Clinical Nurse Leader (CNL) ACTUAL EXAM
Multiple choice 2026 NEWWEST VERSION
QUESTIONS AND VERIFIED CORRECT ANSWERS
ALREADY GRADED A+
Section 1: Priority & Delegation (Questions 1-10)
1. A charge nurse is making assignments for a medical-surgical unit. Which patient should be
assigned to the most experienced RN?
A. A 45-year-old with type 2 diabetes mellitus requiring a wound debridement dressing change.
B. A 62-year-old with COPD who needs discharge teaching on using a new home oxygen
concentrator.
C. A 38-year-old admitted with acute pancreatitis who is exhibiting signs of hypovolemic shock.
D. A 70-year-old with stable angina who is scheduled for a cardiac stress test.
Answer: C
Rationale: The patient in hypovolemic shock (C) is the most unstable and requires complex
assessment and critical thinking skills. The most experienced RN should manage the unstable
patient. Options A, B, and D are stable patients with predictable needs that could be delegated
to less experienced staff or an LPN (with appropriate supervision).
2. A nurse on a medical-surgical unit is delegating tasks to an LPN/LVN. Which task is
appropriate for the nurse to delegate?
A. Administering IV push morphine to a patient with a fractured femur.
B. Performing an initial admission assessment on a new patient with pneumonia.
C. Changing the dressing on a patient's new tracheostomy site.
D. Developing a nursing care plan for a patient with a new colostomy.
Answer: C
Rationale: LPNs/LVNs are licensed to perform stable, predictable tasks, including wound care
and dressing changes for a stable patient. Initial assessments (B), IV push medications (A), and
care plan development (D) are within the scope of practice of the RN and cannot be delegated.
3. The nurse receives a handoff report on four patients. Which patient should the nurse assess
FIRST?
A. A patient with a chest tube who has 50 mL of sanguineous drainage in the past hour.
1
, B. A patient post-appendectomy who is requesting pain medication.
C. A patient with heart failure who has 2+ pitting edema in the lower extremities.
D. A patient with a hip fracture who needs assistance to the bedside commode.
Answer: A
Rationale: 50 mL of sanguineous drainage in one hour is significant and could indicate active
bleeding. This is a potential emergency requiring immediate assessment. Pain (B), stable edema
(C), and mobility (D) are lower priorities. Use the ABCs and "worst first" principle.
4. A nurse is caring for a patient with a continuous enteral feeding. Which finding requires
immediate intervention?
A. Gastric residual volume of 200 mL.
B. Patient lying in a supine position.
C. Bowel sounds present in all four quadrants.
D. Blood glucose level of 140 mg/dL.
Answer: B
Rationale: A patient receiving continuous enteral feedings should have the head of the bed
elevated at least 30-45 degrees to prevent aspiration. A supine position (flat) is a significant risk
factor for aspiration pneumonia. A GRV of 200 mL is acceptable in many institutions (some allow
up to 500 mL). Bowel sounds and a glucose of 140 are expected.
5. The nurse is caring for a patient who had a cardiac catheterization 2 hours ago via the
femoral artery. Which finding is the priority to report to the healthcare provider?
A. The patient reports a pain level of 4/10 at the insertion site.
B. The patient's blood pressure is 110/70 mm Hg, heart rate 80 bpm.
C. The patient's right foot is pale, cool, and the pedal pulse is weak.
D. The patient's urine output is 150 mL over the last 2 hours.
Answer: C
Rationale: A pale, cool foot with a weak pulse (C) indicates acute arterial occlusion or
compromised circulation to the limb. This is a limb-threatening emergency and must be
reported immediately. Pain at the site (A) is expected. Vital signs (B) are stable. Urine output (D)
is within normal limits (30 mL/hr).
6. The nurse is prioritizing care for a patient with a traumatic brain injury (TBI). Which nursing
action should be performed FIRST?
A. Assess the patient's Glasgow Coma Scale (GCS) score.
B. Maintain cervical spine precautions.
C. Administer prescribed mannitol (Osmitrol).
D. Check the patient's serum sodium level.
2
, Answer: B
Rationale: In a TBI, the primary goal is to prevent secondary injury. Cervical spine precautions
(B) must be maintained until spinal injury is ruled out to prevent spinal cord damage. While
ABCs (including GCS) are priority, this question asks for an action; immobilization is the
immediate safety action. This is the most immediate step to ensure safety.
7. The nurse receives a new order to administer 2 units of packed red blood cells (PRBCs) to a
patient with a hemoglobin of 6.8 g/dL. Which action should the nurse take FIRST?
A. Obtain a large-bore IV line.
B. Have the patient sign a consent form.
C. Verify the prescription with another RN.
D. Assess the patient's vital signs.
Answer: C
Rationale: Verification of the blood product prescription and patient identification with another
RN is the FIRST and most critical step in the blood transfusion administration process to prevent
fatal transfusion errors. Vital signs (D) and IV access (A) are done, but they are not the first step.
8. A patient with end-stage COPD is receiving oxygen at 2 L/min via nasal cannula. The
patient's respiratory rate is 8 breaths/min and they are somnolent. What is the nurse's
priority action?
A. Increase the oxygen to 4 L/min.
B. Administer naloxone (Narcan).
C. Prepare for possible intubation.
D. Assess the patient's arterial blood gases (ABGs).
Answer: D
Rationale: The patient is exhibiting signs of hypercapnia (hypoventilation, somnolence). The
priority is to assess the ABGs (D) to confirm CO2 retention and evaluate the acid-base balance.
Increasing oxygen (A) could worsen CO2 narcosis. Naloxone (B) is for opioid overdose. While
intubation (C) may be needed, assessment comes first.
9. The nurse is caring for a patient with a chest tube connected to a closed water-seal
drainage system. Which finding indicates a potential complication?
A. Continuous bubbling in the water-seal chamber.
B. Fluctuation (tidaling) of fluid in the water-seal chamber with respirations.
C. 200 mL of drainage in the collection chamber over 8 hours.
D. The drainage system is kept below the level of the chest.
Answer: A
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the system.
3
, Tidaling (B) is normal and indicates that the system is intact. Drainage of 200 mL over 8 hours
(C) is significant but not immediately life-threatening like an air leak. The system below the
chest (D) is correct positioning.
10. The nurse is preparing to transfer a patient from the ICU to the medical-surgical unit.
Which information should the nurse include in the handoff report?
A. The patient's full family medical history.
B. The patient's complete insurance information.
C. The patient's code status and current mental status.
D. The patient's favorite food and activities.
Answer: C
Rationale: Essential components of a handoff report include the patient's code status, current
diagnosis, mental status, medications, and plan of care. This ensures continuity and safety.
Family history (A) and insurance (B) are not essential for a clinical handoff.
Section 2: Medication & Dosage Calculation (Questions 11-20)
11. The healthcare provider orders heparin 7500 units subcutaneous every 12 hours. The
medication is available as 10,000 units/mL. How many mL will the nurse administer?
A. 0.5 mL
B. 0.75 mL
C. 1 mL
D. 1.5 mL
Answer: B
Rationale: Desired / Have x Quantity = 7,500 units / 10,000 units/mL = 0.75 mL.
12. A patient with a ventricular arrhythmia is prescribed amiodarone 300 mg IV push. The vial
contains 150 mg/3 mL. How many mL will the nurse administer?
A. 4 mL
B. 5 mL
C. 6 mL
D. 7 mL
Answer: C
Rationale: (300 mg / 150 mg) x 3 mL = 2 x 3 mL = 6 mL.
13. A nurse is preparing to administer 1,000 mL of normal saline over 8 hours. The drop factor
is 15 gtt/mL. At what rate (gtt/min) will the nurse set the IV? (Round to the nearest whole
number)
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Multiple choice 2026 NEWWEST VERSION
QUESTIONS AND VERIFIED CORRECT ANSWERS
ALREADY GRADED A+
Section 1: Priority & Delegation (Questions 1-10)
1. A charge nurse is making assignments for a medical-surgical unit. Which patient should be
assigned to the most experienced RN?
A. A 45-year-old with type 2 diabetes mellitus requiring a wound debridement dressing change.
B. A 62-year-old with COPD who needs discharge teaching on using a new home oxygen
concentrator.
C. A 38-year-old admitted with acute pancreatitis who is exhibiting signs of hypovolemic shock.
D. A 70-year-old with stable angina who is scheduled for a cardiac stress test.
Answer: C
Rationale: The patient in hypovolemic shock (C) is the most unstable and requires complex
assessment and critical thinking skills. The most experienced RN should manage the unstable
patient. Options A, B, and D are stable patients with predictable needs that could be delegated
to less experienced staff or an LPN (with appropriate supervision).
2. A nurse on a medical-surgical unit is delegating tasks to an LPN/LVN. Which task is
appropriate for the nurse to delegate?
A. Administering IV push morphine to a patient with a fractured femur.
B. Performing an initial admission assessment on a new patient with pneumonia.
C. Changing the dressing on a patient's new tracheostomy site.
D. Developing a nursing care plan for a patient with a new colostomy.
Answer: C
Rationale: LPNs/LVNs are licensed to perform stable, predictable tasks, including wound care
and dressing changes for a stable patient. Initial assessments (B), IV push medications (A), and
care plan development (D) are within the scope of practice of the RN and cannot be delegated.
3. The nurse receives a handoff report on four patients. Which patient should the nurse assess
FIRST?
A. A patient with a chest tube who has 50 mL of sanguineous drainage in the past hour.
1
, B. A patient post-appendectomy who is requesting pain medication.
C. A patient with heart failure who has 2+ pitting edema in the lower extremities.
D. A patient with a hip fracture who needs assistance to the bedside commode.
Answer: A
Rationale: 50 mL of sanguineous drainage in one hour is significant and could indicate active
bleeding. This is a potential emergency requiring immediate assessment. Pain (B), stable edema
(C), and mobility (D) are lower priorities. Use the ABCs and "worst first" principle.
4. A nurse is caring for a patient with a continuous enteral feeding. Which finding requires
immediate intervention?
A. Gastric residual volume of 200 mL.
B. Patient lying in a supine position.
C. Bowel sounds present in all four quadrants.
D. Blood glucose level of 140 mg/dL.
Answer: B
Rationale: A patient receiving continuous enteral feedings should have the head of the bed
elevated at least 30-45 degrees to prevent aspiration. A supine position (flat) is a significant risk
factor for aspiration pneumonia. A GRV of 200 mL is acceptable in many institutions (some allow
up to 500 mL). Bowel sounds and a glucose of 140 are expected.
5. The nurse is caring for a patient who had a cardiac catheterization 2 hours ago via the
femoral artery. Which finding is the priority to report to the healthcare provider?
A. The patient reports a pain level of 4/10 at the insertion site.
B. The patient's blood pressure is 110/70 mm Hg, heart rate 80 bpm.
C. The patient's right foot is pale, cool, and the pedal pulse is weak.
D. The patient's urine output is 150 mL over the last 2 hours.
Answer: C
Rationale: A pale, cool foot with a weak pulse (C) indicates acute arterial occlusion or
compromised circulation to the limb. This is a limb-threatening emergency and must be
reported immediately. Pain at the site (A) is expected. Vital signs (B) are stable. Urine output (D)
is within normal limits (30 mL/hr).
6. The nurse is prioritizing care for a patient with a traumatic brain injury (TBI). Which nursing
action should be performed FIRST?
A. Assess the patient's Glasgow Coma Scale (GCS) score.
B. Maintain cervical spine precautions.
C. Administer prescribed mannitol (Osmitrol).
D. Check the patient's serum sodium level.
2
, Answer: B
Rationale: In a TBI, the primary goal is to prevent secondary injury. Cervical spine precautions
(B) must be maintained until spinal injury is ruled out to prevent spinal cord damage. While
ABCs (including GCS) are priority, this question asks for an action; immobilization is the
immediate safety action. This is the most immediate step to ensure safety.
7. The nurse receives a new order to administer 2 units of packed red blood cells (PRBCs) to a
patient with a hemoglobin of 6.8 g/dL. Which action should the nurse take FIRST?
A. Obtain a large-bore IV line.
B. Have the patient sign a consent form.
C. Verify the prescription with another RN.
D. Assess the patient's vital signs.
Answer: C
Rationale: Verification of the blood product prescription and patient identification with another
RN is the FIRST and most critical step in the blood transfusion administration process to prevent
fatal transfusion errors. Vital signs (D) and IV access (A) are done, but they are not the first step.
8. A patient with end-stage COPD is receiving oxygen at 2 L/min via nasal cannula. The
patient's respiratory rate is 8 breaths/min and they are somnolent. What is the nurse's
priority action?
A. Increase the oxygen to 4 L/min.
B. Administer naloxone (Narcan).
C. Prepare for possible intubation.
D. Assess the patient's arterial blood gases (ABGs).
Answer: D
Rationale: The patient is exhibiting signs of hypercapnia (hypoventilation, somnolence). The
priority is to assess the ABGs (D) to confirm CO2 retention and evaluate the acid-base balance.
Increasing oxygen (A) could worsen CO2 narcosis. Naloxone (B) is for opioid overdose. While
intubation (C) may be needed, assessment comes first.
9. The nurse is caring for a patient with a chest tube connected to a closed water-seal
drainage system. Which finding indicates a potential complication?
A. Continuous bubbling in the water-seal chamber.
B. Fluctuation (tidaling) of fluid in the water-seal chamber with respirations.
C. 200 mL of drainage in the collection chamber over 8 hours.
D. The drainage system is kept below the level of the chest.
Answer: A
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the system.
3
, Tidaling (B) is normal and indicates that the system is intact. Drainage of 200 mL over 8 hours
(C) is significant but not immediately life-threatening like an air leak. The system below the
chest (D) is correct positioning.
10. The nurse is preparing to transfer a patient from the ICU to the medical-surgical unit.
Which information should the nurse include in the handoff report?
A. The patient's full family medical history.
B. The patient's complete insurance information.
C. The patient's code status and current mental status.
D. The patient's favorite food and activities.
Answer: C
Rationale: Essential components of a handoff report include the patient's code status, current
diagnosis, mental status, medications, and plan of care. This ensures continuity and safety.
Family history (A) and insurance (B) are not essential for a clinical handoff.
Section 2: Medication & Dosage Calculation (Questions 11-20)
11. The healthcare provider orders heparin 7500 units subcutaneous every 12 hours. The
medication is available as 10,000 units/mL. How many mL will the nurse administer?
A. 0.5 mL
B. 0.75 mL
C. 1 mL
D. 1.5 mL
Answer: B
Rationale: Desired / Have x Quantity = 7,500 units / 10,000 units/mL = 0.75 mL.
12. A patient with a ventricular arrhythmia is prescribed amiodarone 300 mg IV push. The vial
contains 150 mg/3 mL. How many mL will the nurse administer?
A. 4 mL
B. 5 mL
C. 6 mL
D. 7 mL
Answer: C
Rationale: (300 mg / 150 mg) x 3 mL = 2 x 3 mL = 6 mL.
13. A nurse is preparing to administer 1,000 mL of normal saline over 8 hours. The drop factor
is 15 gtt/mL. At what rate (gtt/min) will the nurse set the IV? (Round to the nearest whole
number)
4
