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

Question 1: When setting priorities using Maslow's hierarchy, which client need should the RPN address FIRST?

A client requesting information about discharge medications
A client with an oxygen saturation of 88% (Correct answer)
A client expressing fear about an upcoming procedure
A client needing assistance ambulating to the bathroom

Correct answer: A client with an oxygen saturation of 88%

Physiological needs such as oxygenation are the highest priority; SpO2 of 88% indicates hypoxia requiring immediate action.

Question 2: Which type of transmission requires the use of a negative-pressure isolation room?

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

Correct answer: Airborne transmission

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

Question 3: An RPN is preparing to administer insulin, a high-alert medication. Which of the following actions is the MOST critical safety measure the nurse should take?

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

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

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

Question 4: A patient with Crohn's disease is experiencing a flare. Which dietary approach is typically recommended during active disease?

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

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

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

Question 5: Which finding MOST suggests increased intracranial pressure (ICP) in a client following a head injury?

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

Correct answer: Widening pulse pressure and bradycardia

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

Question 6: A client reports pain rated 8/10. Which action is the PRIORITY in the assessment phase?

Notify the physician of severe pain
Administer ordered analgesic immediately
Document the pain rating in the chart
Assess pain characteristics using PQRST (Correct answer)

Correct answer: Assess pain characteristics using PQRST

A thorough PQRST pain assessment must be completed before any intervention to guide appropriate care.

Question 7: The RPN is developing a care plan for a post-surgical client. Which component of the nursing diagnosis identifies the cause of the problem?

Defining characteristics
Expected outcome
Related factor (etiology) (Correct answer)
Problem statement

Correct answer: Related factor (etiology)

The related factor (etiology) component of a nursing diagnosis identifies what is causing or contributing to the problem.

Question 8: While providing care, an RPN notices a colleague documenting a procedure that was not actually performed. According to the CNO standards, what is the RPN's primary responsibility?

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

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

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

Question 9: An RPN is caring for a client with a confirmed Clostridioides difficile (C. difficile) infection. In addition to using a private room, which of the following infection control measures are essential?

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

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

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

Question 10: 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
Administer half the dose and reassess
Administer the full dose as ordered
Hold the medication and notify the prescriber (Correct answer)

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

Ignore it, as it is the colleague's responsibility
Confront the patient about the discrepancy
Report the falsification through the appropriate chain of command or reporting mechanism (Correct answer)
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 12: An RPN is asked by a researcher to share de-identified patient data from charts for a study. The RPN should:

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

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 13: A client's care plan identifies a nursing diagnosis of 'Deficient fluid volume related to vomiting.' Which assessment finding BEST supports this diagnosis?

Moist mucous membranes
Blood pressure 130/80 mmHg
Skin turgor with immediate recoil
Urine specific gravity 1.030 (Correct answer)

Correct answer: Urine specific gravity 1.030

A urine specific gravity of 1.030 indicates concentrated urine, a sign of dehydration consistent with deficient fluid volume.

Question 14: 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 15: 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 16: A nurse assesses a patient with a suspected stroke. Which assessment finding would make the nurse suspect a hemorrhagic stroke over an ischemic stroke?

Sudden onset of unilateral facial droop
Report of the 'worst headache of my life' with rapid onset (Correct answer)
History of atrial fibrillation
Gradual onset of unilateral arm weakness over 30 minutes

Correct answer: Report of the 'worst headache of my life' with rapid onset

A sudden, severe 'thunderclap' headache described as the worst of one's life is a hallmark symptom of subarachnoid hemorrhage, a type of hemorrhagic stroke.

Question 17: When planning care for a client with a newly diagnosed pressure injury (Stage II), which outcome is MOST appropriate?

Client will be repositioned every 4 hours
Client will verbalize understanding of wound care by discharge
Wound will show signs of healing within 2 weeks (Correct answer)
Family will perform dressing changes independently

Correct answer: Wound will show signs of healing within 2 weeks

A measurable outcome focused on wound healing within a realistic timeframe aligns with Stage II pressure injury management.

Question 18: Which statement about surgical asepsis is correct?

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

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

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

Question 19: 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?

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

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

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

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

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

Question 21: A nurse must administer 250 mg of a medication available as 125 mg/5 mL. How many mL should be administered?

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

Correct answer: 10 mL

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

Question 22: When a nurse documents 'patient tolerated procedure well' without supporting observations, this is an example of:

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

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

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

Question 23: 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 24: A nurse is teaching a new mother about newborn jaundice. Which statement by the mother indicates understanding?

'My baby only needs sunlight exposure to treat the jaundice.'
'I will feed my baby frequently to help clear the bilirubin.' (Correct answer)
'Jaundice appearing on day 1 is normal and expected.'
'I should stop breastfeeding until the jaundice resolves.'

Correct answer: 'I will feed my baby frequently to help clear the bilirubin.'

Frequent feedings promote stooling, which eliminates bilirubin and helps reduce physiologic jaundice.

Question 25: 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)
Avoid all weight-bearing activity to prevent fractures
Rely on furniture for balance instead of using a cane

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

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

Question 26: Which of the following is an example of a non-therapeutic communication technique?

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

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

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

Question 27: Which isolation precaution category is used for tuberculosis (TB)?

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

Correct answer: Airborne precautions

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

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

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

Correct answer: Severe hypothermia

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

Question 29: A nurse documents that a patient 'seems confused' in the medical record. What is the primary issue with this entry?

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

Correct answer: It uses subjective language instead of objective observations

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

Question 30: A nurse is found to have practiced while impaired by alcohol. This situation is primarily governed by:

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

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

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

Correct answer: Exhale fully before inhaling the medication

Exhaling fully before inhaling maximizes medication delivery to the airways.

Question 32: A nurse is caring for a client in preterm labor at 30 weeks who is receiving a betamethasone injection. What is the primary purpose of this medication?

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

Correct answer: Accelerate fetal lung maturity by stimulating surfactant production

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

Question 33: 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:

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

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

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

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

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

Question 35: A client is newly prescribed phenelzine (Nardil), an MAOI. Which dietary teaching is most important?

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

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

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

Question 36: The principle of 'non-maleficence' obligates the RPN to:

Provide care equally to all clients
Avoid causing unnecessary harm through actions or omissions (Correct answer)
Maintain honesty in all communications
Always act in the client's best interest

Correct answer: Avoid causing unnecessary harm through actions or omissions

Non-maleficence means refraining from actions that cause unnecessary harm, including errors of omission.

Question 37: A patient's blood pressure is 88/52 mmHg. What is the correct mean arterial pressure (MAP)?

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

Correct answer: 64 mmHg

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

Question 38: 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?

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.
Leave the error as is and add a new note at the end of the shift explaining the correction.
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 39: Which organism is the most common cause of healthcare-associated pneumonia?

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

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

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

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

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

Question 41: A client in alcohol withdrawal is at risk for seizures. Which medication is most commonly used to prevent withdrawal seizures?

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

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

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

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 43: A nurse notes that a newborn's umbilical cord has one artery and one vein instead of the normal two arteries and one vein. What is the most important follow-up action?

Document the finding; no further action is needed
Apply an extra clamp to prevent bleeding
Notify the provider, as this may indicate renal or cardiac anomalies (Correct answer)
Repeat the assessment to confirm the finding

Correct answer: Notify the provider, as this may indicate renal or cardiac anomalies

A single umbilical artery (two-vessel cord) is associated with renal, cardiac, and chromosomal anomalies and must be reported to the provider.

Question 44: An RPN floats to an unfamiliar unit and is asked to perform a skill they have not been trained for. The correct response is to:

Perform the skill and ask a colleague to supervise informally
Refuse the entire float assignment
Attempt the skill using general nursing knowledge
Inform the charge nurse of the limitation and request assignment of a qualified nurse for that task (Correct answer)

Correct answer: Inform the charge nurse of the limitation and request assignment of a qualified nurse for that task

RPNs must practice only within their competence; when assigned tasks beyond training, they must communicate limitations and seek reallocation.

Question 45: Which technique is used to verify correct placement of a small-bore (dobhoff) feeding tube before initiating enteral feedings?

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

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

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

Question 46: A patient in the ED is diagnosed with hypertensive emergency with a blood pressure of 220/130 mmHg and confusion. The nurse should anticipate the blood pressure being lowered by no more than:

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

Correct answer: 25% in the first hour

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

Question 47: An RPN observes that a client's surgical wound has red, warm, swollen edges with purulent drainage. The PRIMARY nursing diagnosis is:

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

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 48: 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 49: Which of the following is defined as professional misconduct under the regulations governing nursing in Ontario?

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

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

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

Question 50: Which principle is violated when an RPN shares a client's HIV status with the client's employer without consent?

Confidentiality (Correct answer)
Beneficence
Veracity
Fidelity

Correct answer: Confidentiality

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

Question 51: Which component is included in a comprehensive Mental Status Examination (MSE)?

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

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

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

Question 52: A client's 16-year-old minor child requests to review their parent's medical records. The RPN should:

Decline and explain that access requires the patient's authorization or legal authority (Correct answer)
Refer the request to the hospital's medical records department without further guidance
Provide the records since the child is the patient's family
Allow limited access with the charge nurse's approval

Correct answer: Decline and explain that access requires the patient's authorization or legal authority

Adult patients' records are protected by HIPAA; a minor child has no automatic right of access without the patient's written authorization.

Question 53: A nurse documents a patient's intake and output (I&O). Which patient population makes accurate I&O documentation most critical?

Patients with fluid and electrolyte imbalances or renal failure (Correct answer)
Patients recovering from minor outpatient procedures
Patients scheduled for discharge the following day
Patients with skin rashes

Correct answer: Patients with fluid and electrolyte imbalances or renal failure

Accurate I&O is especially critical for patients with renal failure or fluid/electrolyte imbalances, where fluid balance directly affects outcomes.

Question 54: A nurse sustains a needlestick injury. What is the FIRST action to take?

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

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

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

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

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

Question 56: 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?

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

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

At bedtime only
30 minutes before meals
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 58: A nurse is performing tracheostomy care. When should the inner cannula be replaced or cleaned?

Only when secretions are visible
Once per day at 0600
Every 8 hours or per facility protocol (Correct answer)
Only when the patient is suctioned

Correct answer: Every 8 hours or per facility protocol

Inner cannulas are cleaned or replaced every 8 hours (or per facility protocol) to prevent secretion buildup and maintain airway patency.

Question 59: What does the term 'incident report' (or occurrence report) serve as in a healthcare setting?

A punitive document placed in the patient's permanent medical record
An internal quality improvement tool to track and analyze adverse events (Correct answer)
A billing document used to charge for unexpected care
A legal document automatically sent to the state board of nursing

Correct answer: An internal quality improvement tool to track and analyze adverse events

Incident reports are internal quality improvement tools used to identify patterns, prevent future errors, and improve patient safety.

Question 60: 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?

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

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

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

Question 61: A patient discloses during an assessment that they plan to seriously harm a specific person. Under the duty-to-warn principle, the RPN must:

Discharge the patient immediately to remove the threat
Notify the potential victim and appropriate authorities after informing the healthcare team (Correct answer)
Maintain confidentiality because patient disclosure is protected
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 62: Which vaccine is recommended for all healthcare workers to prevent occupational transmission of a respiratory illness?

Annual influenza vaccine (Correct answer)
Hepatitis B vaccine
Pneumococcal vaccine
Varicella 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 63: When the thyroid is__________ a goiter occurs.

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

Correct answer: Hypo active

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

Question 64: A nurse is assessing lochia on a postpartum client at day 5. Which description is expected?

Lochia rubra: bright red, moderate flow
Lochia serosa: pinkish-brown, decreasing flow (Correct answer)
Lochia alba: yellow-white, scant flow
No lochia present; discharge has resolved

Correct answer: Lochia serosa: pinkish-brown, decreasing flow

Lochia serosa, which is pinkish-brown and decreasing in amount, is the expected finding between approximately days 3 and 10 postpartum.

Question 65: An RPN suspects a colleague is diverting controlled substances. What is the most appropriate first action?

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

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

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

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

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

Question 67: A client with schizophrenia has been stable on risperidone for two years and now shows involuntary, repetitive facial movements. The nurse recognizes this as:

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

Correct answer: Tardive dyskinesia

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

Question 68: An RPN notices personal feelings of irritation toward a demanding client. The MOST appropriate action is to:

Request an immediate reassignment to another client
Limit interactions with the client to avoid expressing irritation
Reflect on the feelings and discuss them with a supervisor or in clinical supervision (Correct answer)
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 69: Which of the following BEST illustrates the concept of 'empathy' rather than 'sympathy' in nursing?

"I can hear how frightening this diagnosis must feel for you." (Correct answer)
"I feel so sorry for everything you're going through right now."
"Don't worry; many people go through this and do just fine."
"I know exactly how you feel — I lost someone too."

Correct answer: "I can hear how frightening this diagnosis must feel for you."

Empathy communicates understanding of the client's experience from their perspective without merging with or minimizing it.

Question 70: A client is admitted with suspected deep vein thrombosis (DVT). Which assessment finding is MOST consistent with this diagnosis?

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

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

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

Correct answer: To protect the public by regulating nursing practice

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

Question 72: 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
Vitamin K is required for the development of the blood-brain barrier
Newborns lack intestinal bacteria needed to synthesize vitamin K, increasing bleeding risk (Correct answer)
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 73: A patient has a chest tube connected to a water-seal drainage system. The nurse notices the water level in the water-seal chamber is not fluctuating (tidaling). What does this indicate?

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

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

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

Question 74: Under mandatory reporting laws, an RPN is required to report suspected child abuse to:

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

Correct answer: The appropriate child protective services agency

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

Question 75: A patient with chronic venous insufficiency develops leg ulcers. Which intervention is the priority in ulcer management?

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

Correct answer: Apply compression bandaging to improve venous return

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

Question 76: During a disaster drill, the incident commander asks the charge nurse to activate the hospital emergency operations plan. The nurse's first action is to:

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

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

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

Question 77: Which is the safest method to confirm a patient's identity before medication administration?

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

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

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

Question 78: An RPN is preparing to meet a new client with a history of violent behavior. During the pre-interaction phase, the nurse should:

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

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

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

Question 79: A client with chronic kidney disease has a potassium level of 6.2 mEq/L. Which assessment finding is MOST concerning?

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

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

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

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 81: 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
Use correction fluid (White-Out) to cover the mistake
Draw a single line through the error, write 'error,' date, and initial it (Correct answer)
Erase the error completely and rewrite the entry

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 82: 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
Report the situation to the supervisor and follow facility diversion policy (Correct answer)
Document the observation in the patient's chart

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 83: 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 84: The Code of Ethics for nurses primarily serves to:

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

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

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

Correct answer: Gigantism

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

Question 86: A patient with Type 1 diabetes is found unresponsive with a blood glucose of 38 mg/dL. What is the nurse's first action?

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

Correct answer: Administer IV dextrose 50% as ordered

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

Question 87: Which nursing action is MOST effective in preventing hospital-acquired pressure injuries in an immobile patient?

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

Correct answer: Repositioning the patient at least every 2 hours

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

Question 88: 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?

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.
Perform the procedure as ordered, trusting their foundational education.
Refuse to perform the procedure and report the physician for making an inappropriate request.

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 89: Which of the following BEST describes the nurse's role during the working phase of the therapeutic relationship?

Introducing oneself and establishing the purpose and expectations of the relationship
Gathering data and reviewing the client's health history before the first meeting
Reviewing accomplishments and facilitating the client's transition to independence
Collaborating with the client to implement interventions and evaluate progress toward goals (Correct answer)

Correct answer: Collaborating with the client to implement interventions and evaluate progress toward goals

The working phase is action-oriented, centered on implementing planned interventions and continuously evaluating outcomes.

Question 90: Before administering a new medication, the RPN is uncertain about the correct dose. What is the safest action?

Estimate based on similar medications given previously
Administer the dose written on the MAR without questioning
Consult a current drug reference or contact the pharmacist before administration (Correct answer)
Ask a colleague who has given the medication before

Correct answer: Consult a current drug reference or contact the pharmacist before administration

Using a current drug reference or consulting the pharmacist ensures the nurse has accurate, evidence-based information before administration.

Question 91: A nurse is preparing to administer a subcutaneous insulin injection. Which site rotation principle is most important?

Rotate between the abdomen and thigh only
Rotate sites within each anatomical region before moving to another (Correct answer)
Avoid the abdomen in all diabetic patients
Use the same site consistently for predictable absorption

Correct answer: Rotate sites within each anatomical region before moving to another

Rotating within one anatomical region before switching to another ensures consistent insulin absorption rates.

Question 92: How long must most hospitals in the U.S. retain adult patient medical records according to federal regulations and accreditation standards?

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

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

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

Question 93: Which assessment finding is an expected outcome of effective pain management planning for a post-operative client?

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

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

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

Question 94: 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?

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

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 95: 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 walk 50 feet without dyspnea within 3 days (Correct answer)
Client will feel better during activity

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

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

Correct answer: Start a stimulant laxative regimen prophylactically

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

Question 97: A nurse is educating a patient with Type 2 diabetes about foot care. Which instruction is highest priority?

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

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

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

Correct answer: Assess the patient for adverse effects

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

Question 99: An RPN is asked to perform a task that falls outside their competency. The correct response is to:

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

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

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

Question 100: When using the Z-track technique for IM injection, what is the primary purpose?

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

Correct answer: Prevent leakage of irritating medication into subcutaneous tissue

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

Question 101: A nurse is caring for a patient with multiple sclerosis (MS) experiencing fatigue. Which intervention is most appropriate?

Administer stimulant medications without physician order
Schedule activities during the patient's peak energy periods (Correct answer)
Encourage exercising during the hottest part of the day
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 102: A nurse is assigned to a patient in protective (reverse) isolation. What is the primary purpose of this precaution?

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

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

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

Question 103: A nurse is assessing a patient's Morse Fall Scale. Which factor contributes the MOST points to this score?

Secondary diagnosis
Age over 65
History of falling in the past 3 months (Correct answer)
Use of ambulatory aid

Correct answer: History of falling in the past 3 months

A history of falling within the past 3 months carries the highest weighted score (25 points) on the Morse Fall Scale, making it the strongest predictor of future falls.

Question 104: During ambulation, a patient begins to faint. The nurse's correct response is to:

Lower the patient to the floor in a controlled manner by sliding them down the nurse's leg (Correct answer)
Call for help immediately and leave the patient to get assistance
Sit the patient directly on the floor to prevent falling
Support the patient upright and walk them back to bed as quickly as possible

Correct answer: Lower the patient to the floor in a controlled manner by sliding them down the nurse's leg

A controlled descent by sliding the patient down the nurse's leg protects both the patient and nurse from injury when the patient cannot support their own weight.

Question 105: An RPN is providing discharge teaching to a new mother about lochia. The client is 3 days postpartum. Which statement by the mother indicates an understanding of the normal progression?

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

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

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

Question 106: When collecting a health history, the RPN uses open-ended questions. Which question is an example of this technique?

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

Question 107: Which action would place an RPN at risk for a charge of battery?

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

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

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

Correct answer: Passage of meconium within 24–48 hours

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

Question 109: When caring for a minor patient, consent for routine treatment is typically obtained from:

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

Correct answer: A parent or legal guardian

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

Question 110: Which assessment finding in a postpartum client requires IMMEDIATE intervention?

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

Correct answer: Blood pressure 160/110 mmHg with headache

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

Question 111: 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?

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

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 112: 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 113: A terminally ill client requests information about medical aid in dying. The RPN's best initial response is to:

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

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

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

Question 114: A patient's urine culture grows Escherichia coli. The urinary catheter has been in place for 10 days. This scenario best describes which type of infection?

Surgical site infection
Community-acquired infection
Catheter-associated urinary tract infection (CAUTI) (Correct answer)
Ventilator-associated pneumonia

Correct answer: Catheter-associated urinary tract infection (CAUTI)

A CAUTI is defined as a UTI in a patient who had a urinary catheter in place within 48 hours of infection onset.

Question 115: When administering oral medications through a nasogastric (NG) tube, the nurse should:

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

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

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

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

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

Question 117: Which type of law primarily governs the RPN's professional license and scope of practice?

Administrative/regulatory law via the state nursing practice act (Correct answer)
Civil tort law
Federal criminal law
Contract law

Correct answer: Administrative/regulatory law via the state nursing practice act

Nursing licensure and scope of practice are regulated through administrative law, specifically the state nursing practice act and its implementing regulations.

Question 118: A patient returning from surgery is alert but reports dizziness when sitting upright. The nurse's first action should be to:

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

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

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

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

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

Question 120: To promote a therapeutic environment, the RPN should schedule client interactions:

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

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

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

Correct answer: Sundowner's syndrome (sundowning)

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

Question 122: Which of the following BEST describes 'transference' in the context of a therapeutic nurse-client relationship?

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

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

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

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

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

Question 124: Which assessment tool is MOST appropriate for screening an older adult for cognitive impairment?

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

Correct answer: Mini-Mental State Examination (MMSE)

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

Question 125: A patient who is a Jehovah's Witness refuses a blood transfusion ordered by the physician. The RPN should:

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

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

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

Question 126: A client states, 'I don't want to talk about my past.' The RPN should respond by:

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

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

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

Question 127: 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 128: Which of the following statements by an RPN best demonstrates the concept of empathy in a therapeutic nurse-client relationship?

"This must be a very difficult and frightening experience for you." (Correct answer)
"I went through something similar once, and I know exactly how you feel."
"Don't worry, everything will be okay in the end."
"I feel so sorry for you; what you're going through is terrible."

Correct answer: "This must be a very difficult and frightening experience for you."

Empathy involves understanding and acknowledging the client's feelings from their perspective without taking on those feelings (sympathy) or offering false reassurance. [10, 26] This option validates the client's experience and feelings without judgment or comparison, which is a core component of a therapeutic relationship. [13, 27]

Question 129: A patient asks why the nurse washes hands before and after wearing gloves. The best explanation is:

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

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

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

Correct answer: Termination phase

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

Question 131: Which of the following is an example of a pharmacokinetic drug interaction?

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

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

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

Question 132: The ethical principle of 'justice' in nursing practice primarily refers to:

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

Correct answer: Fair and equitable distribution of care and resources

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

Question 133: A patient verbally abuses the RPN during care. The nurse has the right to:

Refuse all further care for that patient without notifying anyone
Leave the unit for the remainder of the shift
Set limits on abusive behavior while continuing to provide care (Correct answer)
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 134: 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
Complete an incident report and notify the supervisor per facility policy (Correct answer)
Only report it if the client asks what happened

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 135: 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 136: A client at 41 weeks gestation is scheduled for a nonstress test (NST). Which result indicates a reactive (normal) NST?

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

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

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

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

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

Question 138: A nurse applies a continuous pulse oximetry probe to a patient's finger. The reading is 84% despite the patient appearing comfortable. What should the nurse do first?

Notify the physician of critical desaturation
Administer supplemental oxygen immediately
Document the reading and continue monitoring
Assess probe placement, perfusion, and patient's actual respiratory status (Correct answer)

Correct answer: Assess probe placement, perfusion, and patient's actual respiratory status

A falsely low reading can result from poor probe placement, nail polish, peripheral vasoconstriction, or motion artifact, so clinical assessment comes before intervention.

Question 139: An RPN is positioning a client who is immobile to prevent the development of pressure injuries. To effectively relieve pressure on the sacrum and coccyx, which position is most recommended?

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

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

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

Question 140: When a colleague's unsafe practice is reported to management but no action is taken, the RPN's next step is to:

Escalate the concern to a higher authority such as the risk manager or nursing director (Correct answer)
Report the issue directly to the state board as the first escalation step
Accept management's inaction and move on
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 141: A patient is on contact precautions. A nurse enters the room to perform wound care. In what order should PPE be donned?

Gown, gloves, mask, goggles
Mask, goggles, gown, gloves
Gloves, gown, 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 142: When removing PPE after caring for a patient on contact precautions, which item should be removed first?

Gown
Gloves (Correct answer)
Goggles
Mask

Correct answer: Gloves

Gloves are removed first because they are the most contaminated item and removing them first prevents contaminating other surfaces during doffing.

Question 143: 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 144: A nurse is performing a suicide risk assessment. Which factor represents the HIGHEST risk for a completed suicide attempt?

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

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

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

Question 145: A client at 32 weeks gestation presents with painless, bright red vaginal bleeding. Which condition does the nurse suspect?

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

Correct answer: Placenta previa

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

Question 146: 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 but limit the information the client can see on their profile.
Accept the request to be friendly and build rapport with the client.
Ignore the request and pretend they did not see it.
Politely decline the request and explain the importance of maintaining a therapeutic relationship. (Correct answer)

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

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

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 148: Which communication technique involves repeating the last word or phrase a client uses to encourage them to continue?

Clarification
Confrontation
Summarization
Reflection (Correct answer)

Correct answer: Reflection

Reflection echoes the client's words to signal active listening and invite further exploration of their thoughts.

Question 149: A patient with MRSA is on contact precautions. The nurse must transport the patient for an X-ray. What action is appropriate?

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

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

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

Question 150: A nurse leaves blank lines in a narrative nursing note. What is the risk associated with this practice?

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

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

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

Question 151: A nurse assesses a newborn and notes a soft, fluctuant swelling on the scalp that crosses the suture lines. This finding is consistent with:

Cephalohematoma
Craniosynostosis
Caput succedaneum (Correct answer)
Subdural hematoma

Correct answer: Caput succedaneum

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

Question 152: In electronic health records (EHR), 'copy and paste' of previous assessments without review poses a risk because:

It takes longer than typing a new entry
EHR systems do not allow copy and paste functions
It can perpetuate inaccurate or outdated information in the record (Correct answer)
It requires additional physician co-signature

Correct answer: It can perpetuate inaccurate or outdated information in the record

Copying old assessments without verifying current patient status can propagate errors and create a misleading picture of the patient's condition.

Question 153: Which defense mechanism is a client using when they say, 'My coworker is the one who is always angry, not me'?

Displacement
Projection (Correct answer)
Reaction formation
Rationalization

Correct answer: Projection

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

Question 154: Which technique should the RPN use when assessing bowel sounds?

Palpate deeply first to assess organ position
Auscultate before palpating to avoid altering bowel activity (Correct answer)
Percuss before auscultating to stimulate sounds
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 155: An RPN signs off on care they did not personally perform in order to help a busy colleague. This constitutes:

Acceptable team documentation practice
Falsification of medical records, a form of fraud (Correct answer)
Legal if the colleague verbally confirms the care was done
A minor charting irregularity correctable with an addendum

Correct answer: Falsification of medical records, a form of fraud

Charting care that one did not personally perform or verify is falsification of medical records, which is both illegal and a serious professional violation.

Question 156: A patient is placed in the Trendelenburg position. Which clinical situation is this position CONTRAINDICATED?

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

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 157: 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?

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

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

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

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

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

Question 159: When should the nurse perform hand hygiene according to WHO's Five Moments for Hand Hygiene?

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

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

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

Question 160: What does 'duty of care' mean for an RPN in the context of professional ethics?

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)
The duty to follow all physician orders without question
The obligation to care for any client regardless of personal risk

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

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

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

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

Question 162: Which statement best describes the concept of 'scope of practice' for an RPN?

The range of tasks any nursing staff member can legally perform
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)

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 163: An RPN is admitting an 82-year-old client to a long-term care facility. The client has a history of osteoporosis, takes a diuretic for hypertension, and wears bifocal glasses. What is the RPN's priority action related to the client's safety?

Complete a comprehensive fall risk assessment using a standardized tool. (Correct answer)
Ensure the client's call bell is within reach at all times.
Teach the client how to use the grab bars in the bathroom.
Request a prescription for a bed alarm from the physician.

Correct answer: Complete a comprehensive fall risk assessment using a standardized tool.

The nursing process dictates that assessment is the first and most critical step. Given the client's multiple risk factors for falls (advanced age, osteoporosis, diuretic use which can cause orthostatic hypotension, and visual impairment), a comprehensive fall risk assessment is the priority. This assessment will guide the development of a person-centered care plan with specific interventions to mitigate these risks.

Question 164: When documenting a patient's refusal of a prescribed treatment, the nurse must include:

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

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

Background
Situation
Assessment (Correct answer)
Recommendation

Correct answer: Assessment

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

Question 166: An RPN prepares a dose of warfarin and notices the INR result is 4.8. What is the priority action?

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

Correct answer: Hold the dose and notify the prescriber immediately

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

Question 167: Which position should the nurse place a postpartum client in immediately after an epidural birth to prevent supine hypotension?

Left lateral or semi-recumbent with a lateral tilt (Correct answer)
Prone with a pillow under the abdomen
Supine with legs flat
High Fowler's position

Correct answer: Left lateral or semi-recumbent with a lateral tilt

Left lateral positioning or uterine displacement prevents aortocaval compression by the gravid uterus, maintaining cardiac output.

Question 168: An RPN is conducting a home care visit for a client with chronic heart failure (CHF). The client reports a weight gain of 2 kg in the past two days and feeling more short of breath than usual. What is the RPN's priority action?

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

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

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

Question 169: 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."
"The focus will be on aggressive new treatments to try and reverse the lung damage."
"We will now stop all treatments aimed at your breathing and focus only on comfort."
"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 170: An RPN is administering an IM injection to an adult patient. Which is the preferred site for a large-volume IM injection?

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

Correct answer: Ventrogluteal site

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

Question 171: When assisting a patient to transfer from bed to wheelchair, the nurse should position the wheelchair at what angle to the bed?

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

Correct answer: 45 degrees

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

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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