Nursing OA (2026/2027) Actual Questions & Study
Guide | Guarantee Pass – New Update
250 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Nursing Process (ADPIE)
2 Prioritization
3 Safety
4 Infection Control
5 Therapeutic Communication
6 Ethics & Legal
7 Delegation
8 Documentation
9 Patient Education
10 Professional Standards
,Q1
A nurse is assessing a client with a new diagnosis of heart failure. Which finding is objective?
A) Client reports shortness of breath
B) Jugular vein distention noted CORRECT
C) Client states, “I feel anxious”
D) Client describes palpitations
Rationale
Objective data are measurable or observable; JVD is a physical finding.
Q2
A nurse is prioritizing care for four clients. Which client should be assessed first?
A) Client with a blood glucose of 180 mg/dL
B) Client with a respiratory rate of 8/min and unresponsiveness CORRECT
C) Client requesting pain medication for a headache
D) Client needing assistance with ambulation
Rationale
Bradypnea with unresponsiveness is a life-threatening emergency (ABCs).
Q3
A nurse is documenting a client’s refusal of a prescribed medication. Which entry is correct?
A) “Client non-compliant with meds”
B) “Client refused lisinopril 10 mg at 08:00, stating ‘I don’t want it.’ Provider CORRECT
notified.”
C) “Client refused medication – will try later”
D) “Client uncooperative”
Rationale
Documentation must be objective, include the exact medication, dose, time, and client’s words.
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,Q4
A nurse is preparing to insert an indwelling urinary catheter. Which action maintains sterility?
A) Use clean gloves for insertion
B) Use sterile gloves and a sterile drape CORRECT
C) Lubricate the catheter with petroleum jelly
D) Clean the meatus with a back-to-front motion
Rationale
Sterile technique is required to prevent CAUTI.
Q5
A client with a new colostomy has a pink, moist stoma. What should the nurse do?
A) Notify the provider immediately
B) Document the finding as normal CORRECT
C) Apply a warm compress
D) Increase the frequency of pouch changes
Rationale
A healthy stoma is pink/red and moist; no intervention needed.
Q6
A nurse is teaching a client about a low-sodium diet. Which food should the client avoid?
A) Fresh chicken breast
B) Canned vegetable soup CORRECT
C) Steamed broccoli
D) White rice
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, Rationale
Canned soups are high in sodium; fresh foods are lower.
Q7
A client with schizophrenia says, “The voices are telling me to hurt myself.” What is the priority
action?
A) Ask the client to describe the voices
B) Implement suicide precautions and notify the provider CORRECT
C) Tell the client to ignore the voices
D) Administer a PRN antipsychotic
Rationale
Command hallucinations to self-harm require immediate safety measures.
Q8
A nurse is delegating to a UAP. Which task is appropriate?
A) Assess a client’s lung sounds
B) Measure and record a client’s intake and output CORRECT
C) Administer a tube feeding
D) Change a sterile dressing
Rationale
I&O measurement is within UAP scope; assessment and sterile procedures require licensed staff.
Q9
A nurse is preparing to administer a blood transfusion. Which action prevents a hemolytic
reaction?
A) Premedicate with acetaminophen
B) Verify client identity and blood product with another nurse CORRECT
C) Warm the blood in a microwave
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