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

Question 1: An RPN is caring for an older adult client with dementia who is agitated and repeatedly trying to climb out of bed. The client does not respond to verbal redirection. What is the most appropriate initial intervention before considering restraints?

Ask a family member to sit with the client.
Apply soft wrist restraints to prevent the client from leaving the bed.
Place a floor mat next to the bed and lower the bed to its lowest position. (Correct answer)
Administer a prescribed sedative medication.

Correct answer: Place a floor mat next to the bed and lower the bed to its lowest position.

The principle of least restraint requires using all possible alternatives before applying physical or chemical restraints. Lowering the bed to its lowest position and placing a floor mat beside it is an environmental safety intervention that reduces the risk of injury from a fall without restricting the client's movement. It is a priority action when a client is attempting to get out of bed.

Question 2: A client states, 'I don't want to talk about my past.' The RPN should respond by:

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
Explaining that discussing the past is necessary for effective treatment

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

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

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 4: When documenting a patient's refusal of a prescribed treatment, the nurse must include:

Only the fact that the patient refused
The refusal, education provided, patient's stated reason, and notification of the physician (Correct answer)
A statement that the patient is non-compliant and difficult
Nothing, as refusals should not be documented

Correct answer: The refusal, education provided, patient's stated reason, and notification of the physician

Complete documentation of refusals includes the patient's reason, teaching provided, and physician notification to demonstrate respect for autonomy and protect the care team.

Question 5: A nurse is assigned to a patient in protective (reverse) isolation. What is the primary purpose of this precaution?

To prevent the patient from spreading infection to others
To protect a severely immunocompromised patient from external pathogens (Correct answer)
To reduce droplet transmission to staff
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 6: 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?

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

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 7: Which assessment finding in a postpartum client requires IMMEDIATE intervention?

Lochia rubra with small clots on day 1
Blood pressure 160/110 mmHg with headache (Correct answer)
Uterine fundus firm at the umbilicus
Mild perineal discomfort at the episiotomy site

Correct answer: Blood pressure 160/110 mmHg with headache

A blood pressure of 160/110 mmHg with headache in a postpartum client signals postpartum preeclampsia, a medical emergency.

Question 8: 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?

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)
Independently diagnosing a client's complex health condition.

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 9: A nurse is caring for a patient with lower extremity weakness who uses a gait belt. Where should the nurse position themselves during ambulation?

To the side of the patient, holding their arm
Behind and to the stronger side of the patient
Behind and to the weaker side of the patient, grasping the belt (Correct answer)
Directly in front of the patient to catch them if they fall forward

Correct answer: Behind and to the weaker side of the patient, grasping the belt

Standing behind and to the weaker side with a firm grip on the gait belt allows the nurse to prevent falls toward the weaker side, which is most likely.

Question 10: An RPN is completing an admission assessment on a new client. Which of the following is the best example of objective data?

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

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 11: A patient with asthma uses a peak flow meter. A reading in the red zone indicates:

A medical emergency requiring immediate emergency care (Correct answer)
Caution — the patient should use a rescue inhaler and contact the provider
Good asthma control requiring no action
Normal variation not requiring intervention

Correct answer: A medical emergency requiring immediate emergency care

A red zone reading (below 50% of personal best) signals a severe asthma episode requiring immediate emergency treatment.

Question 12: An RPN receives a verbal order from a physician by phone. The best practice is to:

Administer the medication and document the verbal order after the physician's next visit
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)
Write it in the chart and have another nurse witness the documentation

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 13: When caring for a client with preeclampsia receiving magnesium sulfate, which finding requires the nurse to withhold the next dose?

Urinary output of 25 mL/hr (Correct answer)
Respiratory rate of 14 breaths/min
Deep tendon reflexes 2+
Blood pressure of 148/96 mmHg

Correct answer: Urinary output of 25 mL/hr

Urinary output below 30 mL/hr indicates decreased renal clearance, increasing the risk of magnesium toxicity.

Question 14: Which of the following is an example of a non-therapeutic communication technique?

Restating the client's words to confirm understanding
Using silence to allow the client time to think
Using open-ended questions to invite exploration
Giving false reassurance such as, 'Everything will work out fine.' (Correct answer)

Correct answer: Giving false reassurance such as, 'Everything will work out fine.'

False reassurance dismisses the client's concerns and blocks genuine exploration of fears or needs.

Question 15: 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 educate the client on the brand names of all their new prescriptions.
To prevent medication errors such as omissions, duplications, and dosing errors during transitions in care. (Correct answer)
To ensure the hospital pharmacy has billed correctly for all administered drugs.
To provide the client with a full supply of all their prescribed medications.

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

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

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 17: Which phase of the nurse-client relationship involves mutually identifying problems and setting goals?

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

Correct answer: Working phase

The working phase is when the nurse and client collaborate on goal-directed problem solving and therapeutic work.

Question 18: 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?

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

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 19: A client with post-traumatic stress disorder (PTSD) is triggered in the unit and begins to dissociate. What is the nurse's immediate intervention?

Leave the client alone in a quiet room until the episode resolves
Use a calm, steady voice and simple grounding techniques such as the 5-4-3-2-1 sensory method (Correct answer)
Administer a benzodiazepine as a PRN to reduce acute distress
Encourage the client to talk through the traumatic memory to process the emotion

Correct answer: Use a calm, steady voice and simple grounding techniques such as the 5-4-3-2-1 sensory method

Grounding techniques reconnect the client to the present moment during dissociation; speaking calmly and guiding sensory awareness is safe, effective, and non-pharmacological.

Question 20: Which finding MOST suggests increased intracranial pressure (ICP) in a client following a head injury?

Bilateral miosis and diaphoresis
Hypotension and tachycardia
Widening pulse pressure and bradycardia (Correct answer)
Symmetric pupil reaction to light

Correct answer: Widening pulse pressure and bradycardia

Cushing's triad — widening pulse pressure, bradycardia, and irregular respirations — is a late sign of dangerously increased ICP.

Question 21: 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?

Vitamin K (Correct answer)
Rh immune globulin
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 22: When should the nurse perform hand hygiene according to WHO's Five Moments for Hand Hygiene?

Before patient contact, before an aseptic task, after body fluid exposure, after patient contact, and after contact with the patient's surroundings (Correct answer)
Whenever gloves are changed
Only before and after direct patient contact
Before and after each shift

Correct answer: Before patient contact, before an aseptic task, after body fluid exposure, after patient contact, and after contact with the patient's surroundings

WHO's Five Moments define all critical points during patient care where hand hygiene must occur to break the chain of infection.

Question 23: The nurse is applying a transdermal nitroglycerin patch. Which instruction to the patient is most important?

Remove the old patch before applying the new one (Correct answer)
Keep the patch in place during showering by covering with tape
Apply the patch to the same location every day
Apply the patch directly over the chest for best effect

Correct answer: Remove the old patch before applying the new one

The old transdermal patch must be removed before applying a new one to prevent cumulative dosing and potential hypotension or toxicity.

Question 24: Which assessment best confirms that a newborn has passed the initial gastrointestinal transition successfully?

Presence of rooting and sucking reflexes
Blood glucose level above 50 mg/dL
Passage of meconium within 24–48 hours (Correct answer)
Urine output of 6 wet diapers by day 1

Correct answer: Passage of meconium within 24–48 hours

Passage of meconium within the first 24–48 hours confirms patency of the gastrointestinal tract.

Question 25: 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?

A legally designated surrogate decision-maker or healthcare proxy (Correct answer)
The attending physician
The RPN caring for the client
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 26: An RPN is positioning a client who is immobile to prevent the development of pressure injuries. To effectively relieve pressure on the sacrum and coccyx, which position is most recommended?

Prone position
High-Fowler's position
30-degree lateral (side-lying) position (Correct answer)
Supine position with a pillow under the knees

Correct answer: 30-degree lateral (side-lying) position

The 30-degree lateral position is recommended in clinical practice guidelines for preventing pressure injuries. This position shifts the client's weight onto the gluteal muscles, which effectively offloads pressure from the bony prominences of the sacrum, coccyx, and greater trochanter (hip bone).

Question 27: A nurse notes a patient's peripheral IV site is cool, pale, and swollen. This assessment finding is consistent with:

Infiltration (Correct answer)
Infection
Phlebitis
Air embolism

Correct answer: Infiltration

Infiltration occurs when IV fluid leaks into surrounding tissue, causing coolness, pallor, and swelling at the site.

Question 28: An RPN is preparing to administer insulin, a high-alert medication. Which of the following actions is the MOST critical safety measure the nurse should take?

Document the injection site in the medication administration record (MAR) immediately after giving the insulin.
Administer the insulin within a 30-minute window of the scheduled time.
Ask the client to state their name and date of birth before administration.
Have another qualified nurse independently double-check the dose and medication. (Correct answer)

Correct answer: Have another qualified nurse independently double-check the dose and medication.

High-alert medications, such as insulin, have a heightened risk of causing significant patient harm when used in error. The Institute for Safe Medication Practices (ISMP) Canada recommends implementing redundant safety checks. An independent double-check by a second qualified professional is a critical strategy to intercept potential errors in dose calculation or medication selection before administration. While the other options are correct nursing procedures, the independent double-check provides the most robust safety guard for this class of medication.

Question 29: A patient returns from surgery with a Jackson-Pratt (JP) drain. The nurse notes the bulb is fully expanded. What action should be taken?

Clamp the drain tubing and continue monitoring
Remove the drain as it is no longer functioning
Empty the drain and recompress the bulb to restore suction (Correct answer)
Notify the surgeon immediately

Correct answer: Empty the drain and recompress the bulb to restore suction

A fully expanded JP drain bulb has lost suction; it must be emptied, measured, the output recorded, and the bulb recompressed to restore negative pressure drainage.

Question 30: A nurse is preparing to administer a medication via metered-dose inhaler (MDI) with a spacer. What is the correct sequence?

Actuate, exhale, then inhale rapidly without holding
Shake, exhale fully, actuate then inhale slowly, hold 10 seconds (Correct answer)
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 31: 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?

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

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 32: A patient with end-stage renal disease on hemodialysis reports feeling itchy all over. This is most likely caused by:

An allergic reaction to the dialysis membrane
Dehydration from excessive fluid removal during dialysis
Low hemoglobin causing skin changes
Accumulation of phosphorus and uremic toxins (Correct answer)

Correct answer: Accumulation of phosphorus and uremic toxins

Uremic pruritus is caused by buildup of phosphorus and uremic toxins in patients with inadequate renal clearance.

Question 33: A nurse is assessing a newborn and notes that the anterior fontanelle is bulging and tense. This finding is associated with:

Increased intracranial pressure (Correct answer)
Dehydration
Normal crying response
Caput succedaneum

Correct answer: Increased intracranial pressure

A bulging, tense anterior fontanelle is a sign of increased intracranial pressure and requires immediate evaluation.

Question 34: 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?

Politely declining the gift and explaining the policy on accepting gifts. (Correct answer)
Accepting the gift but sharing it with the entire nursing team.
Suggesting the client make a donation to the facility's foundation instead.
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 35: A nurse is caring for a trauma patient who develops Beck's triad (hypotension, muffled heart sounds, and jugular venous distension). The nurse should suspect:

Pulmonary embolism
Tension pneumothorax
Aortic dissection
Cardiac tamponade (Correct answer)

Correct answer: Cardiac tamponade

Beck's triad is the classic presentation of cardiac tamponade caused by fluid accumulation in the pericardial sac compressing the heart.

Question 36: 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?

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

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 37: In what way is the head of a patient who may have had a spinal injury supposed to be positioned?

Maintain your head inclined back.
Turn your head to one side.
Maintain a neutral head posture. (Correct answer)
Incline your head forward

Correct answer: Maintain a neutral head posture.

To reduce spine movement in cases of suspected spinal injury, the head should be kept in a neutral position.

Question 38: Which abbreviation is on The Joint Commission's 'Do Not Use' list due to potential for misinterpretation?

U (for units) (Correct answer)
PRN
NPO
BID

Correct answer: U (for units)

The abbreviation 'U' for units is on The Joint Commission's Do Not Use list because it can be mistaken for '0' (zero), potentially causing a 10-fold dosing error.

Question 39: Which of the following BEST describes the RPN's responsibility when a physician's order appears potentially harmful to a patient?

Refuse the order without communicating with the physician
Implement the order because the physician is legally responsible
Ask a coworker to administer the medication instead
Clarify the order with the physician and document the concern before proceeding (Correct answer)

Correct answer: Clarify the order with the physician and document the concern before proceeding

RPNs have a professional and legal duty to question orders that appear unsafe and must clarify before implementation.

Question 40: Which dietary modification is most important for a patient with chronic heart failure to prevent fluid retention?

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

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 41: A patient is on contact precautions. A nurse enters the room to perform wound care. In what order should PPE be donned?

Gloves, gown, mask, goggles
Mask, goggles, gown, gloves
Gown, mask, goggles, gloves (Correct answer)
Gown, gloves, mask, goggles

Correct answer: Gown, mask, goggles, gloves

CDC guidelines specify donning PPE in the order: gown first, then mask/respirator, then goggles/face shield, then gloves — ensuring each layer protects the next.

Question 42: 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 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)
The goal should be broad to allow for flexibility in care.

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

None of the following
Thymosin (Correct answer)
Nemoacid
Oxytocin

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

To stop the patient from biting their tongue, put something in their mouth.
Remove anything close to you to avoid getting hurt. (Correct answer)
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 45: A patient taking phenytoin asks if they can take an antacid at the same time as their morning dose. How should the nurse respond?

No, antacids are contraindicated in all seizure disorders
Yes, antacids enhance phenytoin absorption
Yes, taking them together is safe and may protect the stomach
No, antacids can decrease phenytoin absorption and should be separated by at least 2 hours (Correct answer)

Correct answer: No, antacids can decrease phenytoin absorption and should be separated by at least 2 hours

Antacids can bind to phenytoin in the GI tract and reduce its absorption, so they should be separated by at least 2 hours to ensure therapeutic drug levels.

Question 46: A patient with a known peanut allergy receives a medication and develops wheezing and urticaria. The nurse administers epinephrine. After 5 minutes, symptoms persist. The nurse should:

Administer IV hydrocortisone as the next treatment
Switch to oral diphenhydramine
Administer a second dose of epinephrine (Correct answer)
Wait 15 more minutes before considering a second dose

Correct answer: Administer a second dose of epinephrine

If anaphylaxis symptoms persist after the first dose of epinephrine, a second dose may be administered 5–15 minutes after the first.

Question 47: Under mandatory reporting laws, an RPN is required to report suspected child abuse to:

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

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 48: The nurse's use of 'self-disclosure' in a therapeutic context is BEST described as:

Revealing feelings of frustration when a client is non-compliant
Discussing personal life events to make the client feel comfortable
Avoiding any mention of the nurse's personal life under all circumstances
Sharing brief, purposeful personal information only when it benefits the client (Correct answer)

Correct answer: Sharing brief, purposeful personal information only when it benefits the client

Therapeutic self-disclosure is selective and intentional, used to normalize or illustrate a point that advances client goals.

Question 49: Gonads: What are they?

Thyroid Glands
Hormones
Testis and Ovaries (Correct answer)
Adrenal glands

Correct answer: Testis and Ovaries

The reproductive organs known as gonads generate hormones and gametes, or sex cells. The main gonads in males and females are the testes and ovaries, respectively. Ovaries produce eggs and the hormones progesterone and estrogen, whereas testicles create sperm and the hormone testosterone. The development of secondary sexual traits and the control of the reproductive system are brought about by these hormones. While they do not function as gonads, adrenal glands do secrete certain sex hormones. Reproduction is not directly impacted by thyroid glands.

Question 50: Which action by the nurse best reduces shear forces on a bedridden patient?

Turning the patient every 4 hours
Applying a thin film dressing to bony prominences
Keeping the bed linen tightly tucked under the mattress
Elevating the head of the bed no higher than 30 degrees (Correct answer)

Correct answer: Elevating the head of the bed no higher than 30 degrees

Limiting head-of-bed elevation to 30 degrees or less prevents the patient from sliding down and creating shear forces against the sacrum.

Question 51: A client is admitted with suspected deep vein thrombosis (DVT). Which assessment finding is MOST consistent with this diagnosis?

Absence of dorsalis pedis pulse
Unilateral calf pain, warmth, and redness (Correct answer)
Cool, pale skin in the affected extremity
Bilateral leg edema that is painless

Correct answer: Unilateral calf pain, warmth, and redness

Unilateral calf pain, warmth, and erythema are classic signs of DVT caused by clot formation and inflammation.

Question 52: An RPN notices personal feelings of irritation toward a demanding client. The MOST appropriate action is to:

Limit interactions with the client to avoid expressing irritation
Tell the client that their behavior is difficult to manage
Reflect on the feelings and discuss them with a supervisor or in clinical supervision (Correct answer)
Request an immediate reassignment to another client

Correct answer: Reflect on the feelings and discuss them with a supervisor or in clinical supervision

Countertransference must be acknowledged and processed through supervision to prevent it from affecting client care.

Question 53: A client taking haloperidol (Haldol) develops muscle rigidity, hyperthermia, and altered consciousness. The nurse suspects:

Akathisia
Extrapyramidal side effect (EPS)
Tardive dyskinesia
Neuroleptic malignant syndrome (NMS) (Correct answer)

Correct answer: Neuroleptic malignant syndrome (NMS)

Neuroleptic malignant syndrome is a rare but life-threatening reaction to antipsychotics, characterized by the classic tetrad of hyperthermia, muscle rigidity, altered consciousness, and autonomic instability.

Question 54: A patient is in the ED after an industrial chemical splash to both eyes. The nurse's IMMEDIATE intervention is:

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

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 55: A patient using a walker is descending stairs. Which instruction is correct?

Walkers are not safe for stair use; use crutches instead (Correct answer)
Lead with the stronger leg, then the walker, then the weaker leg
Lead with the walker, then the weaker leg, then the stronger leg
Walkers cannot be used on stairs under any circumstance

Correct answer: Walkers are not safe for stair use; use crutches instead

Standard walkers are not designed for stair use; patients requiring stairs need crutches or a stair-capable assistive device.

Question 56: A patient refuses a prescribed medication. What is the appropriate RPN response?

Crush the medication and place it in food without telling the patient
Administer anyway because it was ordered
Discharge the patient for non-compliance
Document the refusal and notify the prescriber (Correct answer)

Correct answer: Document the refusal and notify the prescriber

Patients have the right to refuse treatment; the nurse must document the refusal and inform the prescriber so the care plan can be adjusted.

Question 57: A patient is being transferred to another unit. Which handoff report format is most widely recommended to ensure safe care transitions?

SBAR (Situation, Background, Assessment, Recommendation) (Correct answer)
Verbal report only, given at the bedside
A phone call to the receiving unit after the patient arrives
A written summary left at the nurses' station

Correct answer: SBAR (Situation, Background, Assessment, Recommendation)

SBAR is the standardized, evidence-based communication format recommended for handoff reports to reduce miscommunication and improve patient safety.

Question 58: What is the primary purpose of a state Board of Nursing?

To advocate for RPN salary increases
To represent nurses in malpractice disputes
To provide continuing education for nurses
To protect the public by regulating nursing practice (Correct answer)

Correct answer: To protect the public by regulating nursing practice

Boards of Nursing exist to protect public health and safety by setting standards for licensure and regulating nursing practice.

Question 59: The therapeutic technique of 'confrontation' is MOST appropriately used to:

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

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

Apply stockings only to the affected leg in DVT patients
Apply stockings after the patient has been ambulating for 30 minutes
Apply stockings over skin lotion to reduce friction
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 61: A patient with Parkinson's disease has difficulty swallowing. Which nursing intervention best reduces aspiration risk?

Offer thin liquids frequently throughout the day
Encourage rapid eating to reduce fatigue
Offer thickened liquids and small bite-sized foods (Correct answer)
Position the patient supine during meals

Correct answer: Offer thickened liquids and small bite-sized foods

Thickened liquids and small bites slow swallowing and reduce the risk of aspiration in patients with dysphagia.

Question 62: A terminally ill client requests information about medical aid in dying. The RPN's best initial response is to:

Provide factual information about options available within state law and notify the care team (Correct answer)
Advise the client against pursuing this option
Immediately contact the ethics committee
Refuse to discuss the topic as it conflicts with nursing values

Correct answer: Provide factual information about options available within state law and notify the care team

RPNs are obligated to provide factual, non-judgmental information about legal options and communicate client wishes to the interdisciplinary team.

Question 63: A patient with a documented penicillin allergy is prescribed amoxicillin. What is the nurse's priority action?

Ask the patient if they have had amoxicillin before
Administer the drug since it is a prescribed order
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 64: A patient with epilepsy is prescribed phenytoin. Which instruction about this medication is most important?

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

Correct answer: Never stop phenytoin abruptly without physician guidance

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

Question 65: A patient's medical record is subpoenaed for a legal case. The nurse should:

Refuse to release any records under any circumstances
Delete electronic entries that seem unfavorable
Submit the record as-is without alteration and notify the facility's legal counsel (Correct answer)
Alter the record to reflect better care before submitting it

Correct answer: Submit the record as-is without alteration and notify the facility's legal counsel

Records must never be altered when subject to legal proceedings; the nurse should follow facility policy and notify legal counsel.

Question 66: A client with diabetes has a blood glucose of 52 mg/dL and is alert and oriented. The RPN should FIRST:

Administer IV dextrose immediately
Give 15 grams of fast-acting carbohydrate by mouth (Correct answer)
Recheck blood glucose in one hour
Notify the physician before taking action

Correct answer: Give 15 grams of fast-acting carbohydrate by mouth

For a conscious hypoglycemic client, the 15-15 rule applies: give 15g of fast-acting carbohydrate and recheck in 15 minutes.

Question 67: 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
Ignore it unless there is direct patient harm
Confront the colleague privately and warn them to stop

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 68: Which assessment technique is used to detect fluid in the lungs (consolidation)?

Inspection
Auscultation (Correct answer)
Palpation
Percussion

Correct answer: Auscultation

Auscultation of lung sounds detects crackles and decreased breath sounds associated with fluid consolidation.

Question 69: 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 the left (weaker) hand
In whichever hand the patient prefers
In the right (stronger) hand (Correct answer)

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 70: An RPN discovers a medication error made by a colleague that did not harm the client. The appropriate action is to:

Complete an incident report and notify the supervisor per facility policy (Correct answer)
Only report it if the client asks what happened
Say nothing since no harm occurred
Quietly correct the documentation without reporting

Correct answer: Complete an incident report and notify the supervisor per facility policy

All medication errors must be reported through proper channels regardless of outcome, to support quality improvement and transparency.

Question 71: A nurse is preparing to ambulate a patient for the first time after three days of bed rest. Which action should the nurse take FIRST?

Obtain a gait belt and place it around the patient's waist
Check the patient's last documented blood pressure and pulse
Apply non-skid footwear before getting the patient out of bed
Have the patient sit upright at the bedside for several minutes before standing (Correct answer)

Correct answer: Have the patient sit upright at the bedside for several minutes before standing

Dangling at the bedside allows the cardiovascular system to adjust before the patient stands, preventing orthostatic hypotension and falls.

Question 72: A patient with Type 1 diabetes is found unresponsive with a blood glucose of 38 mg/dL. What is the nurse's first action?

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

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 73: 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)
"If my discharge becomes pinkish-brown, I should call the clinic immediately."
"I should expect a heavy, bright red flow for at least the first week."
"I won't have any more discharge after today."

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 74: Which component of the SBAR communication tool prompts the nurse to state what they think is the problem?

Background
Assessment (Correct answer)
Recommendation
Situation

Correct answer: Assessment

The 'Assessment' component of SBAR is where the nurse provides their clinical judgment about what is happening with the patient.

Question 75: An RPN is assessing a client's peripheral pulses. A pulse graded as 1+ indicates:

Bounding pulse
Normal pulse
Absent pulse
Weak, thready pulse (Correct answer)

Correct answer: Weak, thready pulse

A 1+ pulse is weak and thready, suggesting diminished cardiac output or peripheral vascular disease.

Question 76: A patient with a suspected pulmonary embolism has sudden onset of pleuritic chest pain, dyspnea, and tachycardia. The MOST definitive diagnostic test the nurse should prepare the patient for is:

Chest X-ray
D-dimer blood test
CT pulmonary angiography (CTPA) (Correct answer)
12-lead ECG

Correct answer: CT pulmonary angiography (CTPA)

CT pulmonary angiography is the gold standard for diagnosing pulmonary embolism, directly visualizing clots in the pulmonary vasculature.

Question 77: An RPN restrains a patient without a physician's order or the patient's consent. This may constitute:

Appropriate emergency intervention with post-hoc documentation
A protected action under the emergency exception clause
False imprisonment and battery (Correct answer)
Acceptable restraint use under nursing judgment

Correct answer: False imprisonment and battery

Restraining a patient without proper authority constitutes false imprisonment, and any unwanted physical contact may constitute battery.

Question 78: When caring for a minor patient, consent for routine treatment is typically obtained from:

The minor patient only if over age 14
A parent or legal guardian (Correct answer)
The attending physician on the minor's behalf
The hospital's patient advocate

Correct answer: A parent or legal guardian

For minors, informed consent for routine treatment must be obtained from a parent or legal guardian, with exceptions for emancipated minors or emergencies.

Question 79: A nurse is preparing to administer erythromycin ophthalmic ointment to a newborn. Which statement best describes its purpose?

To lubricate the eyes damaged by amniotic fluid exposure
To treat congenital cataracts identified at birth
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 80: Which of the following represents a correctly formulated nursing diagnosis?

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

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 81: Which statement best describes the concept of 'scope of practice' for an RPN?

Standards set individually by each hospital for their RPN staff
The specific activities an RPN is educated, competent, and legally authorized to perform (Correct answer)
The range of tasks any nursing staff member can legally perform
The maximum number of clients an RPN can care for at one time

Correct answer: The specific activities an RPN is educated, competent, and legally authorized to perform

Scope of practice defines the legally authorized boundaries of RPN practice based on education, competency, and state licensure.

Question 82: An RPN is asked to witness a client signing an informed consent form but realizes the client did not receive information about the procedure's risks. The RPN should:

Witness the form since obtaining informed consent is the physician's responsibility
Delay signing until the next shift
Refuse to witness and notify the provider that the client needs additional information (Correct answer)
Provide the risk information to the client before witnessing

Correct answer: Refuse to witness and notify the provider that the client needs additional information

The RPN must advocate for the client's right to truly informed consent by notifying the responsible provider rather than witnessing a potentially invalid consent.

Question 83: Which defense mechanism is a client using when they say, 'My coworker is the one who is always angry, not me'?

Projection (Correct answer)
Displacement
Reaction formation
Rationalization

Correct answer: Projection

Projection involves attributing one's own unacceptable thoughts, feelings, or impulses onto another person.

Question 84: A nurse is using the DAR charting format. What does the 'R' in DAR stand for?

Record
Response (Correct answer)
Reporting
Reassessment

Correct answer: Response

In DAR (Data, Action, Response) charting, 'R' stands for Response, which documents how the patient responded to the nursing intervention.

Question 85: 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?

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

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 86: Which action by an RPN constitutes professional misconduct under nursing practice legislation?

Reporting a colleague's unsafe practice to a supervisor
Performing a skill outside the approved scope without delegation (Correct answer)
Documenting patient refusal of care
Asking a physician to clarify an ambiguous order

Correct answer: Performing a skill outside the approved scope without delegation

Performing tasks outside the legislated or employer-approved scope without proper delegation constitutes professional misconduct.

Question 87: A patient with chronic pain is started on a scheduled opioid regimen. Which bowel intervention should the nurse initiate proactively?

Encourage reduced fluid intake to minimize bathroom trips
Start a stimulant laxative regimen prophylactically (Correct answer)
Administer an enema every other day
Recommend a high-fat diet to coat the bowel

Correct answer: Start a stimulant laxative regimen prophylactically

Opioids cause constipation by slowing GI motility; a stimulant laxative should be started preventively when opioid therapy begins.

Question 88: A client is newly prescribed phenelzine (Nardil), an MAOI. Which dietary teaching is most important?

Avoid grapefruit juice due to cytochrome P450 interactions
Increase calcium intake to prevent bone density loss
Avoid tyramine-rich foods such as aged cheese and cured meats (Correct answer)
Limit fluid intake to prevent lithium toxicity

Correct answer: Avoid tyramine-rich foods such as aged cheese and cured meats

MAOIs inhibit the breakdown of tyramine; consuming tyramine-rich foods can cause a hypertensive crisis, which is potentially life-threatening.

Question 89: A client asks the RPN, 'Am I the sickest patient you've had?' The BEST therapeutic response is:

"I'm not allowed to discuss other patients."
"No, I've had much sicker patients than you."
"Yes, your situation is quite serious."
"I'm wondering what makes you ask that question." (Correct answer)

Correct answer: "I'm wondering what makes you ask that question."

Exploring the meaning behind the question is more therapeutically useful than answering at face value.

Question 90: A nurse is teaching a patient with osteoporosis about fall prevention. Which instruction is most important?

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

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

30 minutes before meals
With meals to reduce GI upset (Correct answer)
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 92: A nurse assesses a burn patient and determines the burns cover the entire anterior trunk and both anterior arms. Using the Rule of Nines, what is the total body surface area (TBSA) burned?

36%
45%
27% (Correct answer)
18%

Correct answer: 27%

Anterior trunk = 18%, anterior surface of each arm = 4.5% each (9% total), giving 18% + 9% = 27% TBSA.

Question 93: Which isolation precaution category is used for tuberculosis (TB)?

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

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

At the beginning and end of the shift.
Only after removing gloves.
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 95: A client is receiving oxytocin (Pitocin) augmentation. The nurse notes uterine contractions every 2 minutes lasting 95 seconds. What is the priority action?

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

Correct answer: Discontinue the oxytocin infusion

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

Question 96: 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?

Only document the fall in the incident report to prevent legal discovery of the event.
Document a factual account of the fall, the client's response, and the interventions performed, without mentioning the incident report. (Correct answer)
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 97: Which is the safest method to confirm a patient's identity before medication administration?

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

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

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

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 99: Which catheter size (French) is most appropriate for a routine urinary catheterization of an adult female?

8 Fr
14–16 Fr (Correct answer)
20–22 Fr
24 Fr

Correct answer: 14–16 Fr

A 14–16 Fr catheter is standard for routine adult female urinary catheterization, balancing drainage and patient comfort.

Question 100: An RPN is assigned more clients than can be safely managed. What is the professional obligation?

Delegate all tasks to unlicensed assistive personnel
Refuse the assignment and leave the unit immediately
Accept the assignment without question and do the best possible
Communicate the concern to the supervisor and document the unsafe staffing (Correct answer)

Correct answer: Communicate the concern to the supervisor and document the unsafe staffing

RPNs must advocate for safe staffing by communicating concerns through proper channels while maintaining care until relief is arranged.

Question 101: A client becomes tearful and says, 'Nobody cares if I live or die.' Which response by the RPN best demonstrates therapeutic communication?

"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."
"I care about you, and I'm sure your friends do too."
"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 102: A nurse forgets to sign an entry in the paper medical record. The appropriate action is to:

Rewrite the entire entry on a new line with a signature
Leave it unsigned since the handwriting is recognizable
Ask a supervisor to sign on the nurse's behalf
Return to the entry, add a late signature with the date and time of signing (Correct answer)

Correct answer: Return to the entry, add a late signature with the date and time of signing

An unsigned entry can be corrected by returning to the note, adding a signature, and documenting the date and time the signature was added.

Question 103: A client confides thoughts of self-harm to an RPN and asks the RPN not to tell anyone. The RPN's obligation is to:

Keep the confidence as promised to maintain trust
Document it but take no further action
Report the disclosure to the care team to ensure the client's safety (Correct answer)
Consult with a peer before deciding

Correct answer: Report the disclosure to the care team to ensure the client's safety

Safety supersedes confidentiality when there is risk of self-harm; the RPN must report to the interdisciplinary team immediately.

Question 104: A patient presents with epistaxis that has not stopped despite 20 minutes of direct pressure. The nurse anticipates which intervention?

Application of ice to the forehead
Nasal packing with vasoconstrictive agents (Correct answer)
Administration of protamine sulfate
Immediate surgical ligation

Correct answer: Nasal packing with vasoconstrictive agents

Persistent epistaxis unresponsive to direct pressure is treated with anterior nasal packing, often with vasoconstricting agents like oxymetazoline-soaked gauze.

Question 105: Which type of transmission requires the use of a negative-pressure isolation room?

Droplet transmission
Vehicle-borne transmission
Contact transmission
Airborne transmission (Correct answer)

Correct answer: Airborne transmission

Negative-pressure rooms prevent airborne pathogens from escaping into hallways by keeping air flowing inward.

Question 106: Which finding is consistent with late decelerations on a fetal heart rate monitor?

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

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

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

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 108: The RPN's role in supporting self-management for a client with a chronic illness, such as arthritis, primarily involves which of the following activities?

Collaborating with the client to set realistic goals and provide health teaching. (Correct answer)
Performing all complex care tasks to prevent client error.
Making all health-related decisions on behalf of the client.
Developing a strict daily schedule for the client to follow without deviation.

Correct answer: Collaborating with the client to set realistic goals and provide health teaching.

Self-management support empowers the client to take an active role in their health. The nurse's role is to act as a partner, collaborating with the client to set achievable goals, providing education on their condition, and helping them develop problem-solving skills to manage their illness effectively.

Question 109: 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?

"This means you will be transferred to a hospice facility for end-of-life care."
"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."
"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 110: 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?

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

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 111: 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 112: An RPN receives a telephone order from a physician for a new medication. To ensure safe medication administration, which action is essential for the RPN to take?

Read back the complete order to the prescriber for verification. (Correct answer)
Ask a colleague to listen to the order with them.
Administer the medication immediately as per the verbal order.
Wait for the physician to enter the order into the computer system before administering.

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

To prevent errors from miscommunication, safety standards require the nurse to read back the complete order to the prescriber. This includes the client's name, medication name, dose, route, and frequency. The prescriber must then confirm that the read-back order is correct. This closed-loop communication is a critical safety check for verbal or telephone orders.

Question 113: The ethical principle of 'justice' in nursing practice primarily refers to:

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

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 114: How should an automated external defibrillator (AED) be used correctly?

Make sure the patient is not touched while receiving shock therapy. (Correct answer)
Continue giving shocks until assistance arrives.
Place the pads on top of your clothes.
While examining the heart rhythm, cease CPR.

Correct answer: Make sure the patient is not touched while receiving shock therapy.

To avoid harm, it is crucial to make sure the patient is not touched while receiving shocks.

Question 115: Which characteristic distinguishes a healthcare-associated infection (HAI) from a community-acquired infection?

Community-acquired infections are always more severe
HAIs are always caused by antibiotic-resistant organisms
HAIs occur during or result from healthcare delivery in a facility (Correct answer)
HAIs can only occur in intensive care units

Correct answer: HAIs occur during or result from healthcare delivery in a facility

By definition, an HAI develops during the process of receiving health care and was not present or incubating at the time of admission.

Question 116: A nurse must administer 250 mg of a medication available as 125 mg/5 mL. How many mL should be administered?

2.5 mL
5 mL
10 mL (Correct answer)
15 mL

Correct answer: 10 mL

Using the formula: (desired dose ÷ available dose) × volume = (250 ÷ 125) × 5 = 10 mL.

Question 117: An RPN notices a colleague making derogatory comments about a client's weight. The most appropriate action is to:

Immediately file a formal complaint with the state board
Laugh along to maintain collegial relations
Address the behavior with the colleague and report it if it continues (Correct answer)
Ignore it since it does not directly affect client care

Correct answer: Address the behavior with the colleague and report it if it continues

Professional standards require addressing unprofessional conduct, first directly when safe, and escalating through reporting channels if the behavior continues.

Question 118: Which statement about the administration of enteric-coated tablets is correct?

They should be taken with antacids to enhance absorption
They may be crushed if the patient has difficulty swallowing
They must be swallowed whole to protect the stomach lining (Correct answer)
They can be opened and dissolved in water for NG tube administration

Correct answer: They must be swallowed whole to protect the stomach lining

Enteric-coated tablets must not be crushed or chewed because the coating protects the stomach or ensures the drug releases in the intestine.

Question 119: 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
Accept it and report it to management
Accept it graciously to avoid offending the family
Politely decline and explain professional boundaries around gifts (Correct answer)

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 120: 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)
Vastus lateralis in the thigh
Dorsogluteal site
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 121: A nurse uses a reusable blood pressure cuff on a patient with VRE (vancomycin-resistant Enterococcus). What is required?

The cuff can be reused on the next patient immediately
Sterilize the cuff in an autoclave after use
Dedicate the cuff to that patient only and disinfect before reassignment (Correct answer)
Soak the cuff in bleach for 30 minutes

Correct answer: Dedicate the cuff to that patient only and disinfect before reassignment

Equipment used on a patient with VRE should be dedicated to that patient and properly disinfected before use on another patient to prevent cross-transmission.

Question 122: A nurse administers a PRN medication but forgets to document it immediately. The nurse should:

Ask a colleague to document it for them
Wait until the end of the shift to document all PRN medications at once
Not document it since the time has passed
Document it as soon as possible, noting the actual time of administration (Correct answer)

Correct answer: Document it as soon as possible, noting the actual time of administration

Late entries are acceptable; the nurse must document the actual time of administration and note it as a late entry.

Question 123: When using the Z-track technique for IM injection, what is the primary purpose?

Reduce pain at the injection site
Increase the rate of drug absorption
Avoid hitting a nerve during injection
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 124: Which of the following is an example of the therapeutic technique 'offering general leads'?

"Go on" or "Tell me more." (Correct answer)
"Why did you make that decision?"
"Let me explain what I think is best for you."
"You seem angry about what happened."

Correct answer: "Go on" or "Tell me more."

General leads use brief prompts to encourage the client to continue without directing or interrupting their train of thought.

Question 125: An RPN notices a significant and unexpected change in a client's condition, whose care is generally considered stable and predictable. The RPN's assessment suggests the client's needs now exceed the typical RPN scope of practice. What is the RPN's most critical legal and professional responsibility in this scenario?

Continue providing care to the best of their ability until the end of the shift.
Document the changes and wait for the next scheduled physician rounds.
Immediately communicate the findings to the appropriate Registered Nurse (RN) or physician for reassessment and collaboration. (Correct answer)
Independently initiate complex new interventions to stabilize the client.

Correct answer: Immediately communicate the findings to the appropriate Registered Nurse (RN) or physician for reassessment and collaboration.

The scope of practice for an RPN typically involves caring for clients with more stable and predictable outcomes. When a client's condition becomes unstable or complex, exceeding the RPN's scope or individual competence, the nurse has a professional and legal duty to collaborate and communicate with other healthcare team members, such as an RN or physician, who can manage more complex care needs. This ensures client safety and appropriate care delivery.

Question 126: 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?

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

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 127: Which finding during abdominal assessment requires IMMEDIATE reporting?

Mild bloating after meals
Bowel sounds every 10 seconds
Soft, non-tender abdomen
Rigid, board-like abdomen (Correct answer)

Correct answer: Rigid, board-like abdomen

A rigid, board-like abdomen may indicate peritonitis or internal bleeding and requires immediate physician notification.

Question 128: Which assessment tool is MOST appropriate for screening an older adult for cognitive impairment?

Beck Depression Inventory
Braden Scale
Glasgow Coma Scale
Mini-Mental State Examination (MMSE) (Correct answer)

Correct answer: Mini-Mental State Examination (MMSE)

The MMSE is a validated tool for screening cognitive function in older adults, assessing orientation, memory, and language.

Question 129: When performing range-of-motion exercises for a patient with a painful joint, which principle applies?

Exercise through pain to prevent contracture formation
Perform ROM only when the patient is anesthetized
Move the joint rapidly to reduce discomfort duration
Stop at the point of resistance or patient-reported pain (Correct answer)

Correct answer: Stop at the point of resistance or patient-reported pain

ROM exercises should stop at the point of resistance or reported pain to avoid joint injury, muscle damage, or increased inflammation.

Question 130: 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?

Recheck in 1 hour as this is a normal value
Initiate an IV dextrose infusion immediately
Notify the provider and obtain a full metabolic panel
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 131: A nurse must perform a sterile dressing change. Which action breaks sterile technique?

Opening sterile supplies before donning sterile gloves
Keeping sterile field above waist level
Reaching across the sterile field to retrieve supplies (Correct answer)
Placing sterile items at the center of the sterile field

Correct answer: Reaching across the sterile field to retrieve supplies

Reaching across a sterile field introduces contaminants from non-sterile clothing and arms, breaking sterile technique.

Question 132: A culturally diverse client avoids direct eye contact during conversation. The RPN should:

Encourage the client to make eye contact to improve communication
Consult psychiatry about possible dissociative symptoms
Recognize this as potentially culturally appropriate and adapt accordingly (Correct answer)
Document the behavior as a sign of depression

Correct answer: Recognize this as potentially culturally appropriate and adapt accordingly

Eye contact norms vary by culture; imposing Western communication standards can undermine trust and misrepresent behavior.

Question 133: A nurse is educating a patient with Type 2 diabetes about foot care. Which instruction is highest priority?

Wear open-toed shoes to reduce pressure
Inspect feet daily using a mirror if needed (Correct answer)
Soak feet in hot water for 20 minutes daily
Apply lotion between the toes to prevent dryness

Correct answer: Inspect feet daily using a mirror if needed

Daily foot inspection allows early detection of injuries that can lead to serious complications due to diabetic neuropathy.

Question 134: The concept of 'unconditional positive regard' in the therapeutic relationship means the nurse:

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

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.

Question 135: Which technique should the RPN use when assessing bowel sounds?

Palpate deeply first to assess organ position
Inspect only if the client reports abdominal pain
Percuss before auscultating to stimulate sounds
Auscultate before palpating to avoid altering bowel activity (Correct answer)

Correct answer: Auscultate before palpating to avoid altering bowel activity

Auscultation precedes palpation and percussion in abdominal assessment to prevent artificially altering bowel sounds.

Question 136: 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?

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

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

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 138: Which action is part of the ventilator-associated pneumonia (VAP) prevention bundle?

Positioning the patient supine at 0 degrees
Elevating the head of the bed to 30–45 degrees (Correct answer)
Changing the ventilator circuit daily
Suctioning the airway every hour

Correct answer: Elevating the head of the bed to 30–45 degrees

Elevating the head of the bed 30–45 degrees reduces aspiration of oropharyngeal secretions, a key mechanism in VAP development.

Question 139: An RPN is asked to perform a task that falls outside their competency. The correct response is to:

Decline the task and communicate the competency limitation to the supervisor (Correct answer)
Perform the task since the RPN license permits it
Ask a colleague to supervise while performing the unfamiliar task
Attempt the task and ask for help only if something goes wrong

Correct answer: Decline the task and communicate the competency limitation to the supervisor

RPNs are accountable for practicing only within their competency and must communicate limitations to ensure client safety.

Question 140: 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 information is relevant to workplace safety
Only when the patient provides written authorization (Correct answer)
When the employer requests it in writing

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 141: Which neurotransmitter deficiency is most closely associated with major depressive disorder?

Dopamine excess
Serotonin deficiency (Correct answer)
GABA excess
Acetylcholine deficiency

Correct answer: Serotonin deficiency

Depression is most strongly associated with deficiencies in serotonin (and norepinephrine), which is the basis for SSRI and SNRI pharmacotherapy.

Question 142: A nurse notes a colleague did not perform hand hygiene before entering a patient's room. The best action is to:

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

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 143: A patient discloses during an assessment that they plan to seriously harm a specific person. Under the duty-to-warn principle, the RPN must:

Document the statement and do nothing further until the physician reviews it
Maintain confidentiality because patient disclosure is protected
Discharge the patient immediately to remove the threat
Notify the potential victim and appropriate authorities after informing the healthcare team (Correct answer)

Correct answer: Notify the potential victim and appropriate authorities after informing the healthcare team

The duty to warn (Tarasoff principle) requires healthcare providers to take steps to protect identifiable third parties from credible threats of serious harm.

Question 144: An RPN is reinforcing teaching with an older adult client who has osteoarthritis and reports chronic knee pain. Which non-pharmacological pain management strategy is most appropriate for the RPN to suggest?

Maintaining complete bed rest for several days.
Starting a high-impact aerobic exercise program.
Applying a warm compress to the affected knee. (Correct answer)
Vigorously massaging the joint to increase circulation.

Correct answer: Applying a warm compress to the affected knee.

Applying superficial heat, such as a warm compress or heating pad, can help relax muscles and soothe stiff, painful joints associated with osteoarthritis. Complete bed rest can worsen stiffness, high-impact exercise can damage the joint, and vigorous massage over an inflamed joint is contraindicated. Low-impact exercise is recommended, but heat application is a direct comfort measure.

Question 145: A client with dementia becomes increasingly confused and agitated after sundown each evening. The nurse documents this as:

Sundowner's syndrome (sundowning) (Correct answer)
Confusional psychosis
Nocturnal delirium episode
Circadian rhythm disorder

Correct answer: Sundowner's syndrome (sundowning)

Sundowning is a well-recognized pattern in dementia where confusion, agitation, and behavioral changes worsen in the late afternoon and evening.

Question 146: An RPN is asked by a researcher to share de-identified patient data from charts for a study. The RPN should:

Share the data since it is de-identified and poses no risk
Direct the researcher to the facility's IRB and privacy officer for proper authorization (Correct answer)
Refuse all research data sharing under HIPAA
Obtain verbal consent from each patient before releasing data

Correct answer: Direct the researcher to the facility's IRB and privacy officer for proper authorization

Even de-identified data sharing for research requires proper institutional review board (IRB) approval and privacy officer authorization.

Question 147: 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 1 full-term infant and is currently pregnant for the third time
The client has had 3 deliveries and 1 miscarriage
The client is currently in her third pregnancy and had 1 prior delivery after 20 weeks (Correct answer)
The client has been pregnant 3 times and has 1 living child

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

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

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 149: A patient asks why the nurse washes hands before and after wearing gloves. The best explanation is:

Hand hygiene is required by law only when gloves are worn
Gloves are always sterile and hand hygiene is a formality
Gloves eliminate all risk so washing is done as a courtesy
Gloves may have microperforations and hands can be contaminated during removal (Correct answer)

Correct answer: Gloves may have microperforations and hands can be contaminated during removal

Gloves can have invisible microperforations and hands become contaminated during doffing, so hand hygiene before and after glove use remains essential.

Question 150: A nurse applies wrist restraints to a confused patient. How often must the nurse re-evaluate and document the patient's response to the restraint?

Every 4 hours
Every 30 minutes
Once per shift
Every 2 hours (Correct answer)

Correct answer: Every 2 hours

Joint Commission and most facility policies require reassessment of restrained patients at least every 2 hours, including circulation checks and range-of-motion.

Question 151: A nurse is about to administer a subcutaneous injection. Which skin preparation is correct?

Apply povidone-iodine and wait 2 minutes
Swab the site with alcohol and inject immediately while wet
Clean the site with a dry gauze pad
Swab the site with alcohol and allow it to dry before injecting (Correct answer)

Correct answer: Swab the site with alcohol and allow it to dry before injecting

The alcohol must be allowed to dry completely before injection to ensure its antiseptic action and to prevent stinging.

Question 152: An RPN is caring for a client from a culture with different health beliefs. The ethical approach is to:

Educate the client on why Western medicine is superior
Incorporate the client's cultural beliefs into the care plan after mutual discussion (Correct answer)
Refer the client to a nurse from the same culture
Prioritize evidence-based practices over cultural preferences

Correct answer: Incorporate the client's cultural beliefs into the care plan after mutual discussion

Culturally competent, ethical care integrates the client's beliefs and values while ensuring safe, evidence-based treatment.

Question 153: The nurse is teaching a patient to use crutches with a swing-through gait. Which instruction is correct?

Bear weight through the wrists, not the axillae, when swinging (Correct answer)
Keep the crutch pads firmly pressed into the axillae for support
Advance one crutch, step with the opposite foot, then advance the other crutch
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 154: A nurse assesses a newborn and notes a soft, fluctuant swelling on the scalp that crosses the suture lines. This finding is consistent with:

Subdural hematoma
Caput succedaneum (Correct answer)
Craniosynostosis
Cephalohematoma

Correct answer: Caput succedaneum

Caput succedaneum is edema of the scalp soft tissue that crosses suture lines, unlike cephalohematoma which is confined within one suture.

Question 155: A high-alert medication label on a medication indicates that the nurse should:

Obtain an independent double-check from another nurse before administration (Correct answer)
Administer the medication without additional checks to save time
Document administration only after the full dose is given
Dilute the medication more than usual

Correct answer: Obtain an independent double-check from another nurse before administration

High-alert medications require an independent double-check by a second licensed nurse to reduce the risk of serious patient harm.

Question 156: Which of the following behaviors represents a boundary violation by the RPN?

Using the client's preferred name throughout care
Sitting at the same level as the client during a conversation
Disclosing that the nurse also works the night shift
Accepting an expensive gift from a client after discharge (Correct answer)

Correct answer: Accepting an expensive gift from a client after discharge

Accepting expensive gifts from clients blurs professional limits and compromises the therapeutic relationship.

Question 157: When performing a sterile dressing change, which action would break sterile technique?

Placing sterile supplies on the sterile field
Reaching over the sterile field to retrieve an item (Correct answer)
Opening sterile packages away from the sterile field
Wearing sterile gloves when touching the wound

Correct answer: Reaching over the sterile field to retrieve an item

Reaching over a sterile field contaminates it because non-sterile clothing or ungloved arms pass over sterile items.

Question 158: The Code of Ethics for nurses primarily serves to:

Replace state Nurse Practice Acts as the authority on scope of practice
Provide a framework of moral obligations guiding professional nursing behavior (Correct answer)
Define minimum legal standards for nursing practice
Outline disciplinary procedures for license violations

Correct answer: Provide a framework of moral obligations guiding professional nursing behavior

The Code of Ethics provides a moral framework that guides professional nursing conduct and reflects the values of the profession.

Question 159: Which component is included in a comprehensive Mental Status Examination (MSE)?

Appearance, behavior, mood, affect, thought process, cognition, and insight (Correct answer)
Pain scale rating and functional mobility assessment
Complete blood count and metabolic panel
Past surgical history and current medications

Correct answer: Appearance, behavior, mood, affect, thought process, cognition, and insight

The MSE is a structured psychiatric assessment covering appearance, behavior, speech, mood, affect, thought process and content, perceptions, cognition, insight, and judgment.

Question 160: Which of the following best describes 'charting by exception' (CBE)?

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
Charting after each shift rather than in real time

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 161: Which assessment finding in a patient with chronic obstructive pulmonary disease (COPD) indicates worsening respiratory status?

Mild expiratory wheezing
Respiratory rate of 16 breaths per minute
Use of accessory muscles for breathing (Correct answer)
SpO2 of 93%

Correct answer: Use of accessory muscles for breathing

Use of accessory muscles indicates significant respiratory distress and signals worsening airflow obstruction.

Question 162: Which of the following documentation entries is the best example of objective data?

"Client is complaining of severe pain and appears uncomfortable."
"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."

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 163: 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
Immediately after medications are given for maximum cooperation
At consistent, pre-agreed times to build trust and predictability (Correct answer)

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 164: Which environmental modification is the highest priority to prevent falls in an older adult's hospital room?

Installing grip bars on the walls
Providing a night light in the bathroom
Placing the call bell within easy reach at all times (Correct answer)
Keeping the television remote within reach

Correct answer: Placing the call bell within easy reach at all times

Ensuring the call bell is always within reach is the single highest-priority intervention because it allows the patient to summon help instead of attempting unsafe independent ambulation.

Question 165: A nurse is caring for a client at 38 weeks gestation who reports decreased fetal movement. Which action should the nurse take first?

Instruct the client to perform a kick count
Apply external fetal monitor (Correct answer)
Notify the physician immediately
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 166: The RPN is administering an eye drop to a patient. Which technique is correct?

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

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 167: During shift handoff, the oncoming RPN reviews a client's care plan and notes an outdated nursing diagnosis. The BEST action is to:

Leave it unchanged to maintain consistency
Revise the care plan to reflect the client's current status (Correct answer)
Delete it and add a new one without documentation
Ask the physician to update the diagnosis

Correct answer: Revise the care plan to reflect the client's current status

Care plans must be continuously updated to reflect current assessment findings and evolving client needs.

Question 168: A patient with chronic venous insufficiency develops leg ulcers. Which intervention is the priority in ulcer management?

Elevate the legs below heart level during rest
Massage the affected leg to stimulate circulation
Apply compression bandaging to improve venous return (Correct answer)
Encourage the patient to remain on bed rest until healed

Correct answer: Apply compression bandaging to improve venous return

Compression therapy is the cornerstone of venous ulcer management as it reduces venous hypertension and promotes healing.

Question 169: A client with schizophrenia has been stable on risperidone for two years and now shows involuntary, repetitive facial movements. The nurse recognizes this as:

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

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

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

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 171: Which assessment finding is an expected outcome of effective pain management planning for a post-operative client?

Client requests opioid analgesics every 2 hours
Client rates pain as 2/10 and participates in deep-breathing exercises (Correct answer)
Client avoids all movement to prevent pain
Client is sedated and unresponsive to stimuli

Correct answer: Client rates pain as 2/10 and participates in deep-breathing exercises

Effective pain management results in tolerable pain levels that allow the client to participate in recovery activities such as breathing exercises.

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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