Question 1

A registered nurse (RN) is working on a medical-surgical unit with one licensed practical nurse (LPN) and one unlicensed assistive personnel (UAP). Which task is within the RN’s scope of practice and should NOT be delegated?

Accepted Answer

Answer reason: The initial assessment of a newly admitted client requires comprehensive data collection, clinical judgment, and formulation of nursing diagnoses, which are responsibilities that fall exclusively within the RN’s scope of practice. This task cannot be delegated.
Obtaining vital signs and assisting with ambulation are appropriate tasks for UAP when the client is stable. Reinforcing previously provided teaching may be delegated to an LPN, depending on institutional policy, but the initial assessment must be completed by the RN.

Question 2

Which of the following is NOT a fundamental right of a nurse?

Accepted Answer

Answer reason: Core nursing roles include promoting health, preventing illness, and restoring health. Maintaining illness contradicts the goals of nursing care and is not a fundamental role or right.

Question 3

If a nurse is uncertain about whether he or she is licensed to perform certain tasks, it is best to check?

Accepted Answer

Answer reason: The state Nurse Practice Act legally defines a nurse's scope of practice and what tasks are permitted. Colleagues, employers, or professional certificates do not establish legal authority to perform tasks.

Question 4

What is the primary role of the pediatric nurse?

Accepted Answer

Answer reason: The core role of pediatric nursing centers on advocacy for the child and family, education to promote understanding and participation in care, and management and coordination of care. This best aligns with option B.

Question 5

Who collects the blood specimen?

Accepted Answer

Answer reason: Blood collection falls within the nurse’s legal and professional scope when trained and authorized by facility policy.

Question 6

Nursing diagnoses include the following three types?

Accepted Answer

Answer reason: NANDA-I classifies nursing diagnoses as actual (problem-focused), risk, and health promotion (wellness). Collaborative problems are not nursing diagnoses, and “holistic” is not a NANDA type.

Question 7

What is the primary function of a surgical scrub nurse during an operation?

Accepted Answer

Answer reason: The scrub nurse’s primary role is to maintain the sterile field and pass sterile instruments and supplies to the surgeon. Monitoring vitals and administering anesthesia are anesthesia/circulating nurse roles; diagnosis is not a nursing function.

Question 8

Which nursing personnel is considered the first level professional nurse and provides direct patient care?

Accepted Answer

Answer reason: A staff nurse is the first-line professional nurse who delivers direct bedside care; DNS, ANS, and nursing superintendent are primarily administrative/supervisory roles.

Question 9

Which of the following is NOT a job responsibility of a nursing superintendent in the hospital?

Accepted Answer

Answer reason: Maintaining admission registers is a clerical/ward-level task handled by registration/ward staff, not the nursing superintendent. A superintendent’s role focuses on policy planning, organizational structure, and supervisory rounds.

Question 10

The newly licensed nurse has been asked to perform a procedure that he feels unqualified to perform. The nurse’s best response at this time is to?

Accepted Answer

Answer reason: If a nurse feels unqualified, the safest and professionally responsible action is to refuse and explain the reason, seeking appropriate guidance or training to protect patient safety and remain within scope of practice.

Question 11

To which level of management does the ANS of a hospital belong?

Accepted Answer

Answer reason: Assistant Nursing Superintendent is a middle-level nursing management role, positioned between the Nursing Superintendent (top level) and ward/unit managers and staff (first/operating levels).

Question 12

Which assignment should not be performed by the licensed practical nurse?

Accepted Answer

Answer reason: Initiating a blood transfusion must be done by an RN. LPNs may monitor after initiation. Tasks like inserting a Foley, discontinuing an NG tube, and obtaining sputum specimens are within LPN scope.

Question 13

Which assignment should not be performed by the registered nurse?

Accepted Answer

Answer reason: Suturing is a medical procedure performed by physicians or advanced practice providers, not RNs.

Question 14

The registered nurse arrives at work and is told to report (float) to the intensive care unit (ICU) for the day because the ICU is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the ICU. Which of the following is most appropriate nursing action?

Accepted Answer

Answer reason: When floated to an unfamiliar unit, the RN should accept the assignment but perform only activities within competence and request tasks that can be done safely. Refusal or calling a lawyer is inappropriate; notifying a supervisor may be needed if unsafe, but the best action is to report and clarify safe duties.

Question 15

Members of the team know their boundaries and ask for help before the resuscitation attempt worsens. Match this statement with the most appropriate element of team dynamics listed?

Accepted Answer

Answer reason: The statement describes recognizing personal limits and seeking assistance early, which is the team dynamic of knowing your limitations.

Question 16

In the hospital who runs most of the activities?

Accepted Answer

Answer reason: Nurses coordinate and manage the day-to-day delivery of patient care, providing continuous 24/7 presence on units. They implement providers’ orders, monitor patients, prioritize and delegate tasks, and coordinate with interdisciplinary teams. Physicians direct medical decision-making, but nurses operationalize and oversee most routine activities that keep care moving safely and efficiently.

Question 17

Obstetrics first aid orientation program is targeted to,?

Accepted Answer

Answer reason: Obstetric First Aid orientation is designed for frontline maternal–child health workers who provide basic delivery services at the community level. In many health systems, Auxiliary Nurse Midwives (ANMs) staff subcenters and are the first to recognize and stabilize obstetric emergencies before referral. Training them in first-aid measures (e.g., uterotonics, initial management of eclampsia, rapid referral) reduces delays and improves outcomes. Thus, the program is primarily targeted to ANMs.

Question 18

The primary purpose of nursing assessment is to?

Accepted Answer

Answer reason: Assessment gathers subjective and objective data to identify the patient's responses to health problems and determine needs and priorities. These findings form the basis for nursing diagnoses and subsequent planning. Medical disease diagnosis is a provider role, and creating care plans and administering medications occur after assessment in the nursing process.

Question 19

Nurse practitioners were first allowed to prescribe medications in this state?

Accepted Answer

Answer reason: North Carolina pioneered legislation establishing the nurse practitioner role and granting prescriptive authority under joint regulation by the medical and nursing boards in the early 1970s. California and Texas implemented NP prescribing later and with more restrictions initially. Delaware was not the first state to authorize NP prescribing. Therefore, North Carolina is the correct answer.

Question 20

Which is NOT a trauma nurse’s responsibility?

Accepted Answer

Answer reason: Trauma nurses are responsible for rapid assessment, initiating life-saving interventions (e.g., airway, breathing, circulation support), and coordinating care with the interprofessional trauma team. Making a medical diagnosis is typically the provider’s role (e.g., physician/NP/PA), while nurses identify problems, monitor status, and implement protocol-driven interventions within their scope. Therefore, “Diagnosing conditions” is not a trauma nurse’s responsibility in the traditional scope-of-practice framework.

Question 21

A nurse received order that is unclear. What should nurse do?

Accepted Answer

Answer reason: An unclear or incomplete order must be clarified with the prescribing provider before implementation to ensure client safety and correct treatment. Carrying out an order based on a “best guess” is unsafe and outside standards of care. Asking another nurse does not replace prescriber clarification, and ignoring the order is inappropriate; the nurse should seek clarification and then document appropriately.

Question 22

True or False A nursing assistant can assess a patient’s pain level?

Accepted Answer

Answer reason: False Pain assessment (interpreting and evaluating the patient’s pain and determining needed interventions) is a nursing function requiring RN/LPN judgment. Nursing assistants may obtain and report objective data and patient statements (e.g., pain score) using a tool, but they do not independently assess pain or decide clinical responses. The RN remains accountable for comprehensive assessment and care planning based on reported findings.

Question 23

Based on the LPN's scope of practice in Quebec, what is the best course of action?

Accepted Answer

Answer reason: Proceed with the IV insertion as ordered, because the patient meets all conditions required. This item is primarily about practicing within LPN scope and following applicable conditions/restrictions for performing IV therapy in Quebec. Being a minor alone is not an automatic prohibition, and consent rules depend on the minor’s capacity and the situation rather than always requiring a parent. If the order is valid and the patient meets the required conditions for LPN IV insertion, the safest, most appropriate action is to proceed within scope.

Question 24

The physician orders a platelet count to be performed on Mrs. Smith after breakfast. The nurse is responsible for?

Accepted Answer

Answer reason: Patient education about ordered diagnostic tests is within the nurse’s scope and supports informed participation and anxiety reduction. Writing or entering a medical order is a provider responsibility (and only may occur under specific protocols/authorized order sets), so it is not a general nursing responsibility. The timing “after breakfast” is part of carrying out the order, but “giving the patient breakfast” is not inherently required for the test and is not the key professional responsibility being tested here.

Question 25

A nurse wants to become a specialist in public health nursing. Which educational requirement will the nurse have to obtain?

Accepted Answer

Answer reason: Specialist roles in public health nursing typically require advanced preparation beyond entry-level or baccalaureate education, including graduate coursework that builds expertise in population-focused assessment, epidemiology, program planning, and policy. Basic entry-level preparation and the education level of a general community health nurse are not sufficient for an advanced specialist scope. Graduate education provides the depth needed for leadership, advanced practice functions, and complex community/public health interventions.

Question 26

A nurse prepares to administer medication to a client and notes that the prescribed dose is higher than the recommended dosage. The health care provider was called by the nurse to clarify the prescription and the health care provider instructs the nurse to administer the dose as prescribed. Which action should the nurse take?

Accepted Answer

Answer reason: The nurse has identified a potential medication error (dose higher than recommended) and already sought clarification from the prescriber, yet the order remains potentially unsafe. Under nursing scope of practice and patient safety principles, the nurse must not proceed with an order believed to be harmful and should escalate through the chain of command for further direction and risk mitigation. Involving the nursing supervisor supports timely resolution, documentation, and appropriate consultation (e.g., pharmacy/medical leadership) while protecting the client from preventable adverse drug events.

Question 27

What is the primary role of a practical nurse (PN)?

Accepted Answer

Answer reason: Practical nurses/vocational nurses deliver fundamental bedside care (e.g., hygiene, vital signs, basic assessments, and routine treatments) under the direction of an RN/physician and within facility policy. Diagnosing, independently creating comprehensive care plans, and performing surgery are outside a PN’s legal scope of practice. The safest, most accurate description of the PN’s primary function is providing basic nursing care and reporting findings to the supervising nurse/provider.

Question 28

Nurse practitioner prescriptive authority is regulated by?

Accepted Answer

Answer reason: Prescriptive authority for nurse practitioners is granted and governed at the state level through each state’s Nurse Practice Act and implementing regulations. The state Board of Nursing sets licensure requirements, scope of practice boundaries, and conditions (e.g., collaboration/supervision) that determine whether and how an NP may prescribe. Federal agencies like the DEA regulate controlled-substance registration and compliance, but they do not define an NP’s underlying legal authority to prescribe within a state. Boards of Pharmacy oversee pharmacists and medication dispensing rules rather than NP licensure scope.

Question 29

A new AV fistula has received its post op exam, meets the criteria listed in the KDOQI Rule of 6s and has progressed wires orders to begin cannulation. Which teammates can cannulate the AVF?

Accepted Answer

Answer reason: Cannulation of an AV fistula is a regulated, competency-based skill that must be performed by personnel who are trained and validated as competent per facility policy and scope of practice. Limiting cannulation only to a specific “beginner/intermediate/advanced” label is less defensible than ensuring the individual has completed formal training and competency verification. Once the access is clinically ready (e.g., meeting maturation criteria) and there is an order to begin cannulation, the key safety requirement is that the cannulator is appropriately trained and authorized. This reduces risks such as infiltration, hematoma, thrombosis, and access loss.

Question 30

A staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional intervention?

Accepted Answer

Answer reason: Advanced practice registered nurses (e.g., psychiatric mental health nurse practitioners) have an expanded scope that can include diagnosing mental health conditions and prescribing medications, depending on jurisdiction. The other actions listed—assessment, therapeutic communication, and individualized care planning—are within the registered nurse’s scope and are routinely performed by staff nurses in psychiatric settings. Therefore, prescribing is the distinguishing additional intervention expected of an advanced practice nurse.

Question 31

The use of interpersonal decision making, psychomotor skills, and application of knowledge expected in the role of a licensed health care professional in the context of patient welfare and safety is an example of?

Accepted Answer

Answer reason: Competence refers to the integrated ability to apply knowledge, psychomotor skills, and interpersonal decision-making to perform professional duties safely and effectively. The stem describes expected performance within the licensed role with a focus on patient welfare and safety, which aligns with competency standards. Delegation, supervision, and responsibility are related management concepts but do not, by themselves, define the overall capability to perform to required standards.

Question 32

A nurse was recently promoted to a middle-level manager position. The nurse's title would most likely be which of the following?

Accepted Answer

Answer reason: Middle-level nurse managers typically oversee multiple units or an entire service line and coordinate first-line managers, staffing, budgets, and quality initiatives across a broader area. First-line managers (e.g., nurse managers) generally supervise a single unit and direct day-to-day operations. Executive-level roles include the vice president of patient care services and the chief nurse executive, which are higher than middle management in the organizational hierarchy.

Question 33

Which of the following roles BEST exemplifies the expanded role of the nurse?

Accepted Answer

Answer reason: An expanded nursing role refers to advanced practice nursing with greater autonomy, advanced assessment/diagnostic skills, and authority to manage care (often including prescribing within legal scope). A pediatric nurse practitioner is an advanced practice registered nurse role, whereas circulating, medication, and obstetrical nurses are staff RN roles within traditional nursing practice. The NP role reflects expanded education, clinical decision-making, and broader scope of practice compared with bedside specialty nursing positions.

Question 34

A client with symptoms of influenza that started the previous day ask the clinic nurse about taking oseltamivir (Tamiflu) to treat the infection. Which response should the nurse provide?

Accepted Answer

Answer reason: Early treatment (ideally within 48 hours of symptom onset) may reduce duration and complications, so timely medical evaluation for prescribing is appropriate. While client teaching that influenza is viral is correct, it does not address the client’s specific request for an antiviral that requires a prescription. Stating that OTC medications are sufficient is unsafe because higher-risk clients may benefit from antivirals and need assessment for severity, contraindications, and dosing.

Question 35

The nurse provides care for a pediatric client who presents in the emergency department after falling off a bicycle. The client is diagnosed with hemophilia. Which intervention does the nurse implement without a prescription from the healthcare provider?

Accepted Answer

Answer reason: Cold application causes local vasoconstriction and can help limit bleeding into tissues, which is particularly important in hemophilia. In contrast, giving analgesics generally requires a provider order (unless a standing PRN order exists), and suturing is a provider procedure. Factor VIII replacement is a blood product/medication therapy that requires a prescription and appropriate verification and monitoring before administration.

Question 36

What is the most important aspect to determine when deciding which nursing care delivery system should be used?

Accepted Answer

Answer reason: Licensure level (RN, LPN/VN, UAP) determines what assessments, planning, teaching, and interventions can be performed and what must be delegated or supervised. Choosing a model that does not align with licensure creates unsafe care and exposes the organization to liability, regardless of other staffing characteristics. While experience and staffing numbers affect feasibility and workload, they cannot override the legal limits set by licensure. Staff preference is least important because patient safety and compliance drive the selection of an appropriate delivery system.

Question 37

The client with dementia and confusion is transferred from the hospital to the nursing home. The client’s family has not yet arrived at the nursing home. Which direction is appropriate for the RN to provide to the LPN?

Accepted Answer

Answer reason:  Delegation is based on scope of practice: the RN retains responsibility for comprehensive assessment and cannot assign it to an LPN. Assisting with dressing is a predictable, routine supportive-care task that is appropriate to delegate and also promotes independence and reduces frustration in a confused client. Having the client wait in a wheelchair near the nurses’ station is not a therapeutic or least-restrictive plan and can increase agitation and fall risk if the client attempts to stand. Taking a photograph for medication administration is not required for safe administration and raises privacy/consent concerns, especially when the client is cognitively impaired and family has not arrived.

Question 38

The nurse is unsure whether it is appropriate to delegate I.V. site observation to the licensed practical nurse. Which is the ultimate authority to consult to make this decision?

Accepted Answer

Answer reason: The State Nurse Practice Act is the legal authority that defines the scope of nursing practice and delegation rules within a specific jurisdiction. It overrides facility policies and professional guidelines. While institutional policies and professional standards provide guidance, they must align with the legal framework established by the Nurse Practice Act.

Question 39

In caring for a victim of sexual assault, which task is most appropriate for an LPN/LVN?

Accepted Answer

Answer reason: Therapeutic communication and emotional support are appropriate delegated tasks because they do not require independent clinical judgment or specialized certification. Initial assessment of injuries and emotional status guides care priorities and is an RN responsibility. Maintaining chain of custody and collecting forensic specimens are highly regulated, time-sensitive legal processes typically performed by a Sexual Assault Nurse Examiner (SANE) or other credentialed clinician to preserve evidentiary integrity.

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