CPNRE Canadian Practical Nurse Registration Exam — Questions and Answers

Question 1: During the pre-operative checklist, the PN confirms the client has signed the surgical consent form. Which of the following best describes the PN's role regarding informed consent?

Obtain the signature once the surgeon has explained the procedure (Correct answer)
Ensure the consent is signed at least 24 hours before the procedure
Witness the signature and document, but do not provide information about surgical risks
Explain the procedure, risks, and alternatives to ensure understanding

Correct answer: Obtain the signature once the surgeon has explained the procedure

Informed consent is the surgeon's legal responsibility to explain. The PN's role is to witness the signature after the surgeon has already obtained informed consent, and to notify the surgeon if the client has unanswered questions or expresses doubt.

Question 2: A nurse notices that a client frequently monopolizes group therapy sessions with lengthy personal stories, causing other clients to disengage. The nurse is aware of their own growing frustration with this client. According to principles of the therapeutic nurse-client relationship, the nurse's FIRST priority should be to:

Manage the countertransference by reflecting on personal feelings through supervision or journaling before allowing frustration to influence clinical actions. (Correct answer)
Set a clear time limit for the client's contributions in the next session to ensure equitable group participation.
Discuss the client's behavior with other group members to gain their perspective and consensus on how to address it.
Reassign the client to individual therapy where monopolizing behavior will not affect others.

Correct answer: Manage the countertransference by reflecting on personal feelings through supervision or journaling before allowing frustration to influence clinical actions.

Countertransference — emotional reactions the nurse has toward a client — must be recognized and managed before it affects care. The nurse's first obligation is self-awareness and seeking clinical supervision or engaging in reflective practice. Acting on unprocessed frustration risks boundary violations or punitive responses. Option B may be clinically appropriate later but should not be the first action without processing the nurse's countertransference. Option C breaches confidentiality and is not appropriate. Option D is an avoidance strategy that does not address the underlying clinical or interpersonal dynamics.

Question 3: A practical nurse is assessing a client's peripheral vascular status. The dorsalis pedis pulse is absent bilaterally, but the client reports calf pain only when walking that is relieved by rest. The skin is cool, shiny, and hairless below the knees. The ankle-brachial index (ABI) would be expected to fall in which range, and what does it indicate?

ABI < 0.4, indicating critical limb ischemia with rest pain and imminent tissue loss
ABI > 1.3, indicating arterial wall calcification causing falsely elevated readings (non-compressible vessels)
ABI 0.5–0.8, indicating moderate peripheral arterial disease consistent with intermittent claudication (Correct answer)
ABI 0.9–1.2, indicating normal arterial perfusion despite the clinical findings

Correct answer: ABI 0.5–0.8, indicating moderate peripheral arterial disease consistent with intermittent claudication

The classic triad of intermittent claudication (exertional pain relieved by rest), absent distal pulses, and trophic skin changes (cool, hairless, shiny skin) is consistent with moderate peripheral arterial disease (PAD). An ABI of 0.5–0.8 corresponds to moderate PAD and correlates with claudication symptoms. An ABI < 0.4 indicates critical ischemia, which presents with REST pain (not only with walking), ulceration, or gangrene — more severe than described. An ABI > 1.3 suggests non-compressible calcified vessels (common in diabetics/renal failure), and a normal ABI (0.9–1.2) would contradict the clinical presentation.

Question 4: Which of the following is a key principle of effective interprofessional collaboration in a healthcare setting?

Mutual respect, shared decision-making, and open communication among all team members, including the client. (Correct answer)
A hierarchical structure where the physician makes all final decisions for the team.
Ensuring that each profession's roles are kept separate to avoid overlap and conflict.
Each team member working independently on their tasks to maximize efficiency.

Correct answer: Mutual respect, shared decision-making, and open communication among all team members, including the client.

Effective interprofessional collaboration is built on a foundation of mutual respect for each member's expertise, a client-centered approach that involves shared decision-making, and clear, open communication. This approach contrasts with hierarchical or siloed models and leads to improved patient outcomes.

Question 5: A client with a spinal cord injury at C5 develops bradycardia and hypertension, with a blood pressure of 190/110 mmHg, along with pounding headache and profuse sweating above the injury level. The nurse should first:

Place the client flat and assess for urinary retention
Apply oxygen and prepare for emergency intubation
Sit the client upright and assess for a noxious stimulus below the injury (Correct answer)
Administer antihypertensives as ordered

Correct answer: Sit the client upright and assess for a noxious stimulus below the injury

These signs indicate autonomic dysreflexia; sitting the client upright to lower blood pressure and identifying/eliminating the triggering noxious stimulus (commonly bladder distension) is the priority.

Question 6: A PN is asked by a physician to perform a procedure the PN has never done before. The most appropriate response is to:

Complete the procedure and document any uncertainty
Ask a coworker to observe and guide during the procedure
Refuse the procedure and explain lack of competence (Correct answer)
Perform the procedure following the physician's verbal instructions

Correct answer: Refuse the procedure and explain lack of competence

PNs must only perform procedures within their competence; practicing outside competence violates professional standards and endangers clients.

Question 7: A practical nurse notices that teenage pregnancy rates are high in a rural community. The MOST effective primary prevention strategy would be to:

Create support groups for single-parent families
Provide prenatal care clinics for pregnant teens
Implement comprehensive sex education in schools (Correct answer)
Offer parenting classes for young mothers

Correct answer: Implement comprehensive sex education in schools

Comprehensive sex education is a primary prevention strategy that addresses the root cause by providing knowledge and skills before pregnancy occurs.

Question 8: While assessing a client's respiratory status, the practical nurse hears a high-pitched, musical sound on expiration. This finding is best described as:

Rhonchi
Stridor
Crackles
Wheezing (Correct answer)

Correct answer: Wheezing

Wheezing is a high-pitched, musical sound heard on expiration caused by narrowed airways, commonly associated with asthma or bronchospasm.

Question 9: Which response demonstrates motivational interviewing (MI) techniques with a client ambivalent about taking antidepressants?

'Let's talk about something else until you feel ready.'
'You will not get better without medication. Your doctor knows best.'
'What are your concerns about the medication, and what might be some potential benefits for you?' (Correct answer)
'These medications are very effective. You really should try them.'

Correct answer: 'What are your concerns about the medication, and what might be some potential benefits for you?'

Asking about both concerns and potential benefits elicits the client's ambivalence and engages their own motivation, a core MI technique.

Question 10: A client with dementia becomes agitated and refuses their morning medication. The Practical Nurse documents the refusal and informs the charge nurse. Later, the client's family insists the medication must be given. What is the PN's most appropriate legal and ethical response?

Explain to the family that a competent client has the right to refuse treatment. (Correct answer)
Inform the family that since the client has dementia, their refusal is not valid.
Request the family to sign a waiver before administering the medication.
Administer the medication discreetly in the client's food.

Correct answer: Explain to the family that a competent client has the right to refuse treatment.

Even with a diagnosis of dementia, a client may still have the capacity to make decisions. The fundamental ethical and legal principle is the client's right to autonomy and informed refusal of treatment. Forcing medication would be considered battery. The PN's responsibility is to respect the client's decision, document it, and communicate this to the family and the healthcare team.

Question 11: A nurse uses silence during an interaction with a grieving client. What is the primary therapeutic purpose of this technique?

It gives the nurse time to think of the next question.
It discourages the client from speaking about distressing topics.
It demonstrates the nurse's discomfort with emotional conversations.
It communicates presence, acceptance, and provides space for the client to process emotions. (Correct answer)

Correct answer: It communicates presence, acceptance, and provides space for the client to process emotions.

Therapeutic silence conveys empathy and gives clients the space to reflect, feel heard, and continue at their own pace.

Question 12: A PN administers a medication that was correctly transcribed from a physician's verbal order. The patient suffers a serious adverse reaction. An investigation reveals the original verbal order itself was inappropriate for the patient's documented allergy, which was clearly visible in the chart. Regarding professional accountability, which statement is most accurate?

The PN shares accountability for failing to apply independent clinical judgment before administering the medication (Correct answer)
The PN bears no accountability because the error originated with the physician's verbal order
The PN is protected from accountability because following a physician order is a legally mandated duty
Accountability rests solely with the transcribing nurse who converted the verbal order to written form

Correct answer: The PN shares accountability for failing to apply independent clinical judgment before administering the medication

Professional accountability is not absolved simply by following an order. Each nurse has an independent, non-delegable duty to exercise clinical judgment before administering any medication, including verifying allergies, appropriateness of dose, and contraindications. The documented allergy was accessible; the PN's failure to identify this conflict constitutes a breach of the standard of practice. Regulatory bodies across Canada hold nurses accountable for their own independent assessment, regardless of the order's source.

Question 13: A community health nurse applies the Ottawa Charter for Health Promotion. Which action reflects the 'building healthy public policy' action area?

Advocating for a workplace smoke-free policy (Correct answer)
Teaching a client about healthy eating habits
Establishing a walking club for seniors in the community
Providing a client with information about cancer screening

Correct answer: Advocating for a workplace smoke-free policy

Building healthy public policy involves creating laws, regulations, and policies (such as workplace smoke-free rules) that make healthy choices easier.

Question 14: A client with anorexia nervosa has BMI 14.5 and is medically unstable. What is the priority focus of nursing care?

Encouraging immediate group therapy participation
Discussing meal planning to increase caloric intake
Medical stabilization: monitoring vital signs, electrolytes, and cardiac function (Correct answer)
Promoting insight into distorted body image through therapeutic conversations

Correct answer: Medical stabilization: monitoring vital signs, electrolytes, and cardiac function

Medical stabilization is the priority when a client with anorexia is medically unstable. Life-threatening cardiac dysrhythmias and refeeding syndrome must be addressed first.

Question 15: A practical nurse is caring for a client who has expressed a desire to refuse further life-sustaining treatment. The client's family is strongly opposed to this decision. Which of the following actions best demonstrates the practical nurse's adherence to ethical principles?

Following the family's wishes, as they are the client's support system.
Advocating for the client's right to autonomy and informed decision-making. (Correct answer)
Requesting a psychiatric evaluation to assess the client's decision-making capacity.
Organizing a meeting with the hospital's ethics committee without the client's knowledge.

Correct answer: Advocating for the client's right to autonomy and informed decision-making.

The core ethical principle of autonomy respects the client's right to make their own decisions about their healthcare, even if those decisions conflict with the views of their family or the healthcare team. The practical nurse's primary responsibility is to the client. Advocating for the client's decision upholds this principle. While assessing capacity is important, requesting a psychiatric evaluation without a clear indication of incapacity could be seen as challenging the client's autonomy. Following the family's wishes or involving the ethics committee without consent would violate the principles of client-centered care and confidentiality.

Question 16: A nurse is caring for a postoperative client who had a thyroidectomy 8 hours ago. The client reports tingling around the mouth and fingertips. Chvostek's sign is positive. Which intervention is MOST appropriate as the immediate priority?

Prepare to administer IV calcium gluconate as ordered (Correct answer)
Encourage the client to consume high-calcium foods from the meal tray
Apply supplemental oxygen via nasal cannula at 2 L/min
Elevate the head of the bed to 90 degrees to reduce airway pressure

Correct answer: Prepare to administer IV calcium gluconate as ordered

Perioral tingling, fingertip tingling, and a positive Chvostek's sign are classic indicators of hypocalcemia, which can occur after thyroidectomy due to inadvertent damage or removal of the parathyroid glands. Hypocalcemia can progress rapidly to laryngospasm and tetany, making IV calcium gluconate the priority intervention. Oral calcium intake is far too slow for an acute symptomatic presentation. Oxygen and positioning address airway management but do not correct the underlying electrolyte deficiency causing the symptoms.

Question 17: A practical nurse on a medical unit is preparing to administer an enteral feeding via nasogastric tube to a client who is semi-conscious following a stroke. Before initiating the feed, the nurse aspirates 280 mL of gastric residual volume (GRV). Current agency policy states: hold the feeding and reassess in 1 hour if GRV exceeds 250 mL. The client's last feeding was 4 hours ago. Which action is most appropriate?

Discard the aspirate, hold the feeding, reassess GRV in one hour, and document findings
Return the aspirate to the client, hold the feeding, and notify the physician (Correct answer)
Discard the aspirate and proceed with the feeding at half the prescribed rate
Return the aspirate, delay the feeding by 30 minutes, then proceed if GRV normalizes

Correct answer: Return the aspirate to the client, hold the feeding, and notify the physician

Current evidence and most agency policies recommend returning (re-instilling) gastric aspirate to preserve electrolytes and digestive enzymes — discarding it risks metabolic imbalance. The GRV exceeds the 250 mL policy threshold, requiring the feeding to be held. Because this is a stroke patient with altered consciousness (high aspiration risk) and a significantly elevated GRV, the physician must be notified rather than simply waiting and reassessing independently. Option A incorrectly discards the aspirate. Option C does not follow policy (the threshold was exceeded). Option D proceeds with feeding despite a contraindicated GRV.

Question 18: A practical nurse is conducting a health history interview with a new client. Which of the following is an example of an open-ended question?

"Is your pain worse in the morning?"
"Do you have any allergies?"
"Describe the pain you are feeling." (Correct answer)
"Have you taken any medication for the pain?"

Correct answer: "Describe the pain you are feeling."

An open-ended question encourages the client to provide a detailed narrative response rather than a simple 'yes' or 'no'. "Describe the pain you are feeling" prompts the client to elaborate on their symptoms, yielding more comprehensive subjective data. The other options are closed-ended questions that elicit specific, limited responses.

Question 19: During a code situation, the team leader assigns a specific task to the PN. The PN is unsure how to perform it. What should the PN do?

Attempt the task without disclosure to avoid slowing the team down
Perform a different task without informing the leader
Leave the bedside to consult a policy manual
Immediately inform the team leader that they need assistance or a task reassignment (Correct answer)

Correct answer: Immediately inform the team leader that they need assistance or a task reassignment

In emergency situations, disclosing limitations immediately allows the team leader to reassign tasks quickly and maintain safe client care.

Question 20: A PN is working alongside an RN in a long-term care facility. Which statement best describes their collaborative relationship?

The RN delegates all medication administration to the PN
The RN and PN share responsibility for client care within their respective scopes of practice (Correct answer)
The PN functions independently and does not need to communicate with the RN
The PN must obtain RN approval before performing any nursing task

Correct answer: The RN and PN share responsibility for client care within their respective scopes of practice

PNs and RNs collaborate within their respective scopes of practice, sharing accountability for client-centred care outcomes.

Question 21: A competent adult client who is being treated for a serious infection refuses a prescribed IV antibiotic and asks to be discharged against medical advice (AMA). The PN believes the client will likely die without treatment. What is the MOST legally and ethically correct response?

Notify the public health authority to detain the client, as the infection may pose a public risk
Ensure the client has decision-making capacity, provide information about risks, document the informed refusal, and facilitate the AMA discharge (Correct answer)
Obtain a court order to compel treatment before allowing discharge
Administer the antibiotic without consent because the risk to life overrides refusal

Correct answer: Ensure the client has decision-making capacity, provide information about risks, document the informed refusal, and facilitate the AMA discharge

A competent adult has an absolute legal right to refuse treatment, including life-sustaining treatment. The PN's role is to confirm the client's decision-making capacity, ensure they have received complete information about the consequences of refusal (informed refusal), document thoroughly, and ensure the AMA process is followed per institutional policy. Administering treatment without consent constitutes battery. Court orders and public health detention are not applicable in this context (infectious diseases with public risk follow separate legislation).

Question 22: A practical nurse (PN) is working in a long-term care facility. A resident with moderate dementia has a valid advance directive refusing tube feeding. The resident's adult daughter arrives and insists the PN initiate enteral nutrition, stating she holds power of attorney for her mother's finances. The PN should:

Defer the decision entirely to the attending physician without providing any guidance
Initiate tube feeding and document the family request to protect the facility from liability
Honour the advance directive, as financial power of attorney does not extend to healthcare decisions (Correct answer)
Follow the daughter's instructions, as a power of attorney holder supersedes an advance directive

Correct answer: Honour the advance directive, as financial power of attorney does not extend to healthcare decisions

A financial (property) power of attorney grants authority over financial matters only and does not confer the right to make healthcare decisions. A valid advance directive reflects the resident's autonomous wishes regarding medical treatment and must be honoured. A healthcare proxy or personal care power of attorney would be required to override or interpret a directive. The PN has a professional and legal obligation to understand this distinction and act accordingly.

Question 23: When delegating a task to an unregulated care provider (UCP), the PN must first confirm:

The charge nurse has approved the delegation
The client has no objections to the UCP
The UCP has performed the task before
The task is within the UCP's competence and the situation is appropriate for delegation (Correct answer)

Correct answer: The task is within the UCP's competence and the situation is appropriate for delegation

Safe delegation requires the PN to assess both the UCP's competence and the specific client situation before delegating.

Question 24: A client with a spinal cord injury at T6 is at risk for autonomic dysreflexia. A PN notices the client's blood pressure has risen to 178/100 mmHg and the client reports a pounding headache. What is the priority action?

Document findings and notify the physician at the next scheduled check
Sit the client upright, loosen restrictive clothing, and identify/remove the triggering stimulus (Correct answer)
Administer a prescribed PRN antihypertensive immediately
Place the client in a supine position and apply a cool cloth to the forehead

Correct answer: Sit the client upright, loosen restrictive clothing, and identify/remove the triggering stimulus

Autonomic dysreflexia is a medical emergency. The priority is to sit the client upright (which reflexively lowers BP) and identify and remove the trigger — most commonly a distended bladder or bowel. Placing the client supine would worsen hypertension. Prompt action is essential to prevent stroke.

Question 25: Which assessment finding indicates early hypoxia in a client?

Decreased respiratory rate
Bradycardia
Restlessness and confusion (Correct answer)
Cyanosis of the lips

Correct answer: Restlessness and confusion

Restlessness and confusion are early signs of hypoxia as the brain is highly sensitive to decreased oxygen levels.

Question 26: During the orientation phase of the nurse-client relationship, what is the practical nurse's primary goal?

To establish trust and define the parameters of the relationship. (Correct answer)
To evaluate the effectiveness of the nursing care plan.
To explore the client's feelings and identify solutions to problems.
To promote the client's independence and self-care abilities.

Correct answer: To establish trust and define the parameters of the relationship.

The orientation phase is the initial encounter where the primary goal is to build rapport, establish trust, and clearly define the roles, rules, and boundaries of the professional relationship. This sets the foundation for the subsequent working and termination phases. Evaluating the care plan and exploring solutions occur in the working phase, while promoting independence is a key goal of the termination phase.

Question 27: A practical nurse floats to an unfamiliar unit and is asked to care for patients with conditions outside their usual experience. What is the most appropriate action?

Accept the assignment but clearly communicate limitations and request appropriate support (Correct answer)
Accept the assignment and manage independently to avoid inconveniencing staff
Refuse all patient assignments on the unfamiliar unit
Contact the regulatory body for direction before accepting any patients

Correct answer: Accept the assignment but clearly communicate limitations and request appropriate support

Nurses must communicate competency limitations honestly; accepting the assignment with disclosed limitations and support allows safe care while meeting staffing needs.

Question 28: A practical nurse is administering medications via a client's nasogastric (NG) tube. The medication administration record includes sustained-release morphine sulfate (MS Contin) 30 mg. What is the CORRECT action?

Administer the intact tablet by dissolving it in 60 mL of warm water for 10 minutes before instilling
Contact the prescriber to request a substitute formulation appropriate for NG tube administration (Correct answer)
Crush the tablet thoroughly, dissolve in 30 mL of water, and flush the NG tube before and after administration
Open the sustained-release capsule and mix the beads with 15 mL of applesauce before instilling

Correct answer: Contact the prescriber to request a substitute formulation appropriate for NG tube administration

Sustained-release (SR/XR/ER) formulations must NEVER be crushed, split, or altered, as this destroys the time-release matrix and causes immediate release of the entire dose — a potentially fatal morphine overdose. NG tube administration requires an immediate-release liquid or crushable formulation. The nurse must withhold the medication and contact the prescriber for an appropriate order (e.g., immediate-release morphine oral solution or an IV/SC route). This is a patient safety imperative.

Question 29: A Practical Nurse overhears a colleague discussing a client's confidential health information in the cafeteria with another staff member not involved in the client's care. What is the PN's initial and most appropriate action?

Ignore the conversation to avoid creating a conflict with a coworker.
Approach the colleague privately and remind them of their duty to maintain client confidentiality. (Correct answer)
Confront the colleague loudly in the cafeteria to stop the breach of confidentiality.
Report the colleague to the provincial regulatory body immediately.

Correct answer: Approach the colleague privately and remind them of their duty to maintain client confidentiality.

The PN has a duty to protect client confidentiality and address unprofessional conduct. The most appropriate initial action is to address the issue directly and privately with the colleague. This is a professional and respectful approach that can resolve the situation immediately. If the behavior continues, further steps, such as reporting to a supervisor, would be necessary.

Question 30: A practical nurse is asked by a physician to perform a task that is outside the LPN's legislated scope of practice. Which of the following statements reflects the nurse's professional accountability?

"I have not performed this task before, but I am a quick learner."
"I will document that you ordered me to perform this task to ensure I am covered."
"I will do it this one time since you are here to supervise me."
"I am not authorized or competent to perform this task; we need to find an appropriate practitioner." (Correct answer)

Correct answer: "I am not authorized or competent to perform this task; we need to find an appropriate practitioner."

Licensed Practical Nurses are accountable for knowing and acting consistently with the laws and standards that govern their practice. This includes practicing only within their legislated scope and personal competencies. The nurse must recognize their limitations and refuse to perform tasks they are not authorized or competent to do. This protects the client from harm and upholds the professional standards of the profession. Agreeing to perform the task, even with supervision, or relying on documentation to absolve responsibility is inappropriate and unsafe.

Question 31: A PN working in a walk-in clinic is presented with a signed consent form for a minor procedure. The patient is a 15-year-old who arrived alone, appears mature, and has expressed clear, voluntary understanding of the procedure and its risks. The province has no statute setting a minimum age of consent for medical treatment. What principle governs whether this patient can provide valid consent?

The clinic's policy manual is the controlling authority; if the policy requires parental consent for patients under 16, the PN must refuse to proceed
Because the patient is under 18, any consent must be deferred until a parent is contacted, as the age of majority is the universal legal threshold for medical consent in Canada
Consent from a minor is never valid without parental or guardian co-signature, regardless of assessed capacity or provincial statute
The mature minor doctrine — if the PN and attending provider assess the adolescent as having sufficient capacity to understand and appreciate the nature, risks, and consequences of the treatment, the minor's consent may be legally valid (Correct answer)

Correct answer: The mature minor doctrine — if the PN and attending provider assess the adolescent as having sufficient capacity to understand and appreciate the nature, risks, and consequences of the treatment, the minor's consent may be legally valid

In Canadian jurisdictions without a statutory minimum age of consent, the mature minor doctrine applies: a minor who demonstrates sufficient capacity — the ability to understand the nature of the treatment, its risks and benefits, and the consequences of consenting or refusing — can provide legally valid consent. The PN and provider must document their capacity assessment. The age of 18 is not a universal threshold for medical consent in Canada; capacity, not age, is the governing standard in most provinces. Institutional policy cannot override legal doctrine, though it should be consistent with it.

Question 32: A PN is employed by a home care agency and is visiting a client in a private residence. During the visit, the PN observes a framed photo that strongly suggests the client's spouse may be engaging in criminal activity unrelated to the client's health. The PN should:

Document the observation in the clinical record and notify the agency's legal team
Report the observation to police immediately, as healthcare workers are mandatory reporters for all suspected crimes
Not act on the observation, as it falls entirely outside the PN's professional scope and privacy obligations apply to the home environment
Maintain confidentiality about the observation unless it meets the threshold of a serious and imminent threat to an identifiable person (Correct answer)

Correct answer: Maintain confidentiality about the observation unless it meets the threshold of a serious and imminent threat to an identifiable person

Canadian privacy legislation and professional ethics permit — and in some cases require — disclosure only when there is a serious, foreseeable, and imminent risk of harm to an identifiable individual. Mandatory reporting obligations for health professionals are specific (e.g., child abuse, certain communicable diseases, gunshot wounds) and do not extend to general suspicion of unrelated criminal activity. Reporting based solely on a photograph would violate privacy and exceed the PN's professional role. The PN should consult the agency and, if applicable, legal counsel if the threat threshold appears to be met.

Question 33: Which of the following scenarios constitutes a breach of client confidentiality by a practical nurse?

Collaborating with the physiotherapist about a client's mobility status and care plan.
Discussing a client's difficult diagnosis with a spouse who is not the designated substitute decision-maker, without the client's consent. (Correct answer)
Informing the pharmacist about a client's allergy before dispensing a new medication.
Sharing client information with the oncoming nurse during a shift report.

Correct answer: Discussing a client's difficult diagnosis with a spouse who is not the designated substitute decision-maker, without the client's consent.

Licensed Practical Nurses have a legal and ethical duty to protect the privacy and confidentiality of a client's personal health information. Disclosing information to anyone outside the immediate circle of care, including a spouse, without the client's explicit consent is a breach of this duty. Sharing information during shift report, with the pharmacist for medication safety, or with other members of the interdisciplinary team for care planning are all appropriate and necessary communications for providing safe care.

Question 34: A nurse is assessing a client 24 hours post-coronary artery bypass graft (CABG). Which finding requires immediate intervention?

Serosanguineous drainage from the sternal incision of 10 mL/hr
Temperature of 37.8°C
Chest tube output of 250 mL in the last hour (Correct answer)
Heart rate of 88 beats per minute in sinus rhythm

Correct answer: Chest tube output of 250 mL in the last hour

Chest tube output greater than 200 mL/hour post-cardiac surgery indicates excessive bleeding and requires immediate physician notification to assess for cardiac tamponade or surgical hemorrhage.

Question 35: A client with schizophrenia who has been stable on haloperidol for 18 months suddenly develops muscle rigidity, hyperthermia (40.2°C), diaphoresis, and a blood pressure of 160/100 mmHg. The PN's MOST urgent priority is to:

Apply cooling blankets and reassess vital signs in 30 minutes
Administer a PRN dose of lorazepam as ordered and monitor closely
Discontinue the haloperidol immediately and notify the physician (Correct answer)
Obtain a urine sample for drug toxicology screening

Correct answer: Discontinue the haloperidol immediately and notify the physician

This presentation is consistent with Neuroleptic Malignant Syndrome (NMS), a life-threatening emergency caused by antipsychotic medications. The cardinal features — muscle rigidity, hyperthermia, autonomic instability, and altered consciousness — require immediate discontinuation of the offending antipsychotic and urgent physician notification. NMS carries a significant mortality risk if the causative agent is not stopped promptly. Lorazepam alone does not address the underlying cause. Toxicology screening and cooling measures, while potentially part of broader management, are secondary to stopping the drug and escalating care.

Question 36: A nurse assesses a newborn at 24 hours of life and notes a firm, well-demarcated, non-pitting swelling over the right parietal bone that does not cross the suture lines. The newborn is alert, feeding well, and vital signs are stable. Which complication should the nurse monitor for over the next few days?

Jaundice secondary to breakdown of red blood cells in the hematoma (Correct answer)
Increasing intracranial pressure from subdural hemorrhage
Skull fracture underlying the collection of blood
Infection and abscess formation at the site of the subperiosteal bleed

Correct answer: Jaundice secondary to breakdown of red blood cells in the hematoma

The described findings are classic for a cephalohematoma — a subperiosteal blood collection that respects suture lines. As the red blood cells in the hematoma break down, bilirubin is released, placing the newborn at increased risk for hyperbilirubinemia and jaundice in the days following birth. This is the most clinically relevant complication to monitor for. Subdural hemorrhage is a separate and more serious intracranial injury not associated with this presentation. While an underlying linear skull fracture can co-exist with cephalohematoma, it does not typically alter management in an asymptomatic newborn. Infection of cephalohematomas is rare.

Question 37: A practical nurse is caring for a patient with pulmonary tuberculosis (TB) who requires transport to radiology for a chest X-ray. The patient is currently on airborne precautions. Which sequence of actions is correct before transporting this patient?

Have the nurse don an N95 respirator, place a surgical mask on the patient, and notify the receiving department to prepare an isolation room
Place a surgical mask on the patient, notify receiving department, and have the patient wear a gown
Place a surgical mask on the patient, notify receiving department, and ensure the transport route minimizes exposure to others (Correct answer)
Have the patient don an N95 respirator, notify the receiving department, and ensure the transport is done during low-traffic hours

Correct answer: Place a surgical mask on the patient, notify receiving department, and ensure the transport route minimizes exposure to others

When transporting a TB patient, a surgical mask is placed on the patient (not an N95 — the mask on the patient reduces source emission). The receiving department must be notified so they can prepare and minimize dwell time in common areas. The transport route should minimize exposure. The nurse does not need to wear an N95 during transport outdoors in a corridor if the patient is masked; however, notification and route planning are essential. Placing an N95 on the patient is incorrect — surgical masks contain the patient's respiratory droplets sufficiently for transport.

Question 38: A client reports pain that is 8/10 in severity, and the practical nurse observes the client laughing and chatting on the phone. What is the most appropriate nursing action?

Document the pain rating as inconsistent with behavior
Accept the client's self-report as the most reliable pain indicator (Correct answer)
Reassess the client in one hour without intervention
Administer a lower dose of pain medication than ordered

Correct answer: Accept the client's self-report as the most reliable pain indicator

Self-report is the gold standard for pain assessment; behavioral cues do not always correlate with pain intensity, especially in clients using coping strategies.

Question 39: A palliative care nurse is assessing pain in an 88-year-old resident with end-stage renal disease, severe expressive aphasia following a stroke, and opioid therapy. The resident's serum creatinine has risen sharply. Which pharmacological concern is MOST critical for the practical nurse to flag to the prescribing team?

Increased risk of respiratory depression exclusively from the parent morphine compound, unrelated to renal function
Reduced first-pass metabolism of oral morphine causing supratherapeutic peak serum levels
Accumulation of morphine-6-glucuronide, an active metabolite that cannot be renally cleared, increasing the risk of opioid neurotoxicity including myoclonus and hyperalgesia (Correct answer)
Accelerated morphine clearance due to compensatory hepatic upregulation, causing under-treatment of pain

Correct answer: Accumulation of morphine-6-glucuronide, an active metabolite that cannot be renally cleared, increasing the risk of opioid neurotoxicity including myoclonus and hyperalgesia

Morphine-6-glucuronide (M6G) is a pharmacologically active metabolite of morphine that is renally excreted. In end-stage renal disease, M6G accumulates and crosses the blood-brain barrier, producing opioid neurotoxicity — clinically manifested as myoclonus, allodynia, hyperalgesia, and seizures — rather than classic opioid overdose. The practical nurse must recognize this risk and escalate to the team, as an opioid rotation (e.g., to hydromorphone with dose reduction) is often warranted.

Question 40: A nurse is about to perform a urinary catheter insertion. Which hand hygiene approach is correct immediately before donning sterile gloves?

Wash hands with soap and water for at least 1 minute (Correct answer)
Wipe hands with an antiseptic cloth
Skip hand hygiene since gloves provide full protection
Use alcohol-based hand rub for at least 20-30 seconds

Correct answer: Wash hands with soap and water for at least 1 minute

Before sterile procedures, surgical hand antisepsis with soap and water for at least 1 minute is recommended to reduce transient flora.

Question 41: A client with a terminal diagnosis states: 'I just want to know the truth, how long do I have?' The physician has not yet disclosed the prognosis. What is the best response?

'Based on your diagnosis, most people live about 3-6 months.'
'Do not worry about prognosis right now. Focus on staying positive.'
'I do not know anything about your prognosis so I cannot help you.'
'I understand you want that information. I will let your physician know this is important to you and ask them to speak with you today.' (Correct answer)

Correct answer: 'I understand you want that information. I will let your physician know this is important to you and ask them to speak with you today.'

Prognosis disclosure is the physician's responsibility. The practical nurse advocates for the client's right to information by facilitating an urgent discussion with the physician.

Question 42: During abdominal assessment, the practical nurse should perform the techniques in which order?

Inspection, auscultation, percussion, palpation (Correct answer)
Inspection, palpation, percussion, auscultation
Percussion, inspection, auscultation, palpation
Auscultation, inspection, percussion, palpation

Correct answer: Inspection, auscultation, percussion, palpation

Abdominal assessment follows the order of inspection, auscultation, percussion, and palpation to avoid altering bowel sounds before listening.

Question 43: A practical nurse is preparing to administer two IV medications that are known to be incompatible. What is the safest approach?

Flush the IV line with normal saline between each medication (Correct answer)
Administer both medications simultaneously through a Y-site
Mix both medications in the same syringe and administer quickly
Increase the infusion rate so the medications do not mix

Correct answer: Flush the IV line with normal saline between each medication

Flushing with compatible solution (e.g., normal saline) between incompatible IV medications prevents precipitation and adverse chemical reactions.

Question 44: A practical nurse performs a head-to-toe assessment on a newly admitted client. Which finding requires immediate follow-up?

Temperature 37.2 degrees Celsius
Oxygen saturation of 88% on room air (Correct answer)
Blood pressure 118/76 mmHg
Respiratory rate of 16 breaths per minute

Correct answer: Oxygen saturation of 88% on room air

SpO2 of 88% is below normal (95-100%) and indicates hypoxemia requiring immediate intervention.

Question 45: A client tells the nurse, 'I feel like you're the only one who really understands me. Can we be friends after I'm discharged?' How should the nurse respond?

Refer the client to another nurse to manage the boundary issue.
Explain that professional boundaries prevent a personal friendship but that the therapeutic relationship has value. (Correct answer)
Tell the client that feelings of closeness are signs of dependency and must be addressed.
Accept the offer of friendship since it indicates a trusting therapeutic relationship.

Correct answer: Explain that professional boundaries prevent a personal friendship but that the therapeutic relationship has value.

The nurse acknowledges the client's feelings while clearly maintaining professional boundaries and explaining the distinct nature of the therapeutic relationship.

Question 46: A caustic cleaning solution was sprayed in the client's face while they were working in the kitchen. He is receiving treatment in a hospital for eye damage. The nurse should do the following while helping this client who is temporarily blind to eat:

serve the customer their entire meal.
lead the client to where the foods are on the dish, i.e. clock technique (Correct answer)
Permit the customer to try different meals.
Urge the client's family to feed him.

Correct answer: lead the client to where the foods are on the dish, i.e. clock technique

The 'clock technique' is an effective and respectful method for helping visually impaired clients locate food on their plate. By describing the position of food items as if they were on a clock face (e.g., 'meat at 6 o'clock, vegetables at 9 o'clock'), the nurse provides clear, consistent orientation. This promotes the client's independence and dignity during meal times.

Question 47: A client with COPD has ABG: pH 7.32, PaCO2 58 mmHg, HCO3 28 mEq/L. How should this be interpreted?

Metabolic alkalosis with compensation
Respiratory alkalosis with metabolic compensation
Respiratory acidosis with metabolic compensation (Correct answer)
Metabolic acidosis with respiratory compensation

Correct answer: Respiratory acidosis with metabolic compensation

pH 7.32 (acidosis) + elevated PaCO2 (respiratory cause) + elevated HCO3 (renal compensation) = respiratory acidosis with metabolic compensation.

Question 48: A practical nurse is caring for a client with chronic kidney disease who is receiving a continuous heparin infusion. The client's aPTT comes back at 142 seconds (therapeutic range 60–100 seconds). The client is alert and has no signs of active bleeding. What is the PRIORITY nursing action?

Continue the infusion but recheck the aPTT in one hour
Hold the heparin infusion and notify the physician immediately (Correct answer)
Slow the infusion rate by 25% and document the finding
Administer protamine sulfate as a standing protocol intervention

Correct answer: Hold the heparin infusion and notify the physician immediately

An aPTT of 142 seconds is significantly above the therapeutic range, indicating a dangerously supratherapeutic anticoagulation level. Even without active bleeding, the risk of hemorrhage is high. The nurse must hold the infusion and notify the physician immediately so a dosage adjustment order can be obtained. Protamine sulfate is a reversal agent that requires a physician's order and is not a standing nursing intervention. Independently adjusting the rate or simply rechecking without notifying the physician is outside the PN's scope of practice for this situation.

Question 49: A client with diabetic ketoacidosis (DKA) has been receiving IV insulin and fluids. The nurse notes the client's serum potassium has dropped from 5.0 to 3.1 mEq/L. What is the priority intervention?

Notify the physician and prepare for potassium replacement (Correct answer)
Administer sodium bicarbonate to correct acidosis
Stop the insulin infusion until potassium is corrected
Continue the current insulin infusion rate

Correct answer: Notify the physician and prepare for potassium replacement

Insulin drives potassium into cells; hypokalemia during DKA treatment can cause life-threatening dysrhythmias, requiring potassium replacement before continuing insulin.

Question 50: Which of the following is considered subjective data in a client's health assessment?

The client states, "I feel nauseous." (Correct answer)
The client's respiratory rate is 22 breaths per minute.
The client's blood pressure is 140/90 mmHg.
The client has a rash on their abdomen.

Correct answer: The client states, "I feel nauseous."

Subjective data is information reported by the client from their own perspective, such as feelings, perceptions, and concerns. The client's statement of feeling nauseous is subjective. Respiratory rate, blood pressure, and the presence of a rash are all objective data that can be observed and measured by the nurse.

Question 51: A PN discovers that a colleague has been documenting assessments for clients they have not actually seen. The PN initially says nothing but later is named in a regulatory complaint because the false records were associated with a client who suffered harm. Under the concept of accountability, which statement BEST describes the PN's legal and professional exposure?

The PN has no liability because they were not the one who falsified the records
The PN is only liable if they co-signed or countersigned the falsified records
The PN's liability is limited to their own assigned clients and cannot extend to a colleague's actions
The PN may face professional consequences for failing to report a known unsafe or unethical practice (Correct answer)

Correct answer: The PN may face professional consequences for failing to report a known unsafe or unethical practice

Professional accountability under provincial nursing legislation and codes of ethics requires nurses to report known unsafe or unethical practices. Silence in the face of known misconduct is itself a professional and potentially legal breach. The PN's failure to act on knowledge of falsified documentation — which contributed to patient harm — can result in disciplinary action by the regulatory body, even though the PN did not falsify the records themselves.

Question 52: A practical nurse is participating in a weekly care conference for a long-term care resident. The team is discussing the resident's recent decline in mobility. What is the PN's most valuable contribution to this discussion?

Suggesting a new medication to manage the resident's joint pain.
Making the final decision on whether the resident needs a wheelchair.
Providing specific, daily observations about the resident's ability to ambulate, their level of fatigue, and their response to assistance. (Correct answer)
Contacting the resident's family to inform them of the team's decisions.

Correct answer: Providing specific, daily observations about the resident's ability to ambulate, their level of fatigue, and their response to assistance.

The PN has the most frequent contact with the resident and can provide crucial, detailed information about their daily functional status. These specific observations are vital for the physiotherapist, occupational therapist, and physician to make informed decisions about the plan of care. Making final decisions, suggesting new medications (prescribing), and primary communication of the plan are typically roles of other team members.

Question 53: During assessment of a 58-year-old Indigenous client admitted for an acute exacerbation of COPD, the nurse observes that the client consistently avoids eye contact and gives brief answers. The client's oxygen saturation is 91% on 2L/min, RR is 24, and accessory muscle use is noted. Which action reflects BOTH culturally safe practice AND appropriate clinical prioritization?

Document refusal to engage and escalate to the care team, prioritizing oxygenation management
Pause the assessment to build rapport using indirect conversation before addressing the respiratory findings
Assign a cultural liaison to conduct the full assessment before any nursing intervention to avoid cultural harm
Address the immediate respiratory compromise while acknowledging the client's communication style as a cultural norm, adjusting interaction accordingly throughout care (Correct answer)

Correct answer: Address the immediate respiratory compromise while acknowledging the client's communication style as a cultural norm, adjusting interaction accordingly throughout care

Culturally safe practice does not require deferring urgent clinical care — it requires integrating cultural awareness into all interactions. This client has objective signs of respiratory distress (SpO2 91%, RR 24, accessory muscle use) requiring immediate nursing action. Avoiding eye contact and brevity in some Indigenous cultures reflect respect rather than disengagement or refusal. The nurse should address the clinical emergency while adapting communication style (e.g., not forcing eye contact, using indirect questioning, allowing silence). Delaying intervention to build rapport or reassigning the assessment to a liaison would be clinically unsafe. Documenting it as 'refusal' misinterprets a cultural behaviour.

Question 54: A nurse is caring for a client in traction for a femur fracture. Which assessment finding requires immediate reporting?

Absence of dorsiflexion and inability to feel the foot (foot drop) (Correct answer)
Capillary refill of 2 seconds in the affected extremity
Client reports the weights feel heavy
Mild discomfort at the pin insertion sites

Correct answer: Absence of dorsiflexion and inability to feel the foot (foot drop)

Foot drop and loss of sensation indicate peroneal nerve compression or compartment syndrome, requiring immediate physician notification.

Question 55: Which principle of palliative care best describes treating the whole person — physical, emotional, social, and spiritual dimensions — rather than only the disease?

Holistic care (Correct answer)
Preventive care
Curative care
Restorative care

Correct answer: Holistic care

Holistic care addresses all dimensions of suffering and is a foundational principle of palliative nursing.

Question 56: A practical nurse is administering insulin using a pen device shared on the unit for multiple clients. A colleague mentions this is acceptable because individual pen needles are changed between clients. What is the MOST accurate response by the nurse?

The practice is safe as long as the nurse confirms the client's blood type before administration to check compatibility
The practice is unsafe — insulin pens are single-client devices; reusing the pen body between clients risks backflow contamination of the medication reservoir regardless of needle changes (Correct answer)
The practice is acceptable only if the pen contains a cartridge type rather than a pre-filled pen
The practice is safe because changing the needle between clients prevents cross-contamination of the needle itself

Correct answer: The practice is unsafe — insulin pens are single-client devices; reusing the pen body between clients risks backflow contamination of the medication reservoir regardless of needle changes

Insulin pens — including the pen body and medication cartridge — are single-patient-use devices. When a needle is attached and the pen is used, blood can be drawn back into the cartridge through capillary action (backflow), contaminating the medication reservoir with bloodborne pathogens (HIV, hepatitis B, hepatitis C). Changing the needle does not eliminate this risk because the contamination is in the cartridge, not just the needle. Health Canada, ISMP Canada, and all provincial nursing regulatory bodies explicitly prohibit sharing insulin pen devices between clients. This has been associated with real-world bloodborne pathogen transmission events.

Question 57: A nurse is assigned to care for a client who was convicted of child sexual abuse. The nurse tells the charge nurse: 'I can provide basic physical care, but I cannot engage therapeutically with this person — my values won't allow it.' How should the charge nurse BEST respond?

Document the refusal as a disciplinary concern and report it to the regulatory body for failing to provide care.
Acknowledge the nurse's values, explore whether they can separate personal feelings from professional obligations, and if not, facilitate reassignment without stigmatizing the nurse. (Correct answer)
Remind the nurse that personal values have no place in professional practice and insist they provide full therapeutic care.
Reassign the client immediately to a nurse without personal conflicts to ensure quality care.

Correct answer: Acknowledge the nurse's values, explore whether they can separate personal feelings from professional obligations, and if not, facilitate reassignment without stigmatizing the nurse.

Nurses may hold deeply held personal values that create genuine conflict with caring for certain clients. The ethical and professional response is to acknowledge the nurse's self-awareness (which is itself a professional strength), assess whether the nurse can bracket personal feelings enough to provide non-judgmental therapeutic care, and facilitate a non-punitive reassignment if not. Insisting the nurse suppress values entirely (C) is unrealistic and may harm the client. Immediate reassignment without discussion (A) misses a supervisory opportunity. Disciplinary action (D) is disproportionate when the nurse proactively disclosed a conflict — this is responsible professional behaviour.

Question 58: The practical nurse is assessing capillary refill in a client. Which finding requires immediate follow-up?

Capillary refill of 2 seconds
Capillary refill of 1 second
Capillary refill that varies between fingers
Capillary refill of 4 seconds (Correct answer)

Correct answer: Capillary refill of 4 seconds

Capillary refill greater than 3 seconds indicates poor peripheral perfusion and requires immediate assessment and intervention.

Question 59: A nurse working in a community mental health clinic has developed a strong therapeutic alliance with a client over 14 months. The client asks the nurse to attend their graduation ceremony 'just as a friend.' The nurse feels that refusing will damage the trust built over the long relationship. What is the MOST appropriate action?

Accept the invitation because long-term therapeutic relationships evolve naturally into friendship.
Consult the care team and attend only if the team agrees it falls within acceptable therapeutic practice.
Decline and use the request as a therapeutic opportunity to explore the client's relationship needs and boundaries. (Correct answer)
Attend briefly to honour the relationship milestone, then process the boundary crossing in supervision.

Correct answer: Decline and use the request as a therapeutic opportunity to explore the client's relationship needs and boundaries.

Attending a personal social event constitutes a boundary crossing that compromises professional objectivity and the therapeutic frame, regardless of relationship duration. The nurse's discomfort about 'damaging trust' by declining reflects counter-transference. Rather than attending, the nurse should decline clearly and use the request therapeutically — exploring what it means to the client, what needs it reflects, and reinforcing the professional relationship's value. Long-term therapeutic relationships do not naturally evolve into friendships (D), and peer endorsement does not make a boundary crossing appropriate (C).

Question 60: A practical nurse who is active on social media posts a general reflection on a 'heartbreaking shift' without naming patients, the facility, or any identifying details. A colleague comments on the post mentioning the ward name and the type of cases seen that day. What is the nurse's most appropriate professional obligation at this point?

Remove the original post entirely, as the combination of the post and the comment now creates identifiability risk (Correct answer)
Delete the colleague's comment and send a private message warning the colleague about professional social media use
Report the colleague's comment to the regulatory body as a breach of patient confidentiality
Do nothing, since the nurse's own post was compliant and the colleague is solely responsible for their own comment

Correct answer: Remove the original post entirely, as the combination of the post and the comment now creates identifiability risk

Confidentiality breaches can result from the aggregation of individually innocuous details. Even if the nurse's original post was compliant in isolation, the colleague's comment — adding ward name and case type — may create a mosaic that renders patients identifiable. The nurse now has a professional obligation to mitigate the risk by removing the original post, since it is the anchor to which identifying context has been publicly attached. Reporting to the regulatory body is premature for what may be addressable through immediate corrective action. Doing nothing is ethically indefensible once the nurse is aware of the compounded risk.

Question 61: A unit is experiencing a norovirus outbreak. The infection control team recommends discontinuing the use of alcohol-based hand rub (ABHR) for hand hygiene and switching exclusively to soap and water. A new practical nurse asks why ABHR is being avoided. What is the most accurate explanation?

Norovirus is a non-enveloped virus and ABHR is not reliably effective against non-enveloped viruses; soap and water physically removes the organism (Correct answer)
ABHR concentrations on this unit have expired and are no longer effective against any pathogen
ABHR is bactericidal but not virucidal, so it has no effect on any viral pathogen
Norovirus survives on skin by forming spores that only soap and water can break down

Correct answer: Norovirus is a non-enveloped virus and ABHR is not reliably effective against non-enveloped viruses; soap and water physically removes the organism

Norovirus is a non-enveloped (naked) virus. Alcohol-based hand rubs are highly effective against enveloped viruses (e.g., influenza, COVID-19) but have reduced and inconsistent efficacy against non-enveloped viruses like norovirus and C. diff spores. Soap and water work by mechanically removing the virus from the skin surface and are the recommended hand hygiene method during norovirus outbreaks. ABHR does have some virucidal activity against enveloped viruses, so saying it has no effect on any virus is incorrect. Norovirus does not form spores.

Question 62: A nurse is preparing to transfer a client from the bed to a wheelchair using a gait belt. Where should the nurse position the gait belt?

Around the client's hips, below the waist
Around the client's waist, over clothing (Correct answer)
Around the client's thighs for maximum leverage
Around the client's chest, just below the armpits

Correct answer: Around the client's waist, over clothing

The gait belt is correctly placed around the client's waist over clothing to provide a secure grip without restricting breathing.

Question 63: A practical nurse is in the working phase of a therapeutic relationship with a client recovering from major surgery. Which action is the priority for the nurse during this phase?

Assisting the client to actively problem-solve and practice new coping skills. (Correct answer)
Gathering initial assessment data and establishing a contract for care.
Setting the goals and outlining the expected duration of the relationship.
Summarizing the progress made and preparing the client for discharge.

Correct answer: Assisting the client to actively problem-solve and practice new coping skills.

The working phase is where the bulk of the therapeutic work occurs. The priority is to actively engage the client in exploring their problems, trying new solutions, and learning new skills to promote change and recovery. Gathering data and setting goals occur in the orientation phase, and summarizing progress is characteristic of the termination phase.

Question 64: A nurse is caring for a client with a stage 4 pressure injury to the sacrum with suspected osteomyelitis. The wound care order states: 'Irrigate with normal saline, pack loosely with calcium alginate rope, and cover with a foam dressing.' During assessment, the nurse observes the wound base has a significant amount of firmly adhered yellow slough. Which modification to the wound care approach should the nurse initiate or advocate for?

Switch the packing to a hydrogel-impregnated gauze to promote autolytic debridement of the slough (Correct answer)
Use dry gauze packing and leave it in place for 24 hours to facilitate adherence and mechanical debridement upon removal
Increase irrigation pressure using a 35 mL syringe with an 18-gauge angiocatheter to mechanically remove the slough
Apply enzymatic debridement agent (e.g., collagenase) to the slough prior to alginate packing

Correct answer: Switch the packing to a hydrogel-impregnated gauze to promote autolytic debridement of the slough

Hydrogel-impregnated gauze promotes autolytic debridement by donating moisture to the wound bed, rehydrating necrotic tissue and slough so the body's own enzymes can break it down — making it appropriate for firmly adherent slough in a stage 4 wound. Enzymatic debridement (collagenase) is also valid but typically requires a specific physician order and is not a nurse-initiated modification in most practice settings. High-pressure irrigation (Option B) risks damage to fragile wound tissue and is not recommended for stage 4 wounds with suspected osteomyelitis. Dry gauze packing with intentional adherence (wet-to-dry) is considered outdated and traumatic — it removes healthy granulation tissue along with necrotic tissue and is not evidence-based practice.

Question 65: A practical nurse is assessing the level of consciousness of a client who has sustained a head injury. Which assessment tool is most appropriate for the nurse to use?

Pain Assessment Scale (PQRST)
Glasgow Coma Scale (GCS) (Correct answer)
Morse Fall Scale
Braden Scale

Correct answer: Glasgow Coma Scale (GCS)

The Glasgow Coma Scale (GCS) is a standardized tool used to objectively assess a client's level of consciousness by evaluating eye-opening, verbal, and motor responses. The Braden Scale assesses risk for pressure ulcers, the Morse Fall Scale assesses fall risk, and PQRST is a mnemonic for pain assessment.

Question 66: A nurse notices personal feelings of frustration when caring for a non-compliant client. What is the most therapeutic action?

Reflect on the feelings and seek supervision or peer support to maintain professional care. (Correct answer)
Remind the client that non-compliance makes the nurse's job difficult.
Transfer care of the client to a colleague.
Ignore the feelings and continue care as usual.

Correct answer: Reflect on the feelings and seek supervision or peer support to maintain professional care.

Self-awareness and use of supervision are essential to prevent countertransference from compromising the therapeutic relationship.

Question 67: A nurse is caring for a neonate with suspected hypoglycemia. Which finding would MOST support this diagnosis?

Ruddy skin color
Blood glucose of 3.0 mmol/L
Jitteriness and poor feeding (Correct answer)
Respiratory rate of 45 breaths/min

Correct answer: Jitteriness and poor feeding

Jitteriness, tremors, and poor feeding are classic clinical signs of neonatal hypoglycemia.

Question 68: A Practical Nurse (PN) is asked by a physician to administer a medication intravenously, a procedure the PN has not been trained to perform. Which of the following actions demonstrates professional accountability?

Asking a Registered Nurse (RN) to supervise the procedure.
Administering the medication as requested to maintain a good working relationship.
Refusing to administer the medication and reporting the request to the nursing supervisor. (Correct answer)
Researching the procedure online before attempting to administer the medication.

Correct answer: Refusing to administer the medication and reporting the request to the nursing supervisor.

Professional accountability requires PNs to practice within their legal scope of practice and level of competence. Administering a medication via a route for which they are not trained is unsafe and outside their scope. The appropriate and accountable action is to refuse and report the request to ensure client safety and adhere to professional standards.

Question 69: A practical nurse pays a visit to a northern Ontario home for senior citizens. What crucial safety measure must the practical nurse to recommend to the residents?

Erroneously place an area rug on bare floors
When a chest cold first appears, take an over-the-counter cough medication.
Instead of using a microwave oven to reheat meals, use a stove.
Spend chilly winter days inside. (Correct answer)

Correct answer: Spend chilly winter days inside.

Senior citizens in northern Ontario are at increased risk for hypothermia and falls due to cold weather and icy conditions. Spending chilly winter days indoors significantly reduces their exposure to extreme temperatures and minimizes the risk of slipping on ice or snow. This is a crucial preventative measure to protect their health and safety.

Question 70: A practical nurse working in occupational health identifies a cluster of repetitive strain injuries (RSIs) among workers in a food processing plant. Applying Haddon's Matrix to this injury prevention problem, which intervention addresses the HOST factor during the PRE-EVENT phase?

Installing ergonomic equipment guards that automatically stop machinery when unsafe repetitive motion thresholds are detected
Implementing a pre-employment musculoskeletal screening program to identify workers with predisposing physical vulnerabilities (Correct answer)
Establishing an RSI surveillance system to monitor injury rates and trigger investigations when thresholds are exceeded
Redesigning workstation layouts to reduce awkward postures and force requirements during repetitive tasks

Correct answer: Implementing a pre-employment musculoskeletal screening program to identify workers with predisposing physical vulnerabilities

Haddon's Matrix maps injury prevention interventions across three phases (pre-event, event, post-event) and three factors (host, agent/vehicle, environment). The HOST refers to the human at risk; the PRE-EVENT phase is before the injury-causing mechanism occurs. Pre-employment musculoskeletal screening identifies host vulnerabilities (individual susceptibility) before workers are exposed — a host-level, pre-event intervention. Installing machinery guards addresses the agent/environment during the event phase. Surveillance is a systemic/environmental tool. Workstation redesign targets the environment in the pre-event phase, not the host.

Question 71: Which action by a practical nurse demonstrates the ethical principle of justice in healthcare delivery?

Offering emotional support only to clients with serious diagnoses
Providing extra care to verbally appreciative clients
Prioritizing care based on the client's socioeconomic status
Advocating for a marginalized client to receive the same quality of care as other clients (Correct answer)

Correct answer: Advocating for a marginalized client to receive the same quality of care as other clients

Justice in healthcare means equitable distribution of care regardless of personal characteristics. Advocating for equal quality care demonstrates this principle.

Question 72: A client's INR result is 4.8 and they are prescribed warfarin. What should the practical nurse do?

Administer and schedule a repeat INR in 24 hours
Administer since it may be within therapeutic range for some conditions
Double the warfarin dose since high INR means poor anticoagulation
Hold the warfarin dose and notify the physician with the INR result (Correct answer)

Correct answer: Hold the warfarin dose and notify the physician with the INR result

INR 4.8 is supratherapeutic (therapeutic range is typically 2.0-3.0). Warfarin must be held and the physician notified.

Question 73: A practical nurse is asked to perform a procedure they have not performed since nursing school and feel uncertain about. What should they do first?

Review the policy and proceed independently
Attempt the procedure and ask for help if problems arise
Refuse the assignment entirely and document the refusal
Inform the supervisor of the competency gap and request supervision or support (Correct answer)

Correct answer: Inform the supervisor of the competency gap and request supervision or support

Nurses must practice within their competence; acknowledging a gap and seeking supervision is the legally and ethically correct response.

Question 74: A practical nurse is assessing a newborn who is 12 hours old. Which of the following findings requires immediate intervention?

Passage of a dark, tarry meconium stool
Nasal flaring and sternal retractions (Correct answer)
Acrocyanosis of the hands and feet
Respiratory rate of 50 breaths per minute

Correct answer: Nasal flaring and sternal retractions

Nasal flaring and sternal retractions are signs of respiratory distress in a newborn and require immediate notification of the registered nurse or primary care provider. Acrocyanosis is common in the first 24-48 hours. A respiratory rate of 30-60 breaths per minute is normal. Passing meconium is an expected finding.

Question 75: A nurse is performing a focused neurological assessment on a post-operative client following a transsphenoidal hypophysectomy. Which finding would require the most immediate intervention?

Clear nasal drainage when the client leans forward (Correct answer)
Urine output of 450 mL over the past hour with a urine specific gravity of 1.002
The client reporting a mild bifrontal headache rated 3/10
Serum sodium of 138 mmol/L

Correct answer: Clear nasal drainage when the client leans forward

Clear nasal drainage after transsphenoidal hypophysectomy may represent a CSF leak (rhinorrhea), which is a serious post-operative complication indicating a breach in the dura. CSF can be differentiated from mucus by testing for glucose (CSF is glucose-positive) or by the 'halo sign' on a tissue. This finding requires immediate reporting as it carries risk of meningitis and tension pneumocephalus. Although large urine output with low specific gravity suggests diabetes insipidus (also a complication), the clear drainage is the most immediately life-threatening finding requiring urgent assessment to rule out CSF leakage.

Question 76: When assessing a wound for infection, which finding is most concerning?

Slight pink discoloration at wound edges on day 2
Approximated wound edges with mild bruising
Increased warmth, redness, purulent drainage, and fever (Correct answer)
Mild serosanguinous drainage in first 24-48 hours

Correct answer: Increased warmth, redness, purulent drainage, and fever

Warmth, redness, purulent drainage, and fever are classic signs of wound infection requiring prompt reporting and treatment.

Question 77: Which high-alert medication requires a two-nurse independent double-check (IDC) per Canadian medication safety standards?

Pantoprazole (Pantoloc) 40 mg IV
Acetaminophen (Tylenol) 650 mg oral
Metformin (Glucophage) 500 mg oral
Concentrated electrolytes (e.g., KCl 40 mEq/100 mL IV) (Correct answer)

Correct answer: Concentrated electrolytes (e.g., KCl 40 mEq/100 mL IV)

Concentrated electrolytes (potassium chloride) are a high-alert medication per ISMP Canada and require independent double-check due to fatal error potential.

Question 78: A post-operative client reports pain of 8/10 and is prescribed morphine 2–4 mg IV q4h PRN. The PN checks vital signs and finds RR 10/min, SpO2 93%, and BP 110/70 mmHg. What should the PN do?

Administer 4 mg morphine and monitor closely for the next 15 minutes
Withhold the morphine, reposition the client, apply oxygen, and notify the physician (Correct answer)
Administer 2 mg morphine as the lowest dose is safest
Document the pain score and reassess in 30 minutes

Correct answer: Withhold the morphine, reposition the client, apply oxygen, and notify the physician

A respiratory rate of 10/min and SpO2 of 93% indicate opioid-induced respiratory depression. Administering more opioid is contraindicated. The PN should withhold the dose, stimulate and reposition the client, apply oxygen, and notify the prescriber immediately.

Question 79: Which of the following statements by a practical nurse best demonstrates empathy rather than sympathy?

"This must be a very frightening experience for you. Let's talk about what is making you most anxious." (Correct answer)
"Don't worry, I'm sure everything will turn out fine in the end."
"I know a lot of people in your situation, and they have managed to get through it."
"I'm so sorry you're going through this; it must be awful."

Correct answer: "This must be a very frightening experience for you. Let's talk about what is making you most anxious."

Empathy involves understanding and acknowledging the client's feelings from their perspective. This statement validates the client's fear and opens a dialogue to explore their specific concerns. Sympathy, in contrast, is feeling pity or sorrow for the client's situation, as shown in the 'I'm so sorry' response. Offering false reassurance or comparing the client to others are non-therapeutic techniques that diminish the client's individual experience.

Question 80: Which observation in a catheterized client requires immediate reporting?

Catheter tubing looped below the collection bag
Urine output 50 mL/hour
Collection bag below the level of the bladder
Urine output 20 mL/hour over the past 3 hours (Correct answer)

Correct answer: Urine output 20 mL/hour over the past 3 hours

Urine output under 30 mL/hour for 3 hours indicates oliguria and may signal renal insufficiency, dehydration, or obstruction.

Question 81: A client develops chills, fever, and back pain 20 minutes into a blood transfusion. What is the first nursing action?

Stop the transfusion immediately and maintain IV access with normal saline (Correct answer)
Document and continue monitoring
Slow the rate and notify the physician
Give antipyretic and continue at the same rate

Correct answer: Stop the transfusion immediately and maintain IV access with normal saline

Signs of transfusion reaction require immediately stopping the transfusion while maintaining IV access with normal saline.

Question 82: A practical nurse is assessing a 72-year-old client who presents with a sudden change in behaviour, inattention, and disorganized thinking that fluctuates throughout the day. The client's daughter reports he was perfectly lucid yesterday. Which assessment finding would most help differentiate delirium from dementia in this client?

The presence of short-term memory impairment
The acute onset and fluctuating course of cognitive changes (Correct answer)
The client's inability to recall the current date and year
A score below 24 on the Mini-Mental State Examination

Correct answer: The acute onset and fluctuating course of cognitive changes

The hallmark distinguishing feature of delirium versus dementia is its acute onset (hours to days) and characteristically fluctuating course — the client can appear lucid at one moment and confused the next. Dementia is gradual and progressive without such moment-to-moment fluctuation. Memory impairment, MMSE scores, and disorientation to date can occur in both conditions and are therefore not differentiating features.

Question 83: A 14-year-old with anorexia nervosa is being re-fed on a structured nutrition plan. On day 3, the patient develops muscle weakness, paresthesias, and cardiac arrhythmia on the monitor. Which electrolyte abnormality is most likely responsible, and what nursing action is most appropriate?

Hypernatremia — restrict free water intake and notify the dietitian
Hypokalemia — increase dietary potassium sources and reassess in 4 hours
Hypercalcemia — reposition the patient, encourage ambulation, and continue current feeding plan
Hypophosphatemia — recognize refeeding syndrome, hold the meal, and notify the physician immediately (Correct answer)

Correct answer: Hypophosphatemia — recognize refeeding syndrome, hold the meal, and notify the physician immediately

Refeeding syndrome is a potentially fatal complication that occurs when nutrition is reintroduced too rapidly after starvation. Carbohydrate reintroduction causes insulin release, which drives phosphate, potassium, and magnesium into cells, causing severe hypophosphatemia. Hypophosphatemia manifests as muscle weakness, paresthesias, and life-threatening cardiac arrhythmias. The nurse must recognize this emergency, withhold further feeding, and immediately notify the physician for IV electrolyte replacement and cardiac monitoring. This is not a situation for dietary adjustment or reassessment delay.

Question 84: Fluid intake was 2,800 mL and urine output was 2,200 mL over 24 hours. How should this be interpreted?

Positive fluid balance of 600 mL (Correct answer)
Negative fluid balance of 400 mL
Normal balance, no action needed
Negative fluid balance of 600 mL

Correct answer: Positive fluid balance of 600 mL

2,800 intake - 2,200 output = +600 mL positive balance, meaning the client retained 600 mL more than excreted.

Question 85: A PN is assessing a client's sacral wound and observes a shallow open ulcer with a red-pink wound bed and no slough. How should this wound be staged?

Stage I
Stage IV
Stage III
Stage II (Correct answer)

Correct answer: Stage II

A Stage II pressure injury presents as a shallow open ulcer with a pink or red wound bed. There is partial-thickness loss of skin with no slough or eschar. Stage I involves intact skin with non-blanchable erythema; Stage III involves full-thickness tissue loss.

Question 86: A nurse self-discloses personal information to a client to 'even the playing field.' This behavior is best described as:

A boundary violation that shifts focus from the client to the nurse. (Correct answer)
An example of effective therapeutic communication.
Appropriate use of self-disclosure to build rapport.
A strategy to reduce power imbalance in the relationship.

Correct answer: A boundary violation that shifts focus from the client to the nurse.

Excessive or inappropriate self-disclosure violates therapeutic boundaries and redirects focus away from the client's needs.

Question 87: A nurse is caring for a client at 38 weeks gestation who reports sudden, painless, bright red vaginal bleeding. Which condition does this presentation most likely indicate?

Vasa previa
Bloody show
Placental abruption
Placenta previa (Correct answer)

Correct answer: Placenta previa

Placenta previa typically presents with sudden, painless, bright red vaginal bleeding in the third trimester due to the placenta covering the cervical os.

Question 88: When performing a newborn assessment using the APGAR score at 5 minutes, which score indicates the newborn requires continued close monitoring but no immediate resuscitation?

Score of 7–10
Score of 11–15
Score of 4–6 (Correct answer)
Score of 0–3

Correct answer: Score of 4–6

An APGAR score of 4–6 at 5 minutes indicates the newborn needs continued close monitoring and possible stimulation but typically does not require immediate resuscitation.

Question 89: Which nursing intervention best supports the rehabilitation principle of 'restorative care'?

Delegating all rehabilitation activities to the physiotherapist
Encouraging the client to do as much as possible for themselves with guidance and support (Correct answer)
Completing tasks for the client to ensure efficiency and reduce fatigue
Restricting activity until the client is fully recovered to prevent injury

Correct answer: Encouraging the client to do as much as possible for themselves with guidance and support

Restorative care promotes the client's independence and functional ability by encouraging self-care with appropriate support. 'Doing for' the client when they are capable of doing themselves undermines recovery and prolongs dependence.

Question 90: A client who is 28 weeks pregnant arrives reporting decreased fetal movement. The nurse prepares for which initial assessment?

Non-stress test (NST) (Correct answer)
Contraction stress test (CST)
Amniocentesis
Biophysical profile (BPP)

Correct answer: Non-stress test (NST)

A non-stress test (NST) is the initial, non-invasive assessment used to evaluate fetal well-being when decreased fetal movement is reported.

Question 91: When completing a pain assessment on a non-verbal elderly client with dementia, which tool is most appropriate?

Visual Analogue Scale (VAS)
Numeric Rating Scale (NRS)
PAINAD (Pain Assessment in Advanced Dementia) scale (Correct answer)
Verbal Descriptor Scale

Correct answer: PAINAD (Pain Assessment in Advanced Dementia) scale

The PAINAD scale assesses pain in non-verbal clients with dementia using observable behavioral indicators.

Question 92: A client is prescribed a new antihypertensive medication. After administering the first dose, the practical nurse should prioritize monitoring for which of the following?

The client's understanding of the medication schedule
Adverse effects (Correct answer)
Therapeutic effect
Drug-food interactions

Correct answer: Adverse effects

While all options are important aspects of medication management, the immediate priority after administering the first dose of a new medication is to monitor for any adverse effects, such as orthostatic hypotension with an antihypertensive, which could pose an immediate safety risk to the client. The LPN must have the knowledge to manage adverse reactions.

Question 93: A nurse is managing a client with septic shock who is receiving norepinephrine via central line at 0.15 mcg/kg/min. The client's MAP is 63 mmHg (target ≥65), urine output is 18 mL/hr over the last 2 hours, and serum lactate is 4.2 mmol/L (drawn 1 hour ago). The nurse receives orders to titrate norepinephrine up by 0.05 mcg/kg/min. Which assessment finding would most indicate that increasing the vasopressor is the appropriate next step?

Skin that is cool, mottled, and clammy with weak peripheral pulses
Central venous pressure (CVP) reading of 14 mmHg
Skin that is warm and flushed with bounding peripheral pulses (Correct answer)
Blood pressure of 88/52 mmHg with heart rate of 118 bpm

Correct answer: Skin that is warm and flushed with bounding peripheral pulses

Warm, flushed skin with bounding peripheral pulses suggests distributive (vasodilatory) physiology, the hallmark of septic shock, where vasopressor support is indicated to restore adequate vascular tone and perfusion pressure. Increasing norepinephrine is most appropriate when hypotension is due to vasodilation. Cool, mottled skin with weak pulses suggests cardiogenic or hypovolemic etiology where vasopressors could worsen ischemia or where volume resuscitation is needed first. Tachycardia and low BP alone do not differentiate etiology. A high CVP could indicate fluid overload, where increasing a vasopressor without addressing cardiac output may not be beneficial.

Question 94: A PN working in a long-term care facility disagrees with a care decision made by the most responsible physician regarding a resident's pain management. The PN believes the current order is inadequate based on their ongoing assessment. After raising the concern with the RN team lead and receiving no change, what is the most appropriate next step?

Administer a higher dose than ordered based on the PN's clinical judgment
Document the concern in the chart and follow the established escalation pathway, such as contacting the unit manager or using a structured advocacy tool (Correct answer)
Notify the provincial licensing body that inadequate care is being provided
Contact the resident's family to advise them to request a second physician opinion

Correct answer: Document the concern in the chart and follow the established escalation pathway, such as contacting the unit manager or using a structured advocacy tool

When a PN believes a client's needs are not being met, the professional obligation is to escalate through the facility's established channels — such as the unit manager or a structured communication tool like SBAR or a formal escalation protocol — while documenting the concern. This upholds both client advocacy and professional accountability. Administering a higher dose (A) is unsafe and outside the PN's authority. Contacting the family to orchestrate a physician change (C) oversteps the PN's role and bypasses proper process. Reporting to the licensing body (D) is reserved for serious professional misconduct, not a single unresolved clinical disagreement.

Question 95: A client is prescribed metoprolol (Lopressor) 50 mg oral twice daily. The heart rate is 48 bpm before administration. What should the practical nurse do?

Crush and mix in applesauce since the client has difficulty swallowing
Hold the medication, document the heart rate, and notify the physician (Correct answer)
Administer half the dose since the heart rate is low
Administer since it is within therapeutic range

Correct answer: Hold the medication, document the heart rate, and notify the physician

Metoprolol is a beta-blocker that slows heart rate. A pre-dose rate of 48 bpm (bradycardia) is a reason to hold the medication and notify the physician.

Question 96: A client with chronic renal failure on a potassium-restricted diet selects which food that requires correction?

Apple sauce and white crackers
White rice with butter
Orange juice and a banana (Correct answer)
White bread with cream cheese

Correct answer: Orange juice and a banana

Oranges and bananas are high-potassium foods contraindicated in clients with chronic renal failure on potassium restriction.

Question 97: During a nutritional assessment, the practical nurse uses the MUST tool. What does MUST stand for?

Multi-level Undernutrition Scoring Tool
Malnutrition Universal Screening Tool (Correct answer)
Malnutrition and Underweight Systematic Tool
Minimum Undernutrition Status Test

Correct answer: Malnutrition Universal Screening Tool

MUST stands for Malnutrition Universal Screening Tool and is used to identify adults who are malnourished or at risk of malnutrition.

Question 98: A practical nurse is assessing a 72-year-old client with Type 2 diabetes who presents with a non-healing foot ulcer. During the peripheral vascular assessment, the nurse notes: ABI of 0.58, absent dorsalis pedis pulse bilaterally, and rubor of dependency. Which interpretation and priority action is MOST appropriate?

Severe arterial insufficiency; avoid compression bandaging and refer urgently for vascular assessment (Correct answer)
Mild arterial insufficiency; apply a compression bandage to reduce edema and promote venous return
Normal perfusion variant in elderly diabetics; monitor and reassess in two weeks
Venous insufficiency; elevate the limb above heart level and apply a compression stocking

Correct answer: Severe arterial insufficiency; avoid compression bandaging and refer urgently for vascular assessment

An ABI of 0.58 indicates severe arterial insufficiency (normal is 1.0–1.4; below 0.6 is severe). Rubor of dependency and absent pulses confirm critical limb ischemia. Compression bandaging is contraindicated in arterial insufficiency as it further restricts blood flow and can precipitate limb loss. Urgent vascular referral is the priority. Elevating the limb would worsen arterial perfusion. This is not a normal variant.

Question 99: A client with post-traumatic stress disorder (PTSD) is experiencing a flashback. What is the nurse's priority intervention?

Leave the client alone to process the memory
Administer a PRN antipsychotic medication
Use a calm voice to orient the client to the present environment (Correct answer)
Restrain the client to prevent injury

Correct answer: Use a calm voice to orient the client to the present environment

Grounding techniques using a calm, reassuring voice help orient the client to the present and interrupt the dissociative flashback experience.

Question 100: A client opens eyes to voice, speaks confused words, and localizes pain. What is the Glasgow Coma Scale total?

9
10
12 (Correct answer)
11

Correct answer: 12

Eye opening to voice = 3, confused speech = 4, localizes pain = 5. Total GCS = 3+4+5 = 12.

Question 101: A practical nurse is working with a community health team applying the Population Health Promotion Model (PHPM). The team wants to prioritize an intervention addressing the social determinants of health for a low-income neighbourhood with high rates of type 2 diabetes. Which action BEST reflects intervening at the community level using a health promotion strategy?

Offering one-on-one dietary counselling sessions at the community health centre
Partnering with municipal planners to advocate for a subsidized grocery store in the neighbourhood (Correct answer)
Distributing pamphlets about healthy eating at the local food bank
Screening residents for HbA1c at a community health fair

Correct answer: Partnering with municipal planners to advocate for a subsidized grocery store in the neighbourhood

The PHPM emphasizes acting on social determinants of health at the community and societal levels. Advocating for a subsidized grocery store addresses food insecurity — a structural determinant — rather than individual behaviour change. Pamphlets and individual counselling target individual-level change, and screening is a disease-prevention activity rather than upstream health promotion.

Question 102: A practical nurse is working with a rural Indigenous community to develop a diabetes prevention program. The community elder expresses that traditional healing practices should be integrated into the program. Which action by the nurse BEST reflects the principles of culturally safe health promotion?

Acknowledge the elder's suggestion but prioritize evidence-based clinical interventions to ensure program effectiveness
Include a section on traditional practices in the program materials while maintaining the primary focus on pharmacological prevention
Collaborate with the elder and community members to co-design the program, integrating traditional practices alongside biomedical approaches (Correct answer)
Refer the community to a cultural liaison and continue developing the program using established public health frameworks

Correct answer: Collaborate with the elder and community members to co-design the program, integrating traditional practices alongside biomedical approaches

Culturally safe health promotion requires genuine partnership and co-design with communities, particularly Indigenous communities. Collaboration that integrates traditional knowledge alongside biomedical approaches respects community self-determination, builds trust, and produces more effective outcomes. Simply acknowledging suggestions, delegating to a liaison, or tokenistically adding cultural content without structural integration does not constitute culturally safe practice.

Question 103: A nurse is teaching a new mother about breast engorgement. Which statement by the mother indicates understanding?

I should stop breastfeeding until the engorgement resolves
I can apply warm compresses and massage before feeding to help milk flow (Correct answer)
Engorgement means I have too much milk and should pump and discard it
I should limit feedings to every 4 hours to reduce milk production

Correct answer: I can apply warm compresses and massage before feeding to help milk flow

Warm compresses and breast massage before feeding promote milk let-down and help relieve engorgement while maintaining breastfeeding.

Question 104: A PN is floated to an unfamiliar unit and is asked by the charge nurse to function as the team lead for three unregulated care providers (UCPs) during a short-staffed shift. The PN has not previously coordinated UCPs. What is the BEST response?

Delegate all client care tasks to the UCPs and focus on documentation to manage workload.
Accept the role fully, as PNs are always accountable for UCPs in every practice setting.
Accept care delivery responsibilities but clarify with the charge nurse the specific delegation parameters, available supports, and escalation pathways before the shift begins. (Correct answer)
Refuse the role entirely, as team leadership falls outside the PN scope of practice.

Correct answer: Accept care delivery responsibilities but clarify with the charge nurse the specific delegation parameters, available supports, and escalation pathways before the shift begins.

PNs can assign and monitor tasks performed by UCPs within established organizational frameworks, but effective delegation requires understanding what tasks can be delegated in this specific setting, the competency level of the UCPs, and who to contact when issues arise. Clarifying these parameters before the shift protects clients and ensures the PN functions within a safe, supported scope. Neither blanket acceptance without orientation nor outright refusal reflects sound professional judgment.

Question 105: A practical nurse working in a mental health outpatient clinic uses self-disclosure by sharing, 'I also struggled with anxiety before I learned some coping strategies.' The client then begins asking increasingly personal questions about the nurse's life. Which action BEST reflects the nurse's responsibility at this point?

Continue answering questions honestly, as transparency builds trust and deepens the therapeutic alliance.
Apologize for the initial disclosure and establish that personal topics are off-limits going forward.
Consult a supervisor immediately to determine whether any boundary violations have occurred.
Redirect the conversation back to the client's experience, explaining that the focus of their time together is on the client's needs. (Correct answer)

Correct answer: Redirect the conversation back to the client's experience, explaining that the focus of their time together is on the client's needs.

Judicious self-disclosure can normalize a client's experience, but it must remain purposeful and client-focused. When a client redirects the conversation toward the nurse's personal life, the therapeutic response is to gently refocus without shaming the client or over-correcting. Option A escalates a boundary drift. Option C is unnecessarily harsh and may rupture the alliance. Option D overreacts to what is a manageable and common clinical moment that can be handled in the session.

Question 106: The practical nurse is assessing a client who reports difficulty swallowing and occasional choking on liquids but not solids. Which cranial nerve dysfunction is MOST likely responsible for this specific pattern?

Cranial Nerve V (Trigeminal) — impaired jaw closure affecting the oral preparatory phase
Cranial Nerve XII (Hypoglossal) — weakened tongue preventing posterior propulsion of the bolus
Cranial Nerve VII (Facial) — unilateral facial weakness causing premature bolus spillage
Cranial Nerve IX (Glossopharyngeal) and X (Vagus) — impaired pharyngeal peristalsis and laryngeal protection (Correct answer)

Correct answer: Cranial Nerve IX (Glossopharyngeal) and X (Vagus) — impaired pharyngeal peristalsis and laryngeal protection

Dysphagia to liquids more than solids (thin liquids are harder to control than thick/solid boluses) specifically implicates the pharyngeal and laryngeal phase of swallowing. CN IX and X control the pharyngeal constrictor muscles, soft palate elevation, and vocal cord adduction for airway protection. Failure here allows thin liquids to spill into an unprotected airway before the swallow reflex triggers. CN XII weakness impairs tongue propulsion (affecting both consistencies equally in the oral phase), and CN VII affects lip seal and oral containment rather than pharyngeal/laryngeal protection.

Question 107: Which behavior best demonstrates a practical nurse's commitment to continuing competence?

Seeking additional education after identifying a knowledge gap during practice (Correct answer)
Relying solely on initial nursing education
Completing mandatory annual declarations without additional learning
Reading nursing journals when assigned by management

Correct answer: Seeking additional education after identifying a knowledge gap during practice

Self-identified learning and proactive education demonstrate genuine commitment to continuing competence rather than minimum compliance.

Question 108: A practical nurse is caring for an 82-year-old client with moderate dementia who refuses to open their mouth for oral hygiene. The client becomes agitated and bites down on the toothbrush. Which intervention is most appropriate?

Use a mouth prop to hold the mouth open and complete the oral care quickly
Request a physician order for sedation prior to oral hygiene procedures
Offer a flavoured foam swab and approach during a calm period, using a step-by-step verbal cue (Correct answer)
Document the refusal and defer oral care until the next scheduled assessment

Correct answer: Offer a flavoured foam swab and approach during a calm period, using a step-by-step verbal cue

For clients with dementia who resist oral care, the evidence-based approach is to use distraction (flavoured swabs are less threatening than a toothbrush), time interventions during the client's calmest period of day, and use simple step-by-step verbal or visual cues. Deferring care leads to oral health deterioration and increased aspiration risk. Mouth props without consent are restraints and violate dignity. Sedation is not warranted for routine care resistance.

Question 109: A practical nurse assesses a client with chronic liver disease and notes asterixis. Which assessment technique is used to elicit this sign, and what does it indicate?

Asking the client to extend the arms and wrists with fingers spread and observing for a flapping tremor; indicates hepatic encephalopathy (Correct answer)
Applying pressure to the nail bed and observing capillary refill; indicates peripheral vascular disease
Percussing the abdomen in all four quadrants and listening for fluid shifts; indicates ascites
Asking the client to dorsiflex both feet and observing for calf pain; indicates deep vein thrombosis

Correct answer: Asking the client to extend the arms and wrists with fingers spread and observing for a flapping tremor; indicates hepatic encephalopathy

Asterixis ("liver flap") is elicited by asking the client to hold arms outstretched with wrists dorsiflexed. A flapping, non-rhythmic tremor results from the inability to maintain sustained postures due to metabolic disturbances — most notably the accumulation of ammonia in hepatic encephalopathy. It can also occur in renal failure (uremic encephalopathy) and CO2 narcosis, but in the context of liver disease it strongly suggests hepatic encephalopathy requiring urgent intervention.

Question 110: A client is prescribed subcutaneous heparin 5000 units. Which administration technique is most appropriate?

Aspirate before each injection
Aspirate before injection and massage vigorously after
Inject into the deltoid muscle and apply pressure
Inject into the abdomen 5 cm from the umbilicus, do not aspirate, do not massage (Correct answer)

Correct answer: Inject into the abdomen 5 cm from the umbilicus, do not aspirate, do not massage

Subcutaneous heparin: inject into the abdomen (5 cm from navel), do not aspirate (increases bleeding risk), do not massage (causes bruising and alters absorption).

Question 111: Which situation represents a boundary violation in the nurse-client therapeutic relationship?

Sharing a brief personal experience with a health issue to build rapport
Touching a client's hand briefly when delivering difficult news
Accepting a bottle of wine from a client as thanks for excellent care (Correct answer)
Asking a client about their cultural food preferences for meal planning

Correct answer: Accepting a bottle of wine from a client as thanks for excellent care

Accepting gifts of significant value from clients crosses professional boundaries by creating an inappropriate obligation and blurring the professional relationship.

Question 112: A nurse is caring for a client receiving magnesium sulfate for severe preeclampsia. Which assessment finding requires the nurse to stop the infusion immediately?

Serum magnesium level of 6 mEq/L
Blood pressure of 148/96 mmHg
Respiratory rate of 10 breaths per minute (Correct answer)
Urinary output of 35 mL/hour

Correct answer: Respiratory rate of 10 breaths per minute

A respiratory rate of 10 breaths per minute indicates magnesium toxicity and is a critical finding requiring immediate cessation of the infusion.

Question 113: A practical nurse is administering medications to four clients. Which medication requires the nurse to perform an additional safety check by verifying apical pulse before administration?

Amoxicillin 500 mg orally
Metformin 500 mg orally
Digoxin 0.125 mg orally (Correct answer)
Pantoprazole 40 mg orally

Correct answer: Digoxin 0.125 mg orally

Digoxin is a cardiac glycoside; apical pulse must be counted for one full minute before administration and withheld if the rate is below 60 bpm in adults.

Question 114: After being admitted, a male client diagnosed with bipolar disorder is put in a room with another client. The bipolar client's past indicates episodes of hyperactivity and aggression in the recent past. Later that evening, there is a disturbance, and it is discovered that this client is lawfully hitting the other client;

A client with a hostile past shouldn't have been placed in a two-bed room by the admissions office.
Given the client's history of aggression, the nursing team decided to monitor them closely. (Correct answer)
When a bipolar patient is aware of reality, they don't need to be supervised.
Tranquilizers should have been used to calm a known belligerent customer.

Correct answer: Given the client's history of aggression, the nursing team decided to monitor them closely.

Given the client's documented history of hyperactivity and aggression associated with bipolar disorder, the nursing team has a responsibility to implement close monitoring. This proactive approach is essential to ensure the safety of both the client and other patients, especially when placed in a new environment like a shared room, to prevent potential disturbances or harm.

Question 115: A practical nurse is caring for a client with confirmed pulmonary tuberculosis (TB) who must be transported to radiology for a chest X-ray. Which combination of precautions is correct for this transport?

The client wears an N95 respirator; the transporting nurse wears a surgical mask
No mask is required during brief transport if the hallways are well-ventilated
Both the client and nurse wear N95 respirators throughout transport
The client wears a surgical mask; the transporting nurse wears an N95 respirator (Correct answer)

Correct answer: The client wears a surgical mask; the transporting nurse wears an N95 respirator

For transporting a client with active pulmonary TB, the client should wear a surgical mask to contain droplet nuclei at the source. The transporting nurse wears a fit-tested N95 respirator because TB requires airborne precautions. The client does not need an N95 — a surgical mask at the source is sufficient — but the HCW requires the higher-filtration N95 due to the airborne transmission route.

Question 116: Which measure is most effective in preventing pressure injuries in a bedridden elderly client?

Applying lotion to all bony prominences once daily
Repositioning at least every 2 hours with pressure-relieving surfaces (Correct answer)
Repositioning every 4 hours
Using standard hospital mattress without additional support

Correct answer: Repositioning at least every 2 hours with pressure-relieving surfaces

Repositioning every 2 hours combined with pressure-relieving surfaces is the evidence-based standard for pressure injury prevention.

Question 117: A client tells the nurse: 'I feel so ashamed. I cannot even manage my own diabetes.' Which therapeutic response is most appropriate?

'Most people with diabetes struggle too. You are not alone.'
'Let me review the diabetes management plan with you again.'
'You sound really frustrated with managing your diabetes. Can you tell me more about what has been most challenging?' (Correct answer)
'Diabetes is a difficult disease. You should not be so hard on yourself.'

Correct answer: 'You sound really frustrated with managing your diabetes. Can you tell me more about what has been most challenging?'

Reflecting the client's emotion and using an open question invites them to share more while validating their experience, which is therapeutic active listening.

Question 118: A client on airborne precautions for active pulmonary tuberculosis (TB) requires transport to radiology for a chest X-ray. Which measure is MOST important to implement during transport?

Have the transporting nurse wear a fit-tested N95 respirator and have the client wear nothing
Postpone all non-urgent transport until the client has three consecutive negative sputum smears
Place a surgical mask on the client for the duration of transport (Correct answer)
Transport the client only through negative-pressure corridors designated for infectious clients

Correct answer: Place a surgical mask on the client for the duration of transport

During transport of a client with active TB outside the airborne infection isolation room, the client must wear a surgical mask to contain respiratory droplet nuclei at the source. The healthcare worker transporting the client should also wear an N95 respirator, but the client masking is the critical intervention — the client is the source of infectious particles. Postponing transport is not always clinically feasible. Most facilities do not have negative-pressure transport corridors; source containment via client masking is the practical standard.

Question 119: A practical nurse notes that a physician's handwritten order in a client's chart is illegible. What is the most appropriate action for the nurse to take?

Contact the pharmacy to see how they have interpreted similar orders.
Administer the medication based on the nurse's best judgment of the order.
Contact the prescribing physician directly to clarify the order. (Correct answer)
Ask another experienced nurse on the unit to interpret the order.

Correct answer: Contact the prescribing physician directly to clarify the order.

To ensure client safety and prevent medication errors, the practical nurse must never guess or assume what an illegible order says. The only safe and acceptable action is to contact the original prescriber for clarification before preparing or administering the medication.

Question 120: A nurse working in an Indigenous community wants to incorporate cultural safety into health promotion activities. Which action BEST demonstrates cultural safety?

Inviting community Elders to co-design and lead health sessions (Correct answer)
Providing transportation to the nearest urban health clinic
Displaying Indigenous artwork in the community health centre
Translating all written materials into the local Indigenous language

Correct answer: Inviting community Elders to co-design and lead health sessions

Cultural safety goes beyond translation or décor by actively sharing power — co-designing programs with Elders ensures the community's values and knowledge shape the intervention.

Question 121: A client post-abdominal surgery reports sudden severe abdominal pain with board-like rigidity. What is the priority nursing action?

Apply warm compress and continue monitoring
Administer analgesic and reassess in 30 minutes
Document and report at end of shift
Position in semi-Fowlers and notify the physician immediately (Correct answer)

Correct answer: Position in semi-Fowlers and notify the physician immediately

Sudden severe pain with abdominal rigidity post-surgery suggests peritonitis or anastomotic leak requiring immediate medical intervention.

Question 122: A nurse is applying the stages of change model (Transtheoretical Model) to a client who says 'I know I should quit smoking but I'm not ready yet.' The client is in which stage?

Maintenance
Contemplation (Correct answer)
Precontemplation
Preparation

Correct answer: Contemplation

Acknowledging a problem but not yet committing to change places the client in the contemplation stage, where motivational interviewing is the most appropriate intervention.

Question 123: A client with heart failure is prescribed a fluid restriction of 1,200 mL per 24 hours. At 1400h, the intake record shows: morning medications with 180 mL water, breakfast juice 120 mL, IV piggyback antibiotics in 100 mL NS (completed at 1200h), lunch soup 150 mL, and oral intake of 240 mL since lunch. How many millilitres remain for the rest of the shift and night?

510 mL
370 mL
410 mL (Correct answer)
310 mL

Correct answer: 410 mL

Total intake so far: 180 (medications) + 120 (juice) + 100 (IV piggyback) + 150 (soup) + 240 (oral since lunch) = 790 mL. Remaining: 1,200 − 790 = 410 mL. IV piggyback fluid counts toward fluid intake in clients with restrictions. Errors in fluid restriction management are a common cause of fluid overload and hospital readmission in heart failure clients, making meticulous inclusion of all fluid sources essential.

Question 124: A PN and a respiratory therapist disagree about a client's oxygen therapy plan. What is the best resolution strategy?

Document the disagreement and take no further action
Both professionals should discuss the issue and involve the physician if needed to reach consensus (Correct answer)
The respiratory therapist's decision always takes precedence for breathing issues
The PN should proceed with nursing judgment alone

Correct answer: Both professionals should discuss the issue and involve the physician if needed to reach consensus

Interprofessional disagreements are best resolved through respectful discussion, escalating to the physician when consensus cannot be reached.

Question 125: A practical nurse is preparing to apply a fentanyl transdermal patch 25 mcg/h to a client who was previously opioid-naïve and now has chronic pain. The previous patch was applied 72 hours ago. Upon assessment, the nurse finds two old patches still in place on the client's upper back. What is the FIRST action the nurse should take?

Remove both old patches immediately, complete a full assessment for opioid toxicity, and hold the new patch until the prescriber is notified (Correct answer)
Leave the patches in place, apply the new patch to a fresh site, and document that three patches are in place
Apply the new patch to a fresh site and remove both old patches simultaneously to ensure continuous pain control
Remove one old patch, leave the other in place to maintain partial analgesia, and then apply the new patch

Correct answer: Remove both old patches immediately, complete a full assessment for opioid toxicity, and hold the new patch until the prescriber is notified

Two fentanyl patches on an opioid-naïve client represent a potential overdose situation — the client may have been receiving double the intended dose for an extended period. The nurse must first remove both old patches to stop further drug absorption, then immediately perform a thorough assessment for signs of opioid toxicity (sedation, respiratory depression, pinpoint pupils, altered consciousness). The prescriber must be notified before the new patch is applied. Applying an additional patch before resolving this error, or leaving any old patches in place, could cause fatal respiratory depression. This is a medication safety incident requiring documentation and likely an incident report.

Question 126: What is the primary purpose of using a draw sheet when repositioning a client in bed?

Restraining the client
Reducing friction and shear forces on the skin (Correct answer)
Absorbing moisture
Keeping the client warm

Correct answer: Reducing friction and shear forces on the skin

A draw sheet reduces friction and shear that cause skin breakdown and pressure injuries.

Question 127: While reviewing a fellow team member's documentation, a PN notices that a colleague has been consistently charting vital signs at times when the PN knows the colleague was on break. The documentation appears to have been fabricated. Under professional accountability standards, what is the PN's PRIMARY obligation?

Report directly to the provincial regulatory college, bypassing the employer, to ensure regulatory bodies are immediately informed
Document personal observations in a private log and wait to see if a patient harm event occurs before reporting
Report the concern to the nurse manager or employer, and if the issue is not addressed, escalate to the provincial regulatory college (Correct answer)
Confront the colleague privately and give them an opportunity to self-correct before involving management

Correct answer: Report the concern to the nurse manager or employer, and if the issue is not addressed, escalate to the provincial regulatory college

Falsifying documentation is a serious breach of professional standards that directly endangers patient safety and constitutes professional misconduct. The PN has a duty to report. The correct sequence is to first report to the employer/manager — facilities have processes to investigate and address this. If the employer fails to act or the situation poses ongoing risk, the PN is obligated to escalate to the regulatory college. Bypassing the employer entirely as a first step is generally not appropriate; however, inaction or private logging while harm is ongoing is never acceptable.

Question 128: The practical nurse is administering oral medications and finds that a tablet prescribed for a client is not available on the unit. What is the correct first action?

Crush a different strength tablet to approximate the dose
Substitute a similar medication from another client's supply
Contact the pharmacy to obtain the correct medication (Correct answer)
Document the omission and administer the next scheduled dose instead

Correct answer: Contact the pharmacy to obtain the correct medication

The pharmacy must be contacted to supply the correct, prescribed medication; substituting from another client's supply is unsafe and unprofessional.

Question 129: When performing a mental status assessment, which component does the practical nurse evaluate by asking the client to subtract serial 7s from 100?

Orientation
Memory
Concentration and calculation (Correct answer)
Abstract reasoning

Correct answer: Concentration and calculation

Serial 7 subtraction tests concentration and calculation ability, which is a component of cognitive function in a mental status exam.

Question 130: Which of the following is considered a non-therapeutic communication technique that can block further discussion with a client?

Asking open-ended questions to encourage elaboration.
Using silence to allow the client time to reflect.
Paraphrasing the client's statement to show understanding.
Providing false reassurance by saying "Everything will be just fine." (Correct answer)

Correct answer: Providing false reassurance by saying "Everything will be just fine."

Providing false reassurance is a non-therapeutic technique because it dismisses the client's legitimate feelings and concerns, discouraging them from further expression. It can be perceived as the nurse not taking their situation seriously. Using silence, asking open-ended questions, and paraphrasing are all therapeutic techniques designed to encourage communication.

Question 131: During a bed bath, the PN notices a 2 cm × 1.5 cm area of intact skin over the sacrum that is non-blanchable, dark red, and warm to the touch compared with surrounding tissue. The client has been on bed rest for 3 days. How should this finding be classified and what is the priority action?

Stage 2 pressure injury; cleanse with normal saline, apply a foam dressing, and notify the physician
Suspected deep tissue pressure injury (DTPI); photograph, document, notify the most responsible provider, and offload the area (Correct answer)
Stage 1 pressure injury; apply a moisture barrier cream and continue current repositioning schedule
Suspected deep tissue pressure injury (DTPI); apply a transparent film dressing and reposition off the area immediately

Correct answer: Suspected deep tissue pressure injury (DTPI); photograph, document, notify the most responsible provider, and offload the area

Non-blanchable discolouration that is dark (purple/maroon/dark red) with warmth over a bony prominence after sustained pressure is classified as a Suspected Deep Tissue Pressure Injury (DTPI). Unlike a Stage 1 (which is pink/red and represents superficial changes), DTPI signals deeper tissue destruction that may rapidly evolve to a full-thickness wound. Priority actions are accurate documentation (including photography), immediate offloading of the area, and notification of the most responsible provider so a wound specialist can be involved. A transparent film alone is insufficient management for a DTPI.

Question 132: Which principle underpins the practical nurse's obligation to obtain informed consent?

Autonomy (Correct answer)
Justice
Beneficence
Non-maleficence

Correct answer: Autonomy

Informed consent is fundamentally an expression of patient autonomy, the right to make informed decisions about one's own healthcare.

Question 133: The practical nurse is administering an oral liquid medication to a client with dysphagia. Which action best promotes safe administration?

Position the client upright or at a 45-degree angle before administration (Correct answer)
Mix the medication in a large glass of water to thin it further
Administer the medication rapidly to minimize aspiration time
Instruct the client to tilt their head back while swallowing

Correct answer: Position the client upright or at a 45-degree angle before administration

Upright or semi-upright positioning uses gravity to facilitate swallowing and significantly reduces the risk of aspiration.

Question 134: During a therapeutic interaction, a client with borderline personality disorder says, 'You're the best nurse I've ever had — unlike that other nurse who is absolutely terrible and doesn't care about patients at all.' Recognizing this as a manifestation of splitting, what is the nurse's MOST appropriate initial response?

Acknowledge the client's feelings and, without validating the split perception, calmly restate that all team members are committed to the client's care. (Correct answer)
Immediately document the client's complaint about the other nurse and initiate a formal incident review.
Agree that care quality varies among nurses and validate the client's positive experience with the current nurse.
Tell the client it is not therapeutic to speak negatively about other nurses and set a firm limit on this type of conversation.

Correct answer: Acknowledge the client's feelings and, without validating the split perception, calmly restate that all team members are committed to the client's care.

Splitting — viewing people as entirely good or entirely bad — is a hallmark defense mechanism in borderline personality disorder. The therapeutic response is to neither validate the idealization nor the devaluation, and to reinforce the consistency and collective commitment of the team. Option A reinforces the split by agreeing. Option C misidentifies a psychological defense as a formal complaint. Option D is confrontational and shuts down communication, damaging the therapeutic relationship.

Question 135: Under Canadian nursing legislation, which term refers to the legally protected activities that only regulated nurses may perform?

Authorized procedures
Licensed functions
Controlled acts
Reserved acts (Correct answer)

Correct answer: Reserved acts

Provincial legislation designates certain nursing activities as 'reserved acts' (or controlled acts in some provinces) that only regulated professionals may perform.

Question 136: A client is prescribed insulin glargine (Lantus) 20 units at bedtime. Which practice is incorrect?

Drawing up glargine in a separate syringe
Administering glargine at the same time each day
Injecting glargine subcutaneously in the abdomen
Mixing glargine with regular insulin in the same syringe (Correct answer)

Correct answer: Mixing glargine with regular insulin in the same syringe

Insulin glargine (Lantus) must NEVER be mixed with other insulins as mixing alters its pH and destroys the long-acting profile.

Question 137: A practical nurse is assessing a 74-year-old client with heart failure. During auscultation, an S3 gallop is heard at the apex. Which pathophysiological mechanism best explains this finding?

Turbulent blood flow across a stenotic mitral valve during systole
Premature closure of the pulmonic valve due to elevated pulmonary pressures
Rapid ventricular filling against a non-compliant, volume-overloaded ventricle in early diastole (Correct answer)
Atrial contraction against a stiff ventricle during late diastole

Correct answer: Rapid ventricular filling against a non-compliant, volume-overloaded ventricle in early diastole

An S3 gallop (ventricular gallop) occurs in early diastole (after S2) when blood rushes into a distended, poorly compliant ventricle. In heart failure, the ventricle is volume-overloaded and stiff, causing vibrations during rapid filling — the hallmark of an S3. An S4 (not S3) is associated with atrial contraction against a stiff ventricle. Mitral stenosis produces a different auscultatory profile (opening snap + diastolic rumble), and pulmonic valve changes affect the splitting of S2.

Question 138: A nurse is performing a comprehensive pain assessment on a postoperative client who is non-verbal and has moderate cognitive impairment. The client cannot self-report pain. Which assessment approach is MOST valid for this population?

Rely solely on proxy reporting from family members as the gold standard substitute
Infer pain absence because the client is not crying or guarding the surgical site
Use a behavioural observation tool such as the Abbey Pain Scale, incorporating physiological and behavioural cues (Correct answer)
Administer a standard 0–10 numeric rating scale verbally and document the response

Correct answer: Use a behavioural observation tool such as the Abbey Pain Scale, incorporating physiological and behavioural cues

For non-verbal clients with cognitive impairment, validated behavioural observation tools such as the Abbey Pain Scale, PAINAD, or CPOT are the standard of care. These tools assess facial expressions, body language, vocalizations, consolability, and physiological indicators. The numeric rating scale requires self-report capacity the client lacks. Absence of overt distress does not rule out pain, particularly in cognitively impaired individuals who may have blunted expression. Family proxy reporting alone is not validated as a gold standard and must be combined with direct behavioural observation.

Question 139: During a mental status examination, a nurse notes that a client's speech is fluent and grammatically intact but the content is completely unrelated to the questions asked. The client appears unaware of this disconnect. Which specific finding is the nurse documenting?

Receptive aphasia (Wernicke's aphasia) (Correct answer)
Tangentiality
Circumstantiality
Expressive aphasia (Broca's aphasia)

Correct answer: Receptive aphasia (Wernicke's aphasia)

Receptive (Wernicke's) aphasia is characterized by fluent, grammatically intact speech that lacks meaningful content and fails to respond relevantly to questions — the client cannot comprehend language input, so responses are semantically disconnected. Clients are typically unaware of the deficit. Tangentiality involves drifting off-topic but with a traceable connection. Circumstantiality involves excessive irrelevant detail but eventually reaches the point. Expressive (Broca's) aphasia produces non-fluent, effortful speech with preserved comprehension.

Question 140: During the termination phase, which client response indicates the relationship is ending therapeutically?

The client regresses to behaviors from the orientation phase
The client becomes increasingly dependent and requests more contact
The client expresses realistic summary of progress and demonstrates coping strategies for ongoing needs (Correct answer)
The client denies having any feelings about the relationship ending

Correct answer: The client expresses realistic summary of progress and demonstrates coping strategies for ongoing needs

Realistic review of progress and independent coping strategies indicate healthy therapeutic termination. The client has internalized gains from the relationship.

Question 141: A practical nurse is preparing 0.4 mg of morphine sulfate IV for a post-operative client. The available vial reads 'Morphine Sulfate 1 mg/mL.' After drawing up 0.4 mL, the nurse notices a second vial on the same tray labeled 'Hydromorphone 2 mg/mL.' What is the MOST important immediate action?

Label the syringe immediately, remove the hydromorphone vial from the work area, then perform a final label check before administration (Correct answer)
Verify the drawn-up syringe against the morphine vial label before discarding the hydromorphone vial and proceeding
Administer the morphine promptly before additional distractors appear, since the dose was already verified at the time of drawing
Discard both vials and request entirely new medications from pharmacy to eliminate any risk of mix-up

Correct answer: Label the syringe immediately, remove the hydromorphone vial from the work area, then perform a final label check before administration

Hydromorphone is 5–10 times more potent than morphine and is a high-alert medication involved in numerous fatal errors. The immediate priority when a look-alike/sound-alike (LASA) drug is present on the same tray is to remove the distractor from the workspace, label the prepared syringe immediately to prevent it from being confused with another, and perform a final independent label verification against the original vial before administration. Discarding both vials is wasteful and unnecessary if the correct drug was drawn. Proceeding without labelling the syringe or removing the LASA drug violates safe medication preparation principles.

Question 142: On postpartum day 3, a breastfeeding client reports bilateral breast engorgement, a temperature of 37.9°C, and general flu-like myalgia. The breasts appear symmetrically full and firm without localized redness or a palpable mass. What should the nurse advise?

Apply warm compresses and administer ibuprofen; this pattern is consistent with mastitis
Refer the client to the physician for antibiotic therapy for mastitis
Discontinue breastfeeding temporarily and apply ice packs to reduce inflammation
Increase the frequency of feedings or pumping and reassess in 24 hours (Correct answer)

Correct answer: Increase the frequency of feedings or pumping and reassess in 24 hours

The presentation described — bilateral symmetric engorgement with low-grade temperature and myalgia on day 3 postpartum — is consistent with normal physiologic breast engorgement (milk 'coming in'), not mastitis. Mastitis typically presents as a unilateral wedge-shaped area of erythema, warmth, and induration, usually after the first week. The correct management for engorgement is frequent, effective milk removal (feeding or pumping), proper latch assessment, and symptom management. Antibiotics are not indicated. Discontinuing breastfeeding worsens engorgement. Misdiagnosing this as mastitis leads to unnecessary antibiotic use.

Question 143: A client in acute pain rates their pain 9/10. The ordered analgesic is due in 2 hours. Which response best demonstrates the ethical principle of beneficence?

Offer distraction as the sole intervention
Document the pain rating and wait for the scheduled time
Remind the client the medication schedule cannot be changed
Assess fully, review for PRN medications, and contact the physician to discuss uncontrolled pain (Correct answer)

Correct answer: Assess fully, review for PRN medications, and contact the physician to discuss uncontrolled pain

Beneficence requires actively intervening to promote the client's well-being. Severe pain requires active advocacy, not passive waiting.

Question 144: A client receiving a blood transfusion develops fever, chills, and back pain 15 minutes after the infusion begins. What is the nurse's immediate action?

Stop the transfusion, keep the IV line open with normal saline, and notify the physician (Correct answer)
Slow the infusion rate and administer acetaminophen
Stop the transfusion and remove the IV line immediately
Administer diphenhydramine IV and continue the transfusion at a slower rate

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

Signs of acute hemolytic transfusion reaction require stopping the transfusion immediately while maintaining IV access with normal saline and notifying the physician.

Question 145: A practical nurse (PN) is working in a long-term care facility when a resident's family member, who is also a physician, verbally orders a change in the resident's medication dose outside of the facility. The PN cannot reach the resident's attending physician. What is the most legally defensible action?

Decline to administer the changed dose, document the situation, and continue to attempt to reach the attending physician or supervisor (Correct answer)
Administer the original dose but document the family physician's recommendation for the attending to review
Document the family physician's verbal order and administer the new dose, as the family member is a licensed physician
Contact the provincial nursing regulatory body before taking any action

Correct answer: Decline to administer the changed dose, document the situation, and continue to attempt to reach the attending physician or supervisor

A PN must only follow orders from authorized prescribers within the established care relationship and institutional protocols. A family member who is a physician has no prescribing authority over a patient who is not their patient, and a verbal order given outside institutional channels is not legally valid. The PN's accountability requires declining the change, continuing safe care under existing orders, documenting thoroughly, and escalating appropriately.

Question 146: When a practical nurse is performing the three checks of medication administration, which of the following is the correct procedure?

Check the medication label against the MAR when selecting it, before pouring it, and after administering it.
Check the medication label against the MAR in the medication room, once in the hallway, and again at the bedside.
Check the medication label against the MAR when selecting it, at the bedside before opening, and when documenting.
Check the medication label against the MAR when removing it from the dispenser, when preparing it, and at the bedside before administering it. (Correct answer)

Correct answer: Check the medication label against the MAR when removing it from the dispenser, when preparing it, and at the bedside before administering it.

The three checks of medication administration are a fundamental safety protocol. The nurse must check the medication against the Medication Administration Record (MAR) three times: 1) when taking the medication from its storage location, 2) when preparing or pouring the medication, and 3) at the client's bedside just before administering it.

Question 147: A client expresses anger and frustration about a delayed diagnostic test, stating, "No one here cares about what happens to me!" Which response by the practical nurse best maintains the therapeutic relationship?

"You shouldn't feel that way; we are all working hard to help you."
"Why are you getting so angry? It won't make the test happen any faster."
"I can see you are very upset. Let's talk about what is frustrating you the most." (Correct answer)
"The staff is very busy, but I'm sure the doctor is doing what's best for you."

Correct answer: "I can see you are very upset. Let's talk about what is frustrating you the most."

This response uses the therapeutic techniques of acknowledging the client's feelings and offering to explore the source of their frustration. This validates their experience and keeps communication open. Defending the staff, telling the client how to feel, and asking 'why' questions are all non-therapeutic techniques that can make the client defensive and block further communication.

Question 148: A PN is part of a quality improvement committee reviewing fall prevention. What role does the PN play in this committee?

Contribute frontline observations and nursing expertise to inform evidence-based changes (Correct answer)
Focus only on medication-related quality indicators
Implement whatever changes are decided without providing input
Observe only, since quality improvement is the manager's responsibility

Correct answer: Contribute frontline observations and nursing expertise to inform evidence-based changes

PNs bring valuable frontline clinical knowledge to quality improvement initiatives and are expected to actively contribute.

Question 149: A client has a prescription for morphine 4–8 mg IV PRN for pain. The client rates pain as 7/10. What dose should the practical nurse consider administering first?

8 mg, the maximum dose, to achieve faster relief
6 mg, the midpoint dose, as a compromise
4 mg, the minimum dose, and reassess response (Correct answer)
No dose until the physician specifies an exact amount

Correct answer: 4 mg, the minimum dose, and reassess response

Starting with the lowest effective dose and reassessing follows safe opioid prescribing principles and reduces the risk of adverse effects.

Question 150: A PN administers the correct medication but via the wrong route — the drug was ordered IV but given IM — resulting in delayed therapeutic effect but no lasting patient harm. The PN immediately recognizes the error. Which combination of actions BEST fulfills the PN's legal and professional obligations?

Administer a corrective IV dose promptly to compensate for the error, then complete an incident report without noting the original mistake in the chart to avoid alarming the patient
Document only in the incident report and not in the clinical chart, as the chart is a legal document and self-incriminating entries should be avoided
Notify the charge nurse verbally and rely on the charge nurse to complete all required documentation since the charge nurse holds supervisory accountability
Notify the responsible prescriber immediately, complete an incident/occurrence report per facility policy, document the error factually in the clinical record, and monitor the patient for adverse effects (Correct answer)

Correct answer: Notify the responsible prescriber immediately, complete an incident/occurrence report per facility policy, document the error factually in the clinical record, and monitor the patient for adverse effects

Medication errors require immediate patient safety response (notify prescriber, monitor), transparent documentation in the clinical record (which must reflect what actually happened, not what was ordered), and completion of a facility incident report. The clinical chart is a legal record of care — omitting or falsifying an error constitutes falsification of records, which is a disciplinary offense separate from the original error. Self-reporting and transparency are professional obligations; attempting to administer an unsanctioned 'correction' without a new order compounds the error. The PN retains personal accountability regardless of who is in charge.

Question 151: Which phase of the therapeutic relationship involves establishing trust, clarifying roles, and setting mutual goals?

Working phase
Evaluation phase
Orientation phase (Correct answer)
Termination phase

Correct answer: Orientation phase

The orientation phase focuses on establishing rapport, clarifying the nurse and client roles, and collaboratively setting goals for the relationship.

Question 152: A nurse is assessing a 6-month-old infant brought in by parents who report the baby 'stopped breathing for a moment' during sleep. The infant is alert and feeding well now. This is the second such episode. The infant's 3-year-old sibling died suddenly at home 8 months ago with no determined cause. Which action reflects the nurse's MOST appropriate professional and ethical response?

Reassure the parents this is likely benign breath-holding and arrange follow-up with a pediatrician in 2 weeks
Discharge the infant with an apnea monitor and parent teaching on infant CPR
Document the episodes thoroughly and report concerns to the charge nurse and physician without accusatory statements, following the agency's safeguarding protocol (Correct answer)
Directly question the parents about whether they may have inadvertently obstructed the infant's airway

Correct answer: Document the episodes thoroughly and report concerns to the charge nurse and physician without accusatory statements, following the agency's safeguarding protocol

The combination of recurrent apparent life-threatening events (ALTEs/BRUEs) in an infant and an unexplained sibling death raises significant safeguarding concerns consistent with possible non-accidental suffocation or a familial condition. The nurse's role is to document objectively and escalate through proper channels (charge nurse, physician, and safeguarding protocol) — not to accuse parents or make a diagnosis, but also not to dismiss the pattern. Discharging with an apnea monitor without investigation would be inadequate given the sibling history. Directly accusing parents is inappropriate and could impede a proper multidisciplinary investigation.

Question 153: During a home care visit, a competent patient newly diagnosed with insulin-dependent diabetes mellitus tells the PN, 'Don't tell anyone — I'm a long-haul truck driver and I can't lose my job. I know I'm supposed to report it but I need the income.' What is the PN's most appropriate course of action?

Maintain strict confidentiality, as the capable patient has an explicit right to privacy and autonomous decision-making
Explore the patient's concerns, provide education about reporting obligations and the safety risks to the public, document the conversation thoroughly, and escalate through the care team and duty-to-warn protocols if the patient refuses to self-report (Correct answer)
Encourage the patient to self-report and document the conversation, but take no further action unless the patient makes an explicit threat
Immediately contact the provincial transport authority to report the diagnosis, as public safety takes absolute precedence

Correct answer: Explore the patient's concerns, provide education about reporting obligations and the safety risks to the public, document the conversation thoroughly, and escalate through the care team and duty-to-warn protocols if the patient refuses to self-report

This scenario triggers duty-to-warn considerations because there is an identifiable, serious safety risk to third parties (the public). In Canada, insulin-dependent diabetes may trigger mandatory provincial reporting requirements for commercial vehicle operators, and new-onset IDDM poses real risk while driving large commercial trucks. Confidentiality (A) cannot be maintained when there is a concrete third-party safety risk of this magnitude. Immediately contacting transport authorities (B) is premature — proper process requires education, documentation, and care team consultation first. Encouraging self-report alone (D) is insufficient given the severity and immediacy of potential harm. Option C follows the ethical and legal framework: educate, document, and escalate appropriately.

Question 154: A practical nurse is asked by a supervisor to falsify a patient's chart to conceal a medication error. The nurse should:

Alter only the parts of the chart that cannot be independently verified
Consult a lawyer before deciding whether to comply
Refuse, as falsifying records is a criminal act and a professional misconduct violation (Correct answer)
Comply to maintain the employment relationship and avoid conflict

Correct answer: Refuse, as falsifying records is a criminal act and a professional misconduct violation

Falsifying medical records constitutes fraud and professional misconduct; a nurse must refuse regardless of who makes the request.

Question 155: A PN observes a colleague consistently documenting medications as administered when the patient "refused anyway," stating that charting refusals "takes too long." The colleague is known to be under significant personal stress. What is the PN's most appropriate first action?

Document personal observations and report the concern through the facility's established chain of command (Correct answer)
Speak privately with the colleague and give them an opportunity to self-report before escalating, to preserve the therapeutic team relationship
Consult with the ethics committee before taking any action, as the colleague's personal circumstances create an ethically complex situation
Report the colleague directly to the provincial regulatory body, as this constitutes professional misconduct

Correct answer: Document personal observations and report the concern through the facility's established chain of command

When patient safety is at risk due to falsified documentation, the PN must act promptly. The correct first step is to document specific observations and report through the facility's chain of command (charge nurse, manager), which initiates the proper investigation process. Speaking privately with the colleague (A) risks being perceived as collusion and delays addressing an ongoing patient safety issue. Reporting directly to the regulatory body (C) may be appropriate eventually but bypasses institutional processes that should occur first. Waiting for an ethics committee (D) introduces dangerous delay when patients may be actively harmed. The colleague's personal stress, while unfortunate, does not alter the PN's professional obligation.

Question 156: A client at 38 weeks gestation is GBS positive. Which intervention is expected?

Providing oral amoxicillin before hospital admission
Performing a cesarean section to prevent neonatal GBS infection
Administering IV prophylactic penicillin G during labour (Correct answer)
Waiting until after delivery to treat the infant if symptomatic

Correct answer: Administering IV prophylactic penicillin G during labour

GBS-positive mothers receive IV penicillin G during active labour to prevent vertical transmission to the newborn.

Question 157: During the working phase of the therapeutic nurse-client relationship, what is the primary focus?

Identifying problems, collaborating on goals, and implementing strategies to promote health and coping (Correct answer)
Completing documentation of nursing assessments for legal purposes
Reviewing progress and preparing the client for independent functioning
Establishing trust and explaining the nurse's role

Correct answer: Identifying problems, collaborating on goals, and implementing strategies to promote health and coping

The working phase is the active therapeutic phase where problems are identified, goals are set, and interventions are implemented to achieve health outcomes.

Question 158: Which statement reflects the key difference between a therapeutic relationship and a social relationship?

Therapeutic relationships have defined goals, professional boundaries, and exist primarily to benefit the client. (Correct answer)
Social relationships are limited to specific topics, while therapeutic ones are not.
Therapeutic relationships require less communication skill than social ones.
Social relationships are less meaningful than therapeutic relationships.

Correct answer: Therapeutic relationships have defined goals, professional boundaries, and exist primarily to benefit the client.

Therapeutic relationships are purposeful, time-limited, and client-focused, distinguishing them from mutual social relationships.

Question 159: A client is 12 hours post-cesarean section. During assessment, the PN notes the uterine fundus is firm, at the level of the umbilicus, and displaced to the right of midline. Lochia is rubra with a moderate flow. The client last voided 4 hours ago and reports lower abdominal discomfort. Which condition does this presentation most likely indicate?

Subinvolution of the uterus secondary to retained placental fragments
Normal uterine involution progressing as expected for 12 hours post-delivery
Uterine atony with risk of postpartum hemorrhage requiring immediate oxytocin
Urinary retention causing bladder distension that is displacing the uterus (Correct answer)

Correct answer: Urinary retention causing bladder distension that is displacing the uterus

Uterine displacement to one side of midline (classically to the right) with lower abdominal discomfort and the last void 4 hours ago is the hallmark presentation of a distended bladder displacing the uterus post-cesarean. Post-surgical urinary retention is common due to epidural/spinal anesthesia and indwelling catheter removal. A firm fundus at the umbilicus rules out atony. Subinvolution presents later (beyond 24 hours) with a soft, high fundus. The immediate action is bladder assessment and catheterization if needed.

Question 160: During a therapeutic interaction, a client with borderline personality disorder (BPD) tells the PN, 'You are the only nurse who truly understands me — all the others are cold and don't care.' The MOST therapeutically appropriate response by the PN is:

'It sounds like you've had some difficult interactions with the other nurses.'
'Thank you — I do try my best to connect with all my clients.'
'I appreciate that, but I want you to know that all the nurses here care about your well-being.'
'I'm glad you feel supported. Let's also explore how to build those connections with the rest of the team.' (Correct answer)

Correct answer: 'I'm glad you feel supported. Let's also explore how to build those connections with the rest of the team.'

The client is exhibiting 'splitting,' a core defense mechanism in BPD where individuals perceive people as entirely good or entirely bad. The therapeutic goal is to gently challenge this black-and-white thinking without dismissing the client's feelings. Option D validates the therapeutic relationship while actively redirecting toward reality-based thinking and broader support, which addresses the splitting behavior therapeutically. Option A reinforces the idealization and splitting. Option B colludes with the devaluation of other staff. Option C corrects without building on the therapeutic opportunity the moment presents.

Question 161: A 2-year-old is admitted following ingestion of an unknown quantity of iron tablets from a parent's supplement bottle approximately 90 minutes ago. The child appears alert with mild nausea but no vomiting. Which nursing intervention reflects the most accurate understanding of iron poisoning management?

Administer activated charcoal immediately to bind the iron in the gastrointestinal tract
Reassure the family that iron ingestion is rarely serious in toddlers and monitor for 4 hours
Induce vomiting with ipecac syrup to remove unabsorbed tablets
Prepare the child for whole bowel irrigation and anticipate administration of IV deferoxamine if serum iron is elevated (Correct answer)

Correct answer: Prepare the child for whole bowel irrigation and anticipate administration of IV deferoxamine if serum iron is elevated

Iron poisoning is one of the leading causes of pediatric poisoning fatalities. Activated charcoal does NOT bind iron effectively and is not indicated. Ipecac syrup is no longer recommended in any poisoning. Iron toxicity progresses through five stages; early stability is deceptive. Whole bowel irrigation with polyethylene glycol is used to remove tablets from the GI tract, and IV deferoxamine (an iron chelator) is the specific antidote administered when serum iron levels are elevated or clinical toxicity is present. The nurse should anticipate these interventions and contact Poison Control and the physician promptly.

Question 162: Which statement best describes 'unconditional positive regard' as applied to therapeutic nurse-client relationships?

The nurse only provides positive feedback to build self-esteem
The nurse avoids any criticism of the client's health decisions
The nurse agrees with all the client's decisions and behaviors
The nurse accepts the client as a person of worth regardless of their behaviors or values (Correct answer)

Correct answer: The nurse accepts the client as a person of worth regardless of their behaviors or values

Unconditional positive regard means accepting the client as a person of inherent worth and dignity, separate from their behaviors, values, or decisions, without conditions or judgment.

Question 163: A 4-year-old is admitted with epiglottitis. Which nursing intervention is the HIGHEST priority?

Obtain a throat culture using a tongue depressor
Initiate IV access immediately
Administer humidified oxygen by face mask
Keep the child calm and avoid agitating procedures (Correct answer)

Correct answer: Keep the child calm and avoid agitating procedures

Agitation can cause complete airway obstruction in epiglottitis, so maintaining calm and avoiding invasive procedures until airway is secured is the priority.

Question 164: A practical nurse realizes they made a medication error but the client experienced no harm. What is appropriate?

Tell only the charge nurse verbally
Say nothing since there was no harm
Complete an incident report, notify the charge nurse, assess the client, and notify the physician (Correct answer)
Document in a way that minimizes the description

Correct answer: Complete an incident report, notify the charge nurse, assess the client, and notify the physician

All medication errors must be reported through the incident reporting system regardless of harm, for client safety and regulatory compliance.

Question 165: A practical nurse is caring for a client prescribed clozapine for treatment-resistant schizophrenia. The client's absolute neutrophil count (ANC) today is 900 cells/mm³, down from 1,400 cells/mm³ last week. Which intervention is most appropriate?

Withhold clozapine, notify the prescriber, and increase monitoring frequency (Correct answer)
Administer the dose and document the ANC trend in the chart
Continue clozapine and recheck the ANC in one month as per routine schedule
Discontinue clozapine permanently and initiate reverse isolation precautions

Correct answer: Withhold clozapine, notify the prescriber, and increase monitoring frequency

An ANC of 900 cells/mm³ indicates moderate neutropenia and a significant decline from baseline, placing the client at risk for clozapine-induced agranulocytosis, a life-threatening adverse effect. The nurse must withhold the dose and immediately notify the prescriber. Monitoring frequency must increase (not extend to monthly). Permanent discontinuation and reverse isolation are decisions made by the physician after further evaluation — the nurse should not independently make that determination. Administering the dose in this situation is unsafe.

Question 166: A practical nurse notices strong feelings of irritation arising during sessions with a long-term client who frequently dismisses the nurse's suggestions. Recognizing this as a countertransference reaction, what is the FIRST priority action?

Request an immediate transfer of the client to another nurse to prevent the therapeutic relationship from being compromised.
Increase session frequency to work through the dynamic directly within the therapeutic relationship.
Reflect on the source of the feelings and bring them to clinical supervision to explore how they may be affecting care. (Correct answer)
Disclose the frustration to the client in a controlled way to model authentic communication.

Correct answer: Reflect on the source of the feelings and bring them to clinical supervision to explore how they may be affecting care.

Countertransference — the nurse's emotional reaction to the client — is inevitable and, if unexamined, can harm the therapeutic relationship. The professional obligation is self-reflection followed by clinical supervision, not avoidance (Option A) or premature disclosure (Option C). Supervision is the appropriate mechanism for processing countertransference without burdening or confusing the client. Option D misses the point; the unaddressed countertransference would persist regardless of session frequency.

Question 167: A PN is part of an interdisciplinary team caring for a client with complex chronic pain. The physician prescribes a dose the PN believes is dangerously high based on the client's renal function. The physician dismisses the concern and says to administer it. What is the PN's MOST appropriate next action?

Refuse to administer and file a formal complaint with the regulatory body immediately.
Contact the pharmacist for a second opinion and administer if the pharmacist agrees.
Withhold the medication, document the concern, and escalate to the charge nurse or supervisor while informing the physician of this action. (Correct answer)
Administer the medication as prescribed since the physician has final authority over prescriptions.

Correct answer: Withhold the medication, document the concern, and escalate to the charge nurse or supervisor while informing the physician of this action.

PNs have a professional and ethical obligation to advocate for client safety. When a concern is dismissed by the prescribing physician, the PN must withhold the medication, document the clinical reasoning, and escalate through the organizational chain of command (charge nurse/supervisor). This upholds the PN's accountability within the collaborative team without abandoning care or bypassing internal resolution processes prematurely.

Question 168: A PN is caring for a client receiving continuous enteral nutrition via a nasogastric tube. The client's gastric residual volume (GRV) is 320 mL when checked before medication administration. The facility protocol states to hold feeds for GRV > 250 mL and recheck in 1 hour. Which additional assessment finding would most indicate the need to halt the feed AND notify the provider urgently, rather than simply rechecking in 1 hour?

The client has new abdominal distension, absent bowel sounds in all four quadrants, and a rigid abdomen (Correct answer)
The client reports mild nausea and rates abdominal discomfort at 2/10
The client's last bowel movement was 36 hours ago
The client's blood glucose reading is 9.8 mmol/L

Correct answer: The client has new abdominal distension, absent bowel sounds in all four quadrants, and a rigid abdomen

While an elevated GRV warrants a recheck per protocol, the combination of new abdominal distension, absent bowel sounds in all four quadrants, and rigidity are signs of possible paralytic ileus or bowel obstruction — a potentially life-threatening situation requiring immediate provider notification and cessation of enteral feeding. Mild nausea at 2/10 and 36-hour constipation are concerning but do not carry the same urgency as peritoneal signs. A blood glucose of 9.8 mmol/L is slightly elevated but common in enterally-fed clients and managed per glycaemic protocol, not an urgent indicator to stop feeds.

Question 169: In what order should abdominal assessment techniques be performed?

Auscultation, inspection, percussion, palpation
Palpation, auscultation, percussion, inspection
Inspection, auscultation, percussion, palpation (Correct answer)
Inspection, percussion, palpation, auscultation

Correct answer: Inspection, auscultation, percussion, palpation

Abdominal assessment sequence: inspection, auscultation, percussion, palpation. Auscultation precedes palpation to get unaltered bowel sounds.

Question 170: When preparing to administer a prefilled subcutaneous enoxaparin (Lovenox) syringe, which action is correct?

Do not expel the air bubble; inject as is from the prefilled syringe (Correct answer)
Dilute the enoxaparin with normal saline
Expel the air bubble from the syringe before injection
Administer in the deltoid for fastest absorption

Correct answer: Do not expel the air bubble; inject as is from the prefilled syringe

The air bubble in prefilled enoxaparin syringes is intentional. It follows the medication to prevent drug leakage from the injection tract and must not be expelled.

CPNRE Canadian Practical Nurse Registration Exam

The CPNRE certifies practical nurses in Canada with 170 questions over 4 hours, assessing professional practice, nurse-client partnerships, health alterations, and collaborative care.

170

Questions

240 min

Time Limit

60%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds