for all dependent transfers

Safe client handling programs require use of mechanical lifts and assistive devices to eliminate manual lifting and reduce nurse musculoskeletal injuries.

Question 78: A nurse receives a phone call from a man who identifies himself as the adult son of an elderly client on the unit. The son asks for a detailed update on his mother's condition. The client's chart has no specific instructions about disclosing information to family. What is the nurse's most appropriate action according to the Personal Health Information Protection Act, 2004 (PHIPA)?

Provide the requested information, as he is immediate family.
Ask the son for the client's date of birth to verify his identity before sharing details.
Tell the son to come to the hospital with photo ID to prove his relationship.
Inform the caller that without the client's explicit consent, no health information can be shared. (Correct answer)

Correct answer: Inform the caller that without the client's explicit consent, no health information can be shared.

The Personal Health Information Protection Act, 2004 (PHIPA) governs the collection, use, and disclosure of personal health information. [19, 24] A core principle is that consent is required for disclosure. [25] Unless the client has provided explicit consent or the son is the designated substitute decision-maker for an incapable client, the nurse cannot legally or ethically share personal health information. [23, 26] Being an immediate family member does not automatically grant access to this protected information. [26]

Question 79: A nurse is struggling with a personal health issue that they fear may be affecting their ability to practice safely. According to the CNO's professional standards, the nurse's primary responsibility is to:

Self-reflect on their health and seek help if their health affects their ability to practice safely. (Correct answer)
Take a temporary leave of absence and only self-report to the CNO if a practice error occurs.
Request a less demanding assignment from their manager without disclosing the reason.
Continue working while being extra cautious about their practice.

Correct answer: Self-reflect on their health and seek help if their health affects their ability to practice safely.

The CNO's Code of Conduct explicitly states that nurses are accountable for their own fitness to practice. This includes self-reflecting on their health and seeking assistance if a health condition could impair their ability to provide safe care. This proactive approach is essential for protecting the public.

Question 80: When creating learning goals for a Learning Plan, the CNO recommends using the SMART goal-setting process. What does the 'A' in SMART stand for?

Action-oriented
Attainable (Correct answer)
Assessed
Accountable

Correct answer: Attainable

The CNO recommends setting SMART goals, which stands for Specific, Measurable, Attainable, Relevant, and Time-limited. An attainable goal is one that can be realistically achieved based on the nurse's skill, resources, and area of practice.

Question 81: A capable client refuses a treatment the nurse believes is in the client's best interest. What is the nurse's most appropriate response?

Immediately contact the substitute decision maker
Request a psychiatric evaluation to reassess capacity
Respect the refusal, document it, and report to the team (Correct answer)
Proceed with the treatment to prevent foreseeable harm

Correct answer: Respect the refusal, document it, and report to the team

A capable client has the legal and ethical right to refuse any treatment, and the nurse must respect and document this decision even when it may result in harm.

Question 82: When performing the three checks of medication administration, the nurse reads the medication administration record (MAR), retrieves the medication, and compares it to the MAR. What is the essential third check the nurse must perform?

Asking the client if the medication looks familiar to them.
Checking the expiry date of the medication just before leaving the medication room.
Comparing the medication label to the MAR one last time at the client's bedside. (Correct answer)
Scanning the medication barcode after administering it to the client.

Correct answer: Comparing the medication label to the MAR one last time at the client's bedside.

The three checks are a fundamental safety process. The first check is when retrieving the medication, the second is when preparing it, and the crucial third check occurs at the client's bedside, comparing the medication label against the MAR just before administration. This final check confirms the 'five rights' at the point of care, minimizing the risk of error.

Question 83: A nurse is preparing to administer a high-alert medication that requires an independent double check. Which of the following actions best represents a true independent double check according to the Institute for Safe Medication Practices (ISMP) and CNO's principle of safety?

Both nurses look at the medication vial and the physician's order together at the same time.
The second nurse watches the first nurse draw up the medication and then signs the medication administration record (MAR).
The first nurse states the dose they calculated out loud, and the second nurse confirms it is correct.
The first nurse prepares the medication, and the second nurse performs their own separate check of the order, calculation, and preparation before comparing results. (Correct answer)

Correct answer: The first nurse prepares the medication, and the second nurse performs their own separate check of the order, calculation, and preparation before comparing results.

A true independent double check requires two clinicians to separately and individually check all components of the medication use process (e.g., order, dose calculation, pump settings). This prevents one nurse's potential error from influencing the other's assessment. The other options describe forms of checking that are not independent and can lead to confirmation bias.

Question 84: A nurse gives a double dose of acetaminophen (Tylenol) to a client who only requires a single dose. What, if anything, must the nurse do?

Withhold the client’s next dose of Tylenol
Report the error as soon as possible (Correct answer)
Nothing, because this is an over-the-counter medication
Ask a colleague to help assess the client

Correct answer: Report the error as soon as possible

Explanation: In this scenario, the nurse has made a medication error, which is a safety issue. Reporting the error promptly allows for proper documentation, assessment of the client's condition, and implementation of corrective actions to ensure the client's safety.

Question 85: Which of the following best describes 'implied consent' in nursing practice?

Consent obtained by a nurse in an emergency situation
Consent given by a substitute decision maker on behalf of a client
Consent given verbally without a written signature
Consent inferred from a client's actions or behavior (Correct answer)

Correct answer: Consent inferred from a client's actions or behavior

Implied consent is inferred from a client's voluntary actions, such as extending an arm for a blood pressure check, indicating agreement to the procedure.

Question 86: A nurse is assigned to care for a client with confirmed pulmonary tuberculosis. Which of the following infection control measures is a mandatory component of Airborne Precautions for this client?

Keeping the door to the client's room open to promote air circulation.
Wearing a fluid-resistant surgical mask when entering the client's room.
Ensuring healthcare providers wear a fit-tested N95 respirator when entering the client's room. (Correct answer)
Placing the client in a positive-pressure isolation room.

Correct answer: Ensuring healthcare providers wear a fit-tested N95 respirator when entering the client's room.

Airborne Precautions are required for pathogens transmitted by small airborne particles (droplet nuclei), like tuberculosis. These particles can remain suspended in the air for extended periods. To protect healthcare workers, it is mandatory to wear a fit-tested N95 respirator (or equivalent) that filters these small particles. Other requirements include placing the client in a negative-pressure room and keeping the door closed.

Question 87: When a nurse identifies an adverse event that caused client harm, which action reflects CNO's transparency and disclosure standards?

Wait to disclose until legal counsel reviews the case
Ensure the client and family are informed of what happened as soon as possible (Correct answer)
Document the event using vague language to reduce liability
Only disclose if the client asks specifically about complications

Correct answer: Ensure the client and family are informed of what happened as soon as possible

CNO standards require timely, honest disclosure of adverse events to clients and families, which supports trust and informed decision-making.

Question 88: A nurse is assessing a client who is newly admitted with heart failure. Which assessment finding requires immediate intervention?

Heart rate of 80 bpm and regular
Temperature of 37.1°C
Blood pressure of 118/76 mmHg
Respiratory rate of 28 breaths/min with use of accessory muscles (Correct answer)

Correct answer: Respiratory rate of 28 breaths/min with use of accessory muscles

Tachypnea with accessory muscle use indicates significant respiratory distress and demands immediate nursing intervention.

Question 89: An RN on a palliative care unit disagrees with a physician's decision to order a series of invasive diagnostic tests for a client who has clearly expressed a desire for comfort measures only. The RN has voiced this concern to the physician, who dismissed it. What is the RN's most appropriate next action to demonstrate leadership and client advocacy?

Discuss the situation with the client's family to gain their support in refusing the tests on the client's behalf.
Consult with the charge nurse or nurse manager to discuss the ethical conflict and determine the appropriate next steps in the chain of command. (Correct answer)
Document the disagreement and the client's wishes in the nursing notes and proceed with preparing the client for the tests.
Inform the physician that they will not participate in the care related to the ordered tests.

Correct answer: Consult with the charge nurse or nurse manager to discuss the ethical conflict and determine the appropriate next steps in the chain of command.

The most appropriate action is to follow the established organizational chain of command to resolve a professional and ethical conflict. This demonstrates leadership by using formal processes to ensure client safety and advocate for the client's expressed wishes. Documenting alone is insufficient, involving family may breach confidentiality or shift focus from the competent client's wishes, and refusing care without escalating the issue can be considered abandonment.

Question 90: A nurse is assessing a client's pain using the PQRSTU framework. What does the 'U' stand for?

Urgency
Unit of measurement
Usual pattern
Understanding (what the client thinks is causing the pain) (Correct answer)

Correct answer: Understanding (what the client thinks is causing the pain)

In the PQRSTU mnemonic, 'U' stands for Understanding — what the client believes is causing or contributing to their pain.

Question 91: Vaccinations may cause temporary discomfort but the benefits of protection from disease both for the individual and society outweigh the client's discomfort. This involves which ethical principle?

Fidelity
Autonomy
Beneficence (Correct answer)
Confidentiality

Correct answer: Beneficence

Explanation: Beneficence is an ethical principle that refers to the duty to do good and act in the best interest of the patient. In the scenario provided, the statement emphasizes that although vaccinations may cause temporary discomfort, the overall benefit of protection from disease outweighs the individual's discomfort. This reflects the principle of beneficence, as it highlights the positive outcomes and benefits of vaccination for both the individual and society as a whole.

Question 92: James, a pre-grad practical nursing student who is working on a busy surgical unit, has decided to use a portable bladder ultrasound to assess for urinary retention in a post-operative client. Can James perform this procedure?

No. James must undergo formal training before performing this procedure
No. As a student, he is not authorized to perform this procedure.
Yes. James can perform this but needs a direct order.
Yes. James can perform this procedure because it is not included in the controlled acts. (Correct answer)

Correct answer: Yes. James can perform this procedure because it is not included in the controlled acts.

Explanation: If the procedure of using a portable bladder ultrasound to assess for urinary retention is not considered a controlled act in the province of Ontario, then James, as a pre-grad practical nursing student, may indeed be able to perform this procedure under appropriate supervision and within the scope of his training.

Question 93: When caring for a client with a confirmed Clostridioides difficile (C. diff) infection, which of the following hand hygiene practices is mandatory after removing gloves and before exiting the room?

Using an alcohol-based hand rub (ABHR) with at least 70% alcohol.
Wiping hands with a disinfectant wipe used for surfaces.
Performing hand hygiene is only necessary if the hands are visibly soiled.
Washing hands with soap and running water. (Correct answer)

Correct answer: Washing hands with soap and running water.

Clostridioides difficile produces spores that are highly resistant to the alcohol found in hand sanitizers. The mechanical action of washing with soap and rinsing with running water is required to physically remove the spores from the hands. This is a critical practice to prevent the transmission of C. diff.

Question 94: A nurse disagrees with a substitute decision maker's refusal of a recommended treatment for an incapable client. What is the most appropriate first action?

Immediately file an application with the Consent and Capacity Board
Document the disagreement and take no further action
Discuss concerns with the healthcare team and consider ethics consultation (Correct answer)
Proceed with the treatment to protect the client from harm

Correct answer: Discuss concerns with the healthcare team and consider ethics consultation

When conflict arises with an SDM's decision, the nurse should first address concerns through team discussion and available resources such as ethics consultation before escalating to the Consent and Capacity Board.

Question 95: A nurse is leaving the room of a client on contact and droplet precautions for influenza. The nurse has worn gloves, a gown, a surgical mask, and eye protection. Which sequence for removing (doffing) Personal Protective Equipment (PPE) is correct to minimize self-contamination?

Mask, eye protection, gown, gloves.
Gown, gloves, mask, eye protection.
Gloves, hand hygiene, gown, hand hygiene, mask, eye protection.
Gloves, gown, perform hand hygiene, eye protection, mask, perform hand hygiene. (Correct answer)

Correct answer: Gloves, gown, perform hand hygiene, eye protection, mask, perform hand hygiene.

According to Public Health Ontario guidelines, the correct doffing sequence is designed to remove the most contaminated items first. Gloves and the gown are considered the most contaminated and are removed first. Hand hygiene is performed, followed by the removal of eye protection and the mask. A final hand hygiene is performed after all PPE has been removed.

Question 96: Mary Elizabeth, an RPN, is at her son’s bluegrass concert and someone asks for medical assistance for a man who has collapsed. She assesses that the man’s vital signs are absent and CPR is initiated. What should she consider when applying an automated external defibrillator (AED)?

She must determine if she has the knowledge, skill, and judgment to apply the AED.
She must consider that defibrillation is only one component in the continuum of care required during a cardiac arrest.
She must determine if the client’s condition warrants the performance of the procedure.
All of the above. (Correct answer)
She must determine if this is an emergency.

Correct answer: All of the above.

Explanation: In this emergency situation, Mary Elizabeth must consider several factors before applying an automated external defibrillator (AED) to the collapsed individual. These include determining if it's an emergency, if she has the knowledge and skill to use the AED if the client's condition warrants the procedure, and recognizing that defibrillation is just one part of the care needed during a cardiac arrest. Therefore, the correct answer is E) All of the above.

Question 97: A nurse observes a colleague administering medication without performing client identification checks. What is the most appropriate action?

Document nothing unless the client is harmed
Report the colleague anonymously without speaking to them
Address the concern directly with the colleague and, if needed, escalate to a supervisor (Correct answer)
Ignore it as it is not the nurse's responsibility

Correct answer: Address the concern directly with the colleague and, if needed, escalate to a supervisor

CNO standards require nurses to address unsafe practices directly with colleagues first, and escalate if the behavior continues or poses immediate risk.

Question 98: A nurse is documenting care in a shared electronic health record. Which of the following entries best demonstrates the use of objective, factual language as required by CNO standards?

Client appeared anxious and was uncooperative during dressing change.
Client is complaining of significant pain in his abdomen again.
Client's daughter is angry about the delay in her father's discharge.
Client grimaced and pulled away during dressing change, stating, 'That hurts a lot.' (Correct answer)

Correct answer: Client grimaced and pulled away during dressing change, stating, 'That hurts a lot.'

CNO documentation standards require nurses to use objective language, report observations, and avoid making value judgments or unfounded conclusions. Documenting the client's specific behaviors (grimaced, pulled away) and using a direct quote provides factual, objective data. The other options interpret the client's or family's emotional state ('anxious', 'angry') or use vague, subjective terms ('significant pain') without supporting evidence.

Question 99: According to CNO standards, when should a nurse perform a focused assessment rather than a comprehensive assessment?

On every client encounter regardless of status
Only during initial admission
Only when ordered by a physician
When a client presents with a new or changing specific symptom or concern (Correct answer)

Correct answer: When a client presents with a new or changing specific symptom or concern

A focused assessment is appropriate when evaluating a specific symptom or change in client condition, rather than performing a full head-to-toe review.

Question 100: A nurse notes that a client's capillary refill time is 4 seconds. How should the nurse interpret this finding?

Normal for elderly clients only
Abnormal — may indicate poor peripheral perfusion (Correct answer)
Indicates fluid overload
Normal — within acceptable range

Correct answer: Abnormal — may indicate poor peripheral perfusion

Normal capillary refill time is less than 2 seconds; a 4-second refill suggests impaired peripheral circulation.

Question 101: During assessment, a nurse identifies that a client has a nursing problem that was not identified on the care plan. According to CNO accountability standards, what should the nurse do?

Ignore it if it is not life-threatening
Wait until the next shift to report it
Only document it in a personal notebook
Update the plan of care and communicate the finding to the healthcare team (Correct answer)

Correct answer: Update the plan of care and communicate the finding to the healthcare team

CNO standards require nurses to update the care plan and communicate new findings to ensure continuity and safety of care.

Question 102: A client signs a consent form but demonstrates to the nurse that they do not understand the procedure they are consenting to. What is the nurse's most appropriate action?

Raise concerns with the proposing practitioner and advocate for the client to receive adequate information (Correct answer)
Accept the signed form as constituting valid legal informed consent
Re-educate the client about the procedure without consulting the proposing practitioner
Witness the signature as required by policy and file the form

Correct answer: Raise concerns with the proposing practitioner and advocate for the client to receive adequate information

A signature alone does not constitute informed consent; the nurse who identifies a client's lack of understanding must advocate for the client to receive adequate information from the proposing practitioner.

Question 103: According to the CNO Scope of Practice standard, which of the following is the primary basis for a nurse's authority to practice?

The nurse's individual competence and years of clinical experience.
The policies and procedures of the employing healthcare facility.
Provincial legislation, including the Nursing Act, 1991 and the Regulated Health Professions Act, 1991. (Correct answer)
The orders provided by a physician or nurse practitioner.

Correct answer: Provincial legislation, including the Nursing Act, 1991 and the Regulated Health Professions Act, 1991.

The CNO's Scope of Practice standard states that a nurse's authority to perform activities is defined in legislation, specifically the Nursing Act, 1991 and the Regulated Health Professions Act, 1991 (RHPA). While employer policies, orders, and individual competence are crucial factors in decision-making, the legal authority to practice originates from provincial law.

Question 104: I’m an RPN on a mental health unit. At home, I keep in touch with family and friends through Facebook. Recently, a client “poked” me and invited me to become her “friend.” How should I approach this invitation?

To maintain professional boundaries, do not accept this request. (Correct answer)
It’s OK as long as you remain professional in all of your interactions.
Technology is part of everyone’s lives, so it is expected.
Talk with your colleagues to see what they are doing.

Correct answer: To maintain professional boundaries, do not accept this request.

Explanation: As a healthcare professional, particularly in a mental health unit, maintaining professional boundaries is crucial for providing safe and effective care to clients. Accepting a client's friend request on social media platforms like Facebook blurs the lines between professional and personal relationships, which can compromise the therapeutic relationship and confidentiality. Therefore, it is important for the RPN to decline the client's invitation to maintain appropriate boundaries and uphold professional standards.

Question 105: Your client has reviewed his health record. You answered his questions to ensure he understood the record, but he wants corrections made to a consulting physician's note. What do you do?

Yes, the physicians' notes are commonly changed.
No, you can't change any health record
Yes, if this is true you can change the health record if you are in the team of care.
No, you cannot change another person's notes, you may add a note of the patient’s design or yours. (Correct answer)

Correct answer: No, you cannot change another person's notes, you may add a note of the patient’s design or yours.

Explanation: Health records are legal documents, and altering another healthcare provider's notes without their consent is not permissible. However, patients can request additions or corrections to their health records. In this scenario, the appropriate action is to inform the client that you cannot change the consulting physician's note directly. Instead, you can assist the client in adding a note of their own or yours to provide clarification or additional information. This maintains the integrity of the original note while addressing the client's concerns.

Question 106: A nurse provides education to a client about the importance of handwashing after using the washroom. This action is primarily aimed at breaking which link in the chain of infection?

Portal of Entry
Susceptible Host
Reservoir
Mode of Transmission (Correct answer)

Correct answer: Mode of Transmission

The chain of infection consists of an infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Handwashing is the single most effective way to prevent the spread of infections. It breaks the chain by interrupting the mode of transmission, preventing infectious agents from being transferred from a surface (reservoir) to a susceptible host via the hands.

Question 107: Which of the following is considered the primary purpose of nursing documentation according to the CNO's 'Documentation' practice standard?

To create a legal record to protect the nurse and the employer from litigation.
To serve as a tool for evaluating a nurse's professional practice and performance.
To provide data for quality improvement initiatives and nursing research.
To facilitate communication among healthcare providers for the continuity of client care. (Correct answer)

Correct answer: To facilitate communication among healthcare providers for the continuity of client care.

The CNO 'Documentation' practice standard identifies three key principles: Communication, Documentation Requirements (Accountability), and Information Security. The standard explicitly states that effective communication through documentation is a foundational accountability that promotes safe, coordinated, and quality nursing care by ensuring all team members have clear, complete, and accurate information. While documentation serves legal, research, and evaluation purposes, its primary function in practice is communication for client safety and continuity of care.

Question 108: According to the Health Care Consent Act, a person is presumed to be capable of making treatment decisions unless:

They are over 75 years of age
There are reasonable grounds to believe otherwise (Correct answer)
They have a diagnosed mental illness
A substitute decision maker has been appointed

Correct answer: There are reasonable grounds to believe otherwise

The HCCA establishes a presumption of capacity that can only be set aside when there are reasonable grounds to believe the person lacks capacity for the specific decision.

Question 109: Which of the following statements about an employer's role in a nurse's scope of practice is correct?

Employers are solely responsible for determining a nurse's competence to perform procedures.
Employer policies take precedence over CNO standards of practice if there is a conflict.
Employers can expand a nurse's legislated scope of practice by creating advanced-practice policies.
Employers can limit a nurse's scope of practice but cannot expand it beyond what legislation permits. (Correct answer)

Correct answer: Employers can limit a nurse's scope of practice but cannot expand it beyond what legislation permits.

According to the CNO, employers can establish policies that may restrict or limit what a nurse can do in a specific practice setting. However, they cannot authorize a nurse to perform activities that fall outside the legislated scope of nursing practice. A nurse's primary accountability is to meet CNO standards, even if they conflict with employer policies.

Question 110: A nurse uses clinical reasoning to determine that a post-operative client's increased heart rate and drop in blood pressure indicate possible internal bleeding. This is an example of which step in clinical decision making?

Data collection
Implementation
Interpretation and pattern recognition (Correct answer)
Evaluation of outcomes

Correct answer: Interpretation and pattern recognition

Recognizing that a cluster of vital sign changes points to a specific clinical problem is the interpretation and pattern recognition step of clinical decision making.

Question 111: Under which principle of the CNO's Code of Conduct does the accountability to provide inclusive and culturally safe care by practicing cultural humility fall?

Principle 4: Nurses work respectfully with the health care team.
Principle 1: Nurses respect clients' dignity.
Principle 5: Nurses act with integrity in clients' best interest.
Principle 2: Nurses provide inclusive and culturally safe care by practicing cultural humility. (Correct answer)

Correct answer: Principle 2: Nurses provide inclusive and culturally safe care by practicing cultural humility.

The CNO Code of Conduct is structured around six key principles. Principle 2 is explicitly defined as 'Nurses provide inclusive and culturally safe care by practicing cultural humility.' This principle guides nurses to acknowledge and respond to the unique values, beliefs, and lived experiences of each client.

Question 112: I am an RPN in an acute setting. I think that a medical directive for narcotic use for patients with chronic pain would be helpful. Is this appropriate?

No. This would not be appropriate. (Correct answer)
Yes. This would be appropriate.
Yes. This would be in the best interest of the patient’s pain management.
No. Only an RN can use a medical directive in this situation. An RPN must have an order.

Correct answer: No. This would not be appropriate.

Explanation: In an acute setting, the use of medical directives for narcotic administration, especially for patients with chronic pain, may not be appropriate. Medical directives typically apply to specific procedures or interventions and may not be suitable for managing chronic conditions like pain. Instead, patients with chronic pain should have individualized care plans developed in collaboration with healthcare providers, including physicians, RNs, and other members of the healthcare team. RPNs should adhere to established protocols and obtain orders from authorized healthcare providers for medication administration, including narcotics, to ensure patient safety and legal compliance. Therefore, relying solely on a medical directive for narcotic use in this situation may not provide comprehensive and individualized care for patients with chronic pain.

Question 113: A nurse gives a double dose of acetaminophen (Tylenol) to a client who only requires a single dose. What, if anything, must the nurse do?

Nothing, because this is an over-the-counter medication
Report the error as soon as possible (Correct answer)
Withhold the client’s next dose of Tylenol
Ask a colleague to help assess the client

Correct answer: Report the error as soon as possible

Explanation: In this scenario, the nurse has made a medication error by giving a double dose of acetaminophen (Tylenol) to the client. The appropriate action for the nurse to take is to report the error as soon as possible. Reporting medication errors promptly allows for proper documentation, assessment of the client's condition, and implementation of corrective actions to ensure the client's safety. It is essential to follow organizational policies and procedures for reporting medication errors to prevent harm to the client and improve patient safety.

Question 114: When making treatment decisions on behalf of an incapable person, what standard must a substitute decision maker apply first?

The prior capable wishes expressed by the incapable person when they were capable (Correct answer)
The consensus of the majority of family members present
What the SDM believes is in the incapable person's best medical interest
The recommendation of the treating healthcare team

Correct answer: The prior capable wishes expressed by the incapable person when they were capable

SDMs must first apply any prior capable wishes expressed by the incapable person; only when no wishes are known may they use the best interests standard.

Question 115: A nurse living in a small, remote community is asked by a close friend to provide ongoing wound care for them at home following a minor surgery, as the local clinic has a long waitlist. According to the CNO's 'Professional Boundaries and Nurse-Client Relationships' standard, what is the most appropriate initial response?

Refuse to provide any care, as treating friends is always a boundary violation.
Agree to provide care but insist on being paid to make it a professional arrangement.
Acknowledge the dual roles, set clear boundaries, and agree to provide care only until another provider is available. (Correct answer)
Provide the care without any specific discussion about boundaries, as it is a friend in need.

Correct answer: Acknowledge the dual roles, set clear boundaries, and agree to provide care only until another provider is available.

The CNO acknowledges that in limited circumstances, such as in small communities, nurses may need to provide care to family or friends. The standard requires the nurse to acknowledge the dual roles, establish clear professional boundaries, and transfer care to another provider as soon as one becomes available. An absolute refusal may not be appropriate if no other care is available.

Question 116: A client with limited English proficiency is scheduled for surgery. The surgeon has explained the procedure, but the nurse assesses that the client may not fully understand the risks and benefits. To uphold the ethical value of 'client choice,' what should the nurse do?

Advocate for the client by requesting a qualified medical interpreter to ensure informed consent. (Correct answer)
Document the concern in the client's chart and take no further action.
Ask a family member who speaks some English to translate.
Proceed with the pre-operative checklist as the surgeon has already obtained consent.

Correct answer: Advocate for the client by requesting a qualified medical interpreter to ensure informed consent.

Informed consent is a cornerstone of the ethical value of client choice. For consent to be truly informed, the client must understand the information provided. The nurse acts as a client advocate by ensuring communication barriers are properly addressed through a qualified medical interpreter, rather than relying on family members who may not be impartial or understand medical terminology.

Question 117: The CNO's requirement for all regulated health colleges in Ontario to establish and maintain a Quality Assurance Program is mandated by which legislation?

The Personal Health Information Protection Act, 2004 (PHIPA)
The Health Care Consent Act, 1996
The Regulated Health Professions Act, 1991 (RHPA) (Correct answer)
The Nursing Act, 1991

Correct answer: The Regulated Health Professions Act, 1991 (RHPA)

The Regulated Health Professions Act, 1991 (RHPA) requires all health regulatory colleges in Ontario, including the CNO, to establish and administer a Quality Assurance Program to ensure members practice competently and safely.

Question 118: A nurse is about to administer blood to a client. Which safety check is essential immediately before beginning the transfusion?

Check the client's pain score
Verify client identity and blood product details with a second nurse at the bedside (Correct answer)
Measure the client's weight
Confirm the client's dietary preferences

Correct answer: Verify client identity and blood product details with a second nurse at the bedside

Blood transfusion requires a two-nurse verification of client identity and blood product compatibility to prevent potentially fatal transfusion reactions.

Question 119: A client who was previously capable and is now found incapable once stated clearly that they never wanted cardiopulmonary resuscitation. What is this statement's legal status?

An informal oral statement with no legal weight under the HCCA
A prior capable wish that the substitute decision maker is legally obligated to follow (Correct answer)
An advance directive that is no longer enforceable once the person loses capacity
A general preference that requires physician verification before it can be honored

Correct answer: A prior capable wish that the substitute decision maker is legally obligated to follow

Prior capable wishes expressed by a person while capable retain their legal force under the HCCA and must be followed by the substitute decision maker.

Question 120: A client who appears intoxicated requires emergency treatment. What is the nurse's most appropriate approach?

Administer all necessary treatment under blanket emergency consent without capacity assessment
Defer all treatment until the client is sober and fully capable
Assess the client's current capacity and apply emergency provisions if the client is currently incapable and treatment is urgent (Correct answer)
Assume the client is incapable and contact an SDM before initiating any treatment

Correct answer: Assess the client's current capacity and apply emergency provisions if the client is currently incapable and treatment is urgent

Intoxication may temporarily impair capacity; nurses must assess present capacity and apply appropriate emergency provisions if the client is currently incapable and urgently needs treatment.

Question 121: I’m an RPN working in a long-term care home. At my workplace, off-site physicians sometimes prescribe antihypertensive medications via telephone. Can I use a physician’s signature stamp on orders received by telephone?

Yes. You can use the stamp but you are responsible for getting a follow-up signature.
No. You are responsible for ensuring the off-site physician comes to sign in person.
Yes. This is appropriate to use the stamp.
No. It is not appropriate to use the stamp. (Correct answer)

Correct answer: No. It is not appropriate to use the stamp.

Explanation: It is not appropriate to use the stamp. Using a physician's signature stamp on orders received by telephone is not appropriate practice in healthcare settings, especially in long-term care homes. It's essential to ensure the authenticity of orders, maintain accurate documentation, and adhere to professional standards. Therefore, it is not appropriate to use a signature stamp in this situation, as it could compromise patient safety and legal validity of the orders.

Question 122: What is the relationship between the Regulated Health Professions Act, 1991 (RHPA) and the Nursing Act, 1991?

The two acts are independent and do not relate to one another in the regulation of nursing.
The RHPA applies only to physicians and surgeons, while the Nursing Act applies to all other nurses.
The Nursing Act is the primary legislation, and the RHPA provides supplementary, optional guidelines.
The RHPA is an umbrella legislation for all regulated health professions, while the Nursing Act contains provisions specific to nursing. (Correct answer)

Correct answer: The RHPA is an umbrella legislation for all regulated health professions, while the Nursing Act contains provisions specific to nursing.

The Regulated Health Professions Act, 1991 (RHPA) is the overarching framework that governs all self-regulated health professions in Ontario. [5, 9, 14] The Nursing Act, 1991, is a profession-specific act that works in conjunction with the RHPA. [4, 20] The Nursing Act establishes the CNO and provides specific rules and regulations for the nursing profession that complement the general rules laid out in the RHPA. [4, 9]

Question 123: During a head-to-toe assessment, a CNO-registered nurse notes that a client has unequal pupils. What is the nurse's priority action?

Document the finding and continue the assessment
Reposition the client and reassess in one hour
Notify the physician immediately as this may indicate a neurological emergency (Correct answer)
Administer prescribed pain medication

Correct answer: Notify the physician immediately as this may indicate a neurological emergency

Unequal pupils (anisocoria) can indicate a serious neurological condition such as increased intracranial pressure, requiring immediate physician notification.

Question 124: A Registered Nurse (RN) delegates the task of performing a simple dressing change, which is below the dermis, to an Unregulated Care Provider (UCP) for a stable client. Who is ultimately accountable for the decision to delegate this controlled act?

The client, as they consented to the care.
The healthcare facility, as it has policies on task assignment.
The UCP, as they are the one performing the task.
The RN who delegated the task. (Correct answer)

Correct answer: The RN who delegated the task.

The CNO's Scope of Practice standard clarifies that when a nurse delegates a controlled act, they are responsible for the decision to delegate. This includes ensuring that the delegatee is competent to perform the act safely. While the UCP is responsible for performing the task properly, the delegating nurse retains accountability for the delegation decision itself.

Question 125: Which of the following is the best example of appropriate professional intimacy within a nurse-client relationship?

Sharing details about the nurse's own challenging family situation to build rapport.
Gently holding a distressed client's hand while providing emotional support. (Correct answer)
Asking a client for details about their romantic life to offer personal advice.
Inviting a client to a personal social gathering after they are discharged.

Correct answer: Gently holding a distressed client's hand while providing emotional support.

Professional intimacy involves the psychological, spiritual, and physical aspects of care that create closeness but remain within professional boundaries. Holding a hand for comfort is a therapeutic action that serves the client's emotional needs, whereas the other options cross into a personal or social relationship.

Question 126: A client is identified as a high fall-risk. Which intervention is most appropriate as a first-line safety measure?

Implement a fall prevention care plan including bed alarms, non-slip footwear, and frequent rounding (Correct answer)
Increase sedation to reduce mobility
Keep the client in bed at all times
Apply physical restraints immediately

Correct answer: Implement a fall prevention care plan including bed alarms, non-slip footwear, and frequent rounding

Evidence-based fall prevention combines environmental modifications, assistive devices, client education, and regular monitoring.

Question 127: A nurse has been randomly selected by the CNO for a Quality Assurance (QA) Assessment. What is the primary purpose of this component of the QA Program?

To promote continuing competence and the quality improvement of a nurse's practice. (Correct answer)
To rank nurses' performance for employers.
To gather statistical data on nursing specializations across the province.
To discipline nurses who are not meeting practice standards.

Correct answer: To promote continuing competence and the quality improvement of a nurse's practice.

The CNO states that the purpose of the QA Assessment is to promote nurses' continuing competence and quality improvement of their practice. It is a supportive process that may involve coaching and, if needed, remedial support, rather than a disciplinary measure.

Question 128: Hazel is a 55-year-old woman who has been living in an inner-city shelter for several months. She has COPD and gets pneumonia easily. She is currently on three inhalers several times per day. Hazel is a social smoker. What is your priority as a nurse leader in Hazel’s care?

Teach Hazel about the need to quit smoking.
Ensure that you document Hazel’s behaviour as typically non-compliant.
Take charge of providing the inhalers for Hazel and administer them to her at regular intervals.
Acknowledge that smoking may contribute to exacerbations of COPD and ensure Hazel knows how to use all three inhalers effectively. (Correct answer)

Correct answer: Acknowledge that smoking may contribute to exacerbations of COPD and ensure Hazel knows how to use all three inhalers effectively.

Explanation: The priority for Hazel's care is to ensure her safety and well-being while addressing both her physiological and psychosocial needs. Therefore, the most appropriate action is to acknowledge that smoking may contribute to exacerbations of COPD and ensure Hazel knows how to use all three inhalers effectively. This option prioritizes educating Hazel about managing her COPD while considering the impact of smoking on her health, addressing both her immediate health needs and her autonomy.

Question 129: A client does not speak the same language as the healthcare team and consent is required for a non-emergency procedure. What is the nurse's primary obligation?

Proceed with care and document the language barrier in the client's chart
Arrange for a qualified interpreter to ensure the client can give informed consent (Correct answer)
Defer non-emergency care until administration arranges translation services
Use an available family member as interpreter to facilitate consent

Correct answer: Arrange for a qualified interpreter to ensure the client can give informed consent

Nurses must ensure clients can access information in a language they understand; using qualified interpreters — not family members — protects the integrity and confidentiality of the consent process.

Question 130: A client who consented to surgery last week now expresses hesitation immediately before the procedure. What should the nurse do?

Stop and notify the surgeon, as clients may withdraw consent at any time (Correct answer)
Proceed because consent was already documented and legally valid
Document the concern and proceed according to the signed consent form
Reassure the client briefly and continue as planned

Correct answer: Stop and notify the surgeon, as clients may withdraw consent at any time

Clients have the right to withdraw consent at any point, and any expression of doubt or withdrawal must be communicated to the responsible practitioner before proceeding.

Question 131: A Registered Practical Nurse (RPN) working in a community clinic is asked by a physician to administer a substance by injection, a controlled act. The RPN has not performed this specific type of injection before. What is the most appropriate initial action for the RPN to take?

Decline to perform the procedure and report the physician for inappropriate delegation.
Ask a Registered Nurse (RN) colleague to perform the injection for them.
Administer the injection as ordered, as it is a controlled act authorized to nursing.
Reflect on their individual competence and inform the physician they lack the knowledge, skill, and judgment to perform the act safely. (Correct answer)

Correct answer: Reflect on their individual competence and inform the physician they lack the knowledge, skill, and judgment to perform the act safely.

The CNO's Scope of Practice standard requires nurses to consider three key concepts: authority, context, and competence. While the RPN has the authority to perform the controlled act with an order, they are accountable for ensuring they have the individual competence (knowledge, skill, and judgment) to do so safely. The most appropriate action is to recognize their limitations and communicate this to the ordering provider.

CNO College of Nurses of Ontario Exam

The CNO (College of Nurses of Ontario) registration exam assesses competency in safe and effective care, professional responsibility, ethical practice, legal and regulatory frameworks, and safe medication administration for Ontario nurses.

130

Questions

300 min

Time Limit

70%

To Pass

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