, Question 1
A nurse manager is prioritizing unit-wide interventions after a root-cause
analysis revealed three near-miss medication events. Which action best reflects
a systems-level, high-reliability approach to preventing recurrence?
A. Requiring individual nurses to complete a refresher course on
high-alert medications.
B. Implementing independent double-checks and barcode scanning for all
high-alert medications.
C. Adding a second nurse to the night shift to increase surveillance.
D. Sending a unit-wide email reminding staff to follow the five rights of
medication administration.
Correct Answer: B - Implementing independent double-checks
and barcode scanning for all high-alert medications.
RATIONALE
High-reliability organizations use forcing functions and technology
(barcode scanning, independent double-checks) to make errors less
likely, rather than relying on individual vigilance. Education and
reminders (A, D) are weak, person-focused fixes, and adding staff (C)
does not address the system flaw.
Question 2
A patient with sepsis has a lactate of 4.2 mmol/L and MAP of 58 mm Hg
despite 30 mL/kg crystalloid. Which intervention should the nurse anticipate
next according to the Surviving Sepsis Campaign?
A. Administer a broad-spectrum antibiotic within the next hour.
B. Initiate norepinephrine to maintain MAP 65 mm Hg.
C. Transfuse one unit of packed red blood cells.
D. Obtain a repeat lactate level in 4 hours.
Correct Answer: B - Initiate norepinephrine to maintain MAP 65
mm Hg.
Page 2
, RATIONALE
After adequate fluid resuscitation, vasopressors are indicated to
achieve a MAP 65 mm Hg. Antibiotics (A) are urgent but do not
address the hypotension; transfusion (C) is not indicated without
hemoglobin < 7 g/dL; repeat lactate (D) is monitoring, not immediate
treatment.
Question 3
A nurse is delegating to unlicensed assistive personnel (UAP). Which task is
most appropriate to delegate?
A. Assessing a postoperative patient's incisional pain.
B. Administering a PRN antiemetic to a patient with nausea.
C. Obtaining vital signs on a stable patient 2 hours after surgery.
D. Teaching a patient how to use an incentive spirometer.
Correct Answer: C - Obtaining vital signs on a stable patient 2
hours after surgery.
RATIONALE
UAP can perform routine, stable tasks such as vital signs on stable
patients. Assessment (A), medication administration (B), and patient
teaching (D) require the clinical judgment and licensure of a registered
nurse.
Question 4
Which clinical finding best differentiates acute respiratory distress syndrome
(ARDS) from cardiogenic pulmonary edema?
A. Bilateral crackles on auscultation.
B. A pulmonary artery occlusion pressure (PAOP) of 12 mm Hg.
C. Presence of a third heart sound (S3).
D. Improved oxygenation with diuresis.
Correct Answer: B - A pulmonary artery occlusion pressure
Page 3
, (PAOP) of 12 mm Hg.
RATIONALE
ARDS is a non-cardiogenic cause of pulmonary edema; a PAOP 18
mm Hg supports ARDS rather than cardiogenic edema. Crackles (A)
and S3 (C) are nonspecific, and diuresis response (D) is more
characteristic of cardiogenic edema.
Question 5
A nurse is reviewing a medication order for a patient with a new prescription
for warfarin. Which action best reflects the nurse's role in preventing adverse
drug events?
A. Verify the patient's most recent INR before administration.
B. Administer the medication and monitor for bleeding.
C. Hold the medication if the patient reports any pain.
D. Consult the pharmacist only if the dose seems unusually high.
Correct Answer: A - Verify the patient's most recent INR before
administration.
RATIONALE
Warfarin requires monitoring of INR to ensure therapeutic range and
prevent bleeding or clotting. Administering without checking INR (B)
is unsafe; holding for pain (C) is unrelated; and pharmacist
consultation (D) should be routine for anticoagulants, not only for
high doses.
Question 6
A nurse is preparing to discharge a patient with heart failure. Which instruction
is most critical to include in the discharge teaching?
A. Weigh yourself daily and report a gain of 2-3 pounds in 24 hours.
B. Limit fluid intake to 2 liters per day.
C. Take an extra dose of diuretic if you feel short of breath.
Page 4
A nurse manager is prioritizing unit-wide interventions after a root-cause
analysis revealed three near-miss medication events. Which action best reflects
a systems-level, high-reliability approach to preventing recurrence?
A. Requiring individual nurses to complete a refresher course on
high-alert medications.
B. Implementing independent double-checks and barcode scanning for all
high-alert medications.
C. Adding a second nurse to the night shift to increase surveillance.
D. Sending a unit-wide email reminding staff to follow the five rights of
medication administration.
Correct Answer: B - Implementing independent double-checks
and barcode scanning for all high-alert medications.
RATIONALE
High-reliability organizations use forcing functions and technology
(barcode scanning, independent double-checks) to make errors less
likely, rather than relying on individual vigilance. Education and
reminders (A, D) are weak, person-focused fixes, and adding staff (C)
does not address the system flaw.
Question 2
A patient with sepsis has a lactate of 4.2 mmol/L and MAP of 58 mm Hg
despite 30 mL/kg crystalloid. Which intervention should the nurse anticipate
next according to the Surviving Sepsis Campaign?
A. Administer a broad-spectrum antibiotic within the next hour.
B. Initiate norepinephrine to maintain MAP 65 mm Hg.
C. Transfuse one unit of packed red blood cells.
D. Obtain a repeat lactate level in 4 hours.
Correct Answer: B - Initiate norepinephrine to maintain MAP 65
mm Hg.
Page 2
, RATIONALE
After adequate fluid resuscitation, vasopressors are indicated to
achieve a MAP 65 mm Hg. Antibiotics (A) are urgent but do not
address the hypotension; transfusion (C) is not indicated without
hemoglobin < 7 g/dL; repeat lactate (D) is monitoring, not immediate
treatment.
Question 3
A nurse is delegating to unlicensed assistive personnel (UAP). Which task is
most appropriate to delegate?
A. Assessing a postoperative patient's incisional pain.
B. Administering a PRN antiemetic to a patient with nausea.
C. Obtaining vital signs on a stable patient 2 hours after surgery.
D. Teaching a patient how to use an incentive spirometer.
Correct Answer: C - Obtaining vital signs on a stable patient 2
hours after surgery.
RATIONALE
UAP can perform routine, stable tasks such as vital signs on stable
patients. Assessment (A), medication administration (B), and patient
teaching (D) require the clinical judgment and licensure of a registered
nurse.
Question 4
Which clinical finding best differentiates acute respiratory distress syndrome
(ARDS) from cardiogenic pulmonary edema?
A. Bilateral crackles on auscultation.
B. A pulmonary artery occlusion pressure (PAOP) of 12 mm Hg.
C. Presence of a third heart sound (S3).
D. Improved oxygenation with diuresis.
Correct Answer: B - A pulmonary artery occlusion pressure
Page 3
, (PAOP) of 12 mm Hg.
RATIONALE
ARDS is a non-cardiogenic cause of pulmonary edema; a PAOP 18
mm Hg supports ARDS rather than cardiogenic edema. Crackles (A)
and S3 (C) are nonspecific, and diuresis response (D) is more
characteristic of cardiogenic edema.
Question 5
A nurse is reviewing a medication order for a patient with a new prescription
for warfarin. Which action best reflects the nurse's role in preventing adverse
drug events?
A. Verify the patient's most recent INR before administration.
B. Administer the medication and monitor for bleeding.
C. Hold the medication if the patient reports any pain.
D. Consult the pharmacist only if the dose seems unusually high.
Correct Answer: A - Verify the patient's most recent INR before
administration.
RATIONALE
Warfarin requires monitoring of INR to ensure therapeutic range and
prevent bleeding or clotting. Administering without checking INR (B)
is unsafe; holding for pain (C) is unrelated; and pharmacist
consultation (D) should be routine for anticoagulants, not only for
high doses.
Question 6
A nurse is preparing to discharge a patient with heart failure. Which instruction
is most critical to include in the discharge teaching?
A. Weigh yourself daily and report a gain of 2-3 pounds in 24 hours.
B. Limit fluid intake to 2 liters per day.
C. Take an extra dose of diuretic if you feel short of breath.
Page 4
