Safe and Effective Care Environment
1. A nurse is delegating tasks to a UAP. Which task
is appropriate to delegate?
A. Initial assessment of a newly admitted client
B. Assisting a stable postoperative client with
ambulation
C. Developing the plan of care
D. Administering oral medications
Rationale: UAPs may assist with ambulation of stable
clients, but assessments and medication
administration require licensed nursing judgment.
2. An RN receives a report on four clients. Which
client should the nurse assess first?
A. A client 2 hours postoperative with controlled pain
B. A client with new-onset urinary retention
C. A client scheduled for discharge
D. A client who reports chest pain with
diaphoresis
Rationale: Chest pain with diaphoresis is an
emergency sign of possible myocardial infarction; this
client needs immediate assessment.
3. When assigning clients to LPN/LVNs, the RN
should assign which task?
A. Initiating a blood transfusion
B. Performing client teaching on insulin administration
C. Reinforcing teaching about a low-sodium diet
D. Completing initial admission assessments
Rationale: LPNs may reinforce teaching but should
, not perform initial assessments or initiate complex
interventions.
4. A nurse identifies a fire in a client’s room. What is
the first action?
A. Extinguish the fire
B. Rescue the client
C. Activate the alarm
D. Contain the fire
Rationale: The primary priority is rescuing clients
from immediate harm (“R” of RACE: Rescue).
5. A hospital policy change requires all sterile
dressings to be dated after opening. This is an
example of which leadership style?
A. Laissez-faire
B. Autocratic
C. Democratic
D. Transformational
Rationale: An autocratic leader makes unilateral
decisions, such as mandating immediate policy
changes.
Health Promotion and Maintenance
6. Which immunization is recommended annually for
health care workers?
A. Tetanus-diphtheria
B. Influenza
C. Varicella
D. Meningococcal
, Rationale: Annual influenza vaccination is
recommended for all health care personnel to reduce
transmission.
7. A 16-year-old sexually active female client should
receive which vaccine?
A. Hepatitis A
B. HPV (human papillomavirus)
C. MMR
D. TDAP
Rationale: HPV vaccination is recommended up to
age 26 to prevent cervical cancer and related
conditions.
8. During prenatal care, the nurse teaches about
maternal weight gain. For a client with normal
BMI, the recommended gain is:
A. 10–15 lb
B. 25–35 lb
C. 40–50 lb
D. 15–25 lb
Rationale: Normal BMI pregnant clients should gain
25–35 lb to support fetal growth and maternal
reserves.
9. A community health nurse provides education on
lead exposure. Which finding indicates lead
toxicity?
A. Hypermagnesemia
B. Hypernatremia
C. Anemia
1. A nurse is delegating tasks to a UAP. Which task
is appropriate to delegate?
A. Initial assessment of a newly admitted client
B. Assisting a stable postoperative client with
ambulation
C. Developing the plan of care
D. Administering oral medications
Rationale: UAPs may assist with ambulation of stable
clients, but assessments and medication
administration require licensed nursing judgment.
2. An RN receives a report on four clients. Which
client should the nurse assess first?
A. A client 2 hours postoperative with controlled pain
B. A client with new-onset urinary retention
C. A client scheduled for discharge
D. A client who reports chest pain with
diaphoresis
Rationale: Chest pain with diaphoresis is an
emergency sign of possible myocardial infarction; this
client needs immediate assessment.
3. When assigning clients to LPN/LVNs, the RN
should assign which task?
A. Initiating a blood transfusion
B. Performing client teaching on insulin administration
C. Reinforcing teaching about a low-sodium diet
D. Completing initial admission assessments
Rationale: LPNs may reinforce teaching but should
, not perform initial assessments or initiate complex
interventions.
4. A nurse identifies a fire in a client’s room. What is
the first action?
A. Extinguish the fire
B. Rescue the client
C. Activate the alarm
D. Contain the fire
Rationale: The primary priority is rescuing clients
from immediate harm (“R” of RACE: Rescue).
5. A hospital policy change requires all sterile
dressings to be dated after opening. This is an
example of which leadership style?
A. Laissez-faire
B. Autocratic
C. Democratic
D. Transformational
Rationale: An autocratic leader makes unilateral
decisions, such as mandating immediate policy
changes.
Health Promotion and Maintenance
6. Which immunization is recommended annually for
health care workers?
A. Tetanus-diphtheria
B. Influenza
C. Varicella
D. Meningococcal
, Rationale: Annual influenza vaccination is
recommended for all health care personnel to reduce
transmission.
7. A 16-year-old sexually active female client should
receive which vaccine?
A. Hepatitis A
B. HPV (human papillomavirus)
C. MMR
D. TDAP
Rationale: HPV vaccination is recommended up to
age 26 to prevent cervical cancer and related
conditions.
8. During prenatal care, the nurse teaches about
maternal weight gain. For a client with normal
BMI, the recommended gain is:
A. 10–15 lb
B. 25–35 lb
C. 40–50 lb
D. 15–25 lb
Rationale: Normal BMI pregnant clients should gain
25–35 lb to support fetal growth and maternal
reserves.
9. A community health nurse provides education on
lead exposure. Which finding indicates lead
toxicity?
A. Hypermagnesemia
B. Hypernatremia
C. Anemia
