Answers with Detailed Rationales Actual Exam 2026/2027 –
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TABLE OF CONTENTS
Table
Section Title Questions
Section 1 Safe, Effective Care Environment – Management of Care 30
Section 2 Safe, Effective Care Environment – Safety and Infection Control 30
Section 3 Health Promotion and Maintenance 30
Section 4 Psychosocial Integrity 20
Section 5 Physiological Integrity – Basic Care and Comfort 20
SECTION 1: SAFE, EFFECTIVE CARE ENVIRONMENT – MANAGEMENT OF CARE (30 Questions)
Q1: The practical nurse is caring for a client who was admitted for elective surgery. The client states, "I
don't want any blood transfusions because of my religious beliefs." Which action should the PN take
first?
A. Ask the client to sign a refusal of treatment form immediately
B. Notify the surgeon and document the client's refusal in the medical record
C. Respect the client's autonomy and ensure an informed refusal is documented
D. Explain the risks of refusing blood transfusions in detail to change the client's mind
Correct Answer: C
Rationale: The PN must prioritize the client's right to autonomy and self-determination as a fundamental
ethical principle. An informed refusal requires ensuring the client understands the risks and
,consequences without coercion. The PN should document the discussion and notify the healthcare team
to develop an alternative care plan that respects the client's beliefs.
Q2: The PN is assigned four clients. Which client should the PN assess first?
A. A client with a blood pressure of 148/92 mmHg who reports a mild headache
B. A client with a respiratory rate of 28/min and oxygen saturation of 88% on room air
C. A client with a postoperative temperature of 101.2°F (38.4°C) on POD #2
D. A client with a heart rate of 110 bpm who is anxious about pending discharge
Correct Answer: B
Rationale: Using the ABC priority framework, airway and breathing take precedence over circulation and
all other needs. An oxygen saturation of 88% indicates significant hypoxemia requiring immediate
assessment and intervention. The elevated respiratory rate further supports respiratory compromise as
the highest priority.
Q3: Which task is appropriate for the practical nurse to delegate to an unlicensed assistive personnel
(UAP)?
A. Administering a subcutaneous insulin injection to a newly diagnosed diabetic client
B. Assisting an ambulatory client with a stand-pivot transfer from bed to chair
C. Evaluating the effectiveness of a PRN pain medication for a postoperative client
D. Teaching a client about wound care prior to discharge
Correct Answer: B
Rationale: UAPs may perform non-invasive, routine client care tasks such as ambulation and transfers
after proper training and competency verification. Tasks requiring nursing judgment, assessment,
medication administration, or client education remain within the PN/RN scope of practice and cannot be
delegated to UAPs.
Q4: A client with a history of chronic obstructive pulmonary disease (COPD) is being discharged home
with oxygen therapy. The PN is providing discharge teaching. Which statement by the client indicates a
need for further instruction?
A. "I will keep my oxygen at 2 L/min via nasal cannula as prescribed."
B. "I will use petroleum jelly on my nostrils to prevent dryness from the cannula."
C. "I will post 'No Smoking' signs near my oxygen equipment."
,D. "I will check my oxygen tubing for kinks before turning on the flow."
Correct Answer: B
Rationale: Petroleum-based products are highly flammable and contraindicated near oxygen sources
due to the risk of fire or explosion. Water-based lubricants should be used instead for nasal dryness. The
PN must reinforce oxygen safety teaching, including the prohibition of petroleum products, smoking,
and open flames.
Q5: The PN is reviewing the advance directive of a client who has a living will and durable power of
attorney for healthcare. The client becomes unresponsive and the family requests aggressive
resuscitation measures that contradict the advance directive. Which action should the PN take?
A. Honor the family's wishes because they are the next of kin
B. Follow the advance directive and notify the supervisor and physician immediately
C. Begin resuscitation while waiting for the physician to arrive
D. Ask the family to provide a new written directive before proceeding
Correct Answer: B
Rationale: Advance directives are legally binding documents that express the client's wishes for end-of-
life care. The PN must advocate for the client's documented preferences and immediately involve the
charge nurse, supervisor, and physician to address the family's concerns while upholding the client's
legal rights.
Q6: A client is scheduled for an invasive procedure and asks the PN, "Do I really have to sign this consent
form? My doctor already explained everything." Which response by the PN is most appropriate?
A. "Your doctor's explanation is sufficient; you don't need to sign anything else."
B. "The consent form is a legal requirement, but you can refuse the procedure if you want."
C. "Yes, informed consent is required. Do you have any questions about the procedure before you sign?"
D. "You should ask your doctor to sign the form for you since he explained everything."
Correct Answer: C
Rationale: Informed consent requires that the client voluntarily agrees to the procedure after receiving
adequate information about risks, benefits, and alternatives. The PN verifies understanding, addresses
questions, and witnesses the signature without coercing or providing medical information beyond the
scope of PN practice.
Q7: The PN is caring for a client who is a minor and requires emergency surgery. The parents are
unreachable, and the client is deteriorating rapidly. Which action should the PN take?
, A. Wait for the parents to arrive before any treatment is initiated
B. Obtain a court order for emergency treatment before proceeding
C. Proceed with treatment under implied consent for emergency situations
D. Ask the client for verbal consent since they are old enough to understand
Correct Answer: C
Rationale: Implied consent applies in life-threatening emergencies when the client or legal guardian
cannot provide consent and delaying treatment would cause serious harm. The healthcare team must
act in the client's best interest, document the emergency circumstances thoroughly, and continue
attempts to contact the parents.
Q8: Which of the following is within the scope of practice for a practical nurse? (Select All That Apply)
A. Performing a focused assessment on a stable postoperative client
B. Developing the initial nursing care plan for a newly admitted client
C. Administering oral medications that have been previously administered without adverse effects
D. Initiating IV therapy in a client with no previous IV access
E. Reinforcing teaching provided by the RN about postoperative wound care
F. Evaluating client outcomes and revising the plan of care independently
Correct Answer: A, C, E
Rationale: The PN scope includes focused assessments, administration of medications within established
parameters, and reinforcement of RN-provided teaching. Initial care plan development, initiation of IV
therapy, and independent evaluation and revision of the care plan require RN scope and judgment.
Q9: The PN is supervising a UAP who is providing care to multiple clients. The UAP reports that a client
with diabetes has a blood glucose of 45 mg/dL and is alert but shaky. Which instruction should the PN
give to the UAP first?
A. "Give the client a glass of orange juice and recheck in 15 minutes."
B. "Call the physician immediately and report the blood glucose level."
C. "Have the client lie down and I will assess them right away."
D. "Document the blood glucose in the electronic health record."
Correct Answer: A