PROFESSIONAL NURSING PRACTICE ASSESSMENT| FALL
SEASON READINESS| JULY 2026(QUESTIONS and
CORRECT ANSWERS)
1. A 78-year-old patient with a history of heart failure is admitted with
acute shortness of breath. The nurse notes jugular venous distention,
crackles in the lung bases, and 3+ pitting edema in the lower
extremities. Which of the following interventions should the nurse
initiate first?
A. Administer a loop diuretic as prescribed
B. Place the patient in a high-Fowler's position
C. Initiate continuous pulse oximetry monitoring
D. Restrict oral fluid intake to 1500 mL per day
Correct Answer: B
Explanation: High-Fowler's position promotes venous return to the
lower extremities and reduces preload, immediately alleviating
pulmonary congestion. While diuretics and monitoring are important,
positioning is the priority, independent, and immediate nursing action.
Fluid restriction is a secondary, prescribed intervention.
2. A nurse is caring for a patient on a continuous norepinephrine
infusion. Which assessment finding indicates a potential adverse
effect requiring immediate intervention?
A. Blood pressure of 142/88 mmHg
B. Urine output of 30 mL/hr
C. Pallor and coolness in the extremities
,D. Heart rate of 110 beats per minute
Correct Answer: C
Explanation: Norepinephrine is a potent vasoconstrictor. Pallor and
coolness in the extremities indicate peripheral vasoconstriction and
potential ischemia, which can lead to tissue necrosis. While
hypertension and tachycardia are expected effects, they do not indicate
immediate tissue compromise. A urine output of 30 mL/hr is at the
lower limit of normal and not an immediate emergency.
3. In the context of the "never events" identified by the National
Quality Forum, which of the following is classified as a surgical never
event?
A. Stage 3 pressure ulcer acquired after admission
B. Retained foreign object after surgery
C. Catheter-associated urinary tract infection
D. Fall resulting in a fractured hip
Correct Answer: B
Explanation: The National Quality Forum's list of Serious Reportable
Events (Never Events) includes retained foreign objects after surgery.
While pressure ulcers, CAUTIs, and falls are serious, they are considered
hospital-acquired conditions (HACs) or events for which prevention is
possible, but they are not classified as "never events" in the same
category of extreme, largely preventable adverse events.
4. A patient with terminal cancer is experiencing breakthrough pain
despite being on a scheduled dose of long-acting morphine. The nurse
administers an immediate-release opioid. Which of the following is
,the most important component of the subsequent assessment?
A. Level of consciousness
B. Respiratory rate
C. Pain score on a 0-10 scale
D. Oxygen saturation
Correct Answer: B
Explanation: The most critical adverse effect of opioid administration is
respiratory depression. The respiratory rate must be assessed before
and after administration of an opioid, particularly an immediate-release
formulation. While all options are important, the respiratory rate
provides the most direct and immediate indication of life-threatening
respiratory depression.
5. A nurse is performing a mental status examination on an elderly
patient. The patient is oriented to person and place but is unsure of
the date and year. The patient's short-term memory is intact, but the
patient has difficulty with abstract thinking. The nurse would
document this as:
A. Confusion
B. Delirium
C. Dementia
D. Normal aging
Correct Answer: C
Explanation: The patient's presentation—impaired orientation to time,
intact short-term memory, and difficulty with abstract reasoning—is
consistent with early to moderate dementia. Delirium is typically acute
and fluctuating. While some cognitive changes occur with normal aging
(e.g., slower processing speed), deficits in abstract thinking and
, orientation are not considered normal and indicate a potential cognitive
disorder.
6. The nurse is caring for a patient with a chest tube connected to a
three-chamber water-seal drainage system. The nurse observes
continuous bubbling in the water-seal chamber. What is the priority
nursing action?
A. Document the finding as expected
B. Clamp the chest tube immediately
C. Assess the chest tube system for an air leak
D. Increase the suction pressure
Correct Answer: C
Explanation: Continuous bubbling in the water-seal chamber indicates
an air leak in the system. The nurse should first assess the system to
locate the source of the leak (e.g., a loose connection). Clamping the
tube is only a temporary measure for assessment and may lead to
tension pneumothorax if air cannot escape. Increasing suction will not
resolve a leak. Documenting without action is unsafe.
7. Which of the following instructions is most appropriate for the
nurse to give to a patient who is scheduled for a 24-hour urine
collection to measure creatinine clearance?
A. "You need to be on a low-protein diet for 24 hours prior to the test."
B. "You must discard the first voided urine and note the time."
C. "You should collect all urine in a container kept at room
temperature."
D. "You will need to take an oral dye the night before the collection."
SEASON READINESS| JULY 2026(QUESTIONS and
CORRECT ANSWERS)
1. A 78-year-old patient with a history of heart failure is admitted with
acute shortness of breath. The nurse notes jugular venous distention,
crackles in the lung bases, and 3+ pitting edema in the lower
extremities. Which of the following interventions should the nurse
initiate first?
A. Administer a loop diuretic as prescribed
B. Place the patient in a high-Fowler's position
C. Initiate continuous pulse oximetry monitoring
D. Restrict oral fluid intake to 1500 mL per day
Correct Answer: B
Explanation: High-Fowler's position promotes venous return to the
lower extremities and reduces preload, immediately alleviating
pulmonary congestion. While diuretics and monitoring are important,
positioning is the priority, independent, and immediate nursing action.
Fluid restriction is a secondary, prescribed intervention.
2. A nurse is caring for a patient on a continuous norepinephrine
infusion. Which assessment finding indicates a potential adverse
effect requiring immediate intervention?
A. Blood pressure of 142/88 mmHg
B. Urine output of 30 mL/hr
C. Pallor and coolness in the extremities
,D. Heart rate of 110 beats per minute
Correct Answer: C
Explanation: Norepinephrine is a potent vasoconstrictor. Pallor and
coolness in the extremities indicate peripheral vasoconstriction and
potential ischemia, which can lead to tissue necrosis. While
hypertension and tachycardia are expected effects, they do not indicate
immediate tissue compromise. A urine output of 30 mL/hr is at the
lower limit of normal and not an immediate emergency.
3. In the context of the "never events" identified by the National
Quality Forum, which of the following is classified as a surgical never
event?
A. Stage 3 pressure ulcer acquired after admission
B. Retained foreign object after surgery
C. Catheter-associated urinary tract infection
D. Fall resulting in a fractured hip
Correct Answer: B
Explanation: The National Quality Forum's list of Serious Reportable
Events (Never Events) includes retained foreign objects after surgery.
While pressure ulcers, CAUTIs, and falls are serious, they are considered
hospital-acquired conditions (HACs) or events for which prevention is
possible, but they are not classified as "never events" in the same
category of extreme, largely preventable adverse events.
4. A patient with terminal cancer is experiencing breakthrough pain
despite being on a scheduled dose of long-acting morphine. The nurse
administers an immediate-release opioid. Which of the following is
,the most important component of the subsequent assessment?
A. Level of consciousness
B. Respiratory rate
C. Pain score on a 0-10 scale
D. Oxygen saturation
Correct Answer: B
Explanation: The most critical adverse effect of opioid administration is
respiratory depression. The respiratory rate must be assessed before
and after administration of an opioid, particularly an immediate-release
formulation. While all options are important, the respiratory rate
provides the most direct and immediate indication of life-threatening
respiratory depression.
5. A nurse is performing a mental status examination on an elderly
patient. The patient is oriented to person and place but is unsure of
the date and year. The patient's short-term memory is intact, but the
patient has difficulty with abstract thinking. The nurse would
document this as:
A. Confusion
B. Delirium
C. Dementia
D. Normal aging
Correct Answer: C
Explanation: The patient's presentation—impaired orientation to time,
intact short-term memory, and difficulty with abstract reasoning—is
consistent with early to moderate dementia. Delirium is typically acute
and fluctuating. While some cognitive changes occur with normal aging
(e.g., slower processing speed), deficits in abstract thinking and
, orientation are not considered normal and indicate a potential cognitive
disorder.
6. The nurse is caring for a patient with a chest tube connected to a
three-chamber water-seal drainage system. The nurse observes
continuous bubbling in the water-seal chamber. What is the priority
nursing action?
A. Document the finding as expected
B. Clamp the chest tube immediately
C. Assess the chest tube system for an air leak
D. Increase the suction pressure
Correct Answer: C
Explanation: Continuous bubbling in the water-seal chamber indicates
an air leak in the system. The nurse should first assess the system to
locate the source of the leak (e.g., a loose connection). Clamping the
tube is only a temporary measure for assessment and may lead to
tension pneumothorax if air cannot escape. Increasing suction will not
resolve a leak. Documenting without action is unsafe.
7. Which of the following instructions is most appropriate for the
nurse to give to a patient who is scheduled for a 24-hour urine
collection to measure creatinine clearance?
A. "You need to be on a low-protein diet for 24 hours prior to the test."
B. "You must discard the first voided urine and note the time."
C. "You should collect all urine in a container kept at room
temperature."
D. "You will need to take an oral dye the night before the collection."
