Exam With Correct Questions with Verified
Answers with Rationale (2024/2025) 50 Q&A
50 Questions
MULTIPLE CHOICE
1. A Nurse Is Preparing To Perform A Sterile Dressing Change For A Client Who Has
A Surgical Wound. Which Of The Following Actions Should The Nurse Take To
Prevent Contamination During The Dressing Change?
A) Restart The Procedure If The Sterile Solution Splashes Onto The Sterile Field
When Pouring The Solution Into The Dressing Tray
B) Place The Sterile Dressing On The Unsterile Surface While Preparing
C) Wear Sterile Gloves Throughout The Procedure
D) Use The Sterile Saline That Has Been Open For 24 Hours
E) Keep The Sterile Field Below Waist Level
ANS: A
Rationale: If The Sterile Solution Splashes Onto The Sterile Field, It Compromises
The Sterility Of The Field. The Nurse Should Restart The Procedure To Ensure That
All Aspects Remain Sterile.
2. A Nurse Is Admitting A Client Who Has Meningococcal Meningitis. What Should
The Nurse Do First?
A) Initiate Droplet Precautions
B) Assess The Client's Neurological Status
C) Administer Prescribed Antibiotics
D) Obtain A Complete Blood Count
E) Notify The Infection Control Team
ANS: A
,Rationale: Meningococcal Meningitis Is Highly Contagious, And Droplet
Precautions Should Be Initiated Immediately To Protect Both The Client And Other
Patients And Staff.
3. A Nurse Is Reviewing The Health History Of An Older Adult Who Has A Hip
Fracture. The Nurse Should Identify Which Factor As A Risk For Developing
Pressure Injuries?
A) Urinary Incontinence
B) High Mobility Levels
C) Adequate Hydration
D) Use Of Specialty Mattresses
E) Regular Repositioning
ANS: A
Rationale: Urinary Incontinence Can Increase The Risk Of Skin Breakdown And
Pressure Injuries Due To Moisture And Irritation From Urine.
4. A Nurse Is Performing A Focused Assessment For A Client Who Has
Dysrhythmias. What Indicates Ineffective Cardiac Contractions?
A) Pulse Deficit
B) Elevated Blood Pressure
C) Normal Respiratory Rate
D) Decreased Urine Output
E) Increased Heart Rate
ANS: A
Rationale: A Pulse Deficit Occurs When The Heart Does Not Pump Effectively,
Resulting In Fewer Palpable Pulses Than Heartbeats, Indicating Ineffective Cardiac
Contractions.
5. A Nurse Is Preparing To Transfer A Client From A Chair To The Bed. The Client
Can Bear Partial Weight And Has Upper Body Strength. Which Device Should The
Nurse Use To Transfer The Patient?
A) A Stand-Assist Lift
, B) A Transfer Board
C) A Wheelchair
D) A Gait Belt
E) A Full-Body Sling Lift
ANS: A
Rationale: A Stand-Assist Lift Is Appropriate For Clients Who Can Bear Partial
Weight And Have Upper Body Strength, Providing Support While Enabling Them To
Assist In The Transfer.
6. A Charge Nurse Is Making Assignments For The Upcoming Shift. Which
Assignments Should The Charge Nurse Assign To An LPN?
A) A Client Who Has Dehydration And Inflammatory Bowel Disease
B) A Client Requiring A Psychosocial Assessment
C) A Client With A Complex Wound Care
D) A Client Undergoing A Preoperative Assessment
E) A Client With Multiple Chronic Conditions
ANS: A
Rationale: An LPN Can Manage Stable Clients With Specific Conditions Like
Dehydration And IBD, Allowing For Effective Care While Under The Supervision Of
An RN.
7. A Nurse Is Caring For A Client Who Has A Prescription For A Narcotic
Medication. After Administration, The Nurse Is Left With An Unused Portion. What
Should The Nurse Do?
A) Discard The Medication With Another Nurse As A Witness
B) Return The Medication To The Pharmacy
C) Save The Medication For Future Use
D) Dispose Of It In The Sharps Container
E) Record It As Wasted Medication In The Chart
ANS: A