NURS110 Introduction to Professional Nursing
Assessment 2 2026 - WCU
1. A nurse is evaluating a research study comparing two interventions for postoperative pain
management. The study uses a randomized controlled trial design with a crossover component.
Which factor most critically threatens the internal validity of this design?
A. Selection bias due to non-random assignment
B. Carryover effects from the first intervention to the second
C. Maturation of participants over the study period
D. Hawthorne effect from increased attention during the study
Answer: B
Rationale: In crossover designs, carryover effects occur when the effect of the first treatment persists into
the second period, confounding results. This is a primary threat to internal validity. Selection bias is
minimized by randomization; maturation is less of a threat in short-term pain studies; Hawthorne effect
affects both periods equally and is controlled by crossover.
2. A nursing unit is implementing a quality improvement initiative to reduce catheter-associated
urinary tract infections (CAUTI). The team uses the Plan-Do-Study-Act (PDSA) cycle. After
implementing a new insertion checklist, they observe a 20% reduction in CAUTI rates over three
months. Which action should the team take next to ensure sustained improvement?
A. Declare the intervention successful and discontinue data collection
B. Expand the checklist to other units without further testing
C. Analyze the data for variation and refine the checklist based on feedback
D. Replace the checklist with a different intervention to compare effectiveness
Answer: C
Rationale: The PDSA cycle emphasizes iterative testing and refinement. After initial success, the team
should study the data to understand variability and use feedback to improve the checklist before
spreading it. Declaring success prematurely (A) or expanding without refinement (B) risks failure.
Replacing the intervention (D) abandons a promising change without full analysis.
3. A nurse is caring for a patient with a do-not-resuscitate (DNR) order who develops respiratory
distress. The family requests that the nurse initiate mechanical ventilation despite the DNR. Which
ethical principle most directly conflicts with the family's request?
A. Autonomy
B. Beneficence
C. Nonmaleficence
D. Justice
Answer: A
Page 1
,Rationale: The principle of autonomy respects the patient's self-determination and right to refuse treatment, as documented
in the DNR order. The family's request overrides this autonomy. Beneficence (doing good) and nonmaleficence (avoiding
harm) are relevant but secondary; justice concerns fairness in resource allocation, not directly this conflict.
4. A nurse leader is restructuring a unit to improve interprofessional collaboration. Which model
of care delivery best supports shared decision-making and collective accountability among nurses,
physicians, and allied health professionals?
A. Primary nursing
B. Team nursing
C. Interprofessional collaborative practice
D. Functional nursing
Answer: C
Rationale: Interprofessional collaborative practice emphasizes shared decision-making, mutual respect,
and collective accountability among all team members. Primary nursing focuses on one nurse's
accountability; team nursing assigns tasks but may not foster equal collaboration; functional nursing is
task-oriented and fragmented.
5. A nurse is applying King's Theory of Goal Attainment to a patient with newly diagnosed
diabetes. Which nursing action best reflects the core concept of mutual goal setting?
A. Teaching the patient about diabetic diet and insulin administration
B. Collaborating with the patient to establish realistic blood glucose targets
C. Administering insulin as prescribed and monitoring blood glucose levels
D. Referring the patient to a diabetes educator for follow-up
Answer: B
Rationale: King's theory emphasizes the nurse-patient interaction to achieve mutually set goals.
Collaborating to establish blood glucose targets directly involves the patient in goal setting. Options A,
C, and D are unilateral actions that do not require mutual participation in goal determination.
6. A community health nurse is planning a screening program for hypertension in a low-income
urban neighborhood. Which factor is most likely to limit the program's effectiveness if not
addressed?
A. Lack of culturally appropriate educational materials
B. Insufficient number of screening devices
C. Inadequate training of screening personnel
D. Poor transportation access to screening sites
Answer: D
Rationale: In low-income neighborhoods, transportation barriers can severely limit access to preventive
services, reducing participation and effectiveness. While all options are important, transportation is a
fundamental access issue that must be addressed first, otherwise even well-staffed and equipped
programs may have low uptake.
Page 2
,7. A nurse is reviewing a patient's medication administration record and notices that a newly
prescribed antibiotic has a narrow therapeutic index. What is the nurse's priority action to ensure
patient safety?
A. Administer the medication as ordered and monitor for adverse effects
B. Consult the pharmacist to discuss therapeutic drug monitoring
C. Hold the medication and notify the prescriber of the risk
D. Check the patient's renal function before administering
Answer: B
Rationale: For drugs with a narrow therapeutic index, therapeutic drug monitoring (TDM) is often
essential to maintain efficacy and avoid toxicity. Consulting the pharmacist to establish a TDM plan is a
proactive safety measure. While checking renal function (D) may be part of TDM, it is incomplete;
holding the medication (C) may be premature without discussion; administering without TDM (A) risks
toxicity.
8. A nurse is evaluating a patient's pain using the PQRST mnemonic. The patient describes the
pain as 'sharp, stabbing, and 8/10' and states it started suddenly after lifting a heavy object. Which
component of the PQRST assessment is most critical to differentiate the cause?
A. Provocation/Palliation
B. Quality
C. Region/Radiation
D. Timing
Answer: A
Rationale: The provocation/palliation component (what makes it better or worse) is critical here because
the sudden onset after lifting suggests a musculoskeletal or mechanical cause. Identifying that movement
exacerbates the pain supports this. Quality (sharp) and region are important but less specific; timing
(sudden) is already noted.
9. In a quality improvement project, a nurse analyzes a control chart for central line-associated
bloodstream infections (CLABSI). The chart shows seven consecutive data points below the mean
but within the control limits. What does this pattern indicate?
A. Common cause variation; the process is stable
B. Special cause variation; an assignable cause should be investigated
C. The process is out of control and requires immediate intervention
D. The data are insufficient to draw any conclusion
Answer: B
Rationale: A run of seven or more consecutive points on one side of the mean indicates a non-random
pattern (special cause variation), even if within control limits. This warrants investigation to identify a
potential improvement or an emerging problem. Common cause variation would show random
fluctuation; the process is not out of control but has a signal.
10. A nurse is delegating tasks to unlicensed assistive personnel (UAP) on a medical-surgical unit.
Which task is appropriate to delegate, considering the UAP's training and the patient's stability?
Page 3
, A. Administering oral medications to a patient with stable vital signs
B. Emptying a urinary catheter bag and recording output
C. Assessing a patient's lung sounds during a routine check
D. Changing a sterile dressing on a surgical wound
Answer: B
Rationale: Emptying a urinary catheter bag and recording output is a non-invasive, routine task that
UAPs are trained to perform. Administering medications (A) requires licensed personnel; assessing lung
sounds (C) involves clinical judgment and is the nurse's responsibility; sterile dressing changes (D)
require sterile technique and assessment, beyond UAP scope.
11. A patient with chronic heart failure is prescribed a beta-blocker (carvedilol) and an ACE
inhibitor (lisinopril). The patient's current blood pressure is 98/62 mm Hg and heart rate is 56
bpm. The nurse reviews the medication administration record and notes that both medications are
due. Which action reflects the most appropriate nursing judgment based on current heart failure
guidelines and pharmacological principles?
A. Administer both medications as prescribed, as the combination reduces mortality in heart failure.
B. Hold the beta-blocker due to bradycardia and hypotension, and administer the ACE inhibitor alone.
C. Hold both medications and notify the prescriber of the vital signs before administration.
D. Administer the beta-blocker first, then reassess blood pressure before giving the ACE inhibitor.
Answer: C
Rationale: Current guidelines emphasize that beta-blockers and ACE inhibitors are cornerstone therapies
for heart failure, but significant hypotension (SBP <90) and bradycardia (HR <60) warrant holding
both to prevent further hemodynamic compromise. Option C is correct because it prioritizes patient
safety through prescriber notification. Options A and D ignore the low BP/HR, risking adverse events.
Option B is inappropriate because holding only the beta-blocker still risks hypotension from the ACE
inhibitor, and both medications contribute to the low readings.
12. A nursing student is analyzing a quantitative research study examining the effect of a nurse-led
educational intervention on medication adherence in patients with diabetes. The study reports a
p-value of 0.03 for the primary outcome and a confidence interval of 95% for the mean difference
in adherence scores. Which interpretation of these findings is most consistent with evidence-based
practice?
A. The p-value indicates a 3% probability that the null hypothesis is true, so the intervention is effective.
B. The confidence interval likely includes zero, suggesting no clinically meaningful effect.
C. The p-value suggests statistical significance, but the clinical significance must be evaluated by examining the
effect size and its practical relevance.
D. The results are not reliable because the p-value is above the conventional alpha of 0.01.
Answer: C
Rationale: A p-value of 0.03 is less than 0.05, indicating statistical significance. However, statistical
significance does not automatically imply clinical significance. Nurses must evaluate effect size and
confidence intervals to determine if the intervention has a meaningful impact on patient outcomes.
Option C correctly distinguishes statistical from clinical significance. Option A misinterprets p-value as
the probability of the null hypothesis. Option B is incorrect because a significant p-value typically
corresponds to a 95% CI that excludes zero. Option D uses an overly conservative alpha; 0.05 is
Page 4
Assessment 2 2026 - WCU
1. A nurse is evaluating a research study comparing two interventions for postoperative pain
management. The study uses a randomized controlled trial design with a crossover component.
Which factor most critically threatens the internal validity of this design?
A. Selection bias due to non-random assignment
B. Carryover effects from the first intervention to the second
C. Maturation of participants over the study period
D. Hawthorne effect from increased attention during the study
Answer: B
Rationale: In crossover designs, carryover effects occur when the effect of the first treatment persists into
the second period, confounding results. This is a primary threat to internal validity. Selection bias is
minimized by randomization; maturation is less of a threat in short-term pain studies; Hawthorne effect
affects both periods equally and is controlled by crossover.
2. A nursing unit is implementing a quality improvement initiative to reduce catheter-associated
urinary tract infections (CAUTI). The team uses the Plan-Do-Study-Act (PDSA) cycle. After
implementing a new insertion checklist, they observe a 20% reduction in CAUTI rates over three
months. Which action should the team take next to ensure sustained improvement?
A. Declare the intervention successful and discontinue data collection
B. Expand the checklist to other units without further testing
C. Analyze the data for variation and refine the checklist based on feedback
D. Replace the checklist with a different intervention to compare effectiveness
Answer: C
Rationale: The PDSA cycle emphasizes iterative testing and refinement. After initial success, the team
should study the data to understand variability and use feedback to improve the checklist before
spreading it. Declaring success prematurely (A) or expanding without refinement (B) risks failure.
Replacing the intervention (D) abandons a promising change without full analysis.
3. A nurse is caring for a patient with a do-not-resuscitate (DNR) order who develops respiratory
distress. The family requests that the nurse initiate mechanical ventilation despite the DNR. Which
ethical principle most directly conflicts with the family's request?
A. Autonomy
B. Beneficence
C. Nonmaleficence
D. Justice
Answer: A
Page 1
,Rationale: The principle of autonomy respects the patient's self-determination and right to refuse treatment, as documented
in the DNR order. The family's request overrides this autonomy. Beneficence (doing good) and nonmaleficence (avoiding
harm) are relevant but secondary; justice concerns fairness in resource allocation, not directly this conflict.
4. A nurse leader is restructuring a unit to improve interprofessional collaboration. Which model
of care delivery best supports shared decision-making and collective accountability among nurses,
physicians, and allied health professionals?
A. Primary nursing
B. Team nursing
C. Interprofessional collaborative practice
D. Functional nursing
Answer: C
Rationale: Interprofessional collaborative practice emphasizes shared decision-making, mutual respect,
and collective accountability among all team members. Primary nursing focuses on one nurse's
accountability; team nursing assigns tasks but may not foster equal collaboration; functional nursing is
task-oriented and fragmented.
5. A nurse is applying King's Theory of Goal Attainment to a patient with newly diagnosed
diabetes. Which nursing action best reflects the core concept of mutual goal setting?
A. Teaching the patient about diabetic diet and insulin administration
B. Collaborating with the patient to establish realistic blood glucose targets
C. Administering insulin as prescribed and monitoring blood glucose levels
D. Referring the patient to a diabetes educator for follow-up
Answer: B
Rationale: King's theory emphasizes the nurse-patient interaction to achieve mutually set goals.
Collaborating to establish blood glucose targets directly involves the patient in goal setting. Options A,
C, and D are unilateral actions that do not require mutual participation in goal determination.
6. A community health nurse is planning a screening program for hypertension in a low-income
urban neighborhood. Which factor is most likely to limit the program's effectiveness if not
addressed?
A. Lack of culturally appropriate educational materials
B. Insufficient number of screening devices
C. Inadequate training of screening personnel
D. Poor transportation access to screening sites
Answer: D
Rationale: In low-income neighborhoods, transportation barriers can severely limit access to preventive
services, reducing participation and effectiveness. While all options are important, transportation is a
fundamental access issue that must be addressed first, otherwise even well-staffed and equipped
programs may have low uptake.
Page 2
,7. A nurse is reviewing a patient's medication administration record and notices that a newly
prescribed antibiotic has a narrow therapeutic index. What is the nurse's priority action to ensure
patient safety?
A. Administer the medication as ordered and monitor for adverse effects
B. Consult the pharmacist to discuss therapeutic drug monitoring
C. Hold the medication and notify the prescriber of the risk
D. Check the patient's renal function before administering
Answer: B
Rationale: For drugs with a narrow therapeutic index, therapeutic drug monitoring (TDM) is often
essential to maintain efficacy and avoid toxicity. Consulting the pharmacist to establish a TDM plan is a
proactive safety measure. While checking renal function (D) may be part of TDM, it is incomplete;
holding the medication (C) may be premature without discussion; administering without TDM (A) risks
toxicity.
8. A nurse is evaluating a patient's pain using the PQRST mnemonic. The patient describes the
pain as 'sharp, stabbing, and 8/10' and states it started suddenly after lifting a heavy object. Which
component of the PQRST assessment is most critical to differentiate the cause?
A. Provocation/Palliation
B. Quality
C. Region/Radiation
D. Timing
Answer: A
Rationale: The provocation/palliation component (what makes it better or worse) is critical here because
the sudden onset after lifting suggests a musculoskeletal or mechanical cause. Identifying that movement
exacerbates the pain supports this. Quality (sharp) and region are important but less specific; timing
(sudden) is already noted.
9. In a quality improvement project, a nurse analyzes a control chart for central line-associated
bloodstream infections (CLABSI). The chart shows seven consecutive data points below the mean
but within the control limits. What does this pattern indicate?
A. Common cause variation; the process is stable
B. Special cause variation; an assignable cause should be investigated
C. The process is out of control and requires immediate intervention
D. The data are insufficient to draw any conclusion
Answer: B
Rationale: A run of seven or more consecutive points on one side of the mean indicates a non-random
pattern (special cause variation), even if within control limits. This warrants investigation to identify a
potential improvement or an emerging problem. Common cause variation would show random
fluctuation; the process is not out of control but has a signal.
10. A nurse is delegating tasks to unlicensed assistive personnel (UAP) on a medical-surgical unit.
Which task is appropriate to delegate, considering the UAP's training and the patient's stability?
Page 3
, A. Administering oral medications to a patient with stable vital signs
B. Emptying a urinary catheter bag and recording output
C. Assessing a patient's lung sounds during a routine check
D. Changing a sterile dressing on a surgical wound
Answer: B
Rationale: Emptying a urinary catheter bag and recording output is a non-invasive, routine task that
UAPs are trained to perform. Administering medications (A) requires licensed personnel; assessing lung
sounds (C) involves clinical judgment and is the nurse's responsibility; sterile dressing changes (D)
require sterile technique and assessment, beyond UAP scope.
11. A patient with chronic heart failure is prescribed a beta-blocker (carvedilol) and an ACE
inhibitor (lisinopril). The patient's current blood pressure is 98/62 mm Hg and heart rate is 56
bpm. The nurse reviews the medication administration record and notes that both medications are
due. Which action reflects the most appropriate nursing judgment based on current heart failure
guidelines and pharmacological principles?
A. Administer both medications as prescribed, as the combination reduces mortality in heart failure.
B. Hold the beta-blocker due to bradycardia and hypotension, and administer the ACE inhibitor alone.
C. Hold both medications and notify the prescriber of the vital signs before administration.
D. Administer the beta-blocker first, then reassess blood pressure before giving the ACE inhibitor.
Answer: C
Rationale: Current guidelines emphasize that beta-blockers and ACE inhibitors are cornerstone therapies
for heart failure, but significant hypotension (SBP <90) and bradycardia (HR <60) warrant holding
both to prevent further hemodynamic compromise. Option C is correct because it prioritizes patient
safety through prescriber notification. Options A and D ignore the low BP/HR, risking adverse events.
Option B is inappropriate because holding only the beta-blocker still risks hypotension from the ACE
inhibitor, and both medications contribute to the low readings.
12. A nursing student is analyzing a quantitative research study examining the effect of a nurse-led
educational intervention on medication adherence in patients with diabetes. The study reports a
p-value of 0.03 for the primary outcome and a confidence interval of 95% for the mean difference
in adherence scores. Which interpretation of these findings is most consistent with evidence-based
practice?
A. The p-value indicates a 3% probability that the null hypothesis is true, so the intervention is effective.
B. The confidence interval likely includes zero, suggesting no clinically meaningful effect.
C. The p-value suggests statistical significance, but the clinical significance must be evaluated by examining the
effect size and its practical relevance.
D. The results are not reliable because the p-value is above the conventional alpha of 0.01.
Answer: C
Rationale: A p-value of 0.03 is less than 0.05, indicating statistical significance. However, statistical
significance does not automatically imply clinical significance. Nurses must evaluate effect size and
confidence intervals to determine if the intervention has a meaningful impact on patient outcomes.
Option C correctly distinguishes statistical from clinical significance. Option A misinterprets p-value as
the probability of the null hypothesis. Option B is incorrect because a significant p-value typically
corresponds to a 95% CI that excludes zero. Option D uses an overly conservative alpha; 0.05 is
Page 4
