CPNRE (Canadian Practical Nurse Registration Examination) — Questions and Answers

Question 1: An RPN realizes they forgot to document a medication that was administered two hours prior. What is the proper procedure for adding this information to the client's electronic health record?

Document the medication as if it were just given at the current time.
Create a new entry, clearly labeled as a 'late entry,' and record the actual time the medication was administered. (Correct answer)
Ask a colleague to enter the medication documentation for them.
Wait until the next shift to see if the oncoming nurse can add the entry.

Correct answer: Create a new entry, clearly labeled as a 'late entry,' and record the actual time the medication was administered.

When documenting care after the fact, it is critical to identify the note as a 'late entry.' This ensures the chronological integrity and accuracy of the medical record. The entry should include the current date and time of documentation as well as the specific date and time the care was actually provided.

Question 2: Which therapeutic communication technique involves restating the client's words in the nurse's own words to confirm understanding?

Reflection
Clarification
Paraphrasing (Correct answer)
Summarizing

Correct answer: Paraphrasing

Paraphrasing is restating the client's message in the nurse's own words to check understanding, while reflection mirrors the client's emotional tone.

Question 3: When inserting a nasogastric tube, the nurse asks the patient to swallow. At which landmark should advancement PAUSE to allow swallowing?

At the nasopharynx / back of throat (Correct answer)
At the carina
At the xiphoid process
At the nose

Correct answer: At the nasopharynx / back of throat

Pausing at the nasopharynx and asking the patient to swallow helps guide the tube into the esophagus rather than the trachea.

Question 4: A patient in the ED is diagnosed with hypertensive emergency with a blood pressure of 220/130 mmHg and confusion. The nurse should anticipate the blood pressure being lowered by no more than:

50% in the first hour
10% in the first 15 minutes
25% in the first hour (Correct answer)
All the way to normal within 30 minutes

Correct answer: 25% in the first hour

Overly rapid blood pressure reduction in hypertensive emergency can cause cerebral ischemia; the goal is a maximum 25% reduction in the first hour.

Question 5: Which of the following is defined as professional misconduct under the regulations governing nursing in Ontario?

Failing to report a colleague who is suspected of practicing while impaired. (Correct answer)
Questioning a physician's order that seems unclear.
Delegating a task to an unregulated care provider that is within their job description.
Accepting a small box of chocolates from a client's family as a thank-you gift.

Correct answer: Failing to report a colleague who is suspected of practicing while impaired.

The College of Nurses of Ontario (CNO) regulations and practice standards clearly state that nurses have a professional and ethical obligation to report unsafe or unethical conduct by other healthcare providers to protect the public. Failing to report a colleague suspected of being impaired while on duty is a serious breach of this obligation and constitutes professional misconduct.

Question 6: A client is receiving oxytocin (Pitocin) augmentation. The nurse notes uterine contractions every 2 minutes lasting 95 seconds. What is the priority action?

Increase the oxytocin infusion rate
Document the finding and continue monitoring
Reposition the client to the left lateral position
Discontinue the oxytocin infusion (Correct answer)

Correct answer: Discontinue the oxytocin infusion

Contractions lasting more than 90 seconds (tachysystole) can compromise fetal oxygenation, so the oxytocin must be discontinued.

Question 7: When using the Z-track technique for IM injection, what is the primary purpose?

Increase the rate of drug absorption
Avoid hitting a nerve during injection
Reduce pain at the injection site
Prevent leakage of irritating medication into subcutaneous tissue (Correct answer)

Correct answer: Prevent leakage of irritating medication into subcutaneous tissue

The Z-track technique seals the medication in the muscle by displacing the skin and subcutaneous tissue, preventing irritating drugs from tracking back through the needle path.

Question 8: Which route of administration provides the fastest onset of action in an emergency situation?

Sublingual
Intravenous (Correct answer)
Intramuscular
Subcutaneous

Correct answer: Intravenous

Intravenous administration delivers medication directly into the bloodstream, producing the fastest onset of action.

Question 9: According to Ontario's Personal Health Information Protection Act (PHIPA), an RPN understands that they can access a client's personal health information under which of the following circumstances?

Only when it is necessary for the direct provision of care to that specific client. (Correct answer)
When a colleague from another unit asks about the client's diagnosis out of curiosity.
To review the chart of an interesting case on the unit for educational purposes.
If the client is a family member and the RPN wants to check on their progress.

Correct answer: Only when it is necessary for the direct provision of care to that specific client.

PHIPA and CNO standards dictate that nurses must only access personal health information for which they have a professional purpose. This is often referred to as being within the 'circle of care.' Accessing information out of curiosity, for personal reasons, or for general education without authorization is a breach of privacy.

Question 10: Which symptom is classified as a POSITIVE symptom of schizophrenia?

Avolition
Alogia (poverty of speech)
Flat affect
Delusions (Correct answer)

Correct answer: Delusions

Positive symptoms represent an excess or distortion of normal function and include hallucinations, delusions, and disorganized speech; negative symptoms represent a loss of normal function.

Question 11: Which action would place an RPN at risk for a charge of battery?

Documenting care before it is completed
Administering an injection after the patient clearly refused it (Correct answer)
Delegating a task to an unlicensed assistive personnel
Explaining a procedure to a patient before obtaining consent

Correct answer: Administering an injection after the patient clearly refused it

Battery involves intentional, unauthorized physical contact; administering treatment after a patient's clear refusal constitutes battery.

Question 12: An RPN is conducting a home care visit for a client with chronic heart failure (CHF). The client reports a weight gain of 2 kg in the past two days and feeling more short of breath than usual. What is the RPN's priority action?

Recognize the signs of fluid retention and notify the primary care provider or case manager immediately. (Correct answer)
Advise the client to reduce their sodium intake and continue monitoring at home.
Document the findings and schedule a follow-up visit for the following week.
Instruct the client to elevate their legs and increase their fluid intake.

Correct answer: Recognize the signs of fluid retention and notify the primary care provider or case manager immediately.

A rapid weight gain of 2 kg (4.4 lbs) over two days is a significant indicator of fluid retention and worsening heart failure. This, combined with increased shortness of breath, requires immediate medical attention to adjust medications (like diuretics) and prevent hospitalization. While dietary advice is important, the immediate priority is to report these critical findings.

Question 13: A client with major depressive disorder states, 'There is no point in anything anymore.' Which nursing response is most therapeutic?

'It sounds like you are feeling hopeless. Can you tell me more?' (Correct answer)
'You have so much to live for. Think about your family.'
'Let's focus on positive things and schedule some activities.'
'Everyone feels that way sometimes — it will pass.'

Correct answer: 'It sounds like you are feeling hopeless. Can you tell me more?'

Acknowledging the client's feeling and inviting them to elaborate demonstrates empathy and opens therapeutic dialogue without minimizing or redirecting.

Question 14: How long must most hospitals in the U.S. retain adult patient medical records according to federal regulations and accreditation standards?

30 days after discharge
1 year after discharge
At least 5 to 10 years (varies by state), or until the patient's 21st birthday if a minor (Correct answer)
Indefinitely, with no time limit

Correct answer: At least 5 to 10 years (varies by state), or until the patient's 21st birthday if a minor

Medical record retention requirements vary by state but generally require retention for a minimum of 5–10 years for adults, with extended requirements for minors.

Question 15: An RPN is caring for a post-operative client who has a new order to ambulate. Before developing a plan to get the client out of bed for the first time, what is the most important initial assessment the RPN should perform?

The client's vital signs and level of pain. (Correct answer)
The client's level of understanding of the benefits of ambulation.
The availability of family members to assist.
The client's preference for the time of day to ambulate.

Correct answer: The client's vital signs and level of pain.

Assessing the client's physiological stability through vital signs and determining their level of pain is the priority before any new physical activity. This initial data helps the nurse determine if the client is stable enough to tolerate ambulation and if pain management is needed to facilitate the activity safely.

Question 16: An RPN is working in a long-term care facility. A resident's family member, who is not the substitute decision-maker, asks the RPN for specific details about the resident's recent diagnostic test results. How should the RPN respond?

Politely decline to provide the specific results, explaining that personal health information can only be shared with the resident or their legal substitute decision-maker. (Correct answer)
Provide the information requested to be helpful and maintain a good relationship with the family.
Tell the family member to ask the physician directly during their next visit.
Share general information about the resident's condition but withhold the specific test results.

Correct answer: Politely decline to provide the specific results, explaining that personal health information can only be shared with the resident or their legal substitute decision-maker.

Under privacy legislation, such as the Personal Health Information Protection Act (PHIPA) in Ontario, and the CNO's Code of Conduct, nurses have a strict duty to maintain the confidentiality of client information. Disclosing personal health information without the client's consent (or that of their legal representative) is a breach of privacy and professional misconduct. The correct action is to explain the privacy rules and direct the inquiry appropriately.

Question 17: Which assessment finding in a newborn at 24 hours of age should be reported to the provider immediately?

Presence of vernix in skin folds
Respiratory rate of 68 breaths/min (Correct answer)
Acrocyanosis of the hands and feet
Milia on the nose and cheeks

Correct answer: Respiratory rate of 68 breaths/min

A respiratory rate above 60 breaths/min (tachypnea) in a newborn may indicate respiratory distress and requires immediate evaluation.

Question 18: A client in alcohol withdrawal is at risk for seizures. Which medication is most commonly used to prevent withdrawal seizures?

Methadone
Haloperidol (Haldol)
Lorazepam (Ativan) (Correct answer)
Naltrexone (Vivitrol)

Correct answer: Lorazepam (Ativan)

Benzodiazepines such as lorazepam are the first-line treatment for alcohol withdrawal, preventing seizures by enhancing GABA inhibitory activity to counteract CNS hyperexcitability.

Question 19: A client at 32 weeks gestation presents with painless, bright red vaginal bleeding. Which condition does the nurse suspect?

Placenta previa (Correct answer)
Placental abruption
Bloody show
Preterm labor

Correct answer: Placenta previa

Painless, bright red vaginal bleeding in the third trimester is the classic presentation of placenta previa.

Question 20: An RPN is caring for a client who is refusing a prescribed medication that is crucial for managing their chronic condition. The client is alert and oriented. Which of the following actions best demonstrates the RPN's adherence to the ethical principle of client choice?

Informing the client that their health will deteriorate if they do not comply.
Administering the medication after explaining that the doctor has ordered it.
Contacting the client's family to convince the client to take the medication.
Documenting the refusal and exploring the client's reasons for declining the medication. (Correct answer)

Correct answer: Documenting the refusal and exploring the client's reasons for declining the medication.

The CNO Ethics Practice Standard emphasizes respecting client choice. The most appropriate action is to explore the client's reasoning behind the refusal, which respects their autonomy and allows the nurse to provide further education or address misconceptions. Documenting the refusal is also a critical part of accountability.

Question 21: A client has the right to refuse a medication. If a competent adult client refuses their morning dose of an antihypertensive, what is the RPN's priority action?

Document the refusal in the MAR and discard the medication.
Assess the client's reason for refusal, provide education, and document the event and inform the prescriber. (Correct answer)
Notify the client's family about the refusal to take the medication.
Administer the medication anyway, as it is essential for their health.

Correct answer: Assess the client's reason for refusal, provide education, and document the event and inform the prescriber.

Respecting a client's autonomy includes the 'Right to Refuse'. The RPN's professional responsibility is to first assess the client's understanding and reasons for refusal. The nurse should then provide information about the risks of refusal and the benefits of the medication. If the client still refuses, the nurse must document the refusal, the education provided, and inform the prescriber of the missed dose, as it may have clinical implications.

Question 22: A client with schizophrenia reports hearing voices telling them to harm others. What is the nurse's priority intervention?

Encourage the client to ignore the voices and focus on activities
Ensure the safety of the client and others by following facility protocols (Correct answer)
Document the report and notify the physician at the next scheduled call
Administer a PRN antipsychotic medication immediately

Correct answer: Ensure the safety of the client and others by following facility protocols

Safety is always the priority; the nurse must protect the client and others according to established facility protocols when a client discloses command hallucinations with violent content.

Question 23: Which hand hygiene method is preferred when hands are visibly soiled with organic material?

Alcohol-based hand rub for 30 seconds
Soap and water for at least 20 seconds (Correct answer)
Alcohol-based hand rub for 15 seconds
Antimicrobial foam for 10 seconds

Correct answer: Soap and water for at least 20 seconds

Soap and water must be used when hands are visibly soiled because alcohol-based rubs do not remove organic material or C. diff spores.

Question 24: Which of the following describe hyperthyroidism symptoms and signs?

Cold Clammy Skin
Dry skin
All of the above (Correct answer)
Hair loss

Correct answer: All of the above

An overactive thyroid gland is a defining feature of hyperthyroidism. Hair loss, dry skin, and cold, clammy skin are all indications of hyperthyroidism. Increased perspiration can result in cold, clammy skin, whereas overproduction of thyroid hormones can cause dry skin and hair loss.

Question 25: In the event of a fire in a healthcare center, what should be done first?

Alarm, contain, extinguish, rescue
Extinguish, contain, alarm, rescue
Rescue, alarm, contain, extinguish
Alarm, rescue, contain, extinguish (Correct answer)

Correct answer: Alarm, rescue, contain, extinguish

Setting out the alarm, rescuing anyone in immediate danger, containing the fire, and then making an effort to put it out are the proper sequence of events.

Question 26: A client with obsessive-compulsive disorder (OCD) spends 3 hours each morning performing handwashing rituals. Which therapeutic approach is evidence-based first-line treatment?

Exposure and Response Prevention (ERP) (Correct answer)
Psychodynamic therapy to explore childhood origins
Systematic desensitization
Relaxation training and mindfulness meditation

Correct answer: Exposure and Response Prevention (ERP)

Exposure and Response Prevention (ERP) is the gold-standard cognitive-behavioral therapy for OCD, involving gradual exposure to feared stimuli while preventing the compulsive ritual.

Question 27: A client refuses a recommended blood transfusion due to religious beliefs. What is the RPN's primary ethical obligation?

Document the refusal and respect the client's autonomous decision (Correct answer)
Administer the transfusion because it is life-saving
Contact the client's family to override the refusal
Notify the ethics board before taking any action

Correct answer: Document the refusal and respect the client's autonomous decision

Respecting client autonomy means honoring informed refusals even when the RPN disagrees with the decision.

Question 28: A client with dementia is unable to provide informed consent for a procedure. Who has the legal authority to consent on the client's behalf in most US states?

The RPN caring for the client
The attending physician
A legally designated surrogate decision-maker or healthcare proxy (Correct answer)
The most available family member

Correct answer: A legally designated surrogate decision-maker or healthcare proxy

When a client lacks decision-making capacity, a legally designated surrogate or healthcare proxy provides substitute consent.

Question 29: A nurse is caring for a patient with multiple sclerosis (MS) experiencing fatigue. Which intervention is most appropriate?

Encourage exercising during the hottest part of the day
Schedule activities during the patient's peak energy periods (Correct answer)
Recommend complete bed rest until fatigue resolves
Administer stimulant medications without physician order

Correct answer: Schedule activities during the patient's peak energy periods

Scheduling activities when energy levels are highest helps MS patients manage fatigue and maintain function.

Question 30: Which finding during a postpartum assessment at 12 hours after delivery indicates a normal finding?

Temperature of 38.5°C (101.3°F)
Lochia rubra with large clots
Urine output of 150 mL over 8 hours
Uterine fundus at the umbilicus, firm (Correct answer)

Correct answer: Uterine fundus at the umbilicus, firm

A firm fundus at the umbilical level is expected within the first 12 hours after delivery.

Question 31: A nurse notes a colleague did not perform hand hygiene before entering a patient's room. The best action is to:

Ignore the situation to maintain workplace harmony
Document the observation in the patient's chart
Remind the colleague of hand hygiene policy immediately (Correct answer)
Report directly to the charge nurse without speaking to the colleague

Correct answer: Remind the colleague of hand hygiene policy immediately

Promptly and respectfully reminding the colleague protects the patient and supports a culture of safety and accountability.

Question 32: A client offers an RPN a gift card as a token of appreciation for excellent care. Which action best aligns with the CNO's guidelines on maintaining professional boundaries?

Suggesting the client make a donation to the facility's foundation instead.
Accepting the gift but sharing it with the entire nursing team.
Politely declining the gift and explaining the policy on accepting gifts. (Correct answer)
Accepting the gift to avoid offending the client.

Correct answer: Politely declining the gift and explaining the policy on accepting gifts.

The CNO's practice standard on the Therapeutic Nurse-Client Relationship advises against accepting gifts of significant value to avoid creating a conflict of interest or a feeling of obligation. While small tokens may be acceptable in some contexts, the most professional and safest action is to politely decline and explain the professional and organizational policies. This maintains a clear boundary and ensures the relationship remains therapeutic.

Question 33: To promote a therapeutic environment, the RPN should schedule client interactions:

Randomly throughout the shift to observe natural behavior
Only when the client requests contact to respect autonomy
At consistent, pre-agreed times to build trust and predictability (Correct answer)
Immediately after medications are given for maximum cooperation

Correct answer: At consistent, pre-agreed times to build trust and predictability

Consistency and predictability in scheduling reinforce safety and trust, foundational elements of therapeutic relationships.

Question 34: During administration of a blood transfusion, the patient develops fever, chills, and low back pain within 15 minutes. What is the priority nursing action?

Stop the transfusion and keep the IV line open with normal saline (Correct answer)
Slow the transfusion rate and monitor
Increase the IV flow rate to dilute the reaction
Administer diphenhydramine and continue the transfusion

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

Signs of an acute hemolytic reaction require immediately stopping the transfusion while keeping venous access with normal saline, then notifying the provider and blood bank.

Question 35: An RPN receives a friend request on social media from a client they are currently providing care for in a long-term care facility. What is the most appropriate action for the RPN to take to maintain professional boundaries?

Ignore the request and pretend they did not see it.
Accept the request to be friendly and build rapport with the client.
Politely decline the request and explain the importance of maintaining a therapeutic relationship. (Correct answer)
Accept the request but limit the information the client can see on their profile.

Correct answer: Politely decline the request and explain the importance of maintaining a therapeutic relationship.

Maintaining professional boundaries is a key responsibility for nurses. Accepting a social media request blurs the lines between a therapeutic and personal relationship, which can lead to a boundary violation. The most professional response is to decline and gently explain the rationale for keeping the relationship professional to protect both the client and the nurse.

Question 36: Which of the following scenarios falls within the RPN's autonomous scope of practice in Ontario, according to the Regulated Health Professions Act and the Nursing Act?

Independently diagnosing a client's complex health condition.
Prescribing a new medication for a client with hypertension.
Ordering diagnostic imaging for a suspected fracture.
Initiating wound care for a stage 2 pressure ulcer based on a directive. (Correct answer)

Correct answer: Initiating wound care for a stage 2 pressure ulcer based on a directive.

The scope of practice for an RPN is different from that of an RN or NP. While RPNs cannot independently diagnose or prescribe medications, they can initiate certain procedures if an order or directive is in place and they have the competence to do so. Wound care for a stable, less complex wound often falls within the RPN scope when guided by established protocols or directives.

Question 37: When a nurse receives a verbal order from a physician by phone, what must happen?

The nurse documents the order, reads it back for confirmation, and the physician countersigns within the required timeframe (Correct answer)
Another nurse must be present to witness the phone call
The nurse must refuse all phone orders
The nurse may carry out the order without documentation until the physician arrives

Correct answer: The nurse documents the order, reads it back for confirmation, and the physician countersigns within the required timeframe

Read-back verification and timely physician countersignature are required for verbal/telephone orders to ensure accuracy and accountability.

Question 38: A patient with heart failure reports waking up at night feeling short of breath. This symptom is called:

Dyspnea on exertion
Orthopnea
Paroxysmal nocturnal dyspnea (Correct answer)
Cheyne-Stokes respiration

Correct answer: Paroxysmal nocturnal dyspnea

Paroxysmal nocturnal dyspnea (PND) is sudden shortness of breath that awakens a patient from sleep, characteristic of left-sided heart failure.

Question 39: A patient with a documented penicillin allergy is prescribed amoxicillin. What is the nurse's priority action?

Administer the drug since it is a prescribed order
Ask the patient if they have had amoxicillin before
Give a test dose first and monitor for 30 minutes
Withhold the medication and clarify the order with the prescriber (Correct answer)

Correct answer: Withhold the medication and clarify the order with the prescriber

Amoxicillin is a penicillin-class antibiotic; administering it to a patient with a documented penicillin allergy is unsafe and requires prescriber clarification.

Question 40: Which documentation system uses a structured format of Subjective, Objective, Assessment, and Plan?

SBAR (Situation, Background, Assessment, Recommendation)
PIE (Problem, Intervention, Evaluation)
SOAP (Subjective, Objective, Assessment, Plan) (Correct answer)
DAR (Data, Action, Response)

Correct answer: SOAP (Subjective, Objective, Assessment, Plan)

SOAP notes organize documentation into Subjective data, Objective findings, the Assessment or diagnosis, and the Plan for care.

Question 41: An RPN receives a gift of significant monetary value from a grateful client's family. The most appropriate response is to:

Accept it but donate it to charity
Politely decline and explain professional boundaries around gifts (Correct answer)
Accept it graciously to avoid offending the family
Accept it and report it to management

Correct answer: Politely decline and explain professional boundaries around gifts

Accepting significant gifts can compromise professional boundaries and the therapeutic relationship; declining is the ethically appropriate action.

Question 42: A patient with chronic heart failure is prescribed furosemide. Which electrolyte imbalance is the most common adverse effect?

Hypernatremia
Hypokalemia (Correct answer)
Hypercalcemia
Hyperkalemia

Correct answer: Hypokalemia

Furosemide is a loop diuretic that promotes potassium excretion, frequently causing hypokalemia.

Question 43: According to the principles of Routine Practices, when is it mandatory for an RPN to perform hand hygiene?

Only after removing gloves.
At the beginning and end of the shift.
Only when hands are visibly soiled.
Before initial client contact and after contact with the client's environment. (Correct answer)

Correct answer: Before initial client contact and after contact with the client's environment.

Routine practices include the 4 Moments for Hand Hygiene. Key moments include before initial patient/client contact and after contact with the patient/client or their environment. Hand hygiene is required at many other points as well, including after removing gloves and before a clean/aseptic procedure, but this answer choice captures two of the most fundamental mandatory moments.

Question 44: Which action is required when wasting a controlled substance that was not fully administered?

Flush the remainder and document independently
Return unused portion to the pharmacy without documentation
Dispose of it in a regular sharps container alone
Document the amount wasted and have a second nurse witness and co-sign (Correct answer)

Correct answer: Document the amount wasted and have a second nurse witness and co-sign

Controlled substance wasting must be witnessed and co-signed by a second authorized nurse to ensure accountability and prevent diversion.

Question 45: A client is being discharged from the hospital. The RPN's role in medication reconciliation is to ensure a complete and accurate list of the client's medications. What is the PRIMARY purpose of this process?

To prevent medication errors such as omissions, duplications, and dosing errors during transitions in care. (Correct answer)
To provide the client with a full supply of all their prescribed medications.
To educate the client on the brand names of all their new prescriptions.
To ensure the hospital pharmacy has billed correctly for all administered drugs.

Correct answer: To prevent medication errors such as omissions, duplications, and dosing errors during transitions in care.

Medication reconciliation is a formal process of creating the most accurate list of a patient's current medications and comparing it to what is being ordered at each transition of care. Its main goal is to prevent adverse drug events by identifying and resolving discrepancies like omissions, duplications, incorrect dosages, or drug interactions.

Question 46: A nurse is caring for a client at 38 weeks gestation who reports decreased fetal movement. Which action should the nurse take first?

Notify the physician immediately
Instruct the client to perform a kick count
Apply external fetal monitor (Correct answer)
Perform a biophysical profile

Correct answer: Apply external fetal monitor

Applying an external fetal monitor provides immediate assessment of fetal heart rate and activity patterns.

Question 47: Which is the safest method to confirm a patient's identity before medication administration?

Use two patient identifiers such as name and date of birth (Correct answer)
Check the name on the room door
Verify the bed number matches the MAR
Ask the patient to state their name

Correct answer: Use two patient identifiers such as name and date of birth

Using two independent patient identifiers (e.g., full name and date of birth) is the standard for safe patient identification.

Question 48: A patient with COPD is prescribed long-acting bronchodilators. Which inhaler technique instruction is most important?

Rinse mouth only if using a corticosteroid inhaler
Hold breath for 1-2 seconds after inhaling
Inhale quickly and shallowly for best delivery
Exhale fully before inhaling the medication (Correct answer)

Correct answer: Exhale fully before inhaling the medication

Exhaling fully before inhaling maximizes medication delivery to the airways.

Question 49: During which phase of the therapeutic relationship is the nurse most focused on reviewing accomplishments and managing feelings about ending?

Termination phase (Correct answer)
Orientation phase
Pre-interaction phase
Working phase

Correct answer: Termination phase

The termination phase involves evaluating goal achievement and addressing the client's emotional response to ending the relationship.

Question 50: When administering an IV piggyback medication, the RPN should verify compatibility with which primary solution first?

Check the medication label for expiration date
Confirm with the charge nurse
Ask the prescribing physician
Review the pharmacy compatibility reference or pharmacist (Correct answer)

Correct answer: Review the pharmacy compatibility reference or pharmacist

Drug compatibility must be verified through a reliable pharmacy reference or pharmacist before mixing or co-administering IV medications.

Question 51: A patient has a chest tube connected to a water-seal drainage system. The nurse notices the water level in the water-seal chamber is not fluctuating (tidaling). What does this indicate?

The system is functioning normally
Air is entering the pleural space
The drainage system needs to be replaced immediately
The lung has re-expanded or the tube is kinked/obstructed (Correct answer)

Correct answer: The lung has re-expanded or the tube is kinked/obstructed

Absence of tidaling indicates either successful lung re-expansion (expected) or a kinked or obstructed tube (requiring assessment).

Question 52: While providing care, an RPN notices a colleague documenting a procedure that was not actually performed. According to the CNO standards, what is the RPN's primary responsibility?

Document their own observations in a separate personal note.
Confront the colleague directly and tell them to correct the documentation.
Ignore the situation to avoid conflict with a coworker.
Report the incident to the immediate supervisor or nurse manager. (Correct answer)

Correct answer: Report the incident to the immediate supervisor or nurse manager.

Nurses have an ethical and professional responsibility to act when they witness unsafe or unprofessional conduct. The principle of accountability requires the RPN to report the falsification of documentation to the appropriate authority, such as a manager, to ensure client safety and address the professional misconduct.

Question 53: An RPN is completing an admission assessment on a new client. Which of the following is the best example of objective data?

The client's respiratory rate is 24 breaths per minute and slightly labored. (Correct answer)
The client's spouse states, "He hasn't had much of an appetite for the past three days."
The client rates their abdominal pain as 7 out of 10.
The client reports feeling dizzy when standing up.

Correct answer: The client's respiratory rate is 24 breaths per minute and slightly labored.

Objective data consists of observable and measurable information gathered by the healthcare professional. A respiratory rate of 24 is a measurable vital sign, and the observation of labored breathing is a direct clinical sign. The other options are examples of subjective data, which are reported by the client or their family.

Question 54: A client tells the RPN, "I'm just so fed up with all of this." To encourage the client to expand on their feelings, which response by the RPN demonstrates the therapeutic communication technique of clarification?

"Everyone feels that way sometimes."
"You should focus on the positive things instead."
"Why do you feel that way?"
"I'm not sure I understand what 'all of this' refers to. Can you tell me more?" (Correct answer)

Correct answer: "I'm not sure I understand what 'all of this' refers to. Can you tell me more?"

Clarification is a technique used to ensure the nurse has understood the client's message correctly and to prompt the client to provide more specific information. [17] Asking "Why?" can be perceived as confrontational, while dismissing the feeling or giving advice is non-therapeutic.

Question 55: A client with advanced Chronic Obstructive Pulmonary Disease (COPD) is being introduced to a palliative approach to care. Which statement by the RPN best describes the primary goal of this approach?

"We will now stop all treatments aimed at your breathing and focus only on comfort."
"The focus will be on aggressive new treatments to try and reverse the lung damage."
"This means you will be transferred to a hospice facility for end-of-life care."
"Our main goal is to improve your quality of life by managing symptoms like breathlessness and fatigue." (Correct answer)

Correct answer: "Our main goal is to improve your quality of life by managing symptoms like breathlessness and fatigue."

Palliative care focuses on improving the quality of life for clients and their families by managing distressing symptoms and providing psychosocial and spiritual support. It can be provided at any stage of a serious illness, alongside curative or life-prolonging treatments, and is not exclusively for end-of-life care.

Question 56: A client with generalized anxiety disorder is taught diaphragmatic breathing. What is the primary goal of this technique?

Increase carbon dioxide levels to reduce respiratory alkalosis
Improve oxygen saturation to prevent hypoxia during anxiety episodes
Activate the parasympathetic nervous system to reduce physiological arousal (Correct answer)
Stimulate the sympathetic nervous system to improve alertness

Correct answer: Activate the parasympathetic nervous system to reduce physiological arousal

Diaphragmatic (slow, deep) breathing activates the parasympathetic nervous system, counteracting the fight-or-flight response and reducing physical anxiety symptoms.

Question 57: When a patient appears to have suffered a head injury, what should be done first?

Check for responsiveness. (Correct answer)
Ascertain blood pressure.
Inspect for any neck trauma.
Put ice on your head.

Correct answer: Check for responsiveness.

The patient's state of consciousness and responsiveness must be evaluated as the first priority.

Question 58: An RPN receives a verbal order from a physician by phone. The best practice is to:

Write it in the chart and have another nurse witness the documentation
Refuse verbal orders and insist on written orders only
Repeat the order back to verify, then document it and have the physician countersign within the required timeframe (Correct answer)
Administer the medication and document the verbal order after the physician's next visit

Correct answer: Repeat the order back to verify, then document it and have the physician countersign within the required timeframe

Verbal orders require read-back verification for safety and must be countersigned by the physician within the facility's required timeframe.

Question 59: How do you treat a patient who is having a seizure?

Remove anything close to you to avoid getting hurt. (Correct answer)
To stop the patient from biting their tongue, put something in their mouth.
To stop the patient from moving, restrain them.
To stop the patient from flailing, hold their limbs.

Correct answer: Remove anything close to you to avoid getting hurt.

Shifting close things out of the path during a seizure can help avoid damage.

Question 60: A patient is in the ED after an industrial chemical splash to both eyes. The nurse's IMMEDIATE intervention is:

Administer IV corticosteroids to reduce inflammation
Irrigate both eyes copiously with normal saline for at least 20–30 minutes (Correct answer)
Obtain a slit-lamp ophthalmologic exam before treatment
Apply antibiotic eye drops and patch both eyes

Correct answer: Irrigate both eyes copiously with normal saline for at least 20–30 minutes

Continuous copious eye irrigation is the priority intervention for chemical eye exposure to dilute and remove the offending agent before it causes permanent damage.

Question 61: An RPN is conducting a health history with an older adult client who has recently lost weight. To gather comprehensive data during the assessment phase, which action is most appropriate?

Ask only closed-ended questions to save time.
Complete a physical examination before asking any questions.
Focus solely on the client's current medical diagnosis.
Use a combination of open-ended and focused questions about their diet and health. (Correct answer)

Correct answer: Use a combination of open-ended and focused questions about their diet and health.

The assessment phase of the nursing process involves gathering comprehensive subjective and objective data. Using open-ended questions encourages the client to share their story, while focused questions help clarify specific details. This combination ensures the nurse gathers thorough and relevant information about the client's weight loss and overall health status.

Question 62: A nurse is assessing a 2-hour-old newborn's blood glucose and obtains a result of 38 mg/dL. What is the priority nursing action?

Notify the provider and obtain a full metabolic panel
Recheck in 1 hour as this is a normal value
Initiate an IV dextrose infusion immediately
Encourage breastfeeding or provide formula (Correct answer)

Correct answer: Encourage breastfeeding or provide formula

For a symptomatic or borderline glucose level, the first intervention is oral feeding to raise blood glucose before escalating to IV treatment.

Question 63: The nurse is caring for a patient with left-sided hemiplegia. When helping the patient walk with a cane, where should the cane be held?

Alternating hands each step
In whichever hand the patient prefers
In the right (stronger) hand (Correct answer)
In the left (weaker) hand

Correct answer: In the right (stronger) hand

The cane is held on the stronger side to provide a wider base of support and offload weight from the weaker extremity.

Question 64: A nurse is performing a suicide risk assessment. Which factor represents the HIGHEST risk for a completed suicide attempt?

Stating 'I wish I was dead' during a depressive episode
A history of one prior low-lethality gesture without hospitalization
Feeling sad and tearful without a specific plan
A specific plan with access to a lethal method (Correct answer)

Correct answer: A specific plan with access to a lethal method

The presence of a specific, detailed plan combined with access to a lethal means significantly elevates the risk for a completed suicide and requires immediate intervention.

Question 65: Urine production is _____________ by vasopressin.

Increases
Stops
Decreases (Correct answer)
Intensify

Correct answer: Decreases

One hormone that controls the body's water balance is vasopressin. It works on the kidneys to reduce the amount of urine produced and reabsorb water. Consequently, since vasopressin lowers the amount of pee the body produces, "decreases" is the proper response.

Question 66: The nurse is teaching a patient to use crutches with a swing-through gait. Which instruction is correct?

Advance one crutch, step with the opposite foot, then advance the other crutch
Bear weight through the wrists, not the axillae, when swinging (Correct answer)
Keep the crutch pads firmly pressed into the axillae for support
Place crutches 4–6 inches in front and to the side, then swing both legs forward past the crutches

Correct answer: Bear weight through the wrists, not the axillae, when swinging

Weight must be borne through the palms and wrists; axillary pressure can damage the brachial plexus nerve, causing 'crutch palsy.'

Question 67: A client who has been making progress suddenly says, 'There's no point in continuing; I'll never get better.' The RPN should:

Remind the client of the progress already made to restore motivation
Adjust the treatment goals to be less demanding
Notify the physician that the client is non-compliant with therapy
Acknowledge the discouragement and explore what triggered the change in outlook (Correct answer)

Correct answer: Acknowledge the discouragement and explore what triggered the change in outlook

Exploring the trigger for hopelessness provides therapeutically useful information and validates the client's current experience.

Question 68: Which item is considered single-use and should never be reprocessed?

Stethoscope
Pulse oximeter probe
Blood pressure cuff
Insulin syringe (Correct answer)

Correct answer: Insulin syringe

Insulin syringes are single-use items; reusing them risks needle-stick injury, contamination, and patient harm.

Question 69: An RPN is reinforcing safe sleep education with new parents to reduce the risk of Sudden Infant Death Syndrome (SIDS). Which of the following recommendations is a key component of this teaching?

Place the infant on their back to sleep on a firm, flat surface. (Correct answer)
Place the infant on their stomach to sleep to prevent choking.
Ensure the crib is soft with bumpers, blankets, and stuffed animals for comfort.
Share a bed with the infant to facilitate nighttime feedings.

Correct answer: Place the infant on their back to sleep on a firm, flat surface.

Current safe sleep guidelines to reduce the risk of SIDS strongly recommend placing infants on their back for every sleep. The sleep surface should be firm and flat, such as in a safety-approved crib, and kept clear of all soft objects like pillows, loose blankets, and bumper pads. Stomach sleeping, soft bedding, and bed sharing are all identified risk factors for SIDS.

Question 70: A patient with Crohn's disease is experiencing a flare. Which dietary approach is typically recommended during active disease?

High-fiber diet rich in raw fruits and vegetables
Low-residue diet with small, frequent meals (Correct answer)
Unlimited dairy products to boost calcium intake
High-fat diet to increase caloric density

Correct answer: Low-residue diet with small, frequent meals

A low-residue diet reduces bowel irritation and the frequency of stool during active Crohn's flares.

Question 71: An RPN documents an intervention that was not performed. This action is best described as:

A documentation error
An acceptable workaround in busy settings
Falsification of records (Correct answer)
Anticipatory charting

Correct answer: Falsification of records

Charting care that was not given constitutes falsification of records, a serious breach of professional and legal standards.

Question 72: A client becomes tearful and says, 'Nobody cares if I live or die.' Which response by the RPN best demonstrates therapeutic communication?

"I care about you, and I'm sure your friends do too."
"That must be a very lonely feeling. Can you tell me more about what's been happening?" (Correct answer)
"Of course people care about you — your family is right outside."
"You shouldn't feel that way; things will get better soon."

Correct answer: "That must be a very lonely feeling. Can you tell me more about what's been happening?"

Reflecting the feeling and inviting elaboration acknowledges the client's experience without dismissing or minimizing it.

Question 73: A nurse is assigned to a patient in protective (reverse) isolation. What is the primary purpose of this precaution?

To protect a severely immunocompromised patient from external pathogens (Correct answer)
To reduce droplet transmission to staff
To prevent the patient from spreading infection to others
To contain airborne particles within the patient's room

Correct answer: To protect a severely immunocompromised patient from external pathogens

Reverse isolation protects immunocompromised patients (e.g., those post-bone marrow transplant) from pathogens carried by visitors, staff, or the environment.

Question 74: A blood sugar range of 80–180 is considered normal. Is it true or false?

FALSE (Correct answer)
TRUE

Correct answer: FALSE

Blood sugar levels between 80 and 180 are not regarded as normal. When fasting, normal blood sugar levels normally range from 70–99 mg/dL, and two hours after eating, they can go up to 140 mg/dL. Elevated blood sugar levels, which can be an indication of prediabetes or diabetes, fall between 80 and 180 mg/dL. Maintaining blood sugar levels within the normal range is crucial in order to avoid issues that may arise from either high or low blood sugar.

Question 75: When assisting a patient to transfer from bed to wheelchair, the nurse should position the wheelchair at what angle to the bed?

180 degrees
45 degrees (Correct answer)
Parallel to the bed
90 degrees

Correct answer: 45 degrees

Positioning the wheelchair at a 45-degree angle to the bed minimizes the pivot distance and reduces fall risk during the transfer.

Question 76: The cause of _ and ___ is an aberrant rise in growth hormones.

All of the following
Gigantism (Correct answer)
Blindness
Dwarfism (Correct answer)

Correct answer: Gigantism

An excessive rise in growth hormones can cause gigantism and dwarfism, among other diseases. Dwarfism is characterized by stunted growth and small stature, whereas gigantism is characterized by excessive growth and height. A growth hormone production imbalance that results in aberrant development patterns is the etiology of both disorders.

Question 77: An unresponsive adult patient is found with no pulse. Bystanders report the patient collapsed 8 minutes ago. The nurse correctly prioritizes:

Immediate defibrillation before CPR
Starting high-quality CPR while preparing the defibrillator (Correct answer)
Establishing IV access before initiating CPR
Obtaining a 12-lead ECG before any intervention

Correct answer: Starting high-quality CPR while preparing the defibrillator

After more than 4–5 minutes without CPR, myocardial oxygen depletion means CPR should be initiated first to improve the chance of successful defibrillation.

Question 78: A client asks their RPN for advice on non-health-related personal matters, stating, "You always know what's best, I can't make a decision without you." The RPN recognizes this as a potential issue. What is the primary concern the RPN should address?

The client is attempting to form a social relationship.
The client is not respecting the RPN's professional role.
The RPN may not be qualified to give advice on personal matters.
The client is becoming overly dependent, indicating a power imbalance. (Correct answer)

Correct answer: The client is becoming overly dependent, indicating a power imbalance.

The nurse holds a position of power in the therapeutic relationship due to their knowledge, access to information, and authority. [8, 11] The primary concern is the client's over-dependence, which signals a blurring of boundaries and a misuse of the inherent power dynamic. The RPN's goal is to empower the client, not to foster dependence. [24, 30]

Question 79: When an RPN collaborates with a client to establish goals for their plan of care, which principle is essential for creating an effective goal statement?

The goal should be broad to allow for flexibility in care.
The goal should be created exclusively by the nurse based on the diagnosis.
The goal should focus only on the client's long-term health outcomes.
The goal must be measurable and include a specific timeframe for achievement. (Correct answer)

Correct answer: The goal must be measurable and include a specific timeframe for achievement.

Effective goals in a nursing care plan should follow the SMART criteria: Specific, Measurable, Achievable, Relevant, and Time-bound. A measurable goal with a timeframe, such as "The client will walk 20 meters with a walker by the end of the week," allows the healthcare team to accurately evaluate the client's progress.

Question 80: A nurse is educating a patient with chronic obstructive pulmonary disease about pursed-lip breathing. What is the primary benefit of this technique?

It slows exhalation and prevents airway collapse (Correct answer)
It increases the respiratory rate to improve oxygenation
It strengthens inspiratory muscles over time
It eliminates the need for bronchodilator medications

Correct answer: It slows exhalation and prevents airway collapse

Pursed-lip breathing creates back-pressure that slows exhalation and keeps airways open longer, improving gas exchange.

Question 81: A client with schizophrenia has been stable on risperidone for two years and now shows involuntary, repetitive facial movements. The nurse recognizes this as:

Neuroleptic malignant syndrome
Acute dystonia
Tardive dyskinesia (Correct answer)
Akathisia

Correct answer: Tardive dyskinesia

Tardive dyskinesia is a late-onset, potentially irreversible movement disorder caused by long-term antipsychotic use, characterized by involuntary repetitive movements especially of the face and mouth.

Question 82: An RPN is caring for an adolescent client who asks, "Did you ever feel insecure when you were my age?" Which of the following responses is the most therapeutic use of self-disclosure?

"That's not a professional topic for us to discuss."
Sharing a detailed personal story about their own teenage struggles.
"Yes, it can be a challenging time for many people. Let's talk more about what you're experiencing." (Correct answer)
"No, I was always very confident as a teenager."

Correct answer: "Yes, it can be a challenging time for many people. Let's talk more about what you're experiencing."

Therapeutic self-disclosure should be brief, relevant, and used intentionally to benefit the client. [21, 28] This option briefly answers the question, normalizes the feeling, and skillfully redirects the focus back to the client's needs, which is the primary goal of the therapeutic relationship.

Question 83: A patient's blood pressure is 88/52 mmHg. What is the correct mean arterial pressure (MAP)?

70 mmHg
64 mmHg (Correct answer)
60 mmHg
57 mmHg

Correct answer: 64 mmHg

MAP = (SBP + 2×DBP) / 3 = (88 + 2×52) / 3 = 192 / 3 = 64 mmHg.

Question 84: Which of the following represents a correct application of the '10 Rights of Medication Administration'?

Verifying the client's identity using their name and room number before administering a medication.
Providing education to the client about the purpose and common side effects of a newly prescribed medication. (Correct answer)
Documenting the administration of a PRN analgesic immediately before going to retrieve it from the medication cart.
Crushing an enteric-coated tablet for a client with dysphagia to ensure they can swallow it.

Correct answer: Providing education to the client about the purpose and common side effects of a newly prescribed medication.

The '10 Rights of Medication Administration' is a framework to ensure safety. 'Right Patient Education' is a crucial component, empowering the client to be an active participant in their care. Documenting before administration is an error, crushing enteric-coated tablets is contraindicated as it alters the medication's absorption, and using a room number is not a reliable second identifier.

Question 85: An RPN is assessing a newborn and observes acrocyanosis. Which of the following best describes this finding?

A bluish discoloration of the hands and feet. (Correct answer)
A fine, downy hair covering the newborn's back and shoulders.
A yellowish tint to the skin and sclera.
A bluish discoloration of the lips and mucous membranes.

Correct answer: A bluish discoloration of the hands and feet.

Acrocyanosis is a bluish discoloration of the extremities (hands and feet) and is a common, benign finding in the first 24-48 hours after birth due to immature peripheral circulation. It is important to differentiate it from central cyanosis (bluish lips/mucous membranes), which indicates hypoxemia and is a serious concern.

Question 86: A patient is brought in after a house fire with suspected carbon monoxide poisoning. The pulse oximetry reads 99%. The nurse should:

Apply 100% high-flow oxygen via nonrebreather mask regardless of SpO2 (Correct answer)
Reassure the patient that oxygen saturation is normal
Obtain an arterial blood gas to verify oxygenation
Administer supplemental oxygen at 2 L/min via nasal cannula

Correct answer: Apply 100% high-flow oxygen via nonrebreather mask regardless of SpO2

Pulse oximetry cannot differentiate carboxyhemoglobin from oxyhemoglobin, so CO-poisoned patients must receive 100% O2 to accelerate CO elimination.

Question 87: A patient with chronic pancreatitis is most at risk for which nutritional deficiency?

Vitamin B12 deficiency only
Iron deficiency anemia
Fat-soluble vitamin deficiencies (A, D, E, K) (Correct answer)
Vitamin C deficiency

Correct answer: Fat-soluble vitamin deficiencies (A, D, E, K)

Chronic pancreatitis impairs lipase production, reducing fat absorption and causing fat-soluble vitamin deficiencies.

Question 88: An RPN documents a medication error in the patient's chart. What is the NEXT required action?

File an incident report per facility policy (Correct answer)
Notify the patient's family immediately
Wait to see if the patient shows adverse effects before reporting
Administer a corrective dose without documentation

Correct answer: File an incident report per facility policy

Medication errors must be documented in the chart AND reported via an incident report per facility policy to ensure patient safety and quality improvement.

Question 89: Which lab value is most important to monitor in a patient with chronic kidney disease (CKD)?

Fasting blood glucose
White blood cell count
Serum potassium (Correct answer)
Serum albumin

Correct answer: Serum potassium

Hyperkalemia is a life-threatening complication of CKD because impaired kidneys cannot excrete potassium adequately.

Question 90: Which screening tool is most commonly used by nurses to assess for depression in adult clients?

Mini-Mental State Examination (MMSE)
CAGE questionnaire
PHQ-9 (Patient Health Questionnaire-9) (Correct answer)
AUDIT-C

Correct answer: PHQ-9 (Patient Health Questionnaire-9)

The PHQ-9 is a validated nine-item tool widely used to screen for and monitor the severity of depression in adults.

Question 91: An RPN is assigned to a newly admitted client who requires Airborne Precautions. Which of the following conditions would necessitate these specific precautions?

Seasonal Influenza.
Pulmonary Tuberculosis. (Correct answer)
Methicillin-resistant Staphylococcus aureus (MRSA).
Norovirus.

Correct answer: Pulmonary Tuberculosis.

Airborne Precautions are used for diseases transmitted by small droplet nuclei that can remain suspended in the air for long periods. Pulmonary Tuberculosis is a classic example requiring these precautions, which include a negative-pressure room and an N95 respirator. Influenza requires Droplet Precautions, while MRSA and Norovirus typically require Contact Precautions.

Question 92: Which principle is violated when an RPN shares a client's HIV status with the client's employer without consent?

Beneficence
Confidentiality (Correct answer)
Fidelity
Veracity

Correct answer: Confidentiality

Disclosing protected health information without authorization violates the client's right to confidentiality.

Question 93: When can an RPN legally share a patient's mental health information with the patient's employer?

When the physician approves the release
When the employer requests it in writing
When the information is relevant to workplace safety
Only when the patient provides written authorization (Correct answer)

Correct answer: Only when the patient provides written authorization

Mental health information is especially protected and may only be released to an employer with the patient's explicit written authorization.

Question 94: A nurse documents that a patient 'seems confused' in the medical record. What is the primary issue with this entry?

It should be written in the nursing notes, not the chart
It uses subjective language instead of objective observations (Correct answer)
It does not include the patient's name
It is too brief and should be expanded

Correct answer: It uses subjective language instead of objective observations

Documentation should use objective, measurable observations rather than subjective interpretations like 'seems confused.'

Question 95: Which of the following best describes 'charting by exception' (CBE)?

Charting after each shift rather than in real time
Only documenting findings that deviate from established norms or the care plan (Correct answer)
Documenting every patient interaction in full narrative form
Using only electronic systems for all documentation

Correct answer: Only documenting findings that deviate from established norms or the care plan

Charting by exception documents only abnormal findings or deviations from the plan, assuming normal findings unless noted otherwise.

Question 96: Which dietary modification is most important for a patient with chronic heart failure to prevent fluid retention?

Eliminate all protein from the diet
Increase potassium intake to 5,000 mg per day
Limit sodium intake to 2,000 mg per day (Correct answer)
Consume a high-fat diet to maintain caloric intake

Correct answer: Limit sodium intake to 2,000 mg per day

Restricting sodium reduces fluid retention and decreases the workload on the failing heart.

Question 97: An RPN is assessing a client who is 12 hours postpartum. The RPN palpates the client's fundus and finds it to be boggy, located two fingerbreadths above the umbilicus, and deviated to the right. What is the RPN's priority action?

Document the findings and reassess in one hour.
Assist the client to empty her bladder and then reassess the fundus. (Correct answer)
Administer a PRN analgesic for afterpains.
Encourage the client to breastfeed to stimulate uterine contractions.

Correct answer: Assist the client to empty her bladder and then reassess the fundus.

A full bladder is a common cause of uterine displacement (often to the right) and uterine atony (a boggy fundus). A boggy uterus cannot contract effectively, which places the client at high risk for postpartum hemorrhage. The priority nursing action is to address the underlying cause by helping the client empty her bladder, then reassessing the fundus.

Question 98: When the thyroid is__________ a goiter occurs.

Hypo active (Correct answer)
Normal function
All of the following
Hyper active

Correct answer: Hypo active

When the thyroid gland is hypoactive, or underactive and not releasing enough thyroid hormones, it might result in a goitre. This may result in symptoms like exhaustion, weight gain, and trouble focusing. To stop more issues and enhance general health, it's critical to identify and treat hypoactive thyroid.

Question 99: Which behavior by the RPN is MOST likely to undermine the therapeutic relationship?

Maintaining consistent scheduling of interactions
Sharing personal opinions about the client's life choices (Correct answer)
Summarizing what the client has shared at the end of a conversation
Using silence when the client pauses to reflect

Correct answer: Sharing personal opinions about the client's life choices

Offering unsolicited personal opinions shifts the focus to the nurse's values, breaching professional boundaries and client autonomy.

Question 100: Childhood WBCs aid in the battle against infection because they assist ________________ mature.

Thymosin (Correct answer)
Oxytocin
Nemoacid
None of the following

Correct answer: Thymosin

The thymus gland secretes the hormone thymosin, which is essential for the maturation and development of white blood cells (WBCs) in children. WBCs play a crucial role in the immune system's ability to combat infections. Consequently, thymosin plays a crucial role in the body's capacity to fight infections during childhood by aiding in the maturation of WBCs.

Question 101: An RPN is administering an IM injection to an adult patient. Which is the preferred site for a large-volume IM injection?

Ventrogluteal site (Correct answer)
Dorsogluteal site
Vastus lateralis in the thigh
Deltoid muscle

Correct answer: Ventrogluteal site

The ventrogluteal site is preferred for large-volume IM injections in adults because it is free of major nerves and blood vessels.

Question 102: When performing passive range-of-motion (ROM) exercises on a patient's hip, the nurse should stop and reassess if:

The patient reports pain during the exercise (Correct answer)
The joint reaches its normal end range
The movement requires gentle sustained pressure
The patient reports mild stiffness at the beginning of movement

Correct answer: The patient reports pain during the exercise

Passive ROM should be performed within the pain-free range; pain indicates possible injury, inflammation, or exceeding the joint's safe limits.

Question 103: An RPN prepares a dose of warfarin and notices the INR result is 4.8. What is the priority action?

Administer the dose as prescribed and monitor
Hold the dose and notify the prescriber immediately (Correct answer)
Document and administer at the next scheduled time
Reduce the dose by half without consulting the prescriber

Correct answer: Hold the dose and notify the prescriber immediately

An INR of 4.8 is supratherapeutic and indicates bleeding risk; the nurse must withhold warfarin and contact the prescriber for further orders.

Question 104: Under mandatory reporting laws, an RPN is required to report suspected child abuse to:

The hospital ethics board only
The attending physician, who then decides whether to report
The appropriate child protective services agency (Correct answer)
The nursing supervisor, who files the report on the nurse's behalf

Correct answer: The appropriate child protective services agency

Mandatory reporting laws require healthcare professionals, including RPNs, to report suspected child abuse directly to child protective services.

Question 105: Which site is preferred for intramuscular injection in an infant younger than 12 months?

Deltoid
Ventrogluteal
Vastus lateralis (Correct answer)
Dorsogluteal

Correct answer: Vastus lateralis

The vastus lateralis (anterolateral thigh) is the preferred IM injection site in infants because it is large and well-developed at this age.

Question 106: The ethical principle of 'justice' in nursing practice primarily refers to:

Doing no harm to clients
Fair and equitable distribution of care and resources (Correct answer)
Keeping promises made to clients
Telling the truth to clients at all times

Correct answer: Fair and equitable distribution of care and resources

Justice requires that nursing care be provided fairly without discrimination based on personal characteristics.

Question 107: Which finding is consistent with late decelerations on a fetal heart rate monitor?

Abrupt drops in FHR unrelated to contractions
Decelerations that begin before the onset of contractions
Decelerations that begin and end with contractions
Decelerations that begin after the peak of a contraction (Correct answer)

Correct answer: Decelerations that begin after the peak of a contraction

Late decelerations are gradual decreases in FHR that begin after the peak of a contraction and return to baseline after the contraction ends, indicating uteroplacental insufficiency.

Question 108: A nurse is teaching a patient with osteoporosis about fall prevention. Which instruction is most important?

Remove throw rugs and ensure good lighting in the home (Correct answer)
Wear socks without shoes to feel floor surfaces better
Avoid all weight-bearing activity to prevent fractures
Rely on furniture for balance instead of using a cane

Correct answer: Remove throw rugs and ensure good lighting in the home

Removing environmental hazards like throw rugs and improving lighting are key fall prevention strategies for osteoporosis patients.

Question 109: A nurse is preparing to administer a medication via metered-dose inhaler (MDI) with a spacer. What is the correct sequence?

Shake, exhale fully, actuate then inhale slowly, hold 10 seconds (Correct answer)
Actuate, exhale, then inhale rapidly without holding
Shake, inhale rapidly, actuate simultaneously, no hold needed
Inhale first, then actuate, then hold 5 seconds

Correct answer: Shake, exhale fully, actuate then inhale slowly, hold 10 seconds

Shaking disperses the medication, exhaling empties the lungs, slow inhalation during actuation deposits medication in the airways, and a 10-second breath hold maximizes deposition.

Question 110: Which nursing action is MOST effective in preventing hospital-acquired pressure injuries in an immobile patient?

Massaging bony prominences to improve circulation
Using a standard foam mattress with an absorbent pad
Repositioning the patient at least every 2 hours (Correct answer)
Applying a barrier cream to all skin surfaces twice daily

Correct answer: Repositioning the patient at least every 2 hours

Regular repositioning every 2 hours relieves sustained pressure on vulnerable tissues and is the cornerstone of pressure injury prevention.

Question 111: An RPN must enter the room of a client on Droplet Precautions for influenza. What is the minimum Personal Protective Equipment (PPE) required for routine care?

A gown and gloves only.
A procedure/surgical mask and eye protection. (Correct answer)
Gloves and an N95 respirator.
A procedure/surgical mask only if within one meter of the client.

Correct answer: A procedure/surgical mask and eye protection.

Droplet Precautions are required for pathogens transmitted by large respiratory droplets, such as influenza. When working within 2 meters of the client, the RPN must wear a procedure/surgical mask and eye protection (goggles or face shield) to protect the mucous membranes of the eyes, nose, and mouth from splashes or sprays. A gown and gloves would also be required based on a point-of-care risk assessment for contact with body fluids.

Question 112: Which hormone is generated when one is dehydrated?

ADH (Correct answer)
Thymosin
Renin
Oxytocin

Correct answer: ADH

The hypothalamus produces antidiuretic hormone (ADH), also referred to as vasopressin, which is released by the pituitary gland in reaction to dehydration. Its primary job is to control the body's water balance by boosting the kidneys' ability to reabsorb water, lowering urine production, and preserving water. Thus, the hormone created during dehydration to support fluid balance and avoid excessive water loss is ADH.

Question 113: A client asks the RPN, 'Do you think I should leave my husband?' The BEST therapeutic response is:

"I can't give you personal advice, so let's change the subject."
"Most people in your situation would consider leaving."
"Based on what you've told me, leaving sounds like the safer choice."
"That's a significant decision. What are your thoughts about it?" (Correct answer)

Correct answer: "That's a significant decision. What are your thoughts about it?"

Redirecting the question back to the client promotes autonomy and avoids imposing the nurse's values.

Question 114: Which action should the RPN take first when a medication error is discovered?

Notify the pharmacy department
Assess the patient for adverse effects (Correct answer)
Document the error in the patient's chart
Complete an incident report

Correct answer: Assess the patient for adverse effects

Patient safety is the priority; the RPN must first assess the patient for any adverse effects from the medication error.

Question 115: When reconstituting a powdered medication, what should the nurse do immediately after adding diluent?

Refrigerate the vial for 10 minutes before use
Draw up the solution before mixing is complete
Roll the vial gently between the palms and inspect for complete dissolution (Correct answer)
Shake the vial vigorously to dissolve quickly

Correct answer: Roll the vial gently between the palms and inspect for complete dissolution

Gently rolling ensures complete dissolution without creating excessive bubbles, and visual inspection confirms the solution is clear before use.

Question 116: A nurse prepares to perform a urinary catheter insertion. Which action is essential to prevent CAUTI?

Secure the catheter to the patient's abdomen
Use the largest catheter size available for secure placement
Maintain a closed drainage system and keep the bag below bladder level (Correct answer)
Irrigate the catheter with normal saline every 8 hours

Correct answer: Maintain a closed drainage system and keep the bag below bladder level

A closed drainage system prevents retrograde bacterial entry, and keeping the bag below the bladder prevents reflux of contaminated urine.

Question 117: Which isolation precaution category is used for tuberculosis (TB)?

Standard precautions only
Contact precautions
Airborne precautions (Correct answer)
Droplet precautions

Correct answer: Airborne precautions

TB is transmitted via airborne droplet nuclei that remain suspended in the air, requiring airborne precautions and a negative-pressure room.

Question 118: A nurse is caring for a client in preterm labor at 30 weeks who is receiving a betamethasone injection. What is the primary purpose of this medication?

Reduce fetal heart rate to decrease oxygen demand
Accelerate fetal lung maturity by stimulating surfactant production (Correct answer)
Prevent maternal infection associated with premature rupture of membranes
Stop uterine contractions and prolong pregnancy

Correct answer: Accelerate fetal lung maturity by stimulating surfactant production

Antenatal corticosteroids such as betamethasone stimulate surfactant production in the fetal lungs, reducing the risk of respiratory distress syndrome.

Question 119: What is the first course of action for a patient who has overdosed on opioids?

Administer naloxone (Correct answer)
Elevate the legs
Administer glucose
Execute rescue respiration.

Correct answer: Administer naloxone

Naloxone, a drug that counteracts the effects of opioids, is the first line of treatment for an overdose of opioids.

Question 120: A patient with epilepsy is prescribed phenytoin. Which instruction about this medication is most important?

Never stop phenytoin abruptly without physician guidance (Correct answer)
Expect orange-colored urine as a harmless side effect
Phenytoin can be safely taken with antacids to reduce GI upset
Take phenytoin only when a seizure is imminent

Correct answer: Never stop phenytoin abruptly without physician guidance

Abrupt discontinuation of phenytoin can precipitate status epilepticus, a life-threatening condition.

Question 121: Which of the following represents a correctly formulated nursing diagnosis?

Risk for Infection related to surgical incision. (Correct answer)
Imbalanced Nutrition as evidenced by poor dietary intake.
Pneumonia.
Client is at risk for falling.

Correct answer: Risk for Infection related to surgical incision.

A 'Risk For' nursing diagnosis includes the diagnostic label and the related risk factors. 'Risk for Infection related to surgical incision' correctly identifies a potential problem and its cause. 'Pneumonia' is a medical diagnosis. The other options are incomplete nursing diagnoses as they lack either the related factors or the defining characteristics/evidence.

Question 122: The nurse is performing a capillary blood glucose test. After the lancet puncture, what is the correct action regarding the first drop of blood?

Wipe away the first drop and use the second drop (Correct answer)
Apply pressure to enlarge the first drop for testing
Warm the site for 5 minutes before testing the first drop
Use the first drop for the glucose test strip

Correct answer: Wipe away the first drop and use the second drop

The first drop of blood may be contaminated with tissue fluid, so it is wiped away and the second drop is applied to the test strip for accurate results.

Question 123: An RPN makes an error while documenting a client's vital signs on a paper chart. Which action is the correct procedure for correcting this mistake?

Draw a single line through the incorrect entry, write 'error' or 'mistaken entry' above it with the nurse's initials, and then record the correct information. (Correct answer)
Leave the error as is and add a new note at the end of the shift explaining the correction.
Use correction fluid to cover the error and write the correct information.
Completely black out the error with a marker and chart the correct data in the next available space.

Correct answer: Draw a single line through the incorrect entry, write 'error' or 'mistaken entry' above it with the nurse's initials, and then record the correct information.

The professional and legal standard for correcting an error in a paper health record is to ensure the original entry remains legible. A single line is drawn through the error, it is labeled as an error with the nurse's initials, and the correct information is added. This maintains the integrity and transparency of the legal document.

Question 124: An RPN is teaching a client how to safely use a standard walker. Which instruction is most important for the RPN to include?

"Lift the walker, place it a short distance ahead, then step into it with your affected leg first." (Correct answer)
"Keep all four tips of the walker on the floor and slide it forward."
"Always look down at your feet while you are walking."
"Advance the walker, then step forward with your stronger leg first."

Correct answer: "Lift the walker, place it a short distance ahead, then step into it with your affected leg first."

The correct sequence for using a standard (non-wheeled) walker is to first lift and place the walker a comfortable distance forward, ensuring all four legs are stable on the ground. The client should then step forward with their weaker or affected leg, followed by the stronger leg. This method maintains a wide base of support and ensures stability throughout the movement.

Question 125: An RPN is preparing to administer routine medications to a healthy term newborn within the first hour of life. Which of the following injections is administered to prevent hemorrhagic disease?

Rh immune globulin
Vitamin K (Correct answer)
Erythromycin
Hepatitis B vaccine

Correct answer: Vitamin K

Newborns are born with low levels of Vitamin K, which is essential for blood clotting. An injection of Vitamin K is given prophylactically to all newborns to prevent Vitamin K Deficiency Bleeding (VKDB), a potentially life-threatening condition.

Question 126: An RPN is providing discharge teaching to a new mother about lochia. The client is 3 days postpartum. Which statement by the mother indicates an understanding of the normal progression?

"The flow should change from red to a pinkish-brown colour around this time." (Correct answer)
"I won't have any more discharge after today."
"I should expect a heavy, bright red flow for at least the first week."
"If my discharge becomes pinkish-brown, I should call the clinic immediately."

Correct answer: "The flow should change from red to a pinkish-brown colour around this time."

Normal lochia progresses through three stages. Lochia rubra (red) lasts for about 1-3 days. Lochia serosa (pinkish-brown) occurs from about day 4 to day 10. Lochia alba (yellowish-white) follows and can last for several weeks. A statement indicating the flow will change from red to pinkish-brown around day 3-4 shows correct understanding.

Question 127: A patient is admitted after ingesting an unknown substance. The nurse notes pinpoint pupils, bradycardia, and excessive secretions. Which antidote should the nurse prepare?

N-acetylcysteine
Naloxone
Atropine (Correct answer)
Flumazenil

Correct answer: Atropine

These are classic signs of organophosphate or cholinergic toxicity, and atropine is the primary antidote to block muscarinic effects.

Question 128: A patient withdraws consent for a procedure after signing the consent form but before the procedure begins. The RPN should:

Halt preparation, notify the physician, and document the withdrawal of consent (Correct answer)
Ask the patient to reconsider and explain the medical risks of refusal before stopping
Proceed because the form was already signed
Transfer responsibility to the physician to manage the situation

Correct answer: Halt preparation, notify the physician, and document the withdrawal of consent

Consent can be withdrawn at any time before a procedure begins; the RPN must stop, notify the provider, and document.

Question 129: Which statement about surgical asepsis is correct?

It aims to reduce the number of pathogens to a safe level
It requires the complete elimination of all microorganisms including spores (Correct answer)
It is the same as medical asepsis
It is used for routine patient assessments

Correct answer: It requires the complete elimination of all microorganisms including spores

Surgical asepsis (sterile technique) requires the complete absence of all microorganisms and spores, unlike medical asepsis which only reduces pathogen numbers.

Question 130: A nurse leaves blank lines in a narrative nursing note. What is the risk associated with this practice?

It may allow unauthorized additions to the record later (Correct answer)
It wastes paper resources
It slows down the charting process
It confuses the reader about paragraph breaks

Correct answer: It may allow unauthorized additions to the record later

Blank lines in medical records can be filled in later with unauthorized information, compromising the integrity of the document.

Question 131: An RPN notices that a colleague has been charting vital signs without actually taking them. The RPN should FIRST:

Document the concern in the patient's chart
Report the observation to the nurse manager or appropriate supervisor (Correct answer)
Confront the colleague publicly at the nursing station
Contact the regulatory college immediately before speaking to management

Correct answer: Report the observation to the nurse manager or appropriate supervisor

The appropriate first step is to report the observation through the facility's internal chain of command (supervisor/manager) to protect patient safety.

Question 132: The therapeutic technique of 'confrontation' is MOST appropriately used to:

Challenge the client's beliefs when the nurse disagrees
Correct misinformation provided to the care team
Point out discrepancies between what a client says and what they do (Correct answer)
Insist the client acknowledge maladaptive behavior

Correct answer: Point out discrepancies between what a client says and what they do

Therapeutic confrontation highlights inconsistencies to promote client insight without blame or judgment.

Question 133: A child is brought to the ED after a near-drowning event. The child is conscious and coughing. The nurse's priority intervention is:

Place an NG tube to remove swallowed water
Administer 100% oxygen and monitor for respiratory deterioration (Correct answer)
Obtain a chest X-ray before any intervention
Discharge with home observation instructions

Correct answer: Administer 100% oxygen and monitor for respiratory deterioration

All near-drowning victims require supplemental oxygen and observation for delayed pulmonary edema and hypoxia even if initially appearing well.

Question 134: An RPN is preparing to meet a new client with a history of violent behavior. During the pre-interaction phase, the nurse should:

Examine personal biases and anxieties to prevent them from affecting care (Correct answer)
Arrange for security to be present during the first meeting
Review only the medical chart and skip psychological preparation
Ask a colleague to conduct the initial interaction instead

Correct answer: Examine personal biases and anxieties to prevent them from affecting care

The pre-interaction phase requires the nurse to reflect on personal reactions that could interfere with therapeutic engagement.

Question 135: An RPN is caring for a client with a confirmed Clostridioides difficile (C. difficile) infection. In addition to using a private room, which of the following infection control measures are essential?

Wearing an N95 respirator and using an alcohol-based hand rub upon exiting.
Implementing Droplet Precautions and wearing a surgical mask.
Using routine practices with the addition of eye protection.
Wearing a gown and gloves, and performing hand hygiene with soap and water. (Correct answer)

Correct answer: Wearing a gown and gloves, and performing hand hygiene with soap and water.

Clostridioides difficile requires Contact Precautions, which includes wearing a gown and gloves. Crucially, C. difficile produces spores that are resistant to alcohol-based hand rubs. Therefore, hand hygiene must be performed with soap and water to mechanically remove the spores.

Question 136: During a disaster drill, the incident commander asks the charge nurse to activate the hospital emergency operations plan. The nurse's first action is to:

Notify the charge nurse of each unit to prepare for surge capacity
Call all off-duty staff to return immediately
Follow the chain of command as outlined in the hospital's emergency operations plan (Correct answer)
Move all current patients to discharge as quickly as possible

Correct answer: Follow the chain of command as outlined in the hospital's emergency operations plan

The hospital's emergency operations plan establishes a clear chain of command through the Hospital Incident Command System (HICS) that must be followed during any disaster.

Question 137: A client states, 'I don't want to talk about my past.' The RPN should respond by:

Explaining that discussing the past is necessary for effective treatment
Gently persisting because disclosure is therapeutic
Respecting the limit and exploring what the client is willing to discuss (Correct answer)
Documenting the client's refusal and ending the session

Correct answer: Respecting the limit and exploring what the client is willing to discuss

Respecting boundaries demonstrates that the nurse values the client's autonomy, which itself builds therapeutic trust.

Question 138: A patient is prescribed metformin 500 mg PO BID. When is the best time to administer this medication?

With meals to reduce GI upset (Correct answer)
30 minutes before meals
On an empty stomach for better absorption
At bedtime only

Correct answer: With meals to reduce GI upset

Metformin should be taken with meals to minimize gastrointestinal side effects such as nausea and diarrhea.

Question 139: A nurse is caring for a patient with a seizure disorder. Which safety measure is the highest priority?

Maintaining a dim, quiet environment
Placing a bite block at the bedside
Inserting an oral airway between seizures
Keeping padded side rails up at all times (Correct answer)

Correct answer: Keeping padded side rails up at all times

Padded, raised side rails protect the patient from injury during a seizure; bite blocks and oral airways are contraindicated and should never be forced into the mouth.

Question 140: An RPN suspects a colleague is diverting controlled substances. What is the most appropriate first action?

Report the suspicion to the nurse manager or appropriate authority (Correct answer)
Document observations over several weeks before acting
Confront the colleague privately and warn them to stop
Ignore it unless there is direct patient harm

Correct answer: Report the suspicion to the nurse manager or appropriate authority

RPN professional standards require reporting concerns about colleague conduct that may endanger patients to the appropriate authority promptly.

Question 141: A patient with MRSA is on contact precautions. The nurse must transport the patient for an X-ray. What action is appropriate?

Cover all MRSA wounds and notify the receiving area before transport (Correct answer)
No special precautions are needed outside the room
Cancel the X-ray until precautions are lifted
Apply an N95 to the patient during transport

Correct answer: Cover all MRSA wounds and notify the receiving area before transport

Wounds should be covered and the receiving department notified so they can prepare appropriate precautions and clean surfaces after the visit.

Question 142: A patient on bed rest develops redness over the sacrum that blanches with pressure. The nurse documents this as which stage of pressure injury?

Stage 2
Deep tissue pressure injury
Unstageable
Stage 1 (Correct answer)

Correct answer: Stage 1

Stage 1 pressure injuries present as intact skin with non-blanchable redness; blanchable erythema indicates the area is still at risk but not yet a true pressure injury.

Question 143: When attempting cardiopulmonary resuscitation (CPR) on an unconscious adult, what is the initial course of action?

Check for breathing
Call for help (Correct answer)
Open the airway
Check for responsiveness

Correct answer: Call for help

Making a call for help is the first step in performing CPR to make sure help is on its way.

Question 144: Which organism is the most common cause of healthcare-associated pneumonia?

Staphylococcus aureus
Pseudomonas aeruginosa (Correct answer)
Streptococcus pneumoniae
Escherichia coli

Correct answer: Pseudomonas aeruginosa

Pseudomonas aeruginosa is one of the most common and difficult-to-treat causes of healthcare-associated and ventilator-associated pneumonia.

Question 145: A nurse is caring for a patient with Clostridium difficile (C. diff). Which PPE is required upon entering the room?

Surgical mask and gloves
Gown, gloves, and N95 respirator
N95 respirator and goggles
Gown and gloves (Correct answer)

Correct answer: Gown and gloves

C. diff requires contact precautions, which means wearing a gown and gloves; a mask is not required unless there is a splash risk.

Question 146: A patient with systemic lupus erythematosus (SLE) asks why they should avoid sunlight. The nurse's best response is:

Sunlight depletes vitamin D and worsens joint pain
Sunlight causes photosensitivity and can trigger disease flares (Correct answer)
Sunlight increases risk of hypertension in SLE patients
Sunlight reduces the effectiveness of immunosuppressive medications

Correct answer: Sunlight causes photosensitivity and can trigger disease flares

UV radiation triggers photosensitivity reactions and can precipitate SLE flares.

Question 147: What is the main evaluation instrument for figuring out how severe burns are?

Rule of Nines (Correct answer)
Wong-Baker FACES Pain Rating Scale
ABCDE assessment
Glasgow Coma Scale

Correct answer: Rule of Nines

The percentage of the body surface area affected by burns is estimated using the Rule of Nines.

Question 148: A confused elderly patient keeps trying to climb out of bed despite interventions. Before applying a physical restraint, the nurse should first:

Notify the family and ask them to stay with the patient overnight
Obtain a physician's order and apply the least restrictive restraint available (Correct answer)
Apply mitts to prevent IV dislodgement
Document the behavior and place the patient on 1:1 observation

Correct answer: Obtain a physician's order and apply the least restrictive restraint available

Restraints require a physician's order and must be the least restrictive option necessary; this is the mandatory first step before application.

Question 149: The RPN is administering an eye drop to a patient. Which technique is correct?

Pull down the lower eyelid to create a conjunctival sac and instill the drop (Correct answer)
Ask the patient to blink rapidly after instillation
Place the drop directly on the cornea for fastest absorption
Wipe excess medication toward the inner canthus

Correct answer: Pull down the lower eyelid to create a conjunctival sac and instill the drop

Instilling drops into the conjunctival sac avoids corneal irritation and allows proper absorption of the medication.

Question 150: A competent client with a known history of refusing medical advice now requires a routine medication injection. The client verbally refuses the injection. What is the RPN's legal obligation?

Explain the risks of refusal and then administer the medication if the client does not physically resist.
Administer the medication because it is a routine order and in the client's best interest.
Document the client's refusal, inform the primary health care provider, and do not administer the medication. (Correct answer)
Request a psychiatric evaluation to have the client declared incapable of making decisions.

Correct answer: Document the client's refusal, inform the primary health care provider, and do not administer the medication.

Competent clients have the legal right to refuse treatment, even if that refusal may lead to negative health consequences. Forcing treatment on a competent client who has refused can be considered battery. The RPN's duty is to respect the client's autonomy, document the refusal and the education provided, and inform the appropriate health care team members.

Question 151: A client is admitted to the hospital with an acute exacerbation of heart failure. They are experiencing shortness of breath, bilateral crackles on auscultation, and 2+ pitting edema in their lower extremities. What is the RPN's priority assessment?

Skin integrity on the lower legs.
The client's understanding of their medication regimen.
Respiratory status. (Correct answer)
Nutritional intake for the past 24 hours.

Correct answer: Respiratory status.

Using the ABCs (Airway, Breathing, Circulation) prioritization framework, the client's respiratory status is the most immediate concern. Shortness of breath and crackles indicate impaired gas exchange and fluid in the lungs, which is a life-threatening condition that requires priority assessment and intervention.

Question 152: An RPN is caring for a client who had a fall. The RPN completes an incident report according to facility policy. How should this event be documented in the client's official health record?

Document a factual account of the fall, the client's response, and the interventions performed, without mentioning the incident report. (Correct answer)
Only document the fall in the incident report to prevent legal discovery of the event.
Write "Incident report completed and filed with risk management" in the progress notes.
Place a copy of the incident report in the client's chart for the physician to review.

Correct answer: Document a factual account of the fall, the client's response, and the interventions performed, without mentioning the incident report.

The client's health record should contain objective, factual information about the event (the fall), the assessment findings, and the care provided. The incident report is an internal risk management tool and should not be mentioned or included in the patient's chart.

Question 153: Which of the following documentation entries is the best example of objective data?

"Abdominal dressing is dry and intact with no erythema or swelling noted at the incision site." (Correct answer)
"Client had a good day and was pleasant to staff."
"Client seems depressed and is refusing to eat lunch."
"Client is complaining of severe pain and appears uncomfortable."

Correct answer: "Abdominal dressing is dry and intact with no erythema or swelling noted at the incision site."

Objective data is factual information that is observed, measured, or felt by the healthcare provider. The description of the abdominal dressing is based on direct observation and is not subject to interpretation. The other options include subjective terms ('seems depressed,' 'good day,' 'complaining,' 'appears uncomfortable').

Question 154: Under the Regulated Health Professions Act, 1991, and the Nursing Act, 1991, which of the following is a controlled act that RPNs are authorized to perform with an order or through initiation under specific conditions?

Communicating a diagnosis to a client.
Setting or casting a fracture of a bone.
Prescribing medications.
Performing a procedure below the dermis or a mucous membrane. (Correct answer)

Correct answer: Performing a procedure below the dermis or a mucous membrane.

The Nursing Act, 1991, authorizes RNs and RPNs to perform five controlled acts under specific conditions, such as with an order or through initiation. Performing a prescribed procedure below the dermis or a mucous membrane (e.g., giving an injection or wound care) is one of these authorized controlled acts. Communicating a diagnosis and prescribing are generally reserved for Nurse Practitioners or physicians, and setting fractures is outside the nursing scope.

Question 155: A patient with chest trauma has paradoxical chest wall movement during respiration. The nurse recognizes this as:

Cardiac tamponade
Hemothorax
Open pneumothorax
Flail chest (Correct answer)

Correct answer: Flail chest

Flail chest occurs when three or more consecutive ribs are fractured in two places, causing the segment to move opposite to the rest of the chest wall.

Question 156: When applying elastic compression stockings (TED hose), which action is correct?

Apply stockings over skin lotion to reduce friction
Apply stockings after the patient has been ambulating for 30 minutes
Apply stockings only to the affected leg in DVT patients
Apply stockings while the patient is supine before dependent edema accumulates (Correct answer)

Correct answer: Apply stockings while the patient is supine before dependent edema accumulates

Compression stockings should be applied while the patient is supine (legs elevated) to prevent trapping edema under the stocking.

Question 157: During CPR, the nurse notes the cardiac monitor shows ventricular fibrillation. The MOST appropriate next action is:

Deliver a synchronized cardioversion at 100 J
Administer 1 mg epinephrine IV push
Administer amiodarone 300 mg IV push
Deliver an unsynchronized defibrillation shock (Correct answer)

Correct answer: Deliver an unsynchronized defibrillation shock

Ventricular fibrillation is a shockable rhythm requiring immediate unsynchronized defibrillation as the first intervention.

Question 158: When a nurse documents 'patient tolerated procedure well' without supporting observations, this is an example of:

Charting by exception
Appropriate use of abbreviations
A vague, conclusory statement that lacks objective detail (Correct answer)
Accurate and thorough documentation

Correct answer: A vague, conclusory statement that lacks objective detail

Phrases like 'tolerated well' are conclusory and do not provide the objective data needed to support the statement or defend care if questioned.

Question 159: A fellow RPN consistently arrives late for their shift, leaving the unit understaffed for the first hour. Which professional standard is this RPN failing to uphold?

Leadership
Knowledge Application
Accountability (Correct answer)
Continuing Competence

Correct answer: Accountability

The CNO Professional Standards state that accountability includes being responsible for one's actions and ensuring that practice and conduct meet the standards of the profession. Consistently being late demonstrates a lack of accountability to the public, clients, and colleagues, as it can compromise client safety and care.

Question 160: Which of the following actions by an RPN is the MOST effective way to break the chain of infection at the 'mode of transmission' link?

Administering antibiotics to a client with a bacterial infection.
Performing diligent hand hygiene between all client encounters. (Correct answer)
Ensuring clients are up-to-date on their immunizations.
Covering a client's wound with an occlusive dressing.

Correct answer: Performing diligent hand hygiene between all client encounters.

Hand hygiene is the single most effective intervention to break the chain of infection by interrupting the mode of transmission. It prevents the transfer of microorganisms from the healthcare provider's hands to clients or between clients. Immunizations target the 'susceptible host', antibiotics target the 'infectious agent', and a dressing targets the 'portal of exit'.

Question 161: A nurse is preparing to administer erythromycin ophthalmic ointment to a newborn. Which statement best describes its purpose?

To treat congenital cataracts identified at birth
To lubricate the eyes damaged by amniotic fluid exposure
To prevent ophthalmia neonatorum caused by gonorrhea and chlamydia (Correct answer)
To reduce intraocular pressure in premature newborns

Correct answer: To prevent ophthalmia neonatorum caused by gonorrhea and chlamydia

Prophylactic erythromycin ointment is required by law in many states to prevent bacterial conjunctivitis (ophthalmia neonatorum) from Neisseria gonorrhoeae and Chlamydia trachomatis.

Question 162: Which of the following is an example of a pharmacokinetic drug interaction?

A drug binding to the same receptor as another drug
Combining two sedatives causing additive CNS depression
Two drugs with opposite therapeutic effects canceling each other out
One drug altering the metabolism of another drug in the liver (Correct answer)

Correct answer: One drug altering the metabolism of another drug in the liver

Pharmacokinetic interactions involve one drug altering the absorption, distribution, metabolism, or excretion of another drug.

Question 163: An RPN is administering morning medications to a client who states, "This pill looks different from the one I usually take for my blood pressure." What is the RPN's BEST initial action?

Explain to the client that manufacturers sometimes change the appearance of pills.
Withhold the medication and notify the charge nurse immediately.
Stop and re-verify the medication and order before administering it. (Correct answer)
Administer the medication as ordered and check on the client later.

Correct answer: Stop and re-verify the medication and order before administering it.

This scenario involves the 'Right Medication' and 'Right to Question' principles of medication administration. The client's concern is a red flag that requires immediate attention. The RPN must stop the administration process and re-check the medication against the MAR and the original prescriber's order to ensure accuracy. This action respects the patient's role in their own safety and helps prevent a potential medication error.

Question 164: Which of the following BEST defines 'informed consent' in nursing practice?

The patient signs the consent form provided by the surgeon
The nurse explains the procedure and the patient agrees verbally
The patient receives adequate information about risks, benefits, and alternatives to make a voluntary decision (Correct answer)
The patient is told what will happen and does not object

Correct answer: The patient receives adequate information about risks, benefits, and alternatives to make a voluntary decision

Informed consent requires disclosure of material information (risks, benefits, alternatives), patient comprehension, and voluntary agreement.

Question 165: A client at 41 weeks gestation is scheduled for a nonstress test (NST). Which result indicates a reactive (normal) NST?

Two or more FHR accelerations of 15 bpm lasting 15 seconds within 20 minutes (Correct answer)
Baseline FHR between 100–160 bpm with minimal variability
Fetal movement perceived by the mother at least once in 20 minutes
Absence of FHR decelerations during the test period

Correct answer: Two or more FHR accelerations of 15 bpm lasting 15 seconds within 20 minutes

A reactive NST requires at least two FHR accelerations of ≥15 bpm above baseline lasting ≥15 seconds within a 20-minute window.

Question 166: A nurse is reviewing a client's prenatal record and notes a gravida 3, para 1 (G3P1) designation. How should the nurse interpret this?

The client has been pregnant 3 times and has 1 living child
The client has 1 full-term infant and is currently pregnant for the third time
The client is currently in her third pregnancy and had 1 prior delivery after 20 weeks (Correct answer)
The client has had 3 deliveries and 1 miscarriage

Correct answer: The client is currently in her third pregnancy and had 1 prior delivery after 20 weeks

Gravida refers to the total number of pregnancies (including current), and para refers to deliveries at or after 20 weeks gestation.

Question 167: Which of the following actions by an RPN demonstrates correct principles of body mechanics when preparing to transfer a client from a bed to a wheelchair?

Raising the bed to a comfortable working height. (Correct answer)
Twisting their torso to pivot the client toward the chair.
Bending primarily at the waist to get closer to the client.
Keeping their feet close together to create a stable base.

Correct answer: Raising the bed to a comfortable working height.

Raising the bed to a comfortable working height (typically at the level of the nurse's waist or hips) is a key principle of body mechanics. This action prevents the nurse from bending or stooping, which reduces strain on the back muscles and minimizes the risk of musculoskeletal injury. Other principles include maintaining a wide base of support, bending at the knees, and pivoting with the feet instead of twisting.

Question 168: A patient with Type 1 diabetes is found unresponsive with a blood glucose of 38 mg/dL. What is the nurse's first action?

Give the patient a glass of orange juice to drink
Call the physician before initiating any treatment
Administer oral glucose gel between the cheeks and gums
Administer IV dextrose 50% as ordered (Correct answer)

Correct answer: Administer IV dextrose 50% as ordered

An unresponsive patient cannot safely swallow, so IV dextrose is the appropriate treatment for severe hypoglycemia.

Question 169: Which technique is used to verify correct placement of a small-bore (dobhoff) feeding tube before initiating enteral feedings?

Auscultating over the epigastric area while injecting air
Checking gastric pH of aspirate and confirming with X-ray (Correct answer)
Observing respiratory rate for 5 minutes after insertion
Submerging the tube end in water to check for bubbles

Correct answer: Checking gastric pH of aspirate and confirming with X-ray

Radiographic confirmation plus aspirate pH testing (pH <5 suggests gastric placement) is the gold standard for verifying small-bore feeding tube placement.

Question 170: A patient who is a Jehovah's Witness refuses a blood transfusion ordered by the physician. The RPN should:

Respect the refusal and document it, then notify the physician (Correct answer)
Contact the patient's family to obtain consent
Proceed with the transfusion because the physician ordered it
Call the ethics committee before taking any action

Correct answer: Respect the refusal and document it, then notify the physician

Competent adult patients have the legal right to refuse treatment; the RPN must document the refusal and inform the physician.

Question 171: The concept of 'unconditional positive regard' in the therapeutic relationship means the nurse:

Agrees with all decisions the client makes
Avoids setting any behavioral limits during interactions
Accepts the client as a person of worth regardless of behavior (Correct answer)
Praises the client at every session to build confidence

Correct answer: Accepts the client as a person of worth regardless of behavior

Unconditional positive regard means valuing the client intrinsically without making acceptance contingent on behavior or compliance.

CPNRE (Canadian Practical Nurse Registration Examination)

The CPNRE is the national entry-to-practice examination for Registered Practical Nurses (RPNs) and Licensed Practical Nurses (LPNs) in Canada. It assesses competency across foundations of practice, collaborative practice, and professional/ethical/legal practice domains.

170

Questions

240 min

Time Limit

62%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

rexpn.com — Fees, exam information · verified Oct 2026
cno.org — Test delivery, eligibility, exam format, passing score, retake policy, test dates, score release, score validity · verified Oct 2026