IRRSP EXAM AND PRACTICE EXAM NEWEST 2025
ACTUAL EXAM COMPLETE AND CORRECT, Exams of
Nursing - 206 Questions
This examination assesses advanced reasoning in nursing management of care, including delegation,
prioritization, ethical decision-making, and quality improvement in complex healthcare settings. Designed for
prelicensure candidates at the doctoral level. It contains 206 multiple-choice questions, each with four distractors
and a fully worked rationale that explains why the keyed answer is correct. Content is organized into 8 focused
sections: Management of Care, Safety and Infection Control, Health Promotion and Maintenance, Psychosocial
Integrity, Basic Care and Comfort, Pharmacological Therapies, Reduction of Risk Potential, Physiological
Adaptation. Targeted learning outcomes include: Apply principles of delegation and supervision in
interprofessional teams; Prioritize patient care using clinical judgment and resource allocation; Analyze legal
and ethical frameworks in care management. Every item has been reviewed for clinical accuracy, current
guidelines, and clarity so that students can study with confidence and self-correct as they work through the bank.
Use it as a high-yield review immediately before the exam, or as a structured practice tool during the unit - the
rationales double as concise teaching notes. The recommended writing time is 3 hours, with a passing score of
80%. Aligned with Accredited by the Commission on Collegiate Nursing Education (CCNE) and aligns with
AACN Essentials. standards and reflects the question style commonly seen on accredited program examinations.
Students consistently achieving above the cut score on this bank have historically gone on to earn A+ on the
Section 1: Management of Care (Questions 1-31)
1 A nurse manager is evaluating delegation practices on a medical-surgical
unit. Which scenario represents a breach of the Five Rights of Delegation?
A) An RN assigns the LPN to administer oral medications to a stable patient
while the RN performs a complex wound dressing change.
B) An RN asks the UAP to measure and record vital signs on a patient
receiving a blood transfusion.
C) An RN delegates the initial assessment of a newly admitted patient to the
LPN.
D) An RN directs the UAP to assist a patient with ambulation using a gait
belt.
Answer: C
Rationale: The initial nursing assessment cannot be delegated; it requires the
RN's clinical judgment to establish a baseline. Option C violates the right task
and right circumstance. Options A and D are appropriate delegations, and
option B is unsafe as vital sign monitoring during transfusion is part of the
RN's ongoing assessment.
2 A charge nurse is prioritizing care for four patients. Which patient should the
nurse assess first?
,A) A patient with a new tracheostomy who has a respiratory rate of 24 and
oxygen saturation of 92% on room air.
B) A patient with a history of diabetes who has a blood glucose level of 180
mg/dL and is complaining of thirst.
C) A patient with a chest tube connected to suction who reports mild
discomfort at the insertion site.
D) A patient receiving a blood transfusion who has a temperature of 37.2°C
and feels slightly chilled.
Answer: A
Rationale: Airway and breathing take priority. A new tracheostomy with
borderline oxygen saturation indicates potential airway compromise or
inadequate oxygenation. Options B, C, and D are stable or expected findings;
the transfusion reaction symptoms are mild but less urgent than the respiratory
issue.
3 A patient requires an emergency surgical procedure. The patient is conscious
but refuses to sign the consent form. Which action by the nurse is most
appropriate regarding informed consent?
A) Proceed with the surgery because the patient's family has signed a consent
form.
B) Notify the healthcare provider and document the patient's refusal clearly in
the medical record.
C) Administer a sedative to reduce the patient's anxiety and attempt to obtain
consent later.
D) Ask the chaplain to persuade the patient to consent based on religious
beliefs.
Answer: B
Rationale: The patient has the right to refuse treatment, even in an emergency if
they are competent. The nurse must notify the provider and document the
refusal. Option A is invalid without patient consent. Options C and D violate
autonomy and are coercive; informed consent must be voluntary and free from
undue influence.
,4 A patient with a living will and a durable power of attorney for healthcare
(DPAHC) is admitted with terminal cancer. The DPAHC holder requests
aggressive treatment, while the living will indicates a preference for comfort
care only. Which action by the nurse is most appropriate?
A) Follow the DPAHC holder's request because they have legal authority to
make decisions.
B) Initiate comfort care as per the living will, overriding the DPAHC holder's
decision.
C) Request an ethics consultation to resolve the conflict between the
documents.
D) Continue both treatments until the patient's wishes are clarified by the
primary provider.
Answer: C
Rationale: When a living will and DPAHC conflict, an ethics consultation is
warranted to interpret the patient's wishes and ensure the appropriate surrogate
decision-maker is acting consistently. The DPAHC holder must follow the
patient's known wishes; if unclear, the ethics committee can mediate. Option A
may violate the living will if it's clearly applicable. Option B disregards the
DPAHC's legal role. Option D could cause unnecessary suffering.
5 A quality improvement team is analyzing a run chart of catheter-associated
urinary tract infections (CAUTI) rates after implementing a new insertion
protocol. The chart shows six consecutive data points below the median.
What should the team conclude?
A) The new protocol has caused a shift in the process, indicating special
cause variation.
B) The data are consistent with common cause variation and no change is
needed.
C) The protocol is ineffective; further data collection is required before
conclusions.
D) A control chart is necessary to determine if the process is out of control.
Answer: A
Rationale: A run of six or more consecutive points on one side of the median
indicates a non-random pattern (shift), suggesting special cause variation due
to the protocol change. This warrants investigation and possibly adoption of
the change. Option B is incorrect because common cause variation would show
, random fluctuation. Option C ignores the clear signal. Option D: while a
control chart is useful, a run chart alone can detect this signal.
6 During a patient care conference, the physical therapist and nurse disagree on
the discharge plan for a patient with limited mobility. The nurse prefers a
skilled nursing facility, while the therapist recommends home health. The
team is unable to reach consensus. Which conflict resolution strategy should
the charge nurse employ first?
A) Vote on the plan and proceed with the majority opinion.
B) Refer the disagreement to the attending physician for final decision.
C) Facilitate a discussion to identify common goals and evidence from each
perspective.
D) Implement the nurse's plan as the nurse has the most contact with the
patient.
Answer: C
Rationale: Collaboration and conflict resolution begin with open
communication to understand all viewpoints and find a patient-centered
solution. Voting (A) may polarize the team; referring to the physician (B)
undermines interdisciplinary collaboration and may not consider all factors;
unilaterally following the nurse (D) disregards the therapist's expertise. Option
C respects both disciplines and encourages evidence-based decision-making.
7 A case manager is coordinating discharge for a patient with heart failure,
diabetes, and chronic kidney disease. The patient lives alone and reports
difficulty managing multiple medications. Which intervention is most likely
to reduce hospital readmission risk?
A) Arranging a daily home health aide visit for medication administration.
B) Providing a list of generic pharmacies for cost savings.
C) Scheduling a follow-up appointment with the primary provider within one
week.
D) Enrolling the patient in a transitional care program with nurse-led
telephone support.
Answer: D
Rationale: Transitional care programs (e.g., Naylor's model) that include
follow-up calls, medication reconciliation, and self-management education
have strong evidence for reducing readmissions, especially for complex
ACTUAL EXAM COMPLETE AND CORRECT, Exams of
Nursing - 206 Questions
This examination assesses advanced reasoning in nursing management of care, including delegation,
prioritization, ethical decision-making, and quality improvement in complex healthcare settings. Designed for
prelicensure candidates at the doctoral level. It contains 206 multiple-choice questions, each with four distractors
and a fully worked rationale that explains why the keyed answer is correct. Content is organized into 8 focused
sections: Management of Care, Safety and Infection Control, Health Promotion and Maintenance, Psychosocial
Integrity, Basic Care and Comfort, Pharmacological Therapies, Reduction of Risk Potential, Physiological
Adaptation. Targeted learning outcomes include: Apply principles of delegation and supervision in
interprofessional teams; Prioritize patient care using clinical judgment and resource allocation; Analyze legal
and ethical frameworks in care management. Every item has been reviewed for clinical accuracy, current
guidelines, and clarity so that students can study with confidence and self-correct as they work through the bank.
Use it as a high-yield review immediately before the exam, or as a structured practice tool during the unit - the
rationales double as concise teaching notes. The recommended writing time is 3 hours, with a passing score of
80%. Aligned with Accredited by the Commission on Collegiate Nursing Education (CCNE) and aligns with
AACN Essentials. standards and reflects the question style commonly seen on accredited program examinations.
Students consistently achieving above the cut score on this bank have historically gone on to earn A+ on the
Section 1: Management of Care (Questions 1-31)
1 A nurse manager is evaluating delegation practices on a medical-surgical
unit. Which scenario represents a breach of the Five Rights of Delegation?
A) An RN assigns the LPN to administer oral medications to a stable patient
while the RN performs a complex wound dressing change.
B) An RN asks the UAP to measure and record vital signs on a patient
receiving a blood transfusion.
C) An RN delegates the initial assessment of a newly admitted patient to the
LPN.
D) An RN directs the UAP to assist a patient with ambulation using a gait
belt.
Answer: C
Rationale: The initial nursing assessment cannot be delegated; it requires the
RN's clinical judgment to establish a baseline. Option C violates the right task
and right circumstance. Options A and D are appropriate delegations, and
option B is unsafe as vital sign monitoring during transfusion is part of the
RN's ongoing assessment.
2 A charge nurse is prioritizing care for four patients. Which patient should the
nurse assess first?
,A) A patient with a new tracheostomy who has a respiratory rate of 24 and
oxygen saturation of 92% on room air.
B) A patient with a history of diabetes who has a blood glucose level of 180
mg/dL and is complaining of thirst.
C) A patient with a chest tube connected to suction who reports mild
discomfort at the insertion site.
D) A patient receiving a blood transfusion who has a temperature of 37.2°C
and feels slightly chilled.
Answer: A
Rationale: Airway and breathing take priority. A new tracheostomy with
borderline oxygen saturation indicates potential airway compromise or
inadequate oxygenation. Options B, C, and D are stable or expected findings;
the transfusion reaction symptoms are mild but less urgent than the respiratory
issue.
3 A patient requires an emergency surgical procedure. The patient is conscious
but refuses to sign the consent form. Which action by the nurse is most
appropriate regarding informed consent?
A) Proceed with the surgery because the patient's family has signed a consent
form.
B) Notify the healthcare provider and document the patient's refusal clearly in
the medical record.
C) Administer a sedative to reduce the patient's anxiety and attempt to obtain
consent later.
D) Ask the chaplain to persuade the patient to consent based on religious
beliefs.
Answer: B
Rationale: The patient has the right to refuse treatment, even in an emergency if
they are competent. The nurse must notify the provider and document the
refusal. Option A is invalid without patient consent. Options C and D violate
autonomy and are coercive; informed consent must be voluntary and free from
undue influence.
,4 A patient with a living will and a durable power of attorney for healthcare
(DPAHC) is admitted with terminal cancer. The DPAHC holder requests
aggressive treatment, while the living will indicates a preference for comfort
care only. Which action by the nurse is most appropriate?
A) Follow the DPAHC holder's request because they have legal authority to
make decisions.
B) Initiate comfort care as per the living will, overriding the DPAHC holder's
decision.
C) Request an ethics consultation to resolve the conflict between the
documents.
D) Continue both treatments until the patient's wishes are clarified by the
primary provider.
Answer: C
Rationale: When a living will and DPAHC conflict, an ethics consultation is
warranted to interpret the patient's wishes and ensure the appropriate surrogate
decision-maker is acting consistently. The DPAHC holder must follow the
patient's known wishes; if unclear, the ethics committee can mediate. Option A
may violate the living will if it's clearly applicable. Option B disregards the
DPAHC's legal role. Option D could cause unnecessary suffering.
5 A quality improvement team is analyzing a run chart of catheter-associated
urinary tract infections (CAUTI) rates after implementing a new insertion
protocol. The chart shows six consecutive data points below the median.
What should the team conclude?
A) The new protocol has caused a shift in the process, indicating special
cause variation.
B) The data are consistent with common cause variation and no change is
needed.
C) The protocol is ineffective; further data collection is required before
conclusions.
D) A control chart is necessary to determine if the process is out of control.
Answer: A
Rationale: A run of six or more consecutive points on one side of the median
indicates a non-random pattern (shift), suggesting special cause variation due
to the protocol change. This warrants investigation and possibly adoption of
the change. Option B is incorrect because common cause variation would show
, random fluctuation. Option C ignores the clear signal. Option D: while a
control chart is useful, a run chart alone can detect this signal.
6 During a patient care conference, the physical therapist and nurse disagree on
the discharge plan for a patient with limited mobility. The nurse prefers a
skilled nursing facility, while the therapist recommends home health. The
team is unable to reach consensus. Which conflict resolution strategy should
the charge nurse employ first?
A) Vote on the plan and proceed with the majority opinion.
B) Refer the disagreement to the attending physician for final decision.
C) Facilitate a discussion to identify common goals and evidence from each
perspective.
D) Implement the nurse's plan as the nurse has the most contact with the
patient.
Answer: C
Rationale: Collaboration and conflict resolution begin with open
communication to understand all viewpoints and find a patient-centered
solution. Voting (A) may polarize the team; referring to the physician (B)
undermines interdisciplinary collaboration and may not consider all factors;
unilaterally following the nurse (D) disregards the therapist's expertise. Option
C respects both disciplines and encourages evidence-based decision-making.
7 A case manager is coordinating discharge for a patient with heart failure,
diabetes, and chronic kidney disease. The patient lives alone and reports
difficulty managing multiple medications. Which intervention is most likely
to reduce hospital readmission risk?
A) Arranging a daily home health aide visit for medication administration.
B) Providing a list of generic pharmacies for cost savings.
C) Scheduling a follow-up appointment with the primary provider within one
week.
D) Enrolling the patient in a transitional care program with nurse-led
telephone support.
Answer: D
Rationale: Transitional care programs (e.g., Naylor's model) that include
follow-up calls, medication reconciliation, and self-management education
have strong evidence for reducing readmissions, especially for complex
