NZ NURSING STATE EXAM 300 ACTUAL TEST BANK
QUESTIONS AND CORRECT ANSWERS WITH RATIONALE
LATEST 2026 ALREADY GRADED A+ ASSURED PASS
This comprehensive collection of 300 unique questions is specifically designed
to mirror the format and clinical rigour of the New Zealand Nursing Council
Assessment Programme (NCAP) state final examination. Each question
presents a distinct, real-world clinical scenario that tests critical nursing
competencies across all four domains: professional responsibility,
management of care, interpersonal relationships, and interprofessional
healthcare. The questions cover a wide spectrum of conditions, medications,
and patient populations, ensuring broad revision coverage. Every entry
includes the correct answer and a detailed, evidence-based rationale that
explains the underlying pathophysiology, pharmacology, or nursing priority,
making this an effective self-assessment and learning tool for exam
preparation.
1 A postoperative patient reports sudden chest pain and shortness of breath. Their
oxygen saturation is 88% on room air. What is the nurse’s priority action?
A) Administer prescribed PRN morphine
B) Apply a non-rebreathing mask at 15L/min
C) Document the vital signs in the chart
D) Reassure the patient and stay with them
Answer: B
Rationale: The presentation suggests possible pulmonary embolism or acute
respiratory compromise. Airway and breathing are the immediate priorities;
applying high-flow oxygen addresses hypoxemia before further assessment or
interventions. Morphine may be given later for pain but never before correcting
hypoxia.
2 A Māori patient refuses to make eye contact during the health assessment. What
is the most appropriate nursing response?
A) Gently encourage the patient to look at you to build rapport
B) Document the behaviour as non-compliance
C) Continue the assessment without addressing the behaviour
D) Acknowledge that eye contact may be culturally inappropriate and adjust your
approach
,Answer: D
Rationale: In Māori culture, direct eye contact can be seen as disrespectful or
intimidating, especially in certain contexts. The nurse must practice cultural safety
by recognising this and adapting communication rather than forcing eye contact or
labelling the behaviour negatively.
3 A patient with a history of falls is attempting to get out of bed unassisted. What
is the nurse’s immediate priority?
A) Place a bed alarm and leave the room to get help
B) Verbally instruct the patient to wait and press the call bell
C) Physically assist the patient to a commode while calling for assistance
D) Document the patient’s increased mobility in the progress notes
Answer: C
Rationale: The priority is patient safety. If the patient is already attempting to get
up, the nurse must prevent a fall by providing immediate physical support and
calling for backup. A bed alarm is a preventive measure, not an intervention for an
active attempt.
4 A patient on warfarin has an INR of 4.2. They have no active bleeding but have
bruising on their arms. What should the nurse do first?
A) Administer vitamin K intramuscularly
B) Hold the next dose of warfarin and inform the prescriber
C) Apply cold compresses to the bruises
D) Reassure the patient that bruising is normal
Answer: B
Rationale: The therapeutic INR for most indications is 2.0–3.0. An INR of 4.2 is
supratherapeutic and increases bleeding risk. The nurse should hold the medication
and notify the prescriber for further orders; vitamin K is given only for significant
bleeding or by prescriber order.
5 A patient post-hip replacement suddenly becomes confused and agitated. Their
pulse is 110/min and BP is 90/60 mmHg. What is the most likely cause and the
nurse’s first action?
A) Anaesthesia side effects; administer PRN haloperidol
B) Urinary retention; perform a bladder scan
C) Hypoxia or hypovolaemia; apply oxygen and check fluid status
D) Pain; administer prescribed analgesia
Answer: C
Rationale: Acute confusion with tachycardia and hypotension in a postoperative
patient suggests hypoxia, hypovolaemia, or bleeding. The nurse must first assess
,physiological stability (ABCs) before attributing confusion to pain, retention, or
anaesthesia.
6 A patient with end-stage COPD has an oxygen saturation of 91% on 2L/min
nasal cannula. Their respiratory rate is 28/min. What is the best nursing action?
A) Increase oxygen to 4L/min to achieve SpO2 >95%
B) Keep the current oxygen and reassess in 30 minutes
C) Administer a bronchodilator nebuliser
D) Position the patient supine to promote rest
Answer: C
Rationale: In COPD, the target SpO2 is usually 88–92% to avoid suppressing
hypoxic drive. The current saturation is acceptable, but the tachypnoea suggests
bronchospasm or airway obstruction. A bronchodilator addresses the underlying
cause of increased work of breathing.
7 A nurse discovers a medication error: they gave 10mg of morphine instead of the
prescribed 5mg. The patient is drowsy but rousable with a respiratory rate of
12/min. What should the nurse do first?
A) Complete an incident form and document the error
B) Administer naloxone as per protocol
C) Notify the nurse in charge and monitor the patient closely
D) Wake the patient and offer a glass of water
Answer: C
Rationale: The patient is stable but has received a double dose of an opioid. The
immediate priority is to notify the charge nurse and initiate close monitoring of
respiratory rate and sedation. Naloxone is only indicated if respiratory depression
is severe (RR <10 or desaturation).
8 A patient from a Pacific Island community is admitted with heart failure. They
have extended family members in the room at all times. What should the nurse do?
A) Ask the family to leave during clinical assessments for privacy
B) Explain that visiting hours are restricted to 10 minutes per hour
C) Respect the family presence and involve them in care planning where
appropriate
D) Document that the patient is overly dependent on family
Answer: C
Rationale: Pacific Island cultures often have strong collectivist family structures.
Family presence is a source of support and decision-making. The nurse should
respect this and incorporate the family into the care plan while maintaining clinical
privacy during sensitive examinations.
, 9 A patient with a chest tube has continuous bubbling in the water seal chamber.
What does this indicate and what should the nurse do?
A) Normal finding; no action needed
B) An air leak; check connections and notify the medical team
C) The lung has re-expanded; prepare for removal
D) The suction pressure is too high; decrease suction
Answer: B
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in
the system, which could be from a loose connection, a cracked drainage unit, or a
chest wall leak. The nurse should inspect all connections and notify the medical
team if the leak persists.
10 A patient refuses a blood transfusion due to their religious beliefs as a
Jehovah’s Witness. What is the nurse’s correct response?
A) Explain that the transfusion is medically necessary to save their life
B) Contact the hospital ethics committee to override the refusal
C) Respect the refusal, document it, and inform the medical team
D) Ask the patient’s family to convince them to accept
Answer: C
Rationale: Competent adults have the legal and ethical right to refuse treatment,
including blood products, based on religious beliefs. The nurse must respect
autonomy, document the refusal clearly, and notify the medical team to explore
alternative treatments.
11 A patient with diabetes mellitus type 2 has a capillary blood glucose of 2.8
mmol/L. They are conscious and able to swallow. What is the immediate
treatment?
A) Administer 50% dextrose IV push
B) Give 15g of quick-acting carbohydrate orally, such as glucose gel or juice
C) Give a subcutaneous injection of glucagon
D) Offer a sandwich with peanut butter
Answer: B
Rationale: For a conscious patient with hypoglycaemia, the standard treatment is
15g of rapid-acting oral glucose. IV dextrose and glucagon are reserved for
unconscious or uncooperative patients. Peanut butter is a protein/fat and acts too
slowly.
12 A patient is one day post-mastectomy and refuses to look at the surgical wound
during dressing change. What is the most therapeutic nursing intervention?
QUESTIONS AND CORRECT ANSWERS WITH RATIONALE
LATEST 2026 ALREADY GRADED A+ ASSURED PASS
This comprehensive collection of 300 unique questions is specifically designed
to mirror the format and clinical rigour of the New Zealand Nursing Council
Assessment Programme (NCAP) state final examination. Each question
presents a distinct, real-world clinical scenario that tests critical nursing
competencies across all four domains: professional responsibility,
management of care, interpersonal relationships, and interprofessional
healthcare. The questions cover a wide spectrum of conditions, medications,
and patient populations, ensuring broad revision coverage. Every entry
includes the correct answer and a detailed, evidence-based rationale that
explains the underlying pathophysiology, pharmacology, or nursing priority,
making this an effective self-assessment and learning tool for exam
preparation.
1 A postoperative patient reports sudden chest pain and shortness of breath. Their
oxygen saturation is 88% on room air. What is the nurse’s priority action?
A) Administer prescribed PRN morphine
B) Apply a non-rebreathing mask at 15L/min
C) Document the vital signs in the chart
D) Reassure the patient and stay with them
Answer: B
Rationale: The presentation suggests possible pulmonary embolism or acute
respiratory compromise. Airway and breathing are the immediate priorities;
applying high-flow oxygen addresses hypoxemia before further assessment or
interventions. Morphine may be given later for pain but never before correcting
hypoxia.
2 A Māori patient refuses to make eye contact during the health assessment. What
is the most appropriate nursing response?
A) Gently encourage the patient to look at you to build rapport
B) Document the behaviour as non-compliance
C) Continue the assessment without addressing the behaviour
D) Acknowledge that eye contact may be culturally inappropriate and adjust your
approach
,Answer: D
Rationale: In Māori culture, direct eye contact can be seen as disrespectful or
intimidating, especially in certain contexts. The nurse must practice cultural safety
by recognising this and adapting communication rather than forcing eye contact or
labelling the behaviour negatively.
3 A patient with a history of falls is attempting to get out of bed unassisted. What
is the nurse’s immediate priority?
A) Place a bed alarm and leave the room to get help
B) Verbally instruct the patient to wait and press the call bell
C) Physically assist the patient to a commode while calling for assistance
D) Document the patient’s increased mobility in the progress notes
Answer: C
Rationale: The priority is patient safety. If the patient is already attempting to get
up, the nurse must prevent a fall by providing immediate physical support and
calling for backup. A bed alarm is a preventive measure, not an intervention for an
active attempt.
4 A patient on warfarin has an INR of 4.2. They have no active bleeding but have
bruising on their arms. What should the nurse do first?
A) Administer vitamin K intramuscularly
B) Hold the next dose of warfarin and inform the prescriber
C) Apply cold compresses to the bruises
D) Reassure the patient that bruising is normal
Answer: B
Rationale: The therapeutic INR for most indications is 2.0–3.0. An INR of 4.2 is
supratherapeutic and increases bleeding risk. The nurse should hold the medication
and notify the prescriber for further orders; vitamin K is given only for significant
bleeding or by prescriber order.
5 A patient post-hip replacement suddenly becomes confused and agitated. Their
pulse is 110/min and BP is 90/60 mmHg. What is the most likely cause and the
nurse’s first action?
A) Anaesthesia side effects; administer PRN haloperidol
B) Urinary retention; perform a bladder scan
C) Hypoxia or hypovolaemia; apply oxygen and check fluid status
D) Pain; administer prescribed analgesia
Answer: C
Rationale: Acute confusion with tachycardia and hypotension in a postoperative
patient suggests hypoxia, hypovolaemia, or bleeding. The nurse must first assess
,physiological stability (ABCs) before attributing confusion to pain, retention, or
anaesthesia.
6 A patient with end-stage COPD has an oxygen saturation of 91% on 2L/min
nasal cannula. Their respiratory rate is 28/min. What is the best nursing action?
A) Increase oxygen to 4L/min to achieve SpO2 >95%
B) Keep the current oxygen and reassess in 30 minutes
C) Administer a bronchodilator nebuliser
D) Position the patient supine to promote rest
Answer: C
Rationale: In COPD, the target SpO2 is usually 88–92% to avoid suppressing
hypoxic drive. The current saturation is acceptable, but the tachypnoea suggests
bronchospasm or airway obstruction. A bronchodilator addresses the underlying
cause of increased work of breathing.
7 A nurse discovers a medication error: they gave 10mg of morphine instead of the
prescribed 5mg. The patient is drowsy but rousable with a respiratory rate of
12/min. What should the nurse do first?
A) Complete an incident form and document the error
B) Administer naloxone as per protocol
C) Notify the nurse in charge and monitor the patient closely
D) Wake the patient and offer a glass of water
Answer: C
Rationale: The patient is stable but has received a double dose of an opioid. The
immediate priority is to notify the charge nurse and initiate close monitoring of
respiratory rate and sedation. Naloxone is only indicated if respiratory depression
is severe (RR <10 or desaturation).
8 A patient from a Pacific Island community is admitted with heart failure. They
have extended family members in the room at all times. What should the nurse do?
A) Ask the family to leave during clinical assessments for privacy
B) Explain that visiting hours are restricted to 10 minutes per hour
C) Respect the family presence and involve them in care planning where
appropriate
D) Document that the patient is overly dependent on family
Answer: C
Rationale: Pacific Island cultures often have strong collectivist family structures.
Family presence is a source of support and decision-making. The nurse should
respect this and incorporate the family into the care plan while maintaining clinical
privacy during sensitive examinations.
, 9 A patient with a chest tube has continuous bubbling in the water seal chamber.
What does this indicate and what should the nurse do?
A) Normal finding; no action needed
B) An air leak; check connections and notify the medical team
C) The lung has re-expanded; prepare for removal
D) The suction pressure is too high; decrease suction
Answer: B
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in
the system, which could be from a loose connection, a cracked drainage unit, or a
chest wall leak. The nurse should inspect all connections and notify the medical
team if the leak persists.
10 A patient refuses a blood transfusion due to their religious beliefs as a
Jehovah’s Witness. What is the nurse’s correct response?
A) Explain that the transfusion is medically necessary to save their life
B) Contact the hospital ethics committee to override the refusal
C) Respect the refusal, document it, and inform the medical team
D) Ask the patient’s family to convince them to accept
Answer: C
Rationale: Competent adults have the legal and ethical right to refuse treatment,
including blood products, based on religious beliefs. The nurse must respect
autonomy, document the refusal clearly, and notify the medical team to explore
alternative treatments.
11 A patient with diabetes mellitus type 2 has a capillary blood glucose of 2.8
mmol/L. They are conscious and able to swallow. What is the immediate
treatment?
A) Administer 50% dextrose IV push
B) Give 15g of quick-acting carbohydrate orally, such as glucose gel or juice
C) Give a subcutaneous injection of glucagon
D) Offer a sandwich with peanut butter
Answer: B
Rationale: For a conscious patient with hypoglycaemia, the standard treatment is
15g of rapid-acting oral glucose. IV dextrose and glucagon are reserved for
unconscious or uncooperative patients. Peanut butter is a protein/fat and acts too
slowly.
12 A patient is one day post-mastectomy and refuses to look at the surgical wound
during dressing change. What is the most therapeutic nursing intervention?
