Z NURSING STATE EXAM
N
2025 | 120 Verified Q&A (100%
Correct) | RN & EN Practice
Exam | Pass Guaranteed - A+
Graded
### **PART A: MULTIPLE CHOICE (Q1–60)**
* *Q1 (Māori Health – Te Tiriti):** A Māori patient refuses a blood transfusion due to cultural
beliefs. The nurse respects the patient's decision and explores alternative treatments. This
action best demonstrates which principle of Te Tiriti o Waitangi?
. Kāwanatanga (governance)
A
B. Tino Rangatiratanga (self-determination)
C. Ōritetanga (equality)
D. Wairuatanga (spirituality)
* *[CORRECT]** B
*Rationale: Tino Rangatiratanga affirms Māori autonomy and control over their own affairs,
including health decisions, as protected under Te Tiriti o Waitangi. Distractor A (Kāwanatanga)
refers to Crown governance authority, not patient self-determination; D (Wairuatanga), while
important in holistic Māori health models like Whare Tapa Whā, is not the specific treaty
principle being demonstrated here. Exam tip: NCNZ Competency 1.4 requires nurses to apply
Te Tiriti principles practically—always distinguish between the three core treaty principles
(partnership, protection, participation) and Māori health concepts like wairuatanga.*
---
* *Q2 (Professional/Ethical Practice):** A registered nurse (RN) in a Christchurch public hospital
notices a colleague's documentation errors that could affect patient safety. According to the
NCNZ Code of Conduct, what is the nurse's primary obligation?
A. Report immediately to the Nursing Council of New Zealand
, . Discuss concerns directly with the colleague and follow local escalation policy
B
C. Document the errors in the patient's notes for legal protection
D. Ignore the issue if no immediate harm has occurred
* *[CORRECT]** B
*Rationale: The NCNZ Code of Conduct (2012, updated 2024) requires nurses to raise
concerns directly with colleagues first and follow organisational escalation pathways, promoting
a just culture rather than punitive reporting. Distractor A bypasses local resolution processes; C
is inappropriate as it breaches colleague confidentiality; D violates the duty of candour. Exam
tip: The "4 Ds" of professional accountability—Duty, Dereliction, Direct causation,
Damages—guide NZ exam questions on colleague conduct; always choose the least escalatory
appropriate first step.*
---
* *Q3 (Clinical Assessment):** A 68-year-old patient post-hip replacement has vital signs: BP
92/58 mmHg, HR 118 bpm, RR 24, SpO₂ 94% on room air, temp 36.2°C. Using the NZ Early
Warning Score (NEWS), what is the total score and required action?
. NEWS 5; inform nurse in charge and increase monitoring to 4-hourly
A
B. NEWS 6; urgent review by clinician and continuous monitoring
C. NEWS 7; emergency response team activation
D. NEWS 4; routine observation frequency
* *[CORRECT]** B
*Rationale: Using NZ NEWS parameters (BP <90 systolic = 3 points, HR 111-130 = 2 points, RR
21-24 = 2 points, SpO₂ 94% = 1 point, temp 36.0-36.4°C = 1 point; total = 6), a score of 6
triggers urgent clinician review and continuous monitoring per Te Whatu Ora escalation
protocols. Distractor A underestimates the BP score; C over-escalates (NEWS ≥7 triggers
emergency response); D is dangerously complacent. Exam tip: Memorise NZ NEWS scoring
thresholds—0-4 (routine), 5-6 (urgent), ≥7 (emergency)—and remember that any single red flag
(e.g., airway obstruction) overrides the total score.*
---
* *Q4 (Cardiovascular):** A patient with acute coronary syndrome (ACS) is prescribed aspirin
300 mg stat, clopidogrel 300 mg stat, and fondaparinux 2.5 mg SC daily per NZ ACS guidelines.
The nurse should prioritise which assessment before administering these medications?
. Current INR and platelet count
A
B. Pain score using the NZ pain scale
C. Blood glucose level
D. Body weight for dose calculation
,* *[CORRECT]** A
*Rationale: Before administering dual antiplatelet therapy plus fondaparinux (a factor Xa
inhibitor), baseline coagulation status (INR/platelets) is essential to assess bleeding risk, per NZ
Heart Foundation ACS guidelines and SafeRx high-alert medication protocols. Distractor B,
while important for symptom management, is not a safety prerequisite; C is irrelevant to
anticoagulant administration; D is unnecessary as fondaparinux dosing is weight-independent at
2.5 mg. Exam tip: In NZ exams, "prioritise" questions require identifying the action that prevents
the most serious harm—bleeding from anticoagulants outweighs pain assessment.*
---
* *Q5 (Pharmacology):** A patient with type 2 diabetes is prescribed metformin 500 mg BD and
gliclazide 80 mg daily. The nurse notes the patient's eGFR is 28 mL/min/1.73m². What is the
appropriate action?
. Continue both medications and monitor renal function monthly
A
B. Stop metformin immediately; continue gliclazide with dose reduction
C. Stop gliclazide immediately; continue metformin with dose reduction
D. Stop both medications and initiate insulin therapy
* *[CORRECT]** B
*Rationale: The NZ Medicines Formulary and SafeRx guidelines contraindicate metformin when
eGFR <30 mL/min/1.73m² due to lactic acidosis risk; gliclazide can continue with renal
monitoring but may need dose adjustment. Distractor A violates the eGFR <30 contraindication;
C reverses the correct medication management; D is premature as gliclazide remains viable.
Exam tip: Memorise NZ renal thresholds for metformin—eGFR 30-45 (caution, reduce dose),
<30 (contraindicated); this is a high-yield exam topic.*
---
* *Q6 (Mental Health):** Under the Mental Health (Compulsory Assessment and Treatment) Act
1992, a patient is detained under Section 29 (community treatment order). The patient refuses
oral antipsychotic medication. What is the nurse's legal authority?
. Administer medication by intramuscular injection regardless of refusal
A
B. Administer medication only if the patient lacks capacity under the Code of Health and
Disability Services Consumers' Rights
C. Administer medication as authorised by the responsible clinician under the community
treatment order
D. Cannot administer medication without patient consent under any circumstances
* *[CORRECT]** C
*Rationale: A Section 29 community treatment order authorises the responsible clinician to
specify treatment requirements, including medication administration, which the nurse may
, lawfully administer despite refusal, provided it is within the order's scope. Distractor A is
incorrect as route must be specified; B conflates capacity assessment with the specific
legislative authority of the CTO; D ignores the statutory framework. Exam tip: Know the NZ
mental health legislative hierarchy—MHA 1992 overrides common law consent in specified
circumstances; always verify the section number and responsible clinician's authority.*
---
* *Q7 (Child Health):** A 6-month-old infant presents to a GP clinic in Auckland with fever and
irritability. The nurse notes a non-blanching petechial rash on the trunk. What is the priority
action?
. Administer paracetamol 15 mg/kg and reassess in 30 minutes
A
B. Perform a full set of vital signs and document findings
C. Arrange immediate transfer to emergency department; administer IV benzylpenicillin if sepsis
suspected
D. Apply topical antihistamine for suspected allergic reaction
* *[CORRECT]** C
*Rationale: Non-blanching rash with fever in an infant is a red flag for meningococcal disease,
which has significant incidence in NZ (particularly Māori and Pacific children); immediate ED
transfer and empirical benzylpenicillin per Starship Guidelines is required. Distractor A delays
critical treatment; B is insufficiently urgent; D is dangerous as it misinterprets a sepsis sign as
allergy. Exam tip: NZ has one of the highest meningococcal disease rates in OECD
countries—NCNZ exams heavily test recognition and immediate response; "non-blanching rash
+ fever = emergency" is a mandatory reflex.*
---
* *Q8 (Professional Practice):** A nurse is asked by a patient's family to share the patient's
diagnosis on social media to update relatives overseas. The nurse declines. This decision is
primarily supported by which legislation?
. Health and Disability Commissioner Act 1994
A
B. Privacy Act 2020
C. Health Practitioners Competence Assurance Act 2003
D. Code of Health and Disability Services Consumers' Rights 1996
* *[CORRECT]** B
*Rationale: The Privacy Act 2020 governs the collection, use, and disclosure of personal health
information, prohibiting unauthorised sharing including on social media platforms. Distractor A
establishes the HDC but does not specifically address information disclosure; C regulates
professional registration, not privacy; D outlines consumer rights but the Privacy Act provides
the specific legal framework for information sharing. Exam tip: In NZ nursing exams, distinguish
N
2025 | 120 Verified Q&A (100%
Correct) | RN & EN Practice
Exam | Pass Guaranteed - A+
Graded
### **PART A: MULTIPLE CHOICE (Q1–60)**
* *Q1 (Māori Health – Te Tiriti):** A Māori patient refuses a blood transfusion due to cultural
beliefs. The nurse respects the patient's decision and explores alternative treatments. This
action best demonstrates which principle of Te Tiriti o Waitangi?
. Kāwanatanga (governance)
A
B. Tino Rangatiratanga (self-determination)
C. Ōritetanga (equality)
D. Wairuatanga (spirituality)
* *[CORRECT]** B
*Rationale: Tino Rangatiratanga affirms Māori autonomy and control over their own affairs,
including health decisions, as protected under Te Tiriti o Waitangi. Distractor A (Kāwanatanga)
refers to Crown governance authority, not patient self-determination; D (Wairuatanga), while
important in holistic Māori health models like Whare Tapa Whā, is not the specific treaty
principle being demonstrated here. Exam tip: NCNZ Competency 1.4 requires nurses to apply
Te Tiriti principles practically—always distinguish between the three core treaty principles
(partnership, protection, participation) and Māori health concepts like wairuatanga.*
---
* *Q2 (Professional/Ethical Practice):** A registered nurse (RN) in a Christchurch public hospital
notices a colleague's documentation errors that could affect patient safety. According to the
NCNZ Code of Conduct, what is the nurse's primary obligation?
A. Report immediately to the Nursing Council of New Zealand
, . Discuss concerns directly with the colleague and follow local escalation policy
B
C. Document the errors in the patient's notes for legal protection
D. Ignore the issue if no immediate harm has occurred
* *[CORRECT]** B
*Rationale: The NCNZ Code of Conduct (2012, updated 2024) requires nurses to raise
concerns directly with colleagues first and follow organisational escalation pathways, promoting
a just culture rather than punitive reporting. Distractor A bypasses local resolution processes; C
is inappropriate as it breaches colleague confidentiality; D violates the duty of candour. Exam
tip: The "4 Ds" of professional accountability—Duty, Dereliction, Direct causation,
Damages—guide NZ exam questions on colleague conduct; always choose the least escalatory
appropriate first step.*
---
* *Q3 (Clinical Assessment):** A 68-year-old patient post-hip replacement has vital signs: BP
92/58 mmHg, HR 118 bpm, RR 24, SpO₂ 94% on room air, temp 36.2°C. Using the NZ Early
Warning Score (NEWS), what is the total score and required action?
. NEWS 5; inform nurse in charge and increase monitoring to 4-hourly
A
B. NEWS 6; urgent review by clinician and continuous monitoring
C. NEWS 7; emergency response team activation
D. NEWS 4; routine observation frequency
* *[CORRECT]** B
*Rationale: Using NZ NEWS parameters (BP <90 systolic = 3 points, HR 111-130 = 2 points, RR
21-24 = 2 points, SpO₂ 94% = 1 point, temp 36.0-36.4°C = 1 point; total = 6), a score of 6
triggers urgent clinician review and continuous monitoring per Te Whatu Ora escalation
protocols. Distractor A underestimates the BP score; C over-escalates (NEWS ≥7 triggers
emergency response); D is dangerously complacent. Exam tip: Memorise NZ NEWS scoring
thresholds—0-4 (routine), 5-6 (urgent), ≥7 (emergency)—and remember that any single red flag
(e.g., airway obstruction) overrides the total score.*
---
* *Q4 (Cardiovascular):** A patient with acute coronary syndrome (ACS) is prescribed aspirin
300 mg stat, clopidogrel 300 mg stat, and fondaparinux 2.5 mg SC daily per NZ ACS guidelines.
The nurse should prioritise which assessment before administering these medications?
. Current INR and platelet count
A
B. Pain score using the NZ pain scale
C. Blood glucose level
D. Body weight for dose calculation
,* *[CORRECT]** A
*Rationale: Before administering dual antiplatelet therapy plus fondaparinux (a factor Xa
inhibitor), baseline coagulation status (INR/platelets) is essential to assess bleeding risk, per NZ
Heart Foundation ACS guidelines and SafeRx high-alert medication protocols. Distractor B,
while important for symptom management, is not a safety prerequisite; C is irrelevant to
anticoagulant administration; D is unnecessary as fondaparinux dosing is weight-independent at
2.5 mg. Exam tip: In NZ exams, "prioritise" questions require identifying the action that prevents
the most serious harm—bleeding from anticoagulants outweighs pain assessment.*
---
* *Q5 (Pharmacology):** A patient with type 2 diabetes is prescribed metformin 500 mg BD and
gliclazide 80 mg daily. The nurse notes the patient's eGFR is 28 mL/min/1.73m². What is the
appropriate action?
. Continue both medications and monitor renal function monthly
A
B. Stop metformin immediately; continue gliclazide with dose reduction
C. Stop gliclazide immediately; continue metformin with dose reduction
D. Stop both medications and initiate insulin therapy
* *[CORRECT]** B
*Rationale: The NZ Medicines Formulary and SafeRx guidelines contraindicate metformin when
eGFR <30 mL/min/1.73m² due to lactic acidosis risk; gliclazide can continue with renal
monitoring but may need dose adjustment. Distractor A violates the eGFR <30 contraindication;
C reverses the correct medication management; D is premature as gliclazide remains viable.
Exam tip: Memorise NZ renal thresholds for metformin—eGFR 30-45 (caution, reduce dose),
<30 (contraindicated); this is a high-yield exam topic.*
---
* *Q6 (Mental Health):** Under the Mental Health (Compulsory Assessment and Treatment) Act
1992, a patient is detained under Section 29 (community treatment order). The patient refuses
oral antipsychotic medication. What is the nurse's legal authority?
. Administer medication by intramuscular injection regardless of refusal
A
B. Administer medication only if the patient lacks capacity under the Code of Health and
Disability Services Consumers' Rights
C. Administer medication as authorised by the responsible clinician under the community
treatment order
D. Cannot administer medication without patient consent under any circumstances
* *[CORRECT]** C
*Rationale: A Section 29 community treatment order authorises the responsible clinician to
specify treatment requirements, including medication administration, which the nurse may
, lawfully administer despite refusal, provided it is within the order's scope. Distractor A is
incorrect as route must be specified; B conflates capacity assessment with the specific
legislative authority of the CTO; D ignores the statutory framework. Exam tip: Know the NZ
mental health legislative hierarchy—MHA 1992 overrides common law consent in specified
circumstances; always verify the section number and responsible clinician's authority.*
---
* *Q7 (Child Health):** A 6-month-old infant presents to a GP clinic in Auckland with fever and
irritability. The nurse notes a non-blanching petechial rash on the trunk. What is the priority
action?
. Administer paracetamol 15 mg/kg and reassess in 30 minutes
A
B. Perform a full set of vital signs and document findings
C. Arrange immediate transfer to emergency department; administer IV benzylpenicillin if sepsis
suspected
D. Apply topical antihistamine for suspected allergic reaction
* *[CORRECT]** C
*Rationale: Non-blanching rash with fever in an infant is a red flag for meningococcal disease,
which has significant incidence in NZ (particularly Māori and Pacific children); immediate ED
transfer and empirical benzylpenicillin per Starship Guidelines is required. Distractor A delays
critical treatment; B is insufficiently urgent; D is dangerous as it misinterprets a sepsis sign as
allergy. Exam tip: NZ has one of the highest meningococcal disease rates in OECD
countries—NCNZ exams heavily test recognition and immediate response; "non-blanching rash
+ fever = emergency" is a mandatory reflex.*
---
* *Q8 (Professional Practice):** A nurse is asked by a patient's family to share the patient's
diagnosis on social media to update relatives overseas. The nurse declines. This decision is
primarily supported by which legislation?
. Health and Disability Commissioner Act 1994
A
B. Privacy Act 2020
C. Health Practitioners Competence Assurance Act 2003
D. Code of Health and Disability Services Consumers' Rights 1996
* *[CORRECT]** B
*Rationale: The Privacy Act 2020 governs the collection, use, and disclosure of personal health
information, prohibiting unauthorised sharing including on social media platforms. Distractor A
establishes the HDC but does not specifically address information disclosure; C regulates
professional registration, not privacy; D outlines consumer rights but the Privacy Act provides
the specific legal framework for information sharing. Exam tip: In NZ nursing exams, distinguish
