HealthStream Clinical
Competency Study Guide —
Concept-Based Review
Section 1: Patient-Centered Care & Safety (Questions 1-25)
1. What is the primary goal of a pre-procedure verification (time-out)?
A. To assign blame if an error occurs.
B. To rush through a checklist as a formality.
C. To conduct a final assessment confirming correct patient, procedure, site, and consent before
incision or start.
D. To document the start time for billing purposes.
2. Which action best demonstrates the concept of "speaking up" for patient safety?
A. Assuming the physician is always correct.
B. Voicing a concern about a potential medication error, even to a senior colleague.
C. Documenting the concern quietly in the notes after the fact.
D. Discussing the concern only with other nurses outside the patient's room.
3. The "Two Patient Identifiers" protocol typically excludes which of the following?
A. Patient's full name and date of birth.
B. Patient's room number.
C. Medical record number.
D. A unique barcode on the patient's wristband.
4. What is the most effective method to prevent healthcare-associated infections (HAIs) like
MRSA and C. diff?
A. Wearing gloves for all patient contact.
B. Consistent and correct hand hygiene according to the 5 Moments.
C. Isolating all patients with a fever.
D. Using antibiotics prophylactically.
5. In the SBAR (Situation, Background, Assessment, Recommendation) communication tool,
where would you state, "I am requesting a chest X-ray and a respiratory therapy consult"?
A. Situation
,B. Background
C. Assessment
D. Recommendation
6. What does the "R" in the RACE fire safety acronym stand for?
A. Run.
B. Rescue/Remove anyone in immediate danger.
C. Restrict.
D. Return.
7. A patient at high risk for falls has a yellow armband and non-slip socks. What is the nurse's
next priority action?
A. Document the interventions in place.
B. Ensure the call light is within reach and the bed is in the lowest position.
C. Apply soft wrist restraints at night.
D. Ask the family to stay 24/7.
8. What is the purpose of clinical alarm safety management?
A. To have as many audible alarms as possible for safety.
B. To ensure alarms are properly set, heard, and responded to promptly.
C. To allow staff to become accustomed to alarm sounds.
D. To delegate alarm response to nursing assistants only.
9. The "Five Rights" of medication administration are:
A. Right drug, right dose, right time, right route, right price.
B. Right drug, right dose, right patient, right time, right documentation.
C. Right patient, right room, right diagnosis, right drug, right dose.
D. Right drug, right route, right reason, right response, right documentation.
10. Which scenario best describes a "never event" (serious reportable event)?
A. A patient develops a minor rash to a new antibiotic.
B. A patient falls but has no injury.
C. Performing a surgery on the wrong body part.
D. A medication is given 30 minutes late.
11. What is the primary intent of a root cause analysis (RCA) following a sentinel event?
A. To identify and punish the individual responsible.
B. To improve systems and processes to prevent recurrence.
C. To satisfy regulatory reporting requirements only.
D. To determine the cost of the error.
,12. When using a translator for informed consent, whom should you ideally use?
A. A bilingual family member.
B. A hospital-approved professional translation service or qualified staff member.
C. Another patient who speaks the language.
D. A translation app on a personal phone.
13. What does the term "Just Culture" refer to in healthcare?
A. A culture where all errors are treated as punishable offenses.
B. A blame-free environment where no one is held accountable.
C. A system that balances accountability with analyzing systems-based causes of errors.
D. A culture that prioritizes physician authority above all.
14. Which action is critical for preventing venous thromboembolism (VTE) in an immobilized
post-op patient?
A. Encouraging deep breathing exercises.
B. Applying sequential compression devices (SCDs) as ordered.
C. Limiting fluid intake.
D. Keeping the bed flat at all times.
15. What is the first step in the nursing process and clinical judgment?
A. Planning
B. Assessment
C. Implementation
D. Evaluation
Section 2: Clinical Judgment & Critical Thinking (Questions 16-35)
16. A post-operative patient's blood pressure drops from 128/80 to 88/50, heart rate
increases from 85 to 120, and the dressing is saturated with bright red blood. What is the
nurse's priority action?
A. Notify the physician in 30 minutes.
B. Apply a second dressing on top of the first.
C. Apply direct pressure to the surgical site and activate the rapid response team/call for help.
D. Re-check the blood pressure in 15 minutes.
17. Which finding is the most reliable indicator of fluid volume deficit (dehydration) in an
adult?
A. Complaints of thirst.
B. Tachycardia and decreased urine output.
, C. Dry mucous membranes.
D. Decreased skin turgor.
18. A patient with COPD is on 2 L/min oxygen via nasal cannula. The family increases it to 5
L/min because the patient "seemed short of breath." What is the primary risk?
A. Wasting oxygen supplies.
B. Suppressing the patient's hypoxic drive to breathe, leading to respiratory depression.
C. Causing oxygen toxicity immediately.
D. There is no risk; more oxygen is always better.
19. What is the most critical assessment for a patient receiving a continuous IV infusion of a
high-alert medication like insulin or heparin?
A. Checking the IV site for redness.
B. Monitoring the patient's blood glucose or PTT/INR per protocol.
C. Ensuring the pump is plugged in.
D. Documenting the rate every shift.
20. A patient with heart failure reports sudden, severe shortness of breath and pink, frothy
sputum. The nurse hears crackles bilaterally. What complication should the nurse suspect?
A. Pneumonia
B. Pulmonary embolism
C. Acute pulmonary edema
D. Anxiety attack
21. What is the priority intervention for a patient experiencing a tonic-clonic (grand mal)
seizure?
A. Insert a bite block to protect the tongue.
B. Restrain the patient's limbs to prevent injury.
C. Lower the patient to the floor or bed, turn to the side, and protect the head.
D. Administer emergency anti-seizure medication immediately.
22. When interpreting an arterial blood gas (ABG), which value is used to determine acidosis
or alkalosis first?
A. PaO2
B. PaCO2
C. HCO3-
D. pH
23. A diabetic patient is confused, diaphoretic, and tachycardic. The nurse should:
A. Administer the scheduled dose of insulin.
Competency Study Guide —
Concept-Based Review
Section 1: Patient-Centered Care & Safety (Questions 1-25)
1. What is the primary goal of a pre-procedure verification (time-out)?
A. To assign blame if an error occurs.
B. To rush through a checklist as a formality.
C. To conduct a final assessment confirming correct patient, procedure, site, and consent before
incision or start.
D. To document the start time for billing purposes.
2. Which action best demonstrates the concept of "speaking up" for patient safety?
A. Assuming the physician is always correct.
B. Voicing a concern about a potential medication error, even to a senior colleague.
C. Documenting the concern quietly in the notes after the fact.
D. Discussing the concern only with other nurses outside the patient's room.
3. The "Two Patient Identifiers" protocol typically excludes which of the following?
A. Patient's full name and date of birth.
B. Patient's room number.
C. Medical record number.
D. A unique barcode on the patient's wristband.
4. What is the most effective method to prevent healthcare-associated infections (HAIs) like
MRSA and C. diff?
A. Wearing gloves for all patient contact.
B. Consistent and correct hand hygiene according to the 5 Moments.
C. Isolating all patients with a fever.
D. Using antibiotics prophylactically.
5. In the SBAR (Situation, Background, Assessment, Recommendation) communication tool,
where would you state, "I am requesting a chest X-ray and a respiratory therapy consult"?
A. Situation
,B. Background
C. Assessment
D. Recommendation
6. What does the "R" in the RACE fire safety acronym stand for?
A. Run.
B. Rescue/Remove anyone in immediate danger.
C. Restrict.
D. Return.
7. A patient at high risk for falls has a yellow armband and non-slip socks. What is the nurse's
next priority action?
A. Document the interventions in place.
B. Ensure the call light is within reach and the bed is in the lowest position.
C. Apply soft wrist restraints at night.
D. Ask the family to stay 24/7.
8. What is the purpose of clinical alarm safety management?
A. To have as many audible alarms as possible for safety.
B. To ensure alarms are properly set, heard, and responded to promptly.
C. To allow staff to become accustomed to alarm sounds.
D. To delegate alarm response to nursing assistants only.
9. The "Five Rights" of medication administration are:
A. Right drug, right dose, right time, right route, right price.
B. Right drug, right dose, right patient, right time, right documentation.
C. Right patient, right room, right diagnosis, right drug, right dose.
D. Right drug, right route, right reason, right response, right documentation.
10. Which scenario best describes a "never event" (serious reportable event)?
A. A patient develops a minor rash to a new antibiotic.
B. A patient falls but has no injury.
C. Performing a surgery on the wrong body part.
D. A medication is given 30 minutes late.
11. What is the primary intent of a root cause analysis (RCA) following a sentinel event?
A. To identify and punish the individual responsible.
B. To improve systems and processes to prevent recurrence.
C. To satisfy regulatory reporting requirements only.
D. To determine the cost of the error.
,12. When using a translator for informed consent, whom should you ideally use?
A. A bilingual family member.
B. A hospital-approved professional translation service or qualified staff member.
C. Another patient who speaks the language.
D. A translation app on a personal phone.
13. What does the term "Just Culture" refer to in healthcare?
A. A culture where all errors are treated as punishable offenses.
B. A blame-free environment where no one is held accountable.
C. A system that balances accountability with analyzing systems-based causes of errors.
D. A culture that prioritizes physician authority above all.
14. Which action is critical for preventing venous thromboembolism (VTE) in an immobilized
post-op patient?
A. Encouraging deep breathing exercises.
B. Applying sequential compression devices (SCDs) as ordered.
C. Limiting fluid intake.
D. Keeping the bed flat at all times.
15. What is the first step in the nursing process and clinical judgment?
A. Planning
B. Assessment
C. Implementation
D. Evaluation
Section 2: Clinical Judgment & Critical Thinking (Questions 16-35)
16. A post-operative patient's blood pressure drops from 128/80 to 88/50, heart rate
increases from 85 to 120, and the dressing is saturated with bright red blood. What is the
nurse's priority action?
A. Notify the physician in 30 minutes.
B. Apply a second dressing on top of the first.
C. Apply direct pressure to the surgical site and activate the rapid response team/call for help.
D. Re-check the blood pressure in 15 minutes.
17. Which finding is the most reliable indicator of fluid volume deficit (dehydration) in an
adult?
A. Complaints of thirst.
B. Tachycardia and decreased urine output.
, C. Dry mucous membranes.
D. Decreased skin turgor.
18. A patient with COPD is on 2 L/min oxygen via nasal cannula. The family increases it to 5
L/min because the patient "seemed short of breath." What is the primary risk?
A. Wasting oxygen supplies.
B. Suppressing the patient's hypoxic drive to breathe, leading to respiratory depression.
C. Causing oxygen toxicity immediately.
D. There is no risk; more oxygen is always better.
19. What is the most critical assessment for a patient receiving a continuous IV infusion of a
high-alert medication like insulin or heparin?
A. Checking the IV site for redness.
B. Monitoring the patient's blood glucose or PTT/INR per protocol.
C. Ensuring the pump is plugged in.
D. Documenting the rate every shift.
20. A patient with heart failure reports sudden, severe shortness of breath and pink, frothy
sputum. The nurse hears crackles bilaterally. What complication should the nurse suspect?
A. Pneumonia
B. Pulmonary embolism
C. Acute pulmonary edema
D. Anxiety attack
21. What is the priority intervention for a patient experiencing a tonic-clonic (grand mal)
seizure?
A. Insert a bite block to protect the tongue.
B. Restrain the patient's limbs to prevent injury.
C. Lower the patient to the floor or bed, turn to the side, and protect the head.
D. Administer emergency anti-seizure medication immediately.
22. When interpreting an arterial blood gas (ABG), which value is used to determine acidosis
or alkalosis first?
A. PaO2
B. PaCO2
C. HCO3-
D. pH
23. A diabetic patient is confused, diaphoretic, and tachycardic. The nurse should:
A. Administer the scheduled dose of insulin.
