PNR 207/PNR207 Exam 4 V1 | Transition to PN
Practice - Capstone Q&A with Rationale | Fortis
College
1. A Licensed Practical Nurse (LPN) is preparing to delegate tasks to an Unlicensed Assistive
Personnel (UAP). Which task is most appropriate for the LPN to delegate?
A. Assisting a stable patient with ambulation for the first time post-surgery.
B. Collecting a routine mid-stream urine specimen from a cooperative patient.
C. Performing an initial skin assessment on a newly admitted patient.
D. Updating the nursing care plan for a patient with chronic hypertension.
Correct Answer: B
Explanation: Collecting a routine urine specimen is a standardized procedure that does
not require clinical judgment or nursing assessment. Assessing a patient or updating a care
plan involves the nursing process and must be performed by licensed personnel. Assisting
with the first post-operative ambulation is risky and should be supervised or performed by
a nurse to assess tolerance.
2. Which ethical principle is the nurse upholding when they tell the truth to a patient
regarding a terminal diagnosis?
A. Beneficence
B. Fidelity
,C. Non-maleficence
D. Veracity
Correct Answer: D
Explanation: Veracity refers to the obligation of the healthcare provider to tell the truth
and be honest with patients. This principle is fundamental in building a trusting
relationship between the nurse and the patient. While beneficence means doing good and
non-maleficence means doing no harm, veracity specifically addresses truth-telling.
3. A nurse is using the SBAR communication tool. Which information should the nurse include
in the ‘B’ (Background) section?
A. The patient’s current blood pressure and heart rate.
B. The patient’s admitting diagnosis and medical history.
C. A specific request for a medication change.
D. The nurse’s assessment of why the patient’s condition is deteriorating.
Correct Answer: B
Explanation: The ‘B’ in SBAR stands for Background, which provides historical context
such as the admission diagnosis and pertinent history. Current vital signs belong in the ‘S’
(Situation) or ‘A’ (Assessment) sections depending on the facility’s protocol. The ‘R’
(Recommendation) section is where specific requests for intervention are communicated.
, 4. The nurse is caring for four patients. Using the ABC (Airway, Breathing, Circulation)
framework, which patient should the nurse assess first?
A. A patient reporting abdominal pain following an appendectomy.
B. A patient who needs a dressing change for a chronic pressure ulcer.
C. A patient with a history of asthma who is experiencing inspiratory stridor.
D. A patient with a blood glucose level of 140 mg/dL.
Correct Answer: C
Explanation: Inspiratory stridor is a sign of upper airway obstruction, which is a life-
threatening emergency requiring immediate intervention. This takes priority over post-
operative pain or routine wound care according to the ABC framework. The blood glucose
level of 140 is slightly elevated but not an immediate threat compared to a compromised
airway.
5. A nurse observes a colleague documenting a medication administration that was never
given. What is the nurse’s first action?
A. Report the observation to the nurse manager or supervisor immediately.
B. Ignore the situation if the patient appears to be doing well.
C. Confront the colleague privately to discuss the observation.
D. File an anonymous report with the State Board of Nursing.
Correct Answer: A
Practice - Capstone Q&A with Rationale | Fortis
College
1. A Licensed Practical Nurse (LPN) is preparing to delegate tasks to an Unlicensed Assistive
Personnel (UAP). Which task is most appropriate for the LPN to delegate?
A. Assisting a stable patient with ambulation for the first time post-surgery.
B. Collecting a routine mid-stream urine specimen from a cooperative patient.
C. Performing an initial skin assessment on a newly admitted patient.
D. Updating the nursing care plan for a patient with chronic hypertension.
Correct Answer: B
Explanation: Collecting a routine urine specimen is a standardized procedure that does
not require clinical judgment or nursing assessment. Assessing a patient or updating a care
plan involves the nursing process and must be performed by licensed personnel. Assisting
with the first post-operative ambulation is risky and should be supervised or performed by
a nurse to assess tolerance.
2. Which ethical principle is the nurse upholding when they tell the truth to a patient
regarding a terminal diagnosis?
A. Beneficence
B. Fidelity
,C. Non-maleficence
D. Veracity
Correct Answer: D
Explanation: Veracity refers to the obligation of the healthcare provider to tell the truth
and be honest with patients. This principle is fundamental in building a trusting
relationship between the nurse and the patient. While beneficence means doing good and
non-maleficence means doing no harm, veracity specifically addresses truth-telling.
3. A nurse is using the SBAR communication tool. Which information should the nurse include
in the ‘B’ (Background) section?
A. The patient’s current blood pressure and heart rate.
B. The patient’s admitting diagnosis and medical history.
C. A specific request for a medication change.
D. The nurse’s assessment of why the patient’s condition is deteriorating.
Correct Answer: B
Explanation: The ‘B’ in SBAR stands for Background, which provides historical context
such as the admission diagnosis and pertinent history. Current vital signs belong in the ‘S’
(Situation) or ‘A’ (Assessment) sections depending on the facility’s protocol. The ‘R’
(Recommendation) section is where specific requests for intervention are communicated.
, 4. The nurse is caring for four patients. Using the ABC (Airway, Breathing, Circulation)
framework, which patient should the nurse assess first?
A. A patient reporting abdominal pain following an appendectomy.
B. A patient who needs a dressing change for a chronic pressure ulcer.
C. A patient with a history of asthma who is experiencing inspiratory stridor.
D. A patient with a blood glucose level of 140 mg/dL.
Correct Answer: C
Explanation: Inspiratory stridor is a sign of upper airway obstruction, which is a life-
threatening emergency requiring immediate intervention. This takes priority over post-
operative pain or routine wound care according to the ABC framework. The blood glucose
level of 140 is slightly elevated but not an immediate threat compared to a compromised
airway.
5. A nurse observes a colleague documenting a medication administration that was never
given. What is the nurse’s first action?
A. Report the observation to the nurse manager or supervisor immediately.
B. Ignore the situation if the patient appears to be doing well.
C. Confront the colleague privately to discuss the observation.
D. File an anonymous report with the State Board of Nursing.
Correct Answer: A
