LPN to ADN Bridge Week 3: Clinical Judgment & Prioritization
2026/2027 UPDATE
1. A nurse receives a shift report on four patients. Which patient should the
nurse assess first?
A. A patient who is 2 hours postoperative following a thyroidectomy and has developed hoarseness and a
weak voice.
B. A patient with chronic obstructive pulmonary disease (COPD) with an oxygen saturation of 91% on room
air.
C. A patient with a history of heart failure reporting 2+ pitting edema in the lower extremities.
D. A patient who had a cholecystectomy 12 hours ago and is requesting pain medication for a pain level of
7/10.
Answer: A
Rationale: Airway is the priority. Post-thyroidectomy hoarseness or voice changes can
indicate laryngeal nerve damage or impending airway obstruction due to edema or
hematoma.
2. The RN is delegating tasks to a Licensed Practical Nurse (LPN). Which task is
most appropriate for the LPN?
A. Administering a scheduled subcutaneous insulin injection to a stable patient.
B. Performing the initial admission assessment on a new patient.
C. Developing a teaching plan for a patient newly diagnosed with type 2 diabetes.
D. Evaluating the effectiveness of a new IV anti-hypertensive medication.
Answer: A
Rationale: LPNs can perform routine tasks for stable patients, such as administering
scheduled medications. Admission assessments, teaching plans, and evaluation of unstable
responses are RN responsibilities.
,3. Applying Maslow’s Hierarchy of Needs, which patient requires the nurse’s
immediate attention?
A. A patient who is lonely and requesting a visit from the hospital chaplain.
B. A patient who is worried about how they will pay for their medications after discharge.
C. A patient who is confused and attempting to pull out their peripheral IV line.
D. A patient with a fractured hip who is reporting severe pain.
Answer: C
Rationale: Safety and physiological needs are priority. A confused patient pulling out an IV
line poses an immediate safety risk and potential threat to physiological stability.
4. Using the Nursing Process, which action should the nurse take first when a
patient reports sudden chest pain?
A. Assess the patient’s vital signs and respiratory status.
B. Call the healthcare provider to report the pain.
C. Administer sublingual nitroglycerin as ordered.
D. Obtain a 12-lead electrocardiogram (ECG).
Answer: A
Rationale: The first step of the nursing process is Assessment. The nurse must collect data
on the patient’s current status before intervening or notifying the provider.
5. Which patient should be assigned to the most experienced nurse on the unit?
A. A patient who was just admitted with a suspected ruptured aortic aneurysm.
B. A patient with a history of stroke who requires assistance with feeding.
C. A patient who is ready for discharge following an uncomplicated appendectomy.
D. A patient with pneumonia who is receiving continuous oxygen via nasal cannula.
Answer: A
Rationale: The patient with a suspected ruptured aortic aneurysm is the most unstable
and requires the advanced assessment skills and rapid judgment of an experienced RN.
, 6. The nurse is caring for a patient who is 1 day postoperative. Which finding
should be reported to the provider immediately?
A. A temperature of 99.8°F (37.7°C).
B. Urine output of 200 mL over the last 8 hours.
C. Bright red blood on the surgical dressing that has doubled in size over 1 hour.
D. Reduced bowel sounds in all four quadrants.
Answer: C
Rationale: Active, rapidly increasing bright red bleeding indicates hemorrhage, which is a
circulation priority (ABC).
7. When delegating to an Unlicensed Assistive Personnel (UAP), which
instruction is most appropriate?
A. ‘Monitor the patient for any signs of a transfusion reaction.’
B. ‘Check the patient’s skin for any signs of breakdown while bathing.’
C. ‘Let me know if the patient’s blood pressure is higher than 140/90.’
D. ‘Determine if the patient’s pain has improved after I gave the medication.’
Answer: C
Rationale: UAPs can collect data (like BP) and report specific values. They cannot assess
skin breakdown, monitor for clinical reactions, or evaluate medication effectiveness.
8. A nurse is using the SBAR tool to communicate with a physician. Which
statement represents the ‘B’ (Background)?
A. ‘The patient’s heart rate is currently 115 beats per minute.’
B. ‘I suggest we order a chest X-ray to rule out pneumonia.’
C. ‘The patient is reporting increased shortness of breath.’
D. ‘The patient has a history of asthma and was admitted for an exacerbation.’
Answer: D
Rationale: Background (B) provides the clinical context and history of the patient. ‘A’ is
situation, ‘B’ is background, ‘C’ is assessment/vitals, ‘D’ is recommendation.
2026/2027 UPDATE
1. A nurse receives a shift report on four patients. Which patient should the
nurse assess first?
A. A patient who is 2 hours postoperative following a thyroidectomy and has developed hoarseness and a
weak voice.
B. A patient with chronic obstructive pulmonary disease (COPD) with an oxygen saturation of 91% on room
air.
C. A patient with a history of heart failure reporting 2+ pitting edema in the lower extremities.
D. A patient who had a cholecystectomy 12 hours ago and is requesting pain medication for a pain level of
7/10.
Answer: A
Rationale: Airway is the priority. Post-thyroidectomy hoarseness or voice changes can
indicate laryngeal nerve damage or impending airway obstruction due to edema or
hematoma.
2. The RN is delegating tasks to a Licensed Practical Nurse (LPN). Which task is
most appropriate for the LPN?
A. Administering a scheduled subcutaneous insulin injection to a stable patient.
B. Performing the initial admission assessment on a new patient.
C. Developing a teaching plan for a patient newly diagnosed with type 2 diabetes.
D. Evaluating the effectiveness of a new IV anti-hypertensive medication.
Answer: A
Rationale: LPNs can perform routine tasks for stable patients, such as administering
scheduled medications. Admission assessments, teaching plans, and evaluation of unstable
responses are RN responsibilities.
,3. Applying Maslow’s Hierarchy of Needs, which patient requires the nurse’s
immediate attention?
A. A patient who is lonely and requesting a visit from the hospital chaplain.
B. A patient who is worried about how they will pay for their medications after discharge.
C. A patient who is confused and attempting to pull out their peripheral IV line.
D. A patient with a fractured hip who is reporting severe pain.
Answer: C
Rationale: Safety and physiological needs are priority. A confused patient pulling out an IV
line poses an immediate safety risk and potential threat to physiological stability.
4. Using the Nursing Process, which action should the nurse take first when a
patient reports sudden chest pain?
A. Assess the patient’s vital signs and respiratory status.
B. Call the healthcare provider to report the pain.
C. Administer sublingual nitroglycerin as ordered.
D. Obtain a 12-lead electrocardiogram (ECG).
Answer: A
Rationale: The first step of the nursing process is Assessment. The nurse must collect data
on the patient’s current status before intervening or notifying the provider.
5. Which patient should be assigned to the most experienced nurse on the unit?
A. A patient who was just admitted with a suspected ruptured aortic aneurysm.
B. A patient with a history of stroke who requires assistance with feeding.
C. A patient who is ready for discharge following an uncomplicated appendectomy.
D. A patient with pneumonia who is receiving continuous oxygen via nasal cannula.
Answer: A
Rationale: The patient with a suspected ruptured aortic aneurysm is the most unstable
and requires the advanced assessment skills and rapid judgment of an experienced RN.
, 6. The nurse is caring for a patient who is 1 day postoperative. Which finding
should be reported to the provider immediately?
A. A temperature of 99.8°F (37.7°C).
B. Urine output of 200 mL over the last 8 hours.
C. Bright red blood on the surgical dressing that has doubled in size over 1 hour.
D. Reduced bowel sounds in all four quadrants.
Answer: C
Rationale: Active, rapidly increasing bright red bleeding indicates hemorrhage, which is a
circulation priority (ABC).
7. When delegating to an Unlicensed Assistive Personnel (UAP), which
instruction is most appropriate?
A. ‘Monitor the patient for any signs of a transfusion reaction.’
B. ‘Check the patient’s skin for any signs of breakdown while bathing.’
C. ‘Let me know if the patient’s blood pressure is higher than 140/90.’
D. ‘Determine if the patient’s pain has improved after I gave the medication.’
Answer: C
Rationale: UAPs can collect data (like BP) and report specific values. They cannot assess
skin breakdown, monitor for clinical reactions, or evaluate medication effectiveness.
8. A nurse is using the SBAR tool to communicate with a physician. Which
statement represents the ‘B’ (Background)?
A. ‘The patient’s heart rate is currently 115 beats per minute.’
B. ‘I suggest we order a chest X-ray to rule out pneumonia.’
C. ‘The patient is reporting increased shortness of breath.’
D. ‘The patient has a history of asthma and was admitted for an exacerbation.’
Answer: D
Rationale: Background (B) provides the clinical context and history of the patient. ‘A’ is
situation, ‘B’ is background, ‘C’ is assessment/vitals, ‘D’ is recommendation.
