2019-2023 ATI RN Leadership Proctored Exam With NGN Answers-209 Solved Questions

NGN ATI RN LEADERSHIP PROCTORED EXAM 2019 UPDATED
VERSION 2023 A+ GRADED
Leadership
Form A
1. A nurse tells the unit manager, “I am tired of all the changes on the unit. If things don’t get
better, I’m going to quit.” Which of the following responses by the unit manager is appropriate?
A. You should file a written complaint with hospital administration
B. Just stick with it a little longer. Things will get better soon
C. So, you are upset about all the changes on the unit?
D. I think you have a right to be upset. I am tired of the changes, too
2. A charge nurse notices that two staff nurses are not taking meal breaks during their shifts.
Which of the following actions should the nurse take first?
A. Provide coverage for the nurses’ breaks
B. Review facility policies for taking scheduled breaks
C. Determine the reasons the nurses are not taking scheduled breaks
D. Discuss time management strategies with the nurses
3. A client has a new permanent pacemaker inserted. Which of the following home care
instructions should the nurse include?
A. Regular programming evaluations can be conducted by telephone
B. The client should avoid using remote control devices to prevent dysrhythmias
C. The client should avoid using a microwave oven to heat food
D. Swimming could cause the unit to have an electrical short
4. A nurse manager is reviewing isolation guidelines with a newly licensed nurse. Which of the
following statements by the newly licensed nurse indicates an understanding of the teaching?

A. I will use an alcohol-based hand cleanser when caring for a client who has C. diff
B. I will wear a cover gown when caring for a client who has herpes simplex
C. I will wear an N95 respirator mask when caring for a client who is on contact precautions
D. I will place a client who requires protective isolation in a negative airflow room
5. A staff nurse is supervising a newly licensed nurse who is preparing to administer an
intermittent tube feeding to a client. Which of the following actions by the newly licensed nurse
is appropriate?
A. Adding colored food dye to the formula
B. Flushing the tube with 15 mL of water
C. Elevating the head of the bed to a 20-degree angle
D. Checking residual volume before each feeding
6. A nurse is preparing an education program about professional codes of ethics for nurses.
Which of the following information should the nurse plan to include?
A. A code of ethics is a step-by-step approach to decision-making
B. A code of ethics is a set of principles for nursing practice
C. A code of ethics is legally binding
D. A code of ethics outlines the nurse’s scope of practice
7. A nurse receives change-of-shift report for the following four clients. Which of the following
clients should the nurse assess first?
A. An older adult client who has bacterial pneumonia and a new onset of restlessness
B. A client who is 1-day postoperative following hip fracture repair and reports a pain level of 6
on a scale from 0 to 10
C. A middle adult client who has diabetes mellitus and a morning blood glucose of 172 mg/dL
D. A client who has myasthenia gravis with ptosis and has developed urinary incontinence
8. A charge nurse is assessing staff knowledge about safety procedures regarding needle-stick
injuries. Which of the following statements by a nurse indicates appropriate understanding of
these safety procedures?

A. Prophylactic treatment should be initiated after a needle-stick during preparation of an
injection
B. The needle should be recapped to prevent injury during transport to the biohazard container
C. I should stop the bleeding as soon as possible following a needle-stick injury
D. An incident report should be completed if a client receives a stick from her own used
needle
9. A case manager is reviewing documentation on several clients and notes a progress report that
falsely identifies a client as HIV-positive due to multiple sexual partners. The nurse manager
should identify that which of the following torts has occurred?
A. Libel
B. Battery
C. Slander
D. Negligence
10. A charge nurse making rounds observes that an assistive personnel (AP) has applied wrist
restraints to a client who is agitated and does not have a prescription for restraints. Which of the
following actions should the nurse take first?
A. Inform the unit manager of the incident
B. Review the chart for nonrestraint alternatives for agitation
C. Remove the restraints from the client’s wrists
D. Speak with the AP about the incident
11. To resolve a conflict between staff members regarding potential changes in policy, a nurse
manager decides to implement the changes she prefers regardless of the feelings of those who
oppose those changes. Which of the following conflict resolution strategies is the nurse manager
using?
A. Compromising
B. Collaborating
C. Cooperating
D. Competing

12. A nurse is caring for a client and notices fraying on the electrical cord of the client’s IV
pump. Which of the following actions is the priority for the nurse to take?
A. Remove the IV pump from the client’s room
B. Check the expiration date of the inspection sticker
C. Report the problem to the engineering team
D. Request a replacement IV pump
13. A nurse is providing discharge teaching to the parent of a toddler who has a new diagnosis of
asthma. The parent states she is unable to afford the nebulizer prescribed for the child. Which of
the following referrals should the nurse recommend?
A. Pharmacist
B. Child protective services
C. Social worker
D. Respiratory therapist
14. A charge nurse is completing client care assignments. Which of the following assignments is
appropriate for a licensed practical nurse?
A. A client who requires discharge instructions for type 1 diabetes mellitus
B. A client who requires a blood transfusion to be administered
C. A client who is 1 day postoperative and has a continuous bladder irrigation
D. A client who is receiving IV chemotherapy
15. A nurse is caring for a client who is comatose and has advance directives designating his
adult daughter as his health care proxy. The client’s partner instructs the nurse to institute CPR if
the client experiences cardiac arrest. Which of the following actions should the nurse take?
A. Have the partner notify the daughter about changes to the advance directives
B. Inform the partner that the staff must follow the client’s advance directives
C. Contact the client’s attorney about the partner’s request
D. Initiate new advance directives incorporating the partner’s request

16. A nurse from the labor and delivery unit is assigned to float to a medical-surgical unit. Which
of the following actions should the nurse take first?
A. Inform the nursing supervisor of the lack of experience on the medical-surgical unit
B. Request orientation to the medical-surgical unit
C. Refer to the assigned resource nurse regarding client assignments
D. Clarify competencies with the medical-surgical change nurse
17. A nurse in the emergency department is preparing a married 17-year-old client for an
appendectomy. The client’s parents are end route to the facility but have not spoken with the
surgeon. Which of the following actions should the nurse take?
A. Have the client sign the consent form after the surgeon explains the procedure
B. Obtain consent from the client’s parents by telephone with another nurse listening as a
witness
C. Proceed with the preparation because the client signed a general consent form
D. Delay the surgery until the parents arrive to sign the consent form
18. Client satisfaction surveys from a surgical unit indicate that pain is not being adequately
relieved during the first 12 hr postoperatively. The unit manager decides to identify postoperative
pain as a quality indicator. Which of the following data sources will be helpful in determining
the reason why clients are not receiving adequate pain management after surgery?
A. Pain assessment policy
B. Postoperative care policy
C. Prospective chart audit
D. Retrospective chart audit
19. A nurse manager is reviewing the nursing code of ethics with the staff nurses. Which of the
following statements by a staff nurse indicate understanding of the teaching? (Select all that
apply.)
A. I have the assistive personnel double-check packed RBCs when other nurses are busy
B. I can delegate the removal of an IV catheter to an LPN on the unit
C. I will attend continuing education classes for professional growth

D. The family of a newly admitted client recently treated me to lunch in the hospital cafeteria
E. I administer pain medication to my clients even if they have a history of narcotic
addiction
20. A nurse on a surgical unit is preparing to transfer a client to a rehabilitation facility. Which of
the following information should the nurse include in the change-of-shift report?
A. The time the client received his last dose of pain medication
B. The belief that the client has a difficult relationship with his son
C. The client’s preferred time for bathing
D. The steps to follow when providing wound care
21. A nurse on a medical-surgical unit is delegating client care. Which of the following tasks
should the nurse delegate to assistive personnel?
A. Performing a dressing change on a client’s peripherally inserted central catheter
B. Instructing a client on self-administration of a tap water enema
C. Using a pain rating scale to monitor a client’s pain level
D. Suctioning a client’s long-term tracheostomy
22. A nurse on a medical-surgical unit is making staff assignments. Which of the following tasks
should the nurse delegate to assistive personnel?
A. Pouching a client’s established ostomy
B. Updating a family member about a client’s condition
C. Reinforcing teaching with a client about a low-sodium diet
D. Demonstrating the use of an incentive spirometer to a client
23. A charge nurse is reviewing how to set up a sterile field with a newly licensed nurse. Which
of the following statements by the newly licensed nurse indicates an understanding of the
process?
A. I will open the outermost flap of the sterile tray towards my body
B. I will place the sterile tray on a bedside table that is raised to just below my waist level
C. I can touch the outer 2 inches of the sterile field without gloves

D. I will keep the label of the solution bottle facing up when pouring solution into the
sterile cup
24. A nurse is providing care for four postoperative clients. The nurse should first assess the
client
A. Who reports nausea after the prescribed antiemetic was administered
B. Whose urine output has averaged 32 mL/hr for the past 24 hr
C. Who reports a pain level of 8 on a scale of 0 to 10
D. Whose pulse has been steadily increasing during the past shift
25. A charge nurse overhears a provider and a nurse talking about a client’s diagnosis in the
cafeteria. Which of the following actions should the nurse take first?
A. Remind them that client information is confidential
B. Report the incident to the nursing supervisor
C. Complete an incident report about the situation
D. Discuss the need for client confidentiality at the next staff meeting
26. A facility provides annual staff education regarding ethical practice. A charge nurse
recognizes a need for further education when which of the following behaviors is observed?
A. A nurse refuses to actively participate during an elective abortion procedure scheduled for her
client
B. A nurse gives prescribed opioids to a client who has a terminal illness and respirations of
8/min
C. A nurse explains to a client’s family that a DNR order includes withholding comfort
measures
D. A nurse informs a confused client who wants to go home that he is going to stay at the facility
until he is better
27. The family members of an older adult client are expressing conflict over whether the client
should have surgery that is recommended by the provider. The oldest adult child has durable

power of attorney for health care for the client. The client is oriented to person, place, and time.
Which of the following people has the legal authority to make this health care decision?
A. The provider
B. The partner
C. The client
D. The oldest adult child
28. A nurse is preparing to discharge a client who requires home oxygen. The equipment
company has not yet delivered the oxygen tank. Which of the following actions should the nurse
take?
A. Send an oxygen tank from the facility home with the client
B. Instruct the client’s family to contact the insurance provider about the oxygen equipment
C. Contact social services about the delivery of the oxygen equipment
D. Notify the provider about the delayed oxygen tank delivery
29. A nurse in a long-term care facility is assessing a client who has returned from an acute care
facility following a brief illness. The nurse observes that the client is confused and agitated.
Which of the following actions should the nurse take first?
A. Medicate the client with alprazolam
B. Reorient the client to his surroundings
C. Measure the client’s vital signs
D. Offer reassurance to the family
30. A nurse is caring for a client who is scheduled for a procedure. Which of the following is an
appropriate action when the nurse is witnessing the client signing the consent form? (Select all
that apply.)
A. Inform the client of available alternative therapies
B. Discuss benefits of the procedure with the client
C. Ensure the client gives consent voluntarily
D. Verify that the client affirms understanding of the procedure
E. Confirm the authenticity of the client’s signature

31. A nurse is documenting and completing an incident report after a client falls out of bed.
Which of the following actions should the nurse take when completing the documentation?
A. Document in nurse’s notes, “Photocopy of incident report sent to risk management”
B. Document in incident report, “Client found lying on the floor after falling out of bed”
C. Document in incident report, “Entered room and discovered client lying prone on the
floor”
D. Document in nurse’s notes, “Incident report completed and filed”
32. A nurse is providing discharge instructions to a client who is 2 hr postoperative following
cataract surgery on the left eye. Which of the following instructions should the nurse include in
the teaching?
A. Sleep lying on your right side
B. Bend at the waist if you must pick up an object from the floor
C. Remove your eye shield before going to bed
D. Place an ice pack on your left eye for 2 hours after you get home
33. A client is admitted with tuberculosis and placed in a negative-pressure room. Which of the
following nursing actions is appropriate?
A. Place a sign on the client’s door with the diagnosis
B. Notify the local health department of the admission
C. Determine who had contact with the client in the last 48 hr
D. Ensure that admitting staff undergo PPD skin tests
34. A nurse in the emergency department is preparing to care for a client who arrived via
ambulance. The client is disoriented and has a cardiac arrhythmia. Which of the following
actions should the nurse take?
A. Proceed with treatment without obtaining written consent
B. Have the client sign a consent for treatment
C. Notify risk management before initiating treatment
D. Contact the client’s next of kin to obtain consent for treatment

35. A nurse is preparing a client for surgery. The client has signed the consent form but tells the
nurse that she has reconsidered because she is worried about the pain. Which of the following
responses by the nurse is appropriate?
A. Why didn’t you discuss your concerns with your provider?
B. If you have the procedure now, you won’t have to deal with pain and disability later
C. You’ll be fine. You’ll receive a prescription for pain medication
D. I understand, and it’s not too late to change your mind
36. A charge nurse is evaluating a newly licensed nurse’s understanding of infection control
procedures. Which of the following actions demonstrates that the nurse is following the
appropriate protocol for a client who has streptococcal pharyngitis?
A. Placing the client in a positive-airflow room with 12 air exchanges per hour
B. Explaining to the client that he cannot have visitors until his manifestations resolve
C. Donning sterile gloves when performing routine oral care
D. Wearing a mask when within 1 m (3.3 ft) of the client
37. A nurse is planning to delegate client care assignments. Which of the following tasks should
the nurse plan to delegate to assistive personnel?
A. Informing a family of a client’s progress in physical therapy
B. Teaching a client to perform a finger-stick for testing blood glucose levels
C. Performing postmortem care prior to transferring the client to the morgue
D. Advising a client on self-administration of acetaminophen
38. A nurse is caring for a client who has increased intracranial pressure and is receiving IV
corticosteroids. Which of the following information is most important for the nurse to report at
shift change?
A. Most recent blood glucose reading
B. Laboratory tests scheduled for next shift
C. Reddened area on the coccyx
D. Glasgow Coma Scale score

39. A nurse in an urgent care clinic is admitting a client who has been exposed to a liquid
chemical in an industrial setting. Which of the following actions should the nurse take first?
A. Report the incident to OSHA
B. Irrigate the exposed area with water
C. Remove the client’s clothing
D. Don personal protective equipment
40. A nurse is evaluating care for a group of clients. The nurse should consult the provider for
which of the following clients?
A. A client who requires an IV intermittent bolus dose of vancomycin and has a creatinine
level of 1.5 mg/dL
B. A client who is ready for discharge after coronary artery stent placement and has a
prescription for clopldogrel
C. A client who has a pacemaker and whose cardiac monitor shows sinus rhythm with
intermittent periods of a wide QRS complex after each pacer spike
D. A client who has atrial fibrillation and a rapid ventricular rate of 105/min and is receiving
diltiazem IV and weight-based heparin
41. A nurse is planning care for four clients who were classified using a disaster triage tag
system following a mass casualty event. Which of the following clients should the nurse identify
as the priority?
A. A client who has a green tag
B. A client who has a black tag
C. A client who has a red tag
D. A client who has a yellow tag
42. A nurse is delegating tasks to assistive personnel (AP). Which of the following tasks should
the nurse assign to the AP?
A. Instruct a client about the use of an incentive spirometer
B. Check on a client whose telemetry monitor is continuously beeping

C. Determine whether an oxygen flow meter is accurately set at 2 L/min via nasal cannula
D. Tag a malfunctioning piece of equipment as broken
43. A nurse is assessing a client who had a stroke 2 days ago. Which of the following findings
should the nurse identify as a need for a referral to speech language pathology?
A. Altered level of consciousness
B. Impaired voluntary cough
C. Diminished hand-to-mouth coordination
D. Unilateral ptosis
44. A home health nurse is assessing the home environment during an initial visit to a client who
has a history of falls. Which of the following findings should the nurse identify as increasing the
client’s risk for falls? (Select all that apply.)
A. A two-wheeled walker used to assist the client with ambulation
B. A folding chair without arm rests
C. A throw rug covering some cracked vinyl flooring in the kitchen
D. A wheeled office chair at the client’s computer desk
E. A raised vinyl seat on the toilet in the bathroom
45. A charge nurse is assessing the room of a newly admitted client who has dysphagia. Which
of the following pieces of equipment should the nurse ensure is available in the client’s room?
A. Yankauer suction device
B. Large-handled utensils
C. Nasal cannula and oxygen
D. Bite block
46. A nurse is comparing the rate of medication errors on the medical unit to the rate from a
medical unit in a magnet hospital. Which of the following quality improvement methods is the
nurse using?
A. Risk benefit analysis
B. Structure audit

C. Benchmarking
D. Root cause analysis
47. A nurse is providing an in-service about client rights for a group of nurses. Which of the
following statements should the nurse include in the in-service?
A. A nurse can disclose information to a family member with the client’s permission
B. A nurse can apply restraints on a PRN basis
C. A nurse is responsible for informing clients about treatment options
D. A nurse can administer medications without consent to a client as part of a research study
48. A nurse in a clinic is teaching a newly licensed nurse about sexually transmitted infections.
The nurse should instruct the newly licensed nurse to report which of the following infections to
the health department?
A. Human papillomavirus
B. Trichomoniasis
C. Gonorrhea
D. Candidiasis
49. A charge nurse is educating a group of newly licensed nurses about the case management
approach to client care. Which of the following statements by a newly licensed nurse indicates
an understanding of the responsibilities of a nurse in case management?
A. Each nurse completes one specific task for a group of clients
B. Nurses use critical pathways when caring for clients
C. Nurses who have advanced training provide direct care for select clients
D. Nurses delegate and supervise assigned tasks
50. A nurse is caring for a client who has signed consent for the removal of a tumor in the left
frontal lobe of the brain. The client states, “The tumor is on the right side of my head.” Which of
the following actions should the nurse take?
A. Tell the client to mark the right side of his head with indelible ink
B. Contact the surgery department to validate the operative site

C. Continue with the surgery because the client already gave informed consent
D. Ask the surgeon to clarify the operative site with the client
51. A nurse on a medical-surgical unit is caring for four clients. The nurse should recognize that
which of the following clients is the highest priority?
A. A client who has peripheral vascular disease and has an absent pedal pulse in the right
foot
B. A client who is postoperative following a laminectomy 12 hr ago and is unable to void
C. A client who has MRSA and has an axillary temperature of 38 C (101 F)
D. A client who is newly diagnosed with pancreatic cancer and is scheduled to begin IV
chemotherapy
52. A nurse on a medical-surgical unit is preparing to assign vital sign measurements for a group
of clients. Which of the following clients should the nurse delegate to assistive personnel?
A. A client who has just returned to the unit from the PACU
B. A client who has a closed head injury and increased intracranial pressure
C. A client who has sickle-cell anemia and has completed an infusion of packed RBCs
D. A client who reports acute chest pain
53. A nurse is preparing a client for surgery. The client expresses concern that someone might
steal her purse during the procedure. Which of the following actions should the nurse take?
A. Tell the client to leave her purse in a drawer of the bedside table
B. Offer to store the purse at the nurses’ station
C. Offer to place the purse in the facility safe
D. Place the purse in the clothing bag with the client’s other belongings
54. A case manager observes a family member of a client who has Alzheimer’s disease throwing
books on the floor and sobbing while the client is having a diagnostic test. Which of the
following actions should the case manager take first?
A. Help the caregiver arrange for respite care
B. Offer to have a brief talk with the caregiver

C. Consult social services to explore counseling
D. Refer the caregiver to a local support group
55. A nurse is conducting a disaster preparedness drill with a group of nurses who are orienting
to the facility. Which of the following triage tag colors should the nurse instruct the group to
apply to a client who has full-thickness burns on 72% of his body?
A. Green
B. Yellow
C. Black
D. Red
56. A nurse is caring for a client who has early-stage Alzheimer’s disease. In which of the
following actions is the nurse acting as a client advocate?
A. Performing an updated cognitive assessment on the client
B. Requesting a referral for the client to attend reminiscent therapy sessions
C. Providing assistance for the client when ambulating down the hall
D. Reorienting the client several times throughout the day
57. A nurse is caring for a client who has a prescription for transcutaneous electrical nerve
stimulation (TENS). Which of the following members of the interdisciplinary team should the
nurse contact for assistance?
A. Occupational therapist
B. Respiratory therapist
C. Pharmacist
D. Physical therapist
58. A nurse is caring for a client who has a pressure ulcer on the coccyx. Which of the following
findings indicates the need for a referral to a wound care specialist?
A. Minimal signs of induration at the wound edges
B. Presence of granulated tissue over the wound
C. Presence of slough in the wound bed

D. Epithelialization noted in areas of tissue loss
59. A nurse is planning discharge for a client who has a new diagnosis of COPD and lives alone.
Which of the following actions is the nurse’s priority?
A. Suggest participating in a community support group
B. Provide printed materials for new prescriptions
C. Set up appointments for in-home physical therapy
D. Request a referral for a home safety assessment
60. A charge nurse witnesses an assistive personnel (AP) giving an oral medication to a client
who has dysphagia. Upon questioning, the AP states that a nurse poured the medication into a
cup and asked the AP to give it to the client. Which of the following actions should the charge
nurse take first?
A. Reinforce facility policy regarding medication administration with the AP
B. Discuss the situation with the nurse who poured the medication
C. Complete the appropriate documentation of the incident
D. Auscultate the client’s breath sounds
61. A nurse is observing assistive personnel (AP) administer a 0.9% sodium chloride enema to an
adult client. For which of the following actions by the AP should the nurse intervene?
A. Administers the solution at room temperature
B. Positions the client on her left side with knees flexed
C. Inserts the tubing 8 cm (3.1 in) into the rectum
D. Points tubing in the direction of the umbilicus during insertion
62. A nurse is preparing to transfer a client to the radiology department using a wheelchair.
Which of the following actions should the nurse take?
A. Leave a transfer belt in place until the client returns from radiology
B. Keep the footplates lowered throughout the transfer process
C. Push the wheelchair into the elevator, large wheels last
D. Test the locks on both wheels of the chair prior to transfer

63. A nurse manager is preparing to institute a new system for scheduling staff. Several nurses
have verbalized concern over the possible changes that will occur. Which of the following is an
appropriate method to facilitate the adoption of the new scheduling system?
A. Introduce the new scheduling system by describing how it will save the institution money
B. Offer to reassign staff who do not support the change to another unit
C. Identify nurses who accept the change to help influence other staff nurses
D. Provide a brief overview of the new scheduling system immediately before its
implementation
64. A nurse is planning discharge for a client following a hip arthroplasty. The client tells the
nurse that she lives alone. Which of the following actions should the nurse take first?
A. Report the information to the provider
B. Contact the case manager for a consultation
C. Determine the specific needs of the client
D. Document the client’s living situation in the medical record
65. A charge nurse is making assignments for a medical-surgical unit. Which of the following
clients is appropriate to assign to a licensed practical nurse?
A. A client who has emphysema and has an oxygen saturation level of 92%
B. A client who is scheduled to start oral nutrition 2 days after stroke
C. A client who is scheduled to receive 2 units of RBCs following a hip replacement
D. A client who has dehydration and is being admitted from the emergency department
66. A nurse enters a client’s room and identifies that the client is receiving too much IV fluid
because the IV pump is not working properly. Which of the following actions should the nurse
take first?
A. Place a faulty equipment tag on the pump
B. Auscultate the client’s lungs
C. Complete an incident report
D. Notify the provider

67. A nurse is discussing advance directives with a client. Which of the following statements by
the client indicates an understanding of advance directives?
A. I know I have the right to determine if I remain on a breathing machine
B. I know I’ll need a lawyer to change them later, so I want to get them right
C. I trust my doctor, so I’m going to leave it to him to do what’s best for me
D. By naming a health care proxy, I give up the right to make my own medical decisions
68. A nurse manager is receiving report and is faced with the following situations that require
intervention. Which of the following should the nurse manager address first?
A. Two nurses had a heated disagreement about a scheduling issue
B. No transport assistance is available to take a client to physical therapy
C. Three staff members have called to say they will be absent
D. A client is refusing care from assistive personnel of the opposite gender
69. A nurse is considering placing wrist restraints on a client who has cognitive deficits and has
pulled out his IV catheter. Before using wrist restraints, which of the following actions must the
nurse take first?
A. Attempt less restrictive alternatives
B. Explain the procedure to the client and his family
C. Obtain a prescription for restraints from the provider
D. Document the indications for using wrist restraints
70. Nurses on an inpatient care unit are working to help reduce unit costs. Which of the
following actions is appropriate to include in the cost-containment plan?
A. Return unused supplies from the bedside to the unit’s supply stock
B. Wait to dispose of sharps containers until they are completely full
C. Use clean gloves rather than sterile gloves for colostomy care
D. Store opened bottles of normal saline in a refrigerator for up to 48 hr

Form B
1. A nurse is assessing a client who had a recent stroke. Which of the following findings should
indicate to the nurse the need for referral to an occupational therapist?
A. Facial drooping
B. Receptive aphasia
C. Unilateral neglect
D. Memory loss
2. A charge nurse in the newborn nursery is delegating tasks to an assistive personnel (AP).
Which of the following is an appropriate task for the AP?
A. Show a new mother how to change the newborn’s diaper
B. Inspect the skin of a newborn who is receiving phototherapy
C. Obtain the weight of a newborn who is receiving formula
D. Answer the parents’ questions about newborn circumcision
3. A charge nurse is planning the care of four newborns. An assistive personnel and licensed
practical nurse are available for staffing. Which of the following tasks should the nurse assign to
a licensed practical nurse?
A. Conduct the newborn hearing screening
B. Perform a New Ballard screening
C. Administer a hepatitis B vaccine
D. Obtain vital signs
4. A nurse is completing discharge teaching with a client who is being treated for tuberculosis
(TB). Which of the following statements by the client indicates an understanding of the
teaching?
A. I need to have a TB skin test done once per year
B. I need to take my prescribed medication for 3 months
C. I should have a sputum culture done every 2 to 4 weeks
D. I should wear a mask while around my family

5. A newly licensed nurse is floating to an unfamiliar unit and determines that he does not have
sufficient experience to safely care for his assigned clients. Which of the following actions
should the nurse take?
A. Accept the assignment with help from assistive personnel on the unit
B. Document the concern in the nurse’s notes
C. Notify the risk manager
D. Request that the charge nurse modify the assignment
6. A nurse is conducting an in-service about the nursing code of ethics with a group of newly
licensed nurses. Which of the following information should the nurse include in the teaching as
an example of advocacy?
A. Recommending a referral for a client who requires physical therapy
B. Suggesting a client’s partner attend a support group for emotional support
C. Completing an incident report following a medication error
D. Evaluating a client’s home for safety hazards
7. A nurse is caring for a group of clients. Which of the following clients should the nurse plan to
assess first?
A. A client who has congestive heart failure and has lost 0.9 kg (2 lb) in the past 24 hr
B. A client who has diabetes mellitus and reports paresthesia in his fingers and toes
C. A client who has a new diagnosis of Graves’ disease and a TSH level of 0.2 microunits/mL
D. A client who has a nasogastric tube and has crackles in the lungs
8. A staff development nurse is giving an in-service presentation about advocacy in nursing.
Which of the following statements by a nurse indicates an understanding of the role of a client
advocate?
A. As a client advocate, I will suggest the best course of action for clients who are indecisive
B. In the role of client advocate, I should take responsibility for coordinating each client’s care
C. My role as a client advocate is to empower the clients to make informed health care
decisions

D. As a client advocate, I will adhere to the provider’s prescribed treatments
9. A charge nurse in the emergency department is supervising a nurse who is floating from the
medical-surgical unit. Which of the following assignments is appropriate for the float nurse?
A. Set up a trauma room for an incoming client who was in a motor-vehicle crash
B. Perform a urinary catheterization for a client who has experienced a stroke
C. Administer IV nitroglycerin to a client who is experiencing chest pain
D. Complete a SAD PERSONS assessment scale for a client who has attempted suicide
10. A nurse is planning discharge for a client who has rheumatoid arthritis. Which of the
following statements by the client should the nurse identify as an indication that a referral to an
occupational therapist is necessary?
A. I will need assistance with bathing
B. I am tired of having pain in my joints all the time
C. I’m having difficulty climbing the stairs at my house
D. I need some help planning my meals to maintain my weight
11. A nurse is supervising a newly licensed nurse who is performing surgical asepsis. After
donning a sterile gown and gloves, which of the following actions by the newly licensed nurse
demonstrates correct aseptic technique?
A. The nurse turns her back to the sterile field
B. The nurse puts on a face mask
C. The nurse holds her hands above her waist
D. The nurse applies goggles
12. A home health nurse finds piles of newspapers in the hallway of a client’s home. The nurse
explains the need to discard the newspapers for safety reasons. The client agrees to move the
newspapers into the living room. Which of the following conflict resolution strategies has the
nurse used?
A. Compromising
B. Accommodating

C. Collaborating
D. Smoothing
13. A nurse is explaining ethics and values to a newly licensed nurse. The nurse should explain
that preventing client injury by removing a fall hazard demonstrates which of the following
ethical principles?
A. Nonmaleficence
B. Veracity
C. Autonomy
D. Utility
14. A nurse is caring for a client who has a tumor. The provider recommends surgery. The client
refuses, but the client’s partner wants the surgery performed. Which of the following is the
deciding factor in determining if the surgery will be done?
A. Whether the facility ethics committee reaches a consensus on the case
B. Whether the client understands the risk of refusing the procedure
C. Whether the client’s refusal is based on religious belief
D. Whether the partner is the client’s durable power of attorney for health care
15. A client is brought to the emergency department following a motor-vehicle crash. Drug use is
suspected in the crash, and a voided urine specimen is ordered. The client repeatedly refuses to
provide the specimen. Which of the following is the appropriate action by the nurse?
A. Tell the client that a catheter will be inserted
B. Assess the client for urinary retention
C. Obtain a provider’s prescription for a blood alcohol level
D. Document the client’s refusal in the chart
16. A charge nurse is teaching a newly licensed nurse about proper cleaning of equipment used
for a client who has C. diff. Which of the following solutions should the nurse recommend to
clean the equipment?
A. Chlorine bleach

B. Isopropyl alcohol
C. Triclosan
D. Chlorhexidine
17. A nurse is prioritizing care after receiving change-of-shift report on four clients. Which of the
following clients should the nurse assess first?
A. A client who reports a headache with sensitivity to light
B. A client who reports feeling lightheaded when he stands up from a lying position
C. A client who reports indigestion and pain in her jaw
D. A client who reports an urge to void but has not urinated during the prior shift
18. A nurse is preparing to delegate bathing and turning of a newly admitted client who has endstage bone cancer to an experienced assistive personnel (AP). Which of the following
assessments should the nurse make before delegating care?
A. Does the AP have time to change the client’s central IV-line dressing after turning her?
B. Is the client’s family present so the AP can show them how to turn the client?
C. Has the AP checked the client’s pain level prior to turning her?
D. Has data been collected about specific client needs related to turning?
19. A nurse is preparing a client for an elective mastectomy. The client is wearing a plain gold
wedding band. Which of the following is an appropriate procedure for taking care of this client’s
ring?
A. Place the client’s ring in the facility safe
B. Tape the ring securely to the client’s finger
C. Place the ring in the bag with the client’s clothing
D. Agree to keep the ring for the client until after surgery
20. A nurse is planning care for a client who has Addison’s disease. Which of the following tasks
should the nurse plan to delegate to assistive personnel?
A. Explain to the client about a 24-hr urine specimen collection
B. Remind the client to change positions slowly

C. Decide how often to measure vital signs
D. Determine the client’s muscle strength prior to ambulation
21. A nurse is preparing a client for a cardiac catheterization. Just before the procedure, the client
asks the nurse about the risks of the procedure. Which of the following actions should the nurse
take?
A. Check to see if the medical record indicates the provider explained the procedure to the client
B. Explain the risks of the procedure to the client
C. Notify the provider about the client’s concerns
D. Convey the client’s request to the nurse who witnessed the consent
23. A nurse is providing information to a client about advance directives. The nurse should
explain that advance directives include which of the following?
A. Information regarding organ donation
B. A form with directions for contacting next of kin
C. Instructions regarding treatments the client desires or does not desire
D. Information regarding the disposition of the client’s body upon death
24. A nurse is prioritizing postpartum care for four clients. Which of the following actions should
the nurse take first?
A. Instruct a client who has an episiotomy about a sitz bath
B. Check uterine tone for a client who received methylergonovine
C. Assist a client who requests help breastfeeding her 4-hr-old newborn
D. Administer Rh immune globulin to a client who is Rh-negative and 6 hr postpartum
25. A nurse is planning care for a group of clients and can delegate care to a licensed practical
nurse (LPN) and assistive personnel. Which of the following tasks should the nurse assign to the
LPN?
A. Admitting a new client who has chronic back pain to the unit
B. Ambulating a client who is scheduled for discharge later in the day
C. Administering morphine IV bolus to a client who is 4 hr postoperative

D. Reinforcing teaching with a client who is learning to self-administer insulin
26. A nurse on a medical-surgical unit is caring for four clients. The nurse should recognize that
which of the following clients is the highest priority?
A. A client who has peripheral vascular disease and has an absent pedal pulse in the right
foot
B. A client who has MRSA and has an axillary temperature of 38 C (101 F)
C. A client who is newly diagnosed with pancreatic cancer and is scheduled to begin IV
chemotherapy
D. A client who is postoperative following a laminectomy 12 hr ago and is unable to void
27. A charge nurse is reviewing information about HIPAA with a group of staff nurses. Which of
the following statements by a staff nurse indicates understanding?
A. HIPAA allows clients to request a review of their own medical records
B. HIPAA prohibits the uploading of photographs of client’s providers to social medical sites
C. HIPAA allows facility-specific coding of client health care information to ensure privacy
D. Clients who participate in research studies forfeit their HIPAA right to privacy
28. An infection control nurse is planning an education program for a group of newly licensed
nurses. Which of the following infections should the nurse include when discussing illnesses
requiring droplet precautions?
A. Rotavirus
B. Varicella
C. Mumps
D. Rubeola
29. A nurse in the emergency department is caring for a 16-year-old client who reports
abdominal pain and is accompanied by an adult neighbor. The provider diagnoses a ruptured
appendix and states that the client requires an emergency appendectomy. Which of the following
actions should the nurse take?
A. Obtain consent from the hospital administrator

B. Witness the client signing the consent form
C. Attempt to notify the client’s guardian to obtain consent
D. Ask the adult neighbor to sign the consent form
30. A nurse enters a client’s room and identifies that the client is receiving too much IV fluid
because the IV pump is not working properly. Which of the following actions should the nurse
take first?
A. Complete an incident report
B. Notify the provider
C. Place a faulty equipment tag on the pump
D. Auscultate the client’s lungs
31. A nurse is orienting a newly licensed nurse about the use of restraints. Which of the
following statements by the newly licensed nurse indicates an understanding of the teaching?
A. I will remove a client’s restraints every 4 hours
B. A provider can write a prescription for restraints as needed
C. I need to tie the restraint to the part of the bed frame that moves
D. I should tie the restraints using a square knot
32. A charge nurse suspects that a staff nurse is chemically impaired. Which of the following
actions should the charge nurse take?
A. Report the staff nurse to the facility ethics committee
B. Counsel the staff nurse about substance use
C. Collect data about the staff nurse to support further action
D. Assign clients who are not prescribed narcotics to the staff nurse
33. A nurse is making shift assignments in a hospital. Which of the following tasks is appropriate
to assign to a licensed practical nurse?
A. Administer a nasogastric tube feeding
B. Pick up the meal trays after lunch
C. Determine adequacy of ventilator settings

D. Plan break times for assistive personnel
34. A nurse is observing an assistive personnel (AP) administer a 0.9% sodium chloride enema to
an adult client. For which of the following actions by the AP should the nurse intervene?
A. Inserts the tubing 8 cm (3.1 in) into the rectum
B. Positions the client on her left side with knees flexed
C. Administers the solution at room temperature
D. Points tubing in the direction of the umbilicus during insertion
35. A nurse is planning to discharge a client who has terminal cancer and suggests that the family
might benefit from respite services. When the client’s partner asks how this service can help,
which of the following responses by the nurse is appropriate?
A. This service delivers meals and supplies to reduce your errands away from home
B. The clinicians help reduces the severity of your wife’s physical problems
C. It makes it possible for you to have some time away from caring for your wife
D. This service offers psychological interventions during and after your wife’s illness
36. A nurse is planning to delegate client care assignments. Which of the following tasks should
the nurse plan to delegate to assistive personnel?
A. Teaching a client to perform a finger-stick for testing blood glucose levels
B. Performing postmortem care prior to transferring the client to the morgue
C. Informing a family of a client’s progress in physical therapy
D. Advising a client on self-administration of acetaminophen
37. A nurse is caring for four clients. Which of the following tasks can be delegated to assistive
personnel?
A. Reviewing dietary instructions for a client who has kidney stones
B. Monitoring a client who has a fluid restriction
C. Assessing a client who just returned from hemodialysis
D. Obtaining a stool sample from a client who has renal failure

38. A nurse is providing discharge teaching to a client who has a new diagnosis of diabetes. The
client expresses concern about the cost of blood-glucose monitoring supplies. Which of the
following actions should the nurse take?
A. Refer the client to the social services department
B. Provide the client with a week’s worth of supplies from the hospital
C. Recommend the client reuse the testing lancets
D. Ask the provider about the possibility of less frequent monitoring
39. A case manager is reviewing documentation on several clients and notes a progress report
that falsely identifies a client as HIV-positive due to multiple sexual partners. The nurse manager
should identify that which of the following torts has occurred?
A. Slander
B. Negligence
C. Libel
D. Battery
40. During a staff meeting, a unit manager reviews the results for documenting client education
and finds that they are below the benchmark. Which of the following strategies should the nurse
manager implement first?
A. Include documentation of client education as part of unit nurses’ annual performance
evaluation
B. Offer incentives for the staff once the unit’s results are back in adherence with the benchmark
C. Determine factors that interfere with the documentation of client education
D. Train LPNs to reinforce teaching with clients using a standardized teaching plan
41. An older adult client is awaiting surgery for a fractured right hip. The nurse should recognize
that which of the following can be delegated to assistive personnel?
A. Checking the pulses of the client’s right foot
B. Determining the client’s pain level
C. Recording the client’s vital signs
D. Turning the client

42. A charge nurse is receiving change-of-shift report. Which of the following situations should
the charge nurse address first?
A. The emergency department nurse is waiting to give report on a new admission
B. Transport assistance is unavailable to take a client to occupational therapy
C. Two staff members have called to say they will be absent
D. A nurse on the previous shift wrote an incident report about a medication error
43. A home health nurse is assessing the home environment during an initial visit to a client who
has a history of falls. Which of the following findings should the nurse identify as increasing the
client’s risk for falls? (Select all that apply.)
A. A raised vinyl seat on the toilet in the bathroom
B. A folding chair without arm rests
C. A two-wheeled walker used to assist the client with ambulation
D. A wheeled office chair at the client’s computer desk
E. A throw rug covering some cracked vinyl flooring in the kitchen
44. A nurse is providing discharge teaching to a client following a total knee arthroplasty. Which
of the following information should the nurse include? (Select all that apply.)
A. Advance directives information
B. Medication guideline information
C. Insurance information
D. Contact information for the physical therapist
E. Information about follow-up care
45. A nurse at the local health department is caring for four clients who have communicable
diseases. Which of the following infections should the nurse report to the state health
department?
A. Pediculosis capitis
B. Candida albicans
C. Impetigo contagiosa

D. Chlamydia trachomatis
46. A nurse in the emergency department is preparing to care for a client who arrived via
ambulance. The client is disoriented and has a cardiac arrhythmia. Which of the following
actions should the nurse take?
A. Proceed with treatment without obtaining written consent
B. Notify risk management before initiating treatment
C. Have the client sign a consent for treatment
D. Contact the client’s next of kin to obtain consent for treatment
47. A nurse manager is reviewing guidelines for informed consent with the nursing staff. Which
of the following statements by a staff nurse indicates that the teaching was effective?
A. Guardian consent is required for an emancipated minor
B. Consent can be given by a durable power of attorney
C. A family member can interpret to obtain informed consent from a client who is deaf
D. The nurse can answer any questions the client has about the procedure
48. A nurse is caring for a client who has cancer. The client and her partner are asking the nurse
about hospice care. Which of the following statements by the nurse is appropriate?
A. Hospice care is a multidisciplinary program for clients who are terminally ill
B. Hospice care will prolong the life expectancy of clients who are terminally ill
C. Hospital access is no longer available for clients who are in hospice care
D. Hospice care is helpful for clients at various stages of chronic illness
49. A hospice nurse is caring for a client who has a terminal illness and reports severe pain. After
the nurse administers the prescribed opioid and benzodiazepine, the client becomes somnolent
and difficult to arouse. Which of the following actions should the nurse take?
A. Administer the benzodiazepine but withhold the opioid
B. Contact the provider about replacing the opioid with an NSAID
C. Continue the medication dosages that relieve the client’s pain
D. Withhold the benzodiazepine but continue the opioid

50. A charge nurse notices that two staff nurses are not taking meal breaks during their shifts.
Which of the following actions should the nurse take first?
A. Review facility policies for taking scheduled breaks
B. Discuss time management strategies with the nurses
C. Determine the reasons the nurses are not taking scheduled breaks
D. Provide coverage for the nurses’ breaks
51. A nurse on a medical-surgical unit is caring for four clients. Which of the following findings
is the highest priority?
A. A client whose TPN was discontinued 4 hr ago and is requesting clear liquids
B. A client who has COPD and has an oxygen saturation of 90%
C. A client who had a cholecystectomy 6 hr ago and is requesting pain medication
D. A client who had a cardiac catheterization whose capillary refill in the great toe is 4
seconds
52. A nurse who is caring for a group of clients delegates collection of vital signs to assistive
personnel (AP). Which of the following actions should the nurse take to evaluate the delegated
task?
A. Recheck vital signs that are outside the expected reference range
B. Ask the AP to write a summary of the delegated tasks during the shift
C. Review vital sign trends at the end of the shift
D. Compare the vital signs the AP obtained with those taken by another AP on a previous shift
53. A nurse in a clinic is reviewing laboratory reports for a group of clients. Which of the
following diseases should the nurse report to the state health department?
A. Rotavirus
B. Group B streptococcal disease
C. Pertussis
D. Respiratory syncytial virus

54. A nurse in a long-term care facility should identify that which of the following will provide
security for clients who have dementia?
A. Setting alarms on exits
B. Turning off room lights at night
C. Restricting space to reduce pacing
D. Using a facility-wide paging system
55. A nurse enters the room of a client who is unconscious and finds that the client’s son is
reading her electronic medical records from a monitor located at the bedside. Which of the
following actions should the nurse take first?
A. Report the possible violation of client confidentiality to the nurse manager
B. Complete an incident report regarding the breach of the client’s confidentiality
C. Recommend the son meet the provider to get information about his mother’s condition
D. Log out the computer so that the client’s son is unable to view his mother’s information
56. A nurse is preparing to transfer a client from the emergency department to a medical surgical
unit using the SBAR communication tool. Which of the following information should the nurse
include in the background portion of the report?
A. A prescribed consultation
B. The client’s vital signs
C. The client’s name
D. The client’s code status
57. A nurse who is precepting a newly licensed nurse is discussing the client assignment for the
shift. Which of the following actions should the nurse preceptor take first to demonstrate
appropriate time management?
A. Determine client care goals
B. Complete required tasks
C. Document assessment data
D. Review the client’s new laboratory values

58. A nurse is participating in the development of a disaster management plan for a hospital. The
nurse should recognize that which of the following resources is the highest priority to have
available in response to a bioterrorism event?
A. A sufficient supply of personal protective equipment
B. A network for communication between staff members and families
C. A system for tracking client information
D. A mental health specialist on the response team
59. A nurse preceptor is evaluating a newly licensed nurse’s competency in assisting with a
sterile procedure. Which of the following actions indicates the newly licensed nurse is
maintaining sterile techniques? (Select all that apply.)
A. Holds the sterile solution bottle with the label facing up
B. Prepares a container of sterile solution on the field after putting on sterile gloves
C. Removes the outside packaging of a sterile instrument before dropping it onto the sterile
field
D. Places sterile items within a 1.25 cm (0.5 in) border around the edges of the sterile field
E. Opens the sterile pack by first unfolding the top flap away from her body
60. A nurse is assessing an older adult client who was brought to the emergency department by
his adult son, who reports that the client fell at home. The nurse suspects elder abuse. Which of
the following actions should the nurse take?
A. Ask the client about his injuries with the son present
B. Ask the client’s son to go to the waiting area
C. File an incident report
D. Treat and discharge the client
61. A nurse is reviewing the medication administration record of a client and notices that an
additional dose of medication has been administered. Which of the following actions should the
nurse take first?
A. Notify the provider
B. Inform the nursing supervisor

C. Observe the client’s condition
D. Complete an incident report
62. A charge nurse discovers that a staff nurse on the unit has made repeated medication errors.
Which of the following actions should the charge nurse take first?
A. Identify education opportunities for the nurse regarding safe medication administration
B. Review with the nurse the principles of medication administration
C. Notify the risk management department of the situation
D. Ask the nurse to describe her medication administration procedure
63. A nurse is caring for four clients. For which of the following clients should the nurse
collaborate with the facility ethics committee?
A. A middle adult client who leaves the facility against medical advice
B. A young adult client who is participating in a medical research study
C. An adolescent client whose parents refuse a blood transfusion for religious reasons
D. An older adult client who has advance directives on file
64. A nurse in an ambulatory care setting is orienting a newly licensed nurse who is preparing to
return a call to a client. The nurse should explain that which of the following is an objective of
telehealth?
A. Developing client treatment protocols
B. Establishing communication between providers
C. Assessing client needs
D. Providing medication reconciliation
65. A nurse is triaging a group of clients following a disaster. Which of the following clients
should the nurse recommend for treatments first?
A. A client who has a neck injury and is unable to breathe spontaneously
B. A client who has major burns over 75% of her body surface area
C. A client who has bipolar disorder and is exhibiting signs of hallucination
D. A client who has two open chest wounds with a left tracheal deviation

66. A charge nurse is planning to evacuate clients on the unit because there is a fire on another
floor. Which of the following clients should the nurse evacuate first?
A. A client who is in Buck’s traction for a left hip fracture
B. A client who is confused and restrained for safety
C. A client who is receiving IV chemotherapy and is ambulatory
D. A client who is 1-day postoperative following thoracic surgery and has a chest tube
67. A nurse is assessing a client’s comprehension of a pulmonary function test prior to the
procedure. Which of the following client statements indicates to the nurse an understanding of
the procedure?
A. I will be given contrast dye during this test
B. I will run on a treadmill during this test
C. I might have to wear a nose clip during this test
D. I might have a tube inserted into my airway during this test
68. A charge nurse witnesses two nurses having a loud discussion at the nurses’ station about not
wanting to care for a client who has drug-resistant tuberculosis. Which of the following actions
should the charge nurse take?
A. Recommend that both nurses be terminated
B. Contact the house supervisor to mediate the conflict
C. Make arrangements to take over the client’s care
D. Escort the nurses to the nurses’ lounge to continue the discussion
69. A nurse in the emergency department is triaging four clients. Which of the following clients
should the nurse recommend to be examined first?
A. An adolescent client who has an injured ankle and reports a pain level of 8 on a scale from 0
to 10
B. An adult client who has large ecchymosis on both legs
C. A toddler who has a 2 cm (0.79 in) head laceration oozing dark red blood
D. An older adult client who has dyspnea and a respiratory rate of 26/min

70. A nurse is teaching a client how to use a finger-stick glucometer at home. Which of the
following instructions should the nurse include?
A. Warm the hands prior to piercing the skin
B. Obtain the blood sample from the finger pads
C. Cap the lancet prior to putting it in the trash
D. Elevate the arm for 1 min before taking the blood sample

Form C
1. A nurse is assessing pressure ulcers on four clients to evaluate the effectiveness of a change in
wound care procedure. Which of the following findings indicate wound healing?
A. Erythema on the skin surrounding a client’s wound
B. Inflammation noted on the tissue edges of a client’s wound
C. Increase in serosanguinous exudate from a client’s wound
D. Deep red color on the center of a client’s wound
2. A nurse received change-of-shift report at 0700 for four clients. Which of the following
actions should the nurse perform first?
A. Administer pain medication to a client who has rheumatoid arthritis and received the last dose
at 0400
B. Obtain a breakfast tray for a client who received a morning dose of insulin apart
C. Replace a client’s enteral nutrition feeding solution that has been hanging for 24 hr
D. Restart an infiltrated IV for a client whose IV antibiotic is scheduled for 0900
3. A nurse is orienting a newly licensed nurse on the neurological unit. Which of the following
clients should the nurse assign to the newly licensed nurse?
A. A client who sustained a concussion and is being monitored for complications
B. A client who has a brain tumor and is admitted for chemotherapy
C. A client who has Gullain-Barre syndrome and a tracheostomy

D. A client who has multiple sclerosis and ataxia
4. A nurse is providing teaching to a client about advance directives. Which of the following
statements by the client indicates an understanding of the teaching?
A. My durable power of attorney for health care is part of my advance directives
B. My doctor will need to provide approval for the decisions outlined in my living will
C. Once I sign my living will, a family member must co-sign it
D. I will wait until I have a serious health problem to sign my advance directives
5. A nurse is chairing a committee about preventing infant abduction in a new birth care center.
Which of the following quality control tasks should the nurse assign to be completed first?
A. Establish measurement criteria for infant safety systems
B. Evaluate the selected infant safety system
C. Choose an infant safety system
D. Identify the industry standards for infant safety
6. A nurse notes that a client is eating about half of the food on his plate and coughs frequently
during meals. The nurse plans to perform dysphagia screening to determine the client’s need for
a referral to which of the following providers?
A. Respiratory therapist
B. Physical therapist
C. Occupational therapist
D. Speech therapist
7. A home health nurse is assessing the home environment during an initial visit to a client who
has a history of falls. Which of the following findings should the nurse identify as increasing the
client’s risk for falls? (Select all that apply.)
A. A wheeled office chair at the client’s computer desk
B. A two-wheeled walker used to assist the client with ambulation
C. A throw rug covering some cracked vinyl flooring in the kitchen
D. A folding chair without arm rests

E. A raised vinyl seat on the toilet in the bathroom
8. A nurse manager is planning to assign care for four clients on a medical-surgical unit. Which
of the following clients should the nurse assign to a licensed practical nurse?
A. An adolescent client who is newly diagnosed with diabetes and requires teaching regarding
insulin administration
B. A middle adult client who had a below-the-knee amputation and requires a dressing
change
C. An older adult client who has lung cancer and has periodic episodes of severe dyspnea
D. A young adult client who is postoperative, receiving morphine via epidural, and reports
pruritus
9. While auditing the medical records of clients currently on an oncology unit, the nurse manager
finds that six of the 15 records lack documentation regarding advance directives. Which of the
following is the priority action for the nurse to take?
A. Reinforce the potential consequences of not having this information on record to the nursing
staff
B. Ask nurses who are caring for clients without this information in the medical record to obtain
it
C. Meet with nursing staff to review the policy regarding advance directives
D. Remind nurses to obtain this information during the admission process
10. A nurse is caring for a group of clients. Which of the following clients should the nurse see
first?
A. A client who is postoperative and has a fever
B. A client whose pressure ulcer has serosanguinous drainage on the dressing
C. A client who has diabetes mellitus and is diaphoretic
D. A client who has a fractured hip and reports a pain level of 7 on a scale from 0 to 10
11. A nurse is receiving change-of-shift report for four clients. Which of the following clients
should the nurse care for first?

A. A client who has pneumonia and requires a tracheostomy dressing change
B. A client who has a new colostomy and requires discharge teaching
C. A client who is scheduled for an intermittent enteral feeding in 2 hr and reports diarrhea
D. A client who is 4 hr postoperative following a hernia repair and has pitting edema of the
right leg
12. A nurse manager discovers there is a conflict between nurses working the day shift and
nurses working the night shift. Which of the following actions should the nurse manager take
first?
A. Encourage the nurses to resolve the conflict autonomously
B. Meet with a committee of nurses from each shift to discuss issues related to the conflict
C. Gather information regarding the situation
D. Acknowledge the conflict and encourage the nurses to focus on working as a team
13. A nurse in an urgent care clinic is admitting a client who has been exposed to a liquid
chemical in an industrial setting. Which of the following actions should the nurse take first?
A. Remove the client’s clothing
B. Don personal protective equipment
C. Report the incident to OSHA
D. Irrigate the exposed area with water
14. A newly licensed nurse realizes that she administered metoprolol 25 mg PO to the wrong
client. Which of the following actions should the nurse perform first?
A. Measure the client’s vital signs
B. Call the provider
C. Inform the nurse manager
D. Complete an incident report
15. A nurse is assessing a client who has meningitis. Which of the following findings should the
nurse report to the provider immediately?
A. Increased temperature

B. Generalized rash over trunk
C. Report of photophobia
D. Decreased level of consciousness
16. A client who is febrile is admitted to the hospital for treatment of pneumonia. In accordance
with the care pathway, antibiotic therapy is prescribed. Which of the following situations
requires the nurse to complete a variance report with regard to the care pathway?
A. The route of antibiotic therapy on the care pathway was changed from IV to PO
B. An allergy to penicillin required an alternative antibiotic to be prescribed
C. A blood culture was obtained after antibiotic therapy had been initiated
D. Antibiotic therapy was initiated 2 hr after implementation of the care pathway
17. A nurse manager is making staffing assignments for the maternal newborn unit. Which of the
following clients should the nurse manager assign to a float nurse from the medical-surgical
unit?
A. A client who is post-term and is receiving oxytocin for labor induction
B. A client who has preeclampsia and is receiving a continuous magnesium sulfate infusion
C. A client who gave birth to her first child and requires instruction on breastfeeding techniques
D. A client who is 2 days postoperative following a caesarean birth and is having difficulty
ambulating
18. A nurse is coordinating an inter-professional team to review proposed standards to reduce the
transmission of MRSA. Which of the following members of the inter-professional team should
the nurse consult?
A. Risk management coordinator
B. Nursing supervisor
C. Infection control nurse
D. Clinical pharmacist

19. A nurse is caring for a client who has uterine prolapse. The provider has recommended a total
abdominal hysterectomy, but the client tells the nurse that the surgery is not an option. Which of
the following is an appropriate action for the nurse to take?
A. Initiate a mental health consult to determine the client’s reasons for refusing surgery
B. Inform the client of the consequences of uterine prolapse and the need for intervention
C. Provide the client with information on treatment options and outcomes
D. Discuss with the client her concerns regarding the procedure
20. A nurse in the emergency department is assessing a client who is unconscious following a
motor-vehicle crash. The client requires immediate surgery. Which of the following actions
should the nurse take?
A. Obtain telephone consent from the facility administrator before the surgery
B. Transport the client to the operating room without verifying informed consent
C. Delay the surgery until the nurse can obtain informed consent
D. Ask the anesthesiologist to sign the consent
21. A nurse is planning to delegate client care assignments. Which of the following tasks should
the nurse plan to delegate to assistive personnel?
A. Informing a family of a client’s progress in physical therapy
B. Advising a client on self-administration of acetaminophen
C. Teaching a client to perform a finger-stick for testing blood glucose levels
D. Performing postmortem care prior to transferring the client to the morgue
22. A nurse is working on a quality improvement team that is assessing an increase in client falls
at the facility. After problem identification, which of the following actions should the nurse plan
to take first as part of the quality improvement process?
A. Notify staff of the increased fall rate
B. Identify clients who are at risk for falls
C. Review current literature regarding client falls
D. Implement a fall prevention plan

23. A nurse is completing a performance evaluation for assistive personnel (AP). Which of the
following actions by the AP requires intervention by the nurse?
A. The AP uses alcohol hand antiseptic after caring for a client who has C. diff
B. The AP removes cut flowers from the room of a client who is in a protective environment
C. The AP wears a mask when caring for a client who has varicella
D. The AP closes the door of a client who is on airborne precautions
24. A charge nurse notices that staff nurses are having difficulty using new IV infusion pumps
for medication administration. Which of the following is the priority action by the charge nurse?
A. Demonstrate use of the pump during medication administration
B. Assess the staff nurses’ knowledge deficit
C. Pair an inexperienced nurse with an experienced nurse
D. Plan an in-service education program on the unit
25. A nurse is preparing a shift assignment for assistive personnel (AP) on the unit. Which of the
following tasks should the nurse assign to the AP?
A. Administer the initial bolus feeding to a client who has an NG tube
B. Instruct a client to splint an abdominal incision
C. Check a client’s pain level 30 min after receiving acetaminophen
D. Collect a urine specimen from a newly admitted client
26. A nurse is assisting with triage during a mass casualty event. The nurse applies a red tag to a
client. Which of the following actions should the nurse take?
A. Provide treatment for minor injuries
B. Provide treatment for life-threatening injuries
C. Allow the client to die without further intervention
D. Treat the client’s injuries within 30 min
27. A home health nurse is performing a safety assessment of a client’s home. Which of the
following findings should the nurse identify as a safety hazard?
A. The client’s electrical cord is taped to the floor

B. The client has used tacks to secure the carpet on the stairs
C. The client’s bedside lamp is plugged in using an extension cord with two prongs
D. The client stores cleaning supplies in a locked cabinet above his head
28. A charge nurse is observing a newly licensed nurse provide care for a client who has a C. diff
infection. Which of the following actions by the newly licensed nurse indicates an understanding
of proper infection control procedures?
A. Removes fresh flowers from the client’s room
B. Wears a gown when caring for the client
C. Washes her hands with an alcohol-based hand rub after caring for the client
D. Applies a mask before entering the client’s room
29. A nurse is preparing discharge planning for a client who has a newly placed tracheostomy
tube. The nurse should assess the client’s need for which of the following supplies to manage the
tracheostomy at home? (Select all that apply.)
A. Petroleum jelly
B. Cotton balls
C. Obturator
D. Oxygen tank
E. Pipe cleaners
30. A nurse is caring for four clients who are scheduled to undergo surgery. Which of the
following clients can give informed consent?
A. An adolescent client who is legally emancipated
B. An older adult client who has questions about the procedure
C. An adult client who has alcohol intoxication
D. An adult client who has moderate Alzheimer’s disease
31. A nurse is discussing the safekeeping of valuables with a client who is scheduled for surgery.
Which of the following client statements indicates the need for further teaching?
A. I should leave my valuables with a family member

B. I should remove my dentures before the procedure
C. I can wear my ankle bracelet since I am just having a local anesthetic
D. I can leave my wedding ring on if it is taped in place
32. A nurse is caring for an older adult client who has a Stage III pressure ulcer. The nurse
requests a consultation with the wound care specialist. Which of the following actions by the
nurse is appropriate when working with a consultant?
A. Arrange for the wound care nurse specialist to see the client daily to provide the
recommended treatment
B. Request the consultation after several wound care treatments are tried
C. Provide the consultant with subjective opinions and beliefs about the client’s wound care
D. Arrange the consultation for a time when the nurse caring for the client is able to be
present for the consultation
33. A nurse is observing assistive personnel (AP) administer a 0.9% sodium chloride enema to an
adult client. For which of the following actions by the AP should the nurse intervene?
A. Inserts the tubing 8 cm (3.1 in) into the rectum
B. Points tubing in the direction of the umbilicus during insertion
C. Positions the client on her left side with knees flexed
D. Administers the solution at room temperature
34. A nurse is orienting a newly licensed nurse about client confidentiality. Which of the
following statements by the newly licensed nurse indicates an understanding of the teaching?
A. I can post the client’s vital signs in the client’s room
B. I should discard personal health information documents in the trash before leaving the unit
C. I should encrypt personal health information when sending emails
D. I can use another nurse’s password as long as I log off after using the computer
35. A nurse is participating on a committee that is considering the creation of a policy that will
allow nurses to remove chest tubes. Which of the following is an appropriate resource for the
nurse to consult in planning for this policy?

A. ANA Standards of Practice
B. ANA Code of Ethics
C. State Nurse Practice Act
D. Institute of Medicine
36. A charge nurse observes a licensed practical nurse (LPN) tell a client that she will return with
a medication to help relieve the client’s nausea. The LPN does not return with the medication.
The charge nurse should reinforce which of the following ethical principles with the LPN?
A. Veracity
B. Justice
C. Fidelity
D. Nonmaleficence
37. A nurse administrator is using benchmarking as control criteria while reviewing current
policies and procedures. Which of the following actions should the nurse take?
A. Establish work initiatives to promote a positive environment
B. Use root cause analysis to identify gaps in meeting standards
C. Compare practices within the facility against other high-performing facilities
D. Determine how current practice will affect future performance within the facility
38. A nurse enters a client’s room and identifies that the client is receiving too much IV fluid
because the IV pump is not working properly. Which of the following actions should the nurse
take first?
A. Auscultate the client’s lungs
B. Notify the provider
C. Complete an incident report
D. Place a faulty equipment tag on the pump
39. A client scheduled for a tubal ligation procedure starts to cry as she is wheeled into the
surgical suite. Which of the following nursing statements is an appropriate nursing response?
A. You shouldn’t be worried because the procedure is very safe

B. This won’t take long and it will be over before you know it
C. Why did you make the decision to have this procedure?
D. It’s not too late to cancel the surgery if you want to
40. A facility infection control nurse is reviewing the reports of a group of clients. Which of the
following infections should the nurse report to the public health department?
A. MRSA
B. Health care-acquired pneumonia
C. Lyme disease
D. Bacterial conjunctivitis
41. A nurse on a surgical unit is preparing to transfer a client to a rehabilitation facility. Which of
the following information should the nurse include in the change-of-shift report?
A. The time the client received his last dose of pain medication
B. The belief that the client has a difficult relationship with his son
C. The client’s preferred time for bathing
D. The steps to follow when providing wound care
42. A nurse receives a new prescription over the telephone from a client’s provider. Which of the
following actions should the nurse take first?
A. Document the prescription as a telephone prescription in the medical record
B. Ensure that the provider signs the prescription
C. Write down the complete prescription
D. Read back the prescription to the provider
43. A charge nurse witnesses assistive personnel (AP) falling to follow facility protocol when
discarding contaminated linens. Which of the following actions should the nurse take first?
A. Alert the infection control department
B. Notify the unit manager about the incident
C. Reinforce facility protocols at the next staff meeting
D. Discuss the issue with the AP

44. A nurse is planning care for a client who is disoriented and has a history of wandering.
Which of the following actions should the nurse include in the plan?
A. Remove the clock and calendar from the client’s room
B. Raise all four side rails on the client’s bed
C. Obtain a prescription for a sedative for the client
D. Provide distractions for the client during the day
45. A nurse is caring for a client who has a new diagnosis of chlamydia. Which of the following
actions should the nurse take?
A. Report the infection to the local health department
B. Instruct the client to use condoms until the treatment is completed
C. Initiate contact precautions
D. Apply an antiviral cream to lesions
46. A nurse is teaching a class of newly licensed nurses about evidence-based practice. The nurse
should include which of the following as the first step in evidence-based practice?
A. Develop a clinical question
B. Collect evidence from a variety of sources
C. Apply research to client care practice
D. Critically assess the evidence
47. A nurse assumes the leading role on the hazardous materials team immediately following a
chemical mass casualty incident in the community. As clients arrive at the designated triage area
outside the hospital, which of the following actions should the nurse take?
A. Admit the injured clients to positive-pressure rooms
B. Place shower caps over the clients’ hair
C. Scrub the clients’ skin with betadine solution
D. Remove contaminated clothing

48. A case manager is reviewing documentation on several clients and notes a progress report
that falsely identifies a client as HIV-positive due to multiple sexual partners. The nurse manager
should identify that which of the following torts has occurred?
A. Slander
B. Negligence
C. Battery
D. Libel
49. A nurse is preparing to complete morning assessments on several assigned clients. Which of
the following clients should the nurse plan to assess first?
A. A client who had a bladder scan that indicated 250 mL of urine in the bladder
B. A client who is 3 days postoperative and whose dressing has serosanguinous drainage
C. A client who has diabetes and an early morning blood glucose of 220 mg/dL
D. A client who has a nasogastric tube to intermittent suction and reports nausea
50. A charge nurse overhears a staff nurse discussing a client’s diagnosis in the cafeteria. Which
of the following responses should the charge nurse make?
A. Please stop discussing the client in a public area
B. I will need to notify the client’s provider about this breach of confidentiality
C. We should discuss your concerns with the client’s care team
D. Do you understand the HIPAA regulations?
51. A nurse preceptor is observing a newly hired nurse perform a sterile dressing change. Which
of the following actions should the nurse preceptor identify as maintaining sterile technique?
A. Places sterile gauze 1.3 cm (0.5 in) away from the edge of a sterile drape
B. Uses a sterile-gloved hand to adjust the back of the sterile gown
C. Sets up the sterile field 30 min prior to performing the dressing change
D. Uses sterile forceps to pack sterile gauze into the wound

52. A nurse working in a long-term care facility is assessing an older adult client who has been
receiving antibiotics for 10 days. The client reports frequent loose stools. Which of the following
actions should the nurse take?
A. Perform hand hygiene with alcohol-based hand sanitizer
B. Place the client in a negative-pressure airflow room
C. Clean the equipment in the client’s room with bleach
D. Initiate droplet precautions for the client
53. A nurse is assisting with the orientation of a newly licensed nurse. The newly licensed nurse
is having trouble focusing and has difficulty completing care for his assigned clients. Which of
the following interventions is appropriate?
A. Ask other staff members to take over some of his tasks
B. Offer to provide care for his clients while he takes a break
C. Recommend that he take time to plan at the beginning of his shift
D. Advise him to complete less time-consuming tasks first
54. A nurse is planning discharge for a client who had a lung resection. The nurse initiates a
referral for a social worker. Which of the following assessment data supports this referral?
A. The client needs to have someone come in to help her bathe at home
B. The client needs to arrange financial resources to purchase equipment
C. The client needs to have someone bring oxygen tanks and equipment to her home
D. The client needs to have range-of-motion exercises to assist with ambulation
55. A nurse initiates a referral to an occupational therapist for a client who has rheumatoid
arthritis. Which of the following assessment findings supports the need for this referral?
A. The client requires assistance with completing oral hygiene
B. The client reports pain when chewing solid foods
C. The client has difficulty ambulating with a walker
D. The client expresses the desire to join a support group

56. A nurse is caring for a client who has anorexia nervosa. Which of the following
interdisciplinary team members should be consulted in regard to this client’s care? (Select all
that apply.)
A. Mental health counselor
B. Physical therapist
C. Occupational therapist
D. Case manager
E. Nutritional therapist
57. A nurse is prioritizing care after receiving change-of-shift report on four clients. Which of the
following clients should the nurse assess first?
A. A client who reports feeling lightheaded when he stands up from a lying position
B. A client who reports an urge to void but has not urinated during the prior shift
C. A client who reports a headache with sensitivity to light
D. A client who reports indigestion and pain in her jaw
58. A nurse on an acute mental health unit is assessing four clients. Which of the following
clients is the highest priority?
A. A client who has bipolar disorder and displays constant pacing
B. A client who has schizophrenia and uses neologisms
C. A client who has depressive disorder and has poor personal hygiene
D. A client who has dementia and exhibits aphasia
59. A nurse is planning care for a group of clients. Which of the following actions should the
nurse take first?
A. Obtain a breakfast tray for a client whose total parenteral nutrition was discontinued 4 hr ago
B. Auscultate the bowel sounds of a client who has not had a bowel movement after taking a
laxative 12 hr ago
C. Check a client who has a leg cast and reports a new onset of pain
D. Provide instruction to the caregiver of a client who has dementia and a new diagnosis of
diabetes mellitus

60. A nurse on a medical-surgical unit is caring for a client who asks about advance directives
and states that he wants to appoint a health care proxy. Which of the following responses should
the nurse make?
A. You should appoint a health care proxy before undergoing an invasive procedure
B. You must choose a member of your family to serve as your health care proxy
C. A health care proxy can make decisions for you when you are unable to do so
D. It is necessary for an attorney to approve your health care proxy
61. A nurse in a rehabilitation facility is administering medications to a client who was admitted
earlier that day. The client refuses two of the medications, stating “I’ve never taken these
before.” Which of the following actions should the nurse take first?
A. Consult the pharmacist about the client’s prescribed medications
B. Review the intended purpose of the prescribed medications with the client
C. Compare the client’s medication administration record with the prescriptions on the transfer
orders
D. Call the provider to clarify the client’s prescribed medications
62. A nurse on a medical-surgical unit is caring for four clients. The nurse should recognize that
which of the following clients is the highest priority?
A. A client who is newly diagnosed with pancreatic cancer and is scheduled to begin IV
chemotherapy
B. A client who is postoperative following a laminectomy 12 hr ago and is unable to void
C. A client who has peripheral vascular disease and has an absent pedal pulse in the right
foot
D. A client who has MRSA and has an axillary temperature of 38 C (101 F)
63. A nurse in the emergency department admits a client who has been exposed to cutaneous
anthrax. Which of the following actions should the nurse take?
A. Plan to administer an antiviral medication to the client
B. Place a surgical mask on the client during transfer to the unit

C. Prepare to administer antibiotics to the client
D. Wear an N95 respirator mask while caring for the client
64. A charge nurse notices that two staff nurses are not taking meal breaks during their shifts.
Which of the following actions should the nurse take first?
A. Determine the reasons the nurses are not taking scheduled breaks
B. Review facility policies for taking scheduled breaks
C. Discuss time management strategies with the nurses
D. Provide coverage for the nurses’ breaks
65. A nurse is caring for a client who reports acute pain but refuses IM medication. The nurse
distracts the client and quickly administers the injection. This illustrates which of the following?
A. Battery
B. False imprisonment
C. Libel
D. Assault
66. A nurse is speaking with a visitor who asks a question about the status of a relative who is a
client on the unit. Which of the following responses by the nurse is appropriate?
A. Please ask your relative about this, because I cannot share information about her
B. I will have your relative’s nurse come and talk with you about her care
C. Let me check your relative’s medical record to see how she’s doing
D. I’m not taking care of your relative today, so I don’t have the latest information
67. A nurse suggests respite care for the partner of a client who has mild cognitive impairment.
The client’s partner asks the nurse how that would help. The nurse should explain that respite
care would do which of the following?
A. Send a clinician to assess the safety of leaving her partner alone
B. Allow her to take time off from attending to her partner
C. Help her arrange transferring her partner to an assisted living facility
D. Provide volunteers who will run errands for her

68. A charge nurse observes a client fall during ambulation and notes that his gait belt was not in
place. In reviewing the incident report, the nurse finds no mention of a gait belt. Which of the
following ethical principles should guide the nurse’s subsequent actions?
A. Nonmaleficence
B. Fidelity
C. Veracity
D. Beneficence
69. A nurse is caring for a client who is scheduled for placement of a central venous access
device. Which of the following actions is the nurse’s responsibility in the informed consent
process?
A. Review the risks and benefits of the procedure with the client
B. Assess the client’s understanding after the provider has talked with her
C. Discuss alternative treatment options with the client
D. Place a photocopy of the signed informed consent in the client’s medical record
70. A nurse is providing teaching to assistive personnel about the application of wrist restraints
to a client. Which of the following instructions should the nurse include in the teaching?
A. Secure the client’s restraints with a square knot
B. Remove the client’s restraints every 2 hr
C. Attach the restraints to the fixed portion of the frame of the client’s bed
D. Allow 1 fingerbreadth between the restraint and the client’s wrists