TPATC EXAM QUESTIONS AND ANSWERS 2026. - 150
Questions
This exam assesses advanced knowledge in Management of Care, focusing on delegation, supervision,
prioritization, resource management, legal and ethical decision-making, interprofessional collaboration, and
quality improvement in complex healthcare settings. Questions are designed to evaluate clinical reasoning and
leadership competencies expected of senior nursing students and new graduate nurses. It contains 150
multiple-choice questions, each with four distractors and a fully worked rationale that explains why the keyed
answer is correct. Content is organized into 8 focused sections: Management of Care, Safety and Infection
Control, Health Promotion and Maintenance, Psychosocial Integrity, Basic Care and Comfort, Pharmacological
Therapies, Reduction of Risk Potential, Physiological Adaptation. Targeted learning outcomes include: Apply
principles of delegation and supervision to optimize patient outcomes and team performance.; Prioritize nursing
interventions for multiple patients using clinical judgment and evidence-based frameworks.; Analyze legal and
ethical dilemmas in care management and propose appropriate actions.; Utilize quality improvement and safety
principles to reduce errors and improve care delivery.. Every item has been reviewed for clinical accuracy,
current guidelines, and clarity so that students can study with confidence and self-correct as they work through
the bank. Use it as a high-yield review immediately before the exam, or as a structured practice tool during the
unit - the rationales double as concise teaching notes. The recommended writing time is 3 hours, with a passing
Section 1: Management of Care (Questions 1-19)
1 A charge nurse on a medical-surgical unit is making assignments for the next
shift. Which patient should be assigned to the most experienced registered nurse
(RN)?
A) A patient with a new tracheostomy requiring frequent suctioning and
monitoring for bleeding
B) A patient with a hip fracture who is awaiting transfer to a rehabilitation facility
C) A patient with a urinary tract infection receiving IV antibiotics every 8 hours
D) A patient with type 2 diabetes mellitus requiring insulin dose adjustment based
on sliding scale
Answer: A
Rationale: The patient with a new tracheostomy has an unstable airway and requires
high-level assessment and intervention skills. Assigning this patient to the most
experienced RN ensures safe care. The other patients are more stable and can be
managed by less experienced staff.
2 A nurse manager is reviewing incident reports and notices a trend of medication
errors occurring during shift change. Which quality improvement intervention is
most effective to address this?
A) Reprimanding nurses involved in errors to discourage future mistakes
B) Implementing a standardized handoff communication tool (e.g., SBAR) for
medication reconciliation
,C) Increasing the number of nurses on each shift to reduce workload
D) Requiring all medications to be administered only by nurses with more than 5
years of experience
Answer: B
Rationale: Standardized handoff tools like SBAR improve communication
consistency and reduce errors during transitions of care. Reprimanding individuals
does not address system issues. Increasing staff may help but does not directly target
the handoff process. Restricting administration to experienced nurses is not feasible
and ignores root causes.
3 A nurse is caring for four patients. After receiving shift report, which patient
should the nurse assess first?
A) A patient with a history of heart failure who has crackles in the lung bases and
an oxygen saturation of 92% on room air
B) A patient with a new colostomy who is asking questions about stoma care
C) A patient with a fractured femur in skeletal traction who reports pain of 4/10
D) A patient with a urinary catheter who has not urinated in 6 hours and has a
bladder scanner reading of 150 mL
Answer: A
Rationale: The patient with crackles and low oxygen saturation is showing signs of
acute decompensation (possible pulmonary edema) and requires immediate
assessment and intervention. The other patients have stable or non-urgent concerns
that can be addressed later.
4 A nurse is delegating tasks to a licensed practical nurse (LPN) and a nursing
assistant (NA). Which task is appropriate to delegate to the LPN?
A) Administering a blood transfusion to a stable patient
B) Performing a sterile dressing change on a surgical wound with a drain
C) Assessing the lung sounds of a patient with pneumonia
D) Developing the plan of care for a newly admitted patient
Answer: B
Rationale: LPNs are trained to perform sterile dressing changes and can be delegated
this task if the patient is stable. Blood transfusions require RN assessment and
monitoring. Lung sound assessment and plan of care development are RN
responsibilities that require nursing judgment.
5 A nurse is leading a team in a code blue situation. Which action demonstrates
effective leadership?
,A) The nurse performs chest compressions while directing others verbally
B) The nurse assigns roles clearly and stands back to observe team performance
C) The nurse asks the team for suggestions before making each decision
D) The nurse takes over the most critical task and lets others decide their roles
Answer: B
Rationale: Effective leadership in a code involves clear role assignment and
situational awareness to oversee the team's performance. Performing a task while
directing can lead to divided attention. Seeking consensus during a code wastes
time. Taking over a task without delegating can cause confusion.
6 A nurse discovers that a colleague has been diverting opioid medications. What is
the nurse's first action?
A) Confront the colleague directly about the suspected diversion
B) Report the suspicion to the nurse manager or supervisor immediately
C) Ignore the behavior to avoid conflict with the colleague
D) Document the suspicion in the colleague's personnel file
Answer: B
Rationale: The nurse has a legal and ethical duty to report suspected diversion to a
supervisor to protect patients and ensure appropriate investigation. Confronting the
colleague may be unsafe and is not the proper channel. Ignoring it violates patient
safety. Documenting in personnel files is not within the nurse's scope.
7 A nurse is preparing to discharge a patient with a new diagnosis of heart failure.
Which action is most important to include in the discharge plan?
A) Providing a list of low-sodium foods
B) Scheduling a follow-up appointment with the primary care provider within 1
week
C) Teaching the patient to weigh themselves daily and report a gain of 2-3 pounds
in a day
D) Ensuring the patient has a prescription for a diuretic
Answer: C
Rationale: Daily weight monitoring is critical for early detection of fluid retention, a
key self-management skill for heart failure. While diet and follow-up are important,
weight monitoring directly impacts timely intervention. Prescriptions are
provider-ordered, not nurse-initiated.
, 8 A nurse is managing care for a patient who is post-operative day 1 following a
colectomy. The patient has a nasogastric (NG) tube to low intermittent suction.
Which finding requires immediate notification of the healthcare provider?
A) The NG tube output is 200 mL of greenish fluid over 8 hours
B) The patient reports abdominal cramping and has not passed flatus
C) The patient's heart rate is 110 bpm and blood pressure is 88/56 mm Hg
D) The patient's temperature is 37.8°C (100°F)
Answer: C
Rationale: Tachycardia and hypotension suggest hypovolemia or possible
hemorrhage, which require immediate evaluation. NG output of 200 mL is expected.
Abdominal cramping and lack of flatus are common postoperatively. Low-grade
fever can be normal post-op.
9 A nurse is evaluating the effectiveness of a quality improvement initiative aimed
at reducing catheter-associated urinary tract infections (CAUTIs). Which outcome
measure indicates success?
A) Decreased use of urinary catheters by 20%
B) Reduction in CAUTI rate from 4.5 to 2.1 per 1,000 catheter-days
C) Increased staff compliance with hand hygiene before catheter insertion
D) Increased documentation of catheter necessity in patient charts
Answer: B
Rationale: A reduction in the CAUTI rate per 1,000 catheter-days directly reflects
improved patient outcomes. Decreased catheter use and improved compliance are
process measures that may lead to outcome improvement but are not outcome
measures themselves. Documentation is a process indicator.
10 A nurse is caring for a patient who refuses a life-saving blood transfusion due to
religious beliefs. The patient is alert and oriented. What is the nurse's best
action?
A) Administer the blood transfusion because it is medically necessary
B) Respect the patient's decision and notify the healthcare provider
C) Ask the patient to sign a form refusing treatment and continue to encourage
transfusion
D) Contact the hospital ethics committee to override the patient's decision
Answer: B
Rationale: An alert, oriented adult has the right to refuse treatment based on religious
beliefs. The nurse must respect autonomy and inform the provider to explore
Questions
This exam assesses advanced knowledge in Management of Care, focusing on delegation, supervision,
prioritization, resource management, legal and ethical decision-making, interprofessional collaboration, and
quality improvement in complex healthcare settings. Questions are designed to evaluate clinical reasoning and
leadership competencies expected of senior nursing students and new graduate nurses. It contains 150
multiple-choice questions, each with four distractors and a fully worked rationale that explains why the keyed
answer is correct. Content is organized into 8 focused sections: Management of Care, Safety and Infection
Control, Health Promotion and Maintenance, Psychosocial Integrity, Basic Care and Comfort, Pharmacological
Therapies, Reduction of Risk Potential, Physiological Adaptation. Targeted learning outcomes include: Apply
principles of delegation and supervision to optimize patient outcomes and team performance.; Prioritize nursing
interventions for multiple patients using clinical judgment and evidence-based frameworks.; Analyze legal and
ethical dilemmas in care management and propose appropriate actions.; Utilize quality improvement and safety
principles to reduce errors and improve care delivery.. Every item has been reviewed for clinical accuracy,
current guidelines, and clarity so that students can study with confidence and self-correct as they work through
the bank. Use it as a high-yield review immediately before the exam, or as a structured practice tool during the
unit - the rationales double as concise teaching notes. The recommended writing time is 3 hours, with a passing
Section 1: Management of Care (Questions 1-19)
1 A charge nurse on a medical-surgical unit is making assignments for the next
shift. Which patient should be assigned to the most experienced registered nurse
(RN)?
A) A patient with a new tracheostomy requiring frequent suctioning and
monitoring for bleeding
B) A patient with a hip fracture who is awaiting transfer to a rehabilitation facility
C) A patient with a urinary tract infection receiving IV antibiotics every 8 hours
D) A patient with type 2 diabetes mellitus requiring insulin dose adjustment based
on sliding scale
Answer: A
Rationale: The patient with a new tracheostomy has an unstable airway and requires
high-level assessment and intervention skills. Assigning this patient to the most
experienced RN ensures safe care. The other patients are more stable and can be
managed by less experienced staff.
2 A nurse manager is reviewing incident reports and notices a trend of medication
errors occurring during shift change. Which quality improvement intervention is
most effective to address this?
A) Reprimanding nurses involved in errors to discourage future mistakes
B) Implementing a standardized handoff communication tool (e.g., SBAR) for
medication reconciliation
,C) Increasing the number of nurses on each shift to reduce workload
D) Requiring all medications to be administered only by nurses with more than 5
years of experience
Answer: B
Rationale: Standardized handoff tools like SBAR improve communication
consistency and reduce errors during transitions of care. Reprimanding individuals
does not address system issues. Increasing staff may help but does not directly target
the handoff process. Restricting administration to experienced nurses is not feasible
and ignores root causes.
3 A nurse is caring for four patients. After receiving shift report, which patient
should the nurse assess first?
A) A patient with a history of heart failure who has crackles in the lung bases and
an oxygen saturation of 92% on room air
B) A patient with a new colostomy who is asking questions about stoma care
C) A patient with a fractured femur in skeletal traction who reports pain of 4/10
D) A patient with a urinary catheter who has not urinated in 6 hours and has a
bladder scanner reading of 150 mL
Answer: A
Rationale: The patient with crackles and low oxygen saturation is showing signs of
acute decompensation (possible pulmonary edema) and requires immediate
assessment and intervention. The other patients have stable or non-urgent concerns
that can be addressed later.
4 A nurse is delegating tasks to a licensed practical nurse (LPN) and a nursing
assistant (NA). Which task is appropriate to delegate to the LPN?
A) Administering a blood transfusion to a stable patient
B) Performing a sterile dressing change on a surgical wound with a drain
C) Assessing the lung sounds of a patient with pneumonia
D) Developing the plan of care for a newly admitted patient
Answer: B
Rationale: LPNs are trained to perform sterile dressing changes and can be delegated
this task if the patient is stable. Blood transfusions require RN assessment and
monitoring. Lung sound assessment and plan of care development are RN
responsibilities that require nursing judgment.
5 A nurse is leading a team in a code blue situation. Which action demonstrates
effective leadership?
,A) The nurse performs chest compressions while directing others verbally
B) The nurse assigns roles clearly and stands back to observe team performance
C) The nurse asks the team for suggestions before making each decision
D) The nurse takes over the most critical task and lets others decide their roles
Answer: B
Rationale: Effective leadership in a code involves clear role assignment and
situational awareness to oversee the team's performance. Performing a task while
directing can lead to divided attention. Seeking consensus during a code wastes
time. Taking over a task without delegating can cause confusion.
6 A nurse discovers that a colleague has been diverting opioid medications. What is
the nurse's first action?
A) Confront the colleague directly about the suspected diversion
B) Report the suspicion to the nurse manager or supervisor immediately
C) Ignore the behavior to avoid conflict with the colleague
D) Document the suspicion in the colleague's personnel file
Answer: B
Rationale: The nurse has a legal and ethical duty to report suspected diversion to a
supervisor to protect patients and ensure appropriate investigation. Confronting the
colleague may be unsafe and is not the proper channel. Ignoring it violates patient
safety. Documenting in personnel files is not within the nurse's scope.
7 A nurse is preparing to discharge a patient with a new diagnosis of heart failure.
Which action is most important to include in the discharge plan?
A) Providing a list of low-sodium foods
B) Scheduling a follow-up appointment with the primary care provider within 1
week
C) Teaching the patient to weigh themselves daily and report a gain of 2-3 pounds
in a day
D) Ensuring the patient has a prescription for a diuretic
Answer: C
Rationale: Daily weight monitoring is critical for early detection of fluid retention, a
key self-management skill for heart failure. While diet and follow-up are important,
weight monitoring directly impacts timely intervention. Prescriptions are
provider-ordered, not nurse-initiated.
, 8 A nurse is managing care for a patient who is post-operative day 1 following a
colectomy. The patient has a nasogastric (NG) tube to low intermittent suction.
Which finding requires immediate notification of the healthcare provider?
A) The NG tube output is 200 mL of greenish fluid over 8 hours
B) The patient reports abdominal cramping and has not passed flatus
C) The patient's heart rate is 110 bpm and blood pressure is 88/56 mm Hg
D) The patient's temperature is 37.8°C (100°F)
Answer: C
Rationale: Tachycardia and hypotension suggest hypovolemia or possible
hemorrhage, which require immediate evaluation. NG output of 200 mL is expected.
Abdominal cramping and lack of flatus are common postoperatively. Low-grade
fever can be normal post-op.
9 A nurse is evaluating the effectiveness of a quality improvement initiative aimed
at reducing catheter-associated urinary tract infections (CAUTIs). Which outcome
measure indicates success?
A) Decreased use of urinary catheters by 20%
B) Reduction in CAUTI rate from 4.5 to 2.1 per 1,000 catheter-days
C) Increased staff compliance with hand hygiene before catheter insertion
D) Increased documentation of catheter necessity in patient charts
Answer: B
Rationale: A reduction in the CAUTI rate per 1,000 catheter-days directly reflects
improved patient outcomes. Decreased catheter use and improved compliance are
process measures that may lead to outcome improvement but are not outcome
measures themselves. Documentation is a process indicator.
10 A nurse is caring for a patient who refuses a life-saving blood transfusion due to
religious beliefs. The patient is alert and oriented. What is the nurse's best
action?
A) Administer the blood transfusion because it is medically necessary
B) Respect the patient's decision and notify the healthcare provider
C) Ask the patient to sign a form refusing treatment and continue to encourage
transfusion
D) Contact the hospital ethics committee to override the patient's decision
Answer: B
Rationale: An alert, oriented adult has the right to refuse treatment based on religious
beliefs. The nurse must respect autonomy and inform the provider to explore
