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

Question 1: A patient with a documented penicillin allergy is prescribed amoxicillin. What is the nurse's priority action?

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

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

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

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

Disclosing that the nurse also works the night shift
Using the client's preferred name throughout care
Sitting at the same level as the client during a conversation
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 4: A client taking haloperidol (Haldol) develops muscle rigidity, hyperthermia, and altered consciousness. The nurse suspects:

Extrapyramidal side effect (EPS)
Tardive dyskinesia
Akathisia
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 5: When documenting a patient's refusal of a prescribed treatment, the nurse must include:

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

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 6: Which of the following is the correct way to correct a documentation error in a paper medical record?

Tear out the page and start a new one
Erase the error completely and rewrite the entry
Draw a single line through the error, write 'error,' date, and initial it (Correct answer)
Use correction fluid (White-Out) to cover the mistake

Correct answer: Draw a single line through the error, write 'error,' date, and initial it

The correct method is to draw one line through the error, label it 'error,' and add date and initials to maintain a legible audit trail.

Question 7: An RPN is assessing a newborn 2 hours after birth. Which of the following assessment findings requires immediate notification of the Registered Nurse (RN) or physician?

Presence of nasal flaring and grunting. (Correct answer)
Apical heart rate of 140 beats per minute.
Axillary temperature of 36.8°C.
Respiratory rate of 55 breaths per minute.

Correct answer: Presence of nasal flaring and grunting.

Nasal flaring and grunting are cardinal signs of respiratory distress in a newborn, indicating increased work of breathing. This is an abnormal finding that requires prompt evaluation and intervention. The other options are within normal limits for a term newborn (Normal RR: 30-60 breaths/min; Normal HR: 110-160 bpm; Normal Axillary Temp: 36.5-37.5°C).

Question 8: During a mass casualty incident, a patient is found unresponsive with no spontaneous respirations even after repositioning the airway. Under START triage, this patient is tagged:

Black (expectant/deceased) (Correct answer)
Red (immediate)
Yellow (delayed)
Green (minor)

Correct answer: Black (expectant/deceased)

START triage tags non-breathing patients who remain apneic after airway repositioning as black (expectant/deceased) due to resource limitations.

Question 9: When reconstituting a powdered medication, what should the nurse do immediately after adding diluent?

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

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

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

Question 10: A nurse is teaching a patient with osteoporosis about fall prevention. Which instruction is most important?

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

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

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

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

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

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 13: An RPN is calling a physician to report a client's sudden onset of shortness of breath. Using the SBAR communication tool, which of the following statements represents the 'Assessment' component?

"I believe the client may be experiencing a pulmonary embolism as his oxygen saturation is 88% on room air and he is tachycardic." (Correct answer)
"The client was admitted yesterday with a fractured hip and has no history of respiratory issues."
"This is Nurse Lee calling from Unit 4 about Mr. Chen in room 402B, who is experiencing new-onset dyspnea."
"I request an order for a portable chest x-ray and for you to come assess the client immediately."

Correct answer: "I believe the client may be experiencing a pulmonary embolism as his oxygen saturation is 88% on room air and he is tachycardic."

The 'Assessment' part of SBAR involves the nurse stating their professional conclusion about the situation. Stating "I believe the client may be experiencing a pulmonary embolism" synthesizes the available data (shortness of breath, low oxygen) into a potential clinical problem, which is the core of the assessment step.

Question 14: An RPN in Ontario is asked by a physician to perform a procedure that is within the RPN's scope of practice but one they have not performed in several years. Which of the following is the most appropriate initial action for the RPN to take?

Perform the procedure as ordered, trusting their foundational education.
Refuse to perform the procedure and report the physician for making an inappropriate request.
Inform the physician and their supervisor that they are not currently competent to perform the procedure and request supervision or further training. (Correct answer)
Ask a more experienced RPN colleague to perform the procedure for them.

Correct answer: Inform the physician and their supervisor that they are not currently competent to perform the procedure and request supervision or further training.

According to the College of Nurses of Ontario (CNO), nurses are accountable for practicing within the limits of their individual competence. While a procedure may be within the general scope of practice for an RPN, each nurse must self-assess their own knowledge, skill, and judgment to perform it safely. Informing the relevant parties and seeking assistance is the professionally responsible action that prioritizes client safety.

Question 15: A client asks the RPN, 'Am I the sickest patient you've had?' The BEST therapeutic response is:

"No, I've had much sicker patients than you."
"I'm not allowed to discuss other patients."
"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 16: An RPN notices a colleague making derogatory comments about a client's weight. The most appropriate action is to:

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
Immediately file a formal complaint with the state board

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

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

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

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

Question 18: An RPN is conducting a health history with an older adult client who has recently lost weight. To gather comprehensive data during the assessment phase, which action is most appropriate?

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

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

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

Question 19: A patient presents with a serum potassium of 6.8 mEq/L and peaked T-waves on ECG. The FIRST intervention to protect the heart is to administer:

Sodium polystyrene sulfonate (Kayexalate) PO
Furosemide IV
Calcium gluconate IV (Correct answer)
Regular insulin with dextrose IV

Correct answer: Calcium gluconate IV

Calcium gluconate IV is given first in severe hyperkalemia to stabilize the cardiac membrane and prevent lethal dysrhythmias before other measures lower serum potassium.

Question 20: A postpartum client on day 2 reports calf pain, warmth, and redness in her left leg. Which nursing action takes priority?

Apply warm compresses and elevate the leg
Notify the provider and avoid massaging the leg (Correct answer)
Encourage ambulation to improve circulation
Administer prescribed ibuprofen for discomfort

Correct answer: Notify the provider and avoid massaging the leg

These signs suggest deep vein thrombosis; the nurse must notify the provider and avoid massaging the leg to prevent embolization.

Question 21: When performing a sterile dressing change, which action would break sterile technique?

Reaching over the sterile field to retrieve an item (Correct answer)
Placing sterile supplies on the sterile field
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 22: 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 23: The nurse is performing a capillary blood glucose test. After the lancet puncture, what is the correct action regarding the first drop of blood?

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

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

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

Question 24: A nurse is performing a primary survey on a trauma patient. Using the ABCDE approach, which assessment occurs BEFORE evaluating breathing?

Exposure/environmental control
Disability (neurological status)
Circulation with hemorrhage control
Airway with cervical spine protection (Correct answer)

Correct answer: Airway with cervical spine protection

In the ABCDE trauma primary survey, Airway with simultaneous cervical spine protection is the very first assessment and intervention priority.

Question 25: An RPN is assessing a client who is 12 hours postpartum. The RPN palpates the client's fundus and finds it to be boggy, located two fingerbreadths above the umbilicus, and deviated to the right. What is the RPN's priority action?

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

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

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

Question 26: A client recently diagnosed with heart failure has a new nursing diagnosis of 'Activity intolerance.' Which expected outcome is MOST measurable?

Client will avoid strenuous exercise
Client will understand the importance of rest
Client will feel better during activity
Client will walk 50 feet without dyspnea within 3 days (Correct answer)

Correct answer: Client will walk 50 feet without dyspnea within 3 days

A measurable outcome includes a specific distance, timeframe, and observable criterion such as absence of dyspnea.

Question 27: What ratio of breathing to compression is ideal for adult CPR?

5 compressions to 1 ventilation
30 compressions to 2 ventilations
30 compressions to 1 ventilation (Correct answer)
15 compressions to 2 ventilations

Correct answer: 30 compressions to 1 ventilation

For adult CPR, a compression-to-ventilation ratio of 30 compressions to 2 ventilations is advised.

Question 28: An RPN working a double shift realizes fatigue is impairing clinical judgment. The ethical action is to:

Reduce the pace of care delivery to compensate for fatigue
Delegate all high-risk tasks and continue the shift
Notify the supervisor of the impairment and request relief (Correct answer)
Continue working and increase vigilance

Correct answer: Notify the supervisor of the impairment and request relief

Self-regulation includes recognizing and reporting conditions, including fatigue, that may compromise client safety.

Question 29: A patient with chronic pain rates pain at 8/10 despite scheduled analgesia. Which term describes this pain?

Referred pain
Psychosomatic pain
Breakthrough pain (Correct answer)
Neuropathic pain

Correct answer: Breakthrough pain

Breakthrough pain is pain that exceeds the control provided by a scheduled analgesic regimen and requires additional intervention.

Question 30: A breastfeeding mother reports sore, cracked nipples on day 3 postpartum. What is the most appropriate nursing intervention?

Advise pumping exclusively until healed
Apply antibiotic ointment to the nipples
Evaluate the infant's latch and positioning (Correct answer)
Recommend switching to formula feeding temporarily

Correct answer: Evaluate the infant's latch and positioning

Sore, cracked nipples are most often caused by improper latch, so assessing and correcting positioning is the priority intervention.

Question 31: 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
Recommend a high-fat diet to coat the bowel
Administer an enema every other day
Start a stimulant laxative regimen prophylactically (Correct answer)

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

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

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

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

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

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

Question 34: Which of the following is the therapeutic serum level for lithium carbonate in maintenance therapy?

1.5–2.0 mEq/L
0.6–1.2 mEq/L (Correct answer)
2.5–3.5 mEq/L
0.1–0.3 mEq/L

Correct answer: 0.6–1.2 mEq/L

The therapeutic range for lithium maintenance is 0.6–1.2 mEq/L; levels above 1.5 mEq/L are associated with toxicity.

Question 35: Which patient statement indicates a need for further teaching about sublingual nitroglycerin?

I can take up to three tablets five minutes apart if chest pain persists
I should swallow the tablet with a full glass of water (Correct answer)
I will store my tablets in a dark, cool place away from moisture
I will sit down before placing the tablet under my tongue

Correct answer: I should swallow the tablet with a full glass of water

Sublingual nitroglycerin must dissolve under the tongue, not be swallowed, as swallowing bypasses the rapid sublingual absorption route.

Question 36: An RPN suspects a colleague is diverting controlled substances. What is the most appropriate first action?

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

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 37: A client says, 'I feel like nothing matters anymore.' The RPN responds, 'It sounds like you're feeling hopeless.' This is an example of:

Advice-giving
Projection
False reassurance
Empathic reflection (Correct answer)

Correct answer: Empathic reflection

Empathic reflection names the underlying emotion to demonstrate understanding and validate the client's experience.

Question 38: When performing a head-to-toe assessment, which system should the RPN assess first?

Integumentary
Respiratory
Neurological (Correct answer)
Cardiovascular

Correct answer: Neurological

Neurological status is assessed first in a head-to-toe approach, beginning with level of consciousness.

Question 39: A nurse is about to administer morphine 4 mg IV. The patient's respiratory rate is 10 breaths per minute. What should the nurse do?

Administer the dose slowly over 10 minutes
Hold the medication and notify the prescriber (Correct answer)
Administer the full dose as ordered
Administer half the dose and reassess

Correct answer: Hold the medication and notify the prescriber

A respiratory rate below 12 is a contraindication to opioid administration; the nurse must withhold the dose and contact the prescriber.

Question 40: A nurse is caring for a patient with a seizure disorder. Which safety measure is the highest priority?

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

Correct answer: Keeping padded side rails up at all times

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

Question 41: How should an automated external defibrillator (AED) be used correctly?

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

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

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

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

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

Correct answer: Pseudomonas aeruginosa

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

Question 44: A client asks the RPN, 'Do you think I should leave my husband?' The BEST therapeutic response is:

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

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

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

Question 45: Which action is part of the ventilator-associated pneumonia (VAP) prevention bundle?

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

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

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

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

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

Question 47: Which of the following is an example of objective documentation?

'Patient seems anxious about surgery.'
'Patient reports pain 7/10; grimaces with movement; heart rate 102 bpm.' (Correct answer)
'Patient appears to be in pain.'
'Patient is uncooperative and refuses to comply.'

Correct answer: 'Patient reports pain 7/10; grimaces with movement; heart rate 102 bpm.'

Objective documentation records measurable, observable data such as numeric pain ratings, vital signs, and visible physical signs.

Question 48: A client in alcohol withdrawal is at risk for seizures. Which medication is most commonly used to prevent withdrawal seizures?

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

Correct answer: Lorazepam (Ativan)

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

Question 49: 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 directly over the chest for best effect
Apply the patch to the same location every day

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

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

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

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

Question 51: Which of the following is a contraindication for the use of a heating pad on a patient?

Patient preference for moist rather than dry heat
The patient is over 65 years of age
Mild muscle soreness after physical therapy
Decreased sensation in the extremity being treated (Correct answer)

Correct answer: Decreased sensation in the extremity being treated

Decreased or absent sensation prevents the patient from detecting excessive heat, creating high risk for thermal burns.

Question 52: 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
CT pulmonary angiography (CTPA) (Correct answer)
12-lead ECG
D-dimer blood test

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 53: Which data is considered OBJECTIVE during a client assessment?

Client reports feeling anxious
Client states 'I have a headache'
Blood pressure reading of 158/94 mmHg (Correct answer)
Client describes nausea after eating

Correct answer: Blood pressure reading of 158/94 mmHg

Objective data is measurable and observable by the nurse, such as vital sign readings, unlike subjective data reported by the client.

Question 54: Which site is preferred for intramuscular injection in an infant younger than 12 months?

Deltoid
Dorsogluteal
Ventrogluteal
Vastus lateralis (Correct answer)

Correct answer: Vastus lateralis

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

Question 55: When administering oral medications through a nasogastric (NG) tube, the nurse should:

Mix all medications together in one syringe for efficiency
Crush enteric-coated tablets and dissolve them in normal saline
Clamp the NG tube for 30 minutes after each medication
Flush the tube with 15–30 mL of water before and after each medication (Correct answer)

Correct answer: Flush the tube with 15–30 mL of water before and after each medication

Flushing the NG tube before and after each medication prevents clogging and ensures the full dose reaches the stomach and medications are not mixed.

Question 56: To promote a therapeutic environment, the RPN should schedule client interactions:

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)
Randomly throughout the shift to observe natural behavior

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 57: An RPN is completing a safety check in a client's room. The client is alert, oriented, and mobile with a walker. Which of the following findings poses the greatest immediate safety risk to this client?

A small spill of water is on the floor between the bed and the bathroom. (Correct answer)
The client's personal belongings are cluttered on the bedside table.
The overhead room light is off, but the bedside lamp is on.
The television volume is set too high.

Correct answer: A small spill of water is on the floor between the bed and the bathroom.

For a client who is mobile, particularly with an assistive device like a walker, a spill on the floor creates a significant and immediate slip hazard. This poses a much greater and more direct risk for a fall and injury than the other environmental factors listed. Promptly cleaning spills is a critical safety measure.

Question 58: When a colleague's unsafe practice is reported to management but no action is taken, the RPN's next step is to:

Report the issue directly to the state board as the first escalation step
Accept management's inaction and move on
Escalate the concern to a higher authority such as the risk manager or nursing director (Correct answer)
Confront the unsafe colleague personally to force change

Correct answer: Escalate the concern to a higher authority such as the risk manager or nursing director

If immediate management fails to act on a safety concern, the RPN must escalate through the organizational hierarchy to protect clients.

Question 59: An RPN is assigned to a newly admitted client who requires Airborne Precautions. Which of the following conditions would necessitate these specific precautions?

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

Correct answer: Pulmonary Tuberculosis.

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

Question 60: Under the Health Insurance Portability and Accountability Act (HIPAA), an RPN may share a patient's protected health information (PHI) without authorization for which purpose?

Research without an IRB waiver
Informing the patient's employer of their diagnosis
Marketing materials for the hospital
Treatment, payment, and healthcare operations (Correct answer)

Correct answer: Treatment, payment, and healthcare operations

HIPAA permits disclosure of PHI without patient authorization for treatment, payment, and healthcare operations (TPO).

Question 61: A patient with chronic heart failure is prescribed furosemide. Which electrolyte imbalance is the most common adverse effect?

Hypokalemia (Correct answer)
Hyperkalemia
Hypercalcemia
Hypernatremia

Correct answer: Hypokalemia

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

Question 62: A newborn is assessed at 1 minute after birth and receives an Apgar score of 6. Which intervention is priority?

Transfer to the NICU without delay
Stimulate and provide supplemental oxygen (Correct answer)
Initiate chest compressions
Intubate the newborn immediately

Correct answer: Stimulate and provide supplemental oxygen

An Apgar score of 4–6 indicates moderate depression and requires stimulation and supplemental oxygen.

Question 63: A child is brought to the ED after a near-drowning event. The child is conscious and coughing. The nurse's priority intervention is:

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

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

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

Question 64: A client with schizophrenia reports hearing voices telling them to harm others. What is the nurse's priority intervention?

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

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

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

Question 65: A patient with COPD is prescribed long-acting bronchodilators. Which inhaler technique instruction is most important?

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

Correct answer: Exhale fully before inhaling the medication

Exhaling fully before inhaling maximizes medication delivery to the airways.

Question 66: Which vaccine is recommended for all healthcare workers to prevent occupational transmission of a respiratory illness?

Hepatitis B vaccine
Annual influenza vaccine (Correct answer)
Varicella vaccine
Pneumococcal vaccine

Correct answer: Annual influenza vaccine

Annual influenza vaccination is recommended for all healthcare workers to protect both staff and vulnerable patients from seasonal flu.

Question 67: A client offers an RPN a gift card as a token of appreciation for excellent care. Which action best aligns with the CNO's guidelines on maintaining professional boundaries?

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

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 68: A patient is receiving continuous bladder irrigation (CBI) after a TURP. The nurse observes that the drainage is bright red with clots and the catheter is not draining. What is the priority action?

Increase the CBI irrigation rate
Attempt to manually irrigate the catheter with 50 mL normal saline using a syringe (Correct answer)
Clamp the irrigation tubing and notify the surgeon
Encourage the patient to increase oral fluid intake

Correct answer: Attempt to manually irrigate the catheter with 50 mL normal saline using a syringe

A blocked catheter after TURP requires gentle manual irrigation to dislodge clots and restore drainage, which is the priority over simply increasing flow into a blocked system.

Question 69: A nurse suspects a patient is experiencing elder abuse. Mandatory reporting laws require the nurse to report this to:

Only the attending physician
The appropriate adult protective services or designated agency as required by state law (Correct answer)
The hospital's billing department
The patient's family members first

Correct answer: The appropriate adult protective services or designated agency as required by state law

Nurses are mandated reporters in all U.S. states and must report suspected elder abuse to adult protective services or the legally designated agency.

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

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

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: 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.
Vigorously massaging the joint to increase circulation.
Applying a warm compress to the affected knee. (Correct answer)

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

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

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 73: 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
When the employer requests it in writing
Only when the patient provides written authorization (Correct answer)

Correct answer: Only when the patient provides written authorization

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

Question 74: A patient is prescribed metformin 500 mg PO BID. When is the best time to administer this medication?

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

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

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

Correct answer: It uses subjective language instead of objective observations

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

Question 76: A nurse is caring for a patient with multiple sclerosis (MS) experiencing fatigue. Which intervention is most appropriate?

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

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

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

Question 77: Which action is required when wasting a controlled substance that was not fully administered?

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

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

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

Question 78: When using the Z-track technique for an intramuscular injection, what is the purpose?

To reduce the risk of nerve damage
To ensure the needle enters a large muscle mass
To prevent the medication from leaking back into subcutaneous tissue (Correct answer)
To reduce pain at the injection site

Correct answer: To prevent the medication from leaking back into subcutaneous tissue

The Z-track technique displaces skin and subcutaneous tissue before injection, sealing the medication in the muscle to prevent irritating or staining agents from tracking back.

Question 79: 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:

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

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 80: A patient on digoxin reports nausea, visual disturbances, and seeing yellow-green halos. The nurse's priority action is to:

Hold the dose, assess heart rate, and notify the prescriber (Correct answer)
Give an antiemetic and reassess in 30 minutes
Encourage fluid intake to enhance renal excretion
Administer the next scheduled dose and monitor symptoms

Correct answer: Hold the dose, assess heart rate, and notify the prescriber

These are classic signs of digoxin toxicity; the nurse must withhold the dose, check the apical pulse, and promptly notify the prescriber.

Question 81: A client with post-traumatic stress disorder (PTSD) is triggered in the unit and begins to dissociate. What is the nurse's immediate intervention?

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

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

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

Correct answer: Fair and equitable distribution of care and resources

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

Question 83: Which behavior best demonstrates the RPN's professional accountability?

Referring all clinical decisions to the RN or physician
Completing tasks without questioning orders from supervisors
Acknowledging a clinical error, reporting it, and identifying steps to prevent recurrence (Correct answer)
Avoiding complex clients to reduce risk of error

Correct answer: Acknowledging a clinical error, reporting it, and identifying steps to prevent recurrence

Accountability involves owning one's actions, including errors, and actively contributing to improvements in practice.

Question 84: Which of the following best describes 'charting by exception' (CBE)?

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

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

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

Question 85: A client refuses a recommended blood transfusion due to religious beliefs. What is the RPN's primary ethical obligation?

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

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 86: 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?"
"You seem angry about what happened."
"Let me explain what I think is best for you."

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 87: The Code of Ethics for nurses primarily serves to:

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

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

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

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 89: A nurse notices that a colleague documented a nursing assessment they did not actually perform. The nurse should:

Confront the patient about the discrepancy
Report the falsification through the appropriate chain of command or reporting mechanism (Correct answer)
Ignore it, as it is the colleague's responsibility
Falsify their own record to match the colleague's

Correct answer: Report the falsification through the appropriate chain of command or reporting mechanism

Falsifying medical records is illegal and unethical; the nurse has a professional duty to report such misconduct through proper channels.

Question 90: A patient presents with a core temperature of 28°C (82.4°F), absent shivering, bradycardia, and hypotension. The nurse recognizes this as:

Mild hypothermia
Moderate hypothermia
Normal temperature variant in cold environments
Severe hypothermia (Correct answer)

Correct answer: Severe hypothermia

Severe hypothermia (below 30°C) is characterized by cessation of shivering, cardiovascular instability, and risk of cardiac arrest.

Question 91: A patient with COPD is receiving oxygen therapy at 2 L/min. The nurse notes the patient's respirations have decreased to 8 breaths/min. What should the nurse do first?

Continue monitoring because this is an expected response
Reduce or discontinue the oxygen and notify the physician (Correct answer)
Increase the oxygen flow rate to 6 L/min
Administer a bronchodilator immediately

Correct answer: Reduce or discontinue the oxygen and notify the physician

Some COPD patients rely on hypoxic drive; excessive oxygen can suppress respirations, requiring prompt reduction and physician notification.

Question 92: A nurse is preparing to collect a midstream clean-catch urine specimen from a female patient. Which instruction is correct?

Cleanse the perineum front to back, begin urinating, then collect midstream into the container (Correct answer)
Cleanse the perineum back to front, collect the first stream
Collect all urine from the first morning void into the container
No perineal cleaning is necessary for a midstream specimen

Correct answer: Cleanse the perineum front to back, begin urinating, then collect midstream into the container

Front-to-back perineal cleansing followed by discarding the initial urine stream reduces contamination of the midstream specimen with periurethral bacteria.

Question 93: Which sign indicates that a wound is healing by primary intention?

Wound edges are open with granulation tissue visible
Wound edges are separated and draining purulent fluid
Wound edges are approximated with minimal scar formation (Correct answer)
Wound is left open and packed with gauze

Correct answer: Wound edges are approximated with minimal scar formation

Primary intention healing occurs when wound edges are closed and approximated, resulting in minimal scar tissue.

Question 94: A patient taking phenytoin asks if they can take an antacid at the same time as their morning dose. How should the nurse respond?

Yes, antacids enhance phenytoin absorption
No, antacids are contraindicated in all seizure disorders
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 95: A patient is receiving a continuous heparin infusion. The nurse notes the aPTT result is 3.5 times the control value. What is the appropriate action?

Administer protamine sulfate immediately without a prescriber order
Increase the infusion rate to enhance anticoagulation
Continue the current rate since this is within therapeutic range
Decrease or hold the infusion and notify the prescriber (Correct answer)

Correct answer: Decrease or hold the infusion and notify the prescriber

An aPTT greater than 3 times the control indicates supratherapeutic anticoagulation and bleeding risk; the infusion should be decreased or held and the prescriber notified.

Question 96: In the event of a fire in a healthcare center, what should be done first?

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

Correct answer: Alarm, rescue, contain, extinguish

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

Question 97: An RPN is asked by a researcher to share de-identified patient data from charts for a study. The RPN should:

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

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

To prevent ophthalmia neonatorum caused by gonorrhea and chlamydia (Correct answer)
To lubricate the eyes damaged by amniotic fluid exposure
To treat congenital cataracts identified at birth
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 99: Which assessment technique is used to detect fluid in the lungs (consolidation)?

Inspection
Auscultation (Correct answer)
Percussion
Palpation

Correct answer: Auscultation

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

Question 100: A client at 41 weeks gestation is scheduled for a nonstress test (NST). Which result indicates a reactive (normal) NST?

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

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

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

Question 101: An RPN observes that a client's surgical wound has red, warm, swollen edges with purulent drainage. The PRIMARY nursing diagnosis is:

Infection related to wound contamination as evidenced by purulent drainage (Correct answer)
Risk for infection related to compromised immune function
Impaired skin integrity related to surgical incision
Acute pain related to wound inflammation

Correct answer: Infection related to wound contamination as evidenced by purulent drainage

The presence of purulent drainage and signs of inflammation confirm an actual infection, making 'Infection' the most appropriate diagnosis.

Question 102: Which of the following represents a correct application of the '10 Rights of Medication Administration'?

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

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

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

Question 103: A client with chronic kidney disease has a potassium level of 6.2 mEq/L. Which assessment finding is MOST concerning?

Client reports mild nausea
Heart rate of 52 bpm with peaked T waves on ECG (Correct answer)
Slight decrease in urine output
Mild muscle weakness in the legs

Correct answer: Heart rate of 52 bpm with peaked T waves on ECG

Bradycardia with peaked T waves on ECG indicates severe hyperkalemia affecting cardiac conduction, requiring immediate intervention.

Question 104: Which technique should the RPN use when assessing bowel sounds?

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

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 105: The orientation phase of the therapeutic relationship is characterized by:

Evaluating goal attainment and preparing for discharge
Implementing interventions and problem-solving
Establishing trust, defining roles, and agreeing on goals (Correct answer)
Reviewing the nurse's own assumptions before meeting the client

Correct answer: Establishing trust, defining roles, and agreeing on goals

The orientation phase lays the relational foundation through trust-building, role clarification, and collaborative goal-setting.

Question 106: 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:

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

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

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

Correct answer: Weak, thready pulse

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

Question 108: A client has the right to refuse a medication. If a competent adult client refuses their morning dose of an antihypertensive, what is the RPN's priority action?

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

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

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

Question 109: 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
Encourage breastfeeding or provide formula (Correct answer)
Notify the provider and obtain a full metabolic panel
Initiate an IV dextrose infusion immediately

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

Ignore the situation to maintain workplace harmony
Report directly to the charge nurse without speaking to the colleague
Remind the colleague of hand hygiene policy immediately (Correct answer)
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 111: Which behavior by the RPN is MOST likely to undermine the therapeutic relationship?

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

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

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

Question 112: Which statement best describes the concept of 'scope of practice' for an RPN?

Standards set individually by each hospital for their RPN staff
The maximum number of clients an RPN can care for at one time
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

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 113: What does 'duty of care' mean for an RPN in the context of professional ethics?

The duty to follow all physician orders without question
The obligation to care for any client regardless of personal risk
The requirement to report all ethical concerns to the ethics board
The legal and ethical obligation to provide competent care to clients under the RPN's responsibility (Correct answer)

Correct answer: The legal and ethical obligation to provide competent care to clients under the RPN's responsibility

Duty of care is the legal and ethical standard requiring RPNs to act competently and reasonably toward clients in their care.

Question 114: An RPN notes that a client's urinary output has been 200 mL over the past 8 hours. This finding is classified as:

Normal output
Oliguria (Correct answer)
Polyuria
Anuria

Correct answer: Oliguria

Oliguria is defined as urine output less than 400 mL in 24 hours, making 200 mL in 8 hours a concerning finding.

Question 115: A patient with heart failure reports waking up at night feeling short of breath. This symptom is called:

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

Correct answer: Paroxysmal nocturnal dyspnea

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

Question 116: Which action by an RPN demonstrates a breach of professional boundaries?

Advocating for a client's needs with the care team
Providing emotional support during a difficult diagnosis
Exchanging personal contact information with a client for ongoing friendship (Correct answer)
Explaining a procedure in the client's preferred language

Correct answer: Exchanging personal contact information with a client for ongoing friendship

Exchanging personal contact information for a personal relationship crosses professional boundaries that protect the therapeutic relationship.

Question 117: The therapeutic technique of 'confrontation' is MOST appropriately used to:

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

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

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

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 119: An RPN administers the correct medication but uses the wrong route. This is an example of:

A medication error that must be reported (Correct answer)
Acceptable practice if the outcome is the same
A deviation permitted under RPN scope
An incident that only requires verbal notification to the charge nurse

Correct answer: A medication error that must be reported

Administering medication via the wrong route is a medication error regardless of intent, requiring documentation and incident reporting.

Question 120: A patient verbally abuses the RPN during care. The nurse has the right to:

Refuse all further care for that patient without notifying anyone
Set limits on abusive behavior while continuing to provide care (Correct answer)
Leave the unit for the remainder of the shift
Restrain the patient for staff safety without an order

Correct answer: Set limits on abusive behavior while continuing to provide care

RPNs can set professional limits on abusive behavior while maintaining the duty to provide necessary care and notifying supervisors.

Question 121: An RPN discovers that a coworker is diverting controlled substances for personal use. The PRIMARY obligation is to:

Confront the coworker privately and give them a chance to stop
Ignore it unless patient harm is directly observed
Document the observation in the patient's chart
Report the situation to the supervisor and follow facility diversion policy (Correct answer)

Correct answer: Report the situation to the supervisor and follow facility diversion policy

Drug diversion is a patient safety and legal issue requiring immediate reporting through proper channels per facility policy.

Question 122: 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?

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

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 123: Which symptom is classified as a POSITIVE symptom of schizophrenia?

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

Correct answer: Delusions

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

Question 124: 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?

Once per shift
Every 30 minutes
Every 4 hours
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 125: A patient is on contact precautions. A nurse enters the room to perform wound care. In what order should PPE be donned?

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

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 126: Which patient is at HIGHEST risk for developing a healthcare-associated infection?

A 45-year-old patient admitted for observation after a fall
An 80-year-old patient with diabetes on immunosuppressive therapy post-transplant (Correct answer)
A 25-year-old patient receiving IV antibiotics for cellulitis
A 30-year-old ambulatory patient having elective surgery

Correct answer: An 80-year-old patient with diabetes on immunosuppressive therapy post-transplant

Advanced age, diabetes, and immunosuppressive therapy each independently increase infection risk; together they create the highest vulnerability.

Question 127: A nurse is educating a patient with chronic obstructive pulmonary disease about pursed-lip breathing. What is the primary benefit of this technique?

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

Correct answer: It slows exhalation and prevents airway collapse

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

Question 128: A nurse is preparing to administer vitamin K to a newborn. Which statement best explains the rationale for this injection?

Newborns have immature immune systems requiring vitamin K supplementation
Newborns lack intestinal bacteria needed to synthesize vitamin K, increasing bleeding risk (Correct answer)
Vitamin K is required for the development of the blood-brain barrier
Vitamin K prevents hyperbilirubinemia in the first week of life

Correct answer: Newborns lack intestinal bacteria needed to synthesize vitamin K, increasing bleeding risk

Newborns are born without intestinal flora that synthesize vitamin K, making them susceptible to hemorrhagic disease of the newborn.

Question 129: 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
Ask the physician to update the diagnosis
Delete it and add a new one without documentation
Revise the care plan to reflect the client's current status (Correct answer)

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

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

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

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

Question 131: An RPN is assigned more clients than can be safely managed. What is the professional obligation?

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

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 132: 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 provide the client with a full supply of all their prescribed medications.
To ensure the hospital pharmacy has billed correctly for all administered drugs.
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)

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

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

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

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

Question 134: A blood sugar range of 80–180 is considered normal. Is it true or false?

TRUE
FALSE (Correct answer)

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

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

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

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

Question 136: 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
Continuing Competence
Accountability (Correct answer)

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: A patient is prescribed a walker for ambulation. Which instruction is most important when teaching the patient to use a standard walker?

Keep all four walker legs on the floor at all times while stepping
Move the walker forward only as far as one foot length at a time
Advance the weaker leg first, then move the walker forward
Place both hands on the walker and advance it 12–18 inches ahead before stepping (Correct answer)

Correct answer: Place both hands on the walker and advance it 12–18 inches ahead before stepping

The walker should be advanced 12–18 inches ahead so the patient steps into it, maintaining center of gravity within the base of support.

Question 138: When providing foot care education to a client with type 2 diabetes, which of the following instructions is most crucial for the RPN to emphasize?

Trim toenails with a curved edge to match the shape of the toe.
Visually inspect the entire surface of both feet every day. (Correct answer)
Apply moisturizing lotion between the toes to prevent dryness.
Soak feet in hot water for 20 minutes daily to soften the skin.

Correct answer: Visually inspect the entire surface of both feet every day.

Due to the risk of peripheral neuropathy, a client with diabetes may not feel minor injuries to their feet. Daily visual inspection is the most critical preventative measure to detect cuts, blisters, or signs of infection early. Soaking feet can cause skin to dry and crack, lotion between toes can lead to fungal infections, and nails should be trimmed straight across.

Question 139: An RPN is caring for an adolescent client who asks, "Did you ever feel insecure when you were my age?" Which of the following responses is the most therapeutic use of self-disclosure?

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

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

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

Question 140: The concept of 'unconditional positive regard' in the therapeutic relationship means the nurse:

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

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

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

Question 141: Which intervention is most effective at preventing central line-associated bloodstream infections (CLABSIs)?

Flushing the line with heparin every shift
Capping the line with a needleless connector
Using maximum sterile barrier precautions during insertion (Correct answer)
Changing the dressing every 24 hours

Correct answer: Using maximum sterile barrier precautions during insertion

Maximum sterile barrier precautions (sterile gown, gloves, mask, cap, and large drape) during insertion are the most effective CLABSI prevention strategy.

Question 142: A nurse is documenting informed consent. Which element is NOT required as part of informed consent documentation?

Alternatives to the proposed treatment
The nurse's personal opinion on whether the patient should proceed (Correct answer)
The patient's signature confirming understanding
A description of the procedure and its risks

Correct answer: The nurse's personal opinion on whether the patient should proceed

Informed consent documentation captures the patient's decision after receiving objective information; the nurse's personal opinion is not a required element.

Question 143: Which statement about surgical asepsis is correct?

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

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

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

Question 144: Which characteristic distinguishes a healthcare-associated infection (HAI) from a community-acquired infection?

HAIs are always caused by antibiotic-resistant organisms
Community-acquired infections are always more severe
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 145: Which principle is violated when an RPN shares a client's HIV status with the client's employer without consent?

Beneficence
Fidelity
Confidentiality (Correct answer)
Veracity

Correct answer: Confidentiality

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

Question 146: A nurse is assessing a newborn and notes that the anterior fontanelle is bulging and tense. This finding is associated with:

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

Correct answer: Increased intracranial pressure

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

Question 147: Which environmental modification is the highest priority to prevent falls in an older adult's hospital room?

Placing the call bell within easy reach at all times (Correct answer)
Installing grip bars on the walls
Providing a night light in the bathroom
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 148: An RPN receives a friend request on social media from a client they are currently providing care for in a long-term care facility. What is the most appropriate action for the RPN to take to maintain professional boundaries?

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

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

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

Question 149: Veracity as an ethical principle requires the RPN to:

Be truthful with clients even when the truth is difficult (Correct answer)
Protect the client from distressing information
Provide only information the client specifically requests
Support the physician's decision to withhold a diagnosis

Correct answer: Be truthful with clients even when the truth is difficult

Veracity obligates the RPN to be truthful in all communications with clients, supporting informed decision-making.

Question 150: 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?

Administer the medication immediately as per the verbal order.
Read back the complete order to the prescriber for verification. (Correct answer)
Ask a colleague to listen to the order with them.
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 151: A patient on contact precautions for MRSA requires assistance walking to the bathroom. The nurse should:

Don gloves and gown, assist the patient, then remove PPE and perform hand hygiene (Correct answer)
Ask the patient to perform hand hygiene and walk unassisted to limit staff contact
Have the patient use a bedpan instead to avoid leaving the room
Wear only gloves since the patient is ambulatory

Correct answer: Don gloves and gown, assist the patient, then remove PPE and perform hand hygiene

Contact precautions require both gloves and a gown during any patient contact; proper PPE donning and doffing with hand hygiene prevents transmission.

Question 152: A patient withdraws consent for a procedure after signing the consent form but before the procedure begins. The RPN should:

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

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

Accept it graciously to avoid offending the family
Accept it and report it to management
Accept it but donate it to charity
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 154: 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)
Dilute the medication more than usual
Document administration only after the full dose is given
Administer the medication without additional checks to save time

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 155: A patient returning from surgery is alert but reports dizziness when sitting upright. The nurse's first action should be to:

Administer prescribed antiemetics before attempting ambulation
Lower the head of the bed and notify the surgeon
Check blood pressure in supine and then sitting positions (Correct answer)
Have the patient dangle at the bedside before standing

Correct answer: Check blood pressure in supine and then sitting positions

Orthostatic hypotension is a common post-operative finding; measuring blood pressure in supine and sitting positions confirms the cause before further action.

Question 156: Standard precautions apply to which of the following?

All patients regardless of diagnosis (Correct answer)
Immunocompromised patients only
Patients with known infections only
Blood and body fluids only

Correct answer: All patients regardless of diagnosis

Standard precautions are applied to every patient encounter because infection status is not always known.

Question 157: A patient is brought in after a house fire with suspected carbon monoxide poisoning. The pulse oximetry reads 99%. The nurse should:

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

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

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

Question 158: A client is admitted with suspected deep vein thrombosis (DVT). Which assessment finding is MOST consistent with this diagnosis?

Unilateral calf pain, warmth, and redness (Correct answer)
Absence of dorsalis pedis pulse
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 159: A nurse sustains a needlestick injury. What is the FIRST action to take?

Complete an incident report
Obtain baseline blood work immediately
Wash the site thoroughly with soap and water (Correct answer)
Report the exposure to the charge nurse

Correct answer: Wash the site thoroughly with soap and water

Immediate washing with soap and water helps remove potential pathogens and is the first step in post-exposure management.

Question 160: An RPN notices that a colleague has been charting vital signs without actually taking them. The RPN should FIRST:

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

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

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

Question 161: A patient is placed in the Trendelenburg position. Which clinical situation is this position CONTRAINDICATED?

Hip replacement surgery
Postural drainage of lower lobes
Increased intracranial pressure (Correct answer)
Hypovolemic shock while awaiting IV access

Correct answer: Increased intracranial pressure

Trendelenburg increases venous return to the head, which raises intracranial pressure and is dangerous in patients with head injury or ICP elevation.

Question 162: A nurse is found to have practiced while impaired by alcohol. This situation is primarily governed by:

The state nursing practice act and regulatory college standards (Correct answer)
Criminal law only
Federal HIPAA regulations
Hospital human resources policy exclusively

Correct answer: The state nursing practice act and regulatory college standards

Practicing while impaired is a professional conduct issue governed by the state nursing practice act and regulatory body standards.

Question 163: Which of the following BEST describes 'transference' in the context of a therapeutic nurse-client relationship?

The client transfers medical information to a new care team
The nurse transfers a client to a different unit for specialized care
The client unconsciously redirects feelings from past relationships onto the nurse (Correct answer)
The nurse unconsciously projects personal feelings onto the client

Correct answer: The client unconsciously redirects feelings from past relationships onto the nurse

Transference occurs when clients displace emotions from significant past figures onto the nurse, which requires clinical awareness.

Question 164: Which patient statement indicates a need for further teaching about safe use of a quad cane?

'I can use the cane handle to push myself up from a chair.' (Correct answer)
'I will make sure all four tips touch the floor before I put weight on the cane.'
'I will place the cane on my stronger side when walking.'
'I will advance the cane before stepping forward with my weaker leg.'

Correct answer: 'I can use the cane handle to push myself up from a chair.'

Using the cane handle to push up from a chair is unsafe because it can tip the cane and cause a fall; the patient should push up from the chair armrests.

Question 165: Which finding is consistent with late decelerations on a fetal heart rate monitor?

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

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

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

Question 166: Which of the following represents a correctly formulated nursing diagnosis?

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

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 167: 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 168: A client admitted for chest pain has an irregularly irregular heart rhythm on ECG. The RPN should:

Assume it is an artifact and continue monitoring
Assess the client, document findings, and notify the physician (Correct answer)
Reapply ECG leads and retake the reading
Administer a PRN antiarrhythmic medication

Correct answer: Assess the client, document findings, and notify the physician

An irregularly irregular rhythm may indicate atrial fibrillation; the RPN must assess the client and report findings to the physician.

Question 169: An RPN is assessing a newborn and observes acrocyanosis. Which of the following best describes this finding?

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

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

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

Question 170: Which of the following describe hyperthyroidism symptoms and signs?

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

Correct answer: All of the above

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

Question 171: When collecting a health history, the RPN uses open-ended questions. Which question is an example of this technique?

'Tell me what brings you to the hospital today.' (Correct answer)
'Is your pain sharp or dull?'
'Have you had surgery before?'
'Do you smoke cigarettes?'

Correct answer: 'Tell me what brings you to the hospital today.'

Open-ended questions invite the client to elaborate in their own words, providing richer subjective assessment data.

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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