REX-PN EXAM 300 ACTUAL QUESTIONS AND CORRECT
ANSWERS WITH RATIONALE LATEST 2026-2027 ALREADY
GRADED A+
.
The REx-PN (Registered Practical Nurse) exam, administered by the College
of Nurses of Ontario, is a computerized adaptive test that assesses the entry-
level competencies of practical nursing candidates in Canada. It evaluates
clinical judgment, decision-making, and safe nursing practice across all client
populations. The exam content is organized by Client Needs categories,
including Management of Care, Safety and Infection Control, Health
Promotion and Maintenance, Psychosocial Integrity, Basic Care and Comfort,
Pharmacological and Parenteral Therapies, Reduction of Risk Potential, and
Physiological Adaptation. Multiple question formats are used, including
multiple choice, multiple response, and calculated fill-in-the-blank. Successful
completion is required for registration as a practical nurse.
1. A client with chronic obstructive pulmonary disease (COPD) has an oxygen
saturation of 88% on room air. The practical nurse should anticipate which
intervention?
A. Apply oxygen at 2 L/min via nasal cannula
B. Apply oxygen at 6 L/min via non-rebreather mask
C. Position the client in a supine position
D. Encourage deep breathing and coughing exercises
Answer: A. Apply oxygen at 2 L/min via nasal cannula
Rationale: For clients with COPD, oxygen therapy should be administered
cautiously at low flow rates (1-2 L/min) to maintain oxygen saturation between 88-
92% without suppressing the hypoxic drive. A non-rebreather mask delivers high-
flow oxygen, which can lead to respiratory depression in COPD clients. Supine
positioning impairs ventilation, and while deep breathing is beneficial, it does not
address the immediate hypoxemia. Safe oxygen administration is a key component
of Basic Care and Comfort .
2. The practical nurse is preparing to administer a prescribed antibiotic to a client.
Which action is most important to perform before giving the medication?
A. Check the client's temperature
,B. Verify the client's allergy status
C. Assess the client's pain level
D. Review the client's dietary intake
Answer: B. Verify the client's allergy status
Rationale: Verifying allergy status is a critical safety step before administering any
medication to prevent potentially fatal anaphylactic reactions. This is a
fundamental principle of safe medication administration and falls under Safety and
Infection Control . While checking temperature, pain level, and dietary intake may
be relevant for specific situations, they are not the priority safety action for all
medication administrations.
3. A client is 12 hours post-operative from a total knee arthroplasty. The practical
nurse assesses the client's surgical dressing, which is intact with a small amount of
serosanguineous drainage. The client rates pain as 6 out of 10. What is the nurse's
priority action?
A. Administer the prescribed PRN analgesic
B. Document the findings as normal
C. Notify the healthcare provider
D. Reinforce the dressing with an ABD pad
Answer: A. Administer the prescribed PRN analgesic
Rationale: Pain management is a priority in post-operative care. A pain score of
6/10 indicates moderate to severe pain requiring intervention. Administering the
prescribed analgesic addresses the client's immediate comfort and promotes
healing and mobility. The dressing findings are expected at 12 hours post-op, so
notification or reinforcement is not required. This action aligns with Basic Care
and Comfort .
4. The practical nurse is assisting with a sterile dressing change. After opening the
sterile field, the nurse notices a damp spot on the sterile drape. What should the
nurse do?
A. Continue the procedure, as the spot is small
B. Discard the contaminated drape and obtain a new sterile field
C. Cover the damp spot with a sterile towel
D. Note the damp spot in the client's chart
Answer: B. Discard the contaminated drape and obtain a new sterile field
Rationale: A sterile field is considered contaminated if it becomes wet or damp
because moisture can wick microorganisms from non-sterile surfaces. The only
correct action is to discard the contaminated drape and establish a new sterile field.
This is a fundamental principle of surgical asepsis and falls under Safety and
Infection Control .
,5. A client receiving a blood transfusion reports chills and low back pain. What is
the practical nurse's first action?
A. Slow the transfusion rate
B. Stop the transfusion and maintain the IV line with normal saline
C. Administer an antihistamine
D. Notify the healthcare provider
Answer: B. Stop the transfusion and maintain the IV line with normal saline
Rationale: Chills and low back pain are classic signs of an acute hemolytic
transfusion reaction. The immediate priority is to stop the transfusion to prevent
further hemolysis and maintain IV access with normal saline. Notifying the
provider and administering medications are important secondary actions, but
stopping the transfusion is the first step. This action is critical for Safety and
Infection Control .
6. A client with type 2 diabetes mellitus is scheduled for a colonoscopy. The
practical nurse should reinforce which instruction regarding the client's oral
hypoglycemic medication?
A. Take the medication as usual on the day of the procedure
B. Hold the medication on the day of the procedure until after the test
C. Double the dose of medication the day before the procedure
D. Take the medication with a full glass of water
Answer: B. Hold the medication on the day of the procedure until after the test
Rationale: Clients are typically NPO for procedures and may experience
hypoglycemia if they take oral hypoglycemic agents without food. The medication
should be held until after the procedure and the client is able to eat. This
instruction is consistent with the principles of pharmacological management and
safety and infection control .
7. The practical nurse is assessing a client who has just had a seizure. Which
finding should be reported to the healthcare provider immediately?
A. Post-ictal confusion lasting 10 minutes
B. Incontinence of urine during the seizure
C. A bitten tongue with active bleeding
D. A respiratory rate of 28 breaths per minute
Answer: C. A bitten tongue with active bleeding
Rationale: While post-ictal confusion and incontinence are common post-seizure
findings, a bitten tongue with active bleeding requires immediate assessment and
intervention to prevent aspiration and control bleeding. An elevated respiratory rate
, may be transient and should be monitored. This situation falls under Reduction of
Risk Potential .
8. A client is prescribed digoxin for heart failure. Which assessment finding
indicates a potential adverse effect of this medication?
A. Heart rate of 58 beats per minute
B. Blood pressure of 128/76 mmHg
C. Respiratory rate of 16 breaths per minute
D. Serum potassium level of 3.8 mEq/L
Answer: A. Heart rate of 58 beats per minute
Rationale: Digoxin can cause bradycardia as a sign of toxicity. A heart rate below
60 beats per minute warrants holding the medication and notifying the provider.
The other options are within normal limits. This is a medication safety concern
under Pharmacological and Parenteral Therapies .
9. A client who is 2 days post-operative is ambulating for the first time. The
practical nurse should instruct the client to:
A. Keep the head down and look at the floor while walking
B. Use a walker and take small, shuffling steps
C. Stand up quickly from the chair to avoid dizziness
D. Hold the nurse's arm and walk at a normal pace
Answer: B. Use a walker and take small, shuffling steps
Rationale: A walker provides stability and support for a post-operative client who
may be weak. Taking small, shuffling steps helps maintain balance and prevents
falls. Standing quickly can cause orthostatic hypotension, and walking at a normal
pace may be too fast. This promotes safe mobility and falls under Basic Care and
Comfort .
10. A client with a urinary tract infection is prescribed nitrofurantoin. The practical
nurse should instruct the client to take this medication with:
A. Food or milk
B. A full glass of water only
C. An antacid
D. A glass of grapefruit juice
Answer: A. Food or milk
Rationale: Nitrofurantoin should be taken with food or milk to enhance absorption
and reduce gastrointestinal upset. This instruction is important for medication
adherence and comfort, falling under Pharmacological and Parenteral Therapies .
ANSWERS WITH RATIONALE LATEST 2026-2027 ALREADY
GRADED A+
.
The REx-PN (Registered Practical Nurse) exam, administered by the College
of Nurses of Ontario, is a computerized adaptive test that assesses the entry-
level competencies of practical nursing candidates in Canada. It evaluates
clinical judgment, decision-making, and safe nursing practice across all client
populations. The exam content is organized by Client Needs categories,
including Management of Care, Safety and Infection Control, Health
Promotion and Maintenance, Psychosocial Integrity, Basic Care and Comfort,
Pharmacological and Parenteral Therapies, Reduction of Risk Potential, and
Physiological Adaptation. Multiple question formats are used, including
multiple choice, multiple response, and calculated fill-in-the-blank. Successful
completion is required for registration as a practical nurse.
1. A client with chronic obstructive pulmonary disease (COPD) has an oxygen
saturation of 88% on room air. The practical nurse should anticipate which
intervention?
A. Apply oxygen at 2 L/min via nasal cannula
B. Apply oxygen at 6 L/min via non-rebreather mask
C. Position the client in a supine position
D. Encourage deep breathing and coughing exercises
Answer: A. Apply oxygen at 2 L/min via nasal cannula
Rationale: For clients with COPD, oxygen therapy should be administered
cautiously at low flow rates (1-2 L/min) to maintain oxygen saturation between 88-
92% without suppressing the hypoxic drive. A non-rebreather mask delivers high-
flow oxygen, which can lead to respiratory depression in COPD clients. Supine
positioning impairs ventilation, and while deep breathing is beneficial, it does not
address the immediate hypoxemia. Safe oxygen administration is a key component
of Basic Care and Comfort .
2. The practical nurse is preparing to administer a prescribed antibiotic to a client.
Which action is most important to perform before giving the medication?
A. Check the client's temperature
,B. Verify the client's allergy status
C. Assess the client's pain level
D. Review the client's dietary intake
Answer: B. Verify the client's allergy status
Rationale: Verifying allergy status is a critical safety step before administering any
medication to prevent potentially fatal anaphylactic reactions. This is a
fundamental principle of safe medication administration and falls under Safety and
Infection Control . While checking temperature, pain level, and dietary intake may
be relevant for specific situations, they are not the priority safety action for all
medication administrations.
3. A client is 12 hours post-operative from a total knee arthroplasty. The practical
nurse assesses the client's surgical dressing, which is intact with a small amount of
serosanguineous drainage. The client rates pain as 6 out of 10. What is the nurse's
priority action?
A. Administer the prescribed PRN analgesic
B. Document the findings as normal
C. Notify the healthcare provider
D. Reinforce the dressing with an ABD pad
Answer: A. Administer the prescribed PRN analgesic
Rationale: Pain management is a priority in post-operative care. A pain score of
6/10 indicates moderate to severe pain requiring intervention. Administering the
prescribed analgesic addresses the client's immediate comfort and promotes
healing and mobility. The dressing findings are expected at 12 hours post-op, so
notification or reinforcement is not required. This action aligns with Basic Care
and Comfort .
4. The practical nurse is assisting with a sterile dressing change. After opening the
sterile field, the nurse notices a damp spot on the sterile drape. What should the
nurse do?
A. Continue the procedure, as the spot is small
B. Discard the contaminated drape and obtain a new sterile field
C. Cover the damp spot with a sterile towel
D. Note the damp spot in the client's chart
Answer: B. Discard the contaminated drape and obtain a new sterile field
Rationale: A sterile field is considered contaminated if it becomes wet or damp
because moisture can wick microorganisms from non-sterile surfaces. The only
correct action is to discard the contaminated drape and establish a new sterile field.
This is a fundamental principle of surgical asepsis and falls under Safety and
Infection Control .
,5. A client receiving a blood transfusion reports chills and low back pain. What is
the practical nurse's first action?
A. Slow the transfusion rate
B. Stop the transfusion and maintain the IV line with normal saline
C. Administer an antihistamine
D. Notify the healthcare provider
Answer: B. Stop the transfusion and maintain the IV line with normal saline
Rationale: Chills and low back pain are classic signs of an acute hemolytic
transfusion reaction. The immediate priority is to stop the transfusion to prevent
further hemolysis and maintain IV access with normal saline. Notifying the
provider and administering medications are important secondary actions, but
stopping the transfusion is the first step. This action is critical for Safety and
Infection Control .
6. A client with type 2 diabetes mellitus is scheduled for a colonoscopy. The
practical nurse should reinforce which instruction regarding the client's oral
hypoglycemic medication?
A. Take the medication as usual on the day of the procedure
B. Hold the medication on the day of the procedure until after the test
C. Double the dose of medication the day before the procedure
D. Take the medication with a full glass of water
Answer: B. Hold the medication on the day of the procedure until after the test
Rationale: Clients are typically NPO for procedures and may experience
hypoglycemia if they take oral hypoglycemic agents without food. The medication
should be held until after the procedure and the client is able to eat. This
instruction is consistent with the principles of pharmacological management and
safety and infection control .
7. The practical nurse is assessing a client who has just had a seizure. Which
finding should be reported to the healthcare provider immediately?
A. Post-ictal confusion lasting 10 minutes
B. Incontinence of urine during the seizure
C. A bitten tongue with active bleeding
D. A respiratory rate of 28 breaths per minute
Answer: C. A bitten tongue with active bleeding
Rationale: While post-ictal confusion and incontinence are common post-seizure
findings, a bitten tongue with active bleeding requires immediate assessment and
intervention to prevent aspiration and control bleeding. An elevated respiratory rate
, may be transient and should be monitored. This situation falls under Reduction of
Risk Potential .
8. A client is prescribed digoxin for heart failure. Which assessment finding
indicates a potential adverse effect of this medication?
A. Heart rate of 58 beats per minute
B. Blood pressure of 128/76 mmHg
C. Respiratory rate of 16 breaths per minute
D. Serum potassium level of 3.8 mEq/L
Answer: A. Heart rate of 58 beats per minute
Rationale: Digoxin can cause bradycardia as a sign of toxicity. A heart rate below
60 beats per minute warrants holding the medication and notifying the provider.
The other options are within normal limits. This is a medication safety concern
under Pharmacological and Parenteral Therapies .
9. A client who is 2 days post-operative is ambulating for the first time. The
practical nurse should instruct the client to:
A. Keep the head down and look at the floor while walking
B. Use a walker and take small, shuffling steps
C. Stand up quickly from the chair to avoid dizziness
D. Hold the nurse's arm and walk at a normal pace
Answer: B. Use a walker and take small, shuffling steps
Rationale: A walker provides stability and support for a post-operative client who
may be weak. Taking small, shuffling steps helps maintain balance and prevents
falls. Standing quickly can cause orthostatic hypotension, and walking at a normal
pace may be too fast. This promotes safe mobility and falls under Basic Care and
Comfort .
10. A client with a urinary tract infection is prescribed nitrofurantoin. The practical
nurse should instruct the client to take this medication with:
A. Food or milk
B. A full glass of water only
C. An antacid
D. A glass of grapefruit juice
Answer: A. Food or milk
Rationale: Nitrofurantoin should be taken with food or milk to enhance absorption
and reduce gastrointestinal upset. This instruction is important for medication
adherence and comfort, falling under Pharmacological and Parenteral Therapies .
