Arkansas NHA State Exam - a Review of Questions and Correct
Answers/ Arkansas NHA Exam Prep Test Bank (Newest!) - 149
Questions
Section 1: Patient Care and Safety (Questions 1-15)
1 A patient with a history of recurrent Clostridioides difficile infection is admitted with diarrhea. The nurse
implements contact precautions. Which additional measure is MOST critical to prevent transmission to other
patients?
A) Use of alcohol-based hand rub after glove removal
B) Dedicating equipment such as stethoscopes to the patient
C) Placing the patient in a negative pressure room
D) Requiring visitors to wear N95 masks
Answer: B
Rationale: C. difficile spores are resistant to alcohol-based hand rubs; hand washing with soap and water is
recommended. Dedicating non-critical equipment minimizes fomite transmission. Negative pressure is for airborne
pathogens, and N95 masks are not indicated for contact precautions.
2 A healthcare organization is implementing a Just Culture model to address a medication error where a nurse
administered a high-alert drug via the wrong route. Which outcome is MOST consistent with this model?
A) Termination of the nurse for violating policy
B) Retraining the nurse without punitive action if the error was unintentional
C) Disciplinary action based on the severity of patient harm
D) Reporting the nurse to the state board of nursing
Answer: B
Rationale: Just Culture differentiates between human error, at-risk behavior, and reckless behavior. Unintentional
errors warrant system improvements and retraining, not punishment. Disciplinary action is reserved for reckless
behavior. Severity of harm alone does not determine culpability.
3 During a root cause analysis of a wrong-site surgery, the team identifies that the preoperative checklist was
completed but the surgeon did not pause for a time-out. Which of the following is the MOST effective
system-level intervention?
A) Requiring the surgeon to sign the surgical site with a marker
B) Implementing a mandatory independent double-check of the consent form
C) Redesigning the checklist to include a forced pause before incision
D) Providing additional training on the importance of time-outs
Answer: C
Rationale: System-level interventions that force behavior (e.g., electronic prompts, mandatory pauses) are more
effective than training or voluntary compliance. Signing the site is already standard; the issue is the lack of a pause.
Redesigning the checklist to require a pause addresses the latent failure.
4 A patient is receiving a continuous heparin infusion. The nurse notes the aPTT is 120 seconds (therapeutic range
60-80 seconds). The infusion is running at 14 mL/hr. The pharmacy supplies heparin 25,000 units in 500 mL
D5W. How many units of heparin is the patient receiving per hour? (Round to the nearest whole unit.)
A) 500 units/hr
,B) 600 units/hr
C) 700 units/hr
D) 800 units/hr
Answer: C
Rationale: Concentration: 25,000 units / 500 mL = 50 units/mL. Rate: 14 mL/hr × 50 units/mL = 700 units/hr. The
aPTT is supratherapeutic, but the question asks for the current dose, not an adjustment.
5 A patient develops sudden dyspnea, chest pain, and hypotension after central line insertion. The nurse suspects
an air embolism. Which immediate action is MOST appropriate?
A) Place the patient in Trendelenburg position on the left side
B) Administer 100% oxygen via non-rebreather mask
C) Clamp the central line and aspirate from the catheter
D) Lower the head of the bed and call for a chest X-ray
Answer: A
Rationale: Trendelenburg with left lateral positioning (Durant maneuver) traps air in the right ventricle, preventing
outflow obstruction. Oxygen is secondary. Clamping may be done but aspiration is unlikely to remove large air
volumes. Chest X-ray is not immediate.
6 A nurse is caring for a patient with a nasogastric tube set to low intermittent suction. The nurse notes that the
drainage is green and the pH is 3. What is the MOST appropriate interpretation?
A) The tube is in the stomach; continue current management
B) The tube has migrated into the duodenum; notify the provider
C) The tube is in the respiratory tract; remove immediately
D) The drainage indicates a gastrointestinal bleed; test for occult blood
Answer: A
Rationale: Green aspirate with pH "d 5 indicates gastric placement. Duodenal aspirate is typically bile-stained
(yellow-green) with pH > 6. Respiratory aspirate is clear and pH > 7. No signs of bleeding. Confirmation of
placement is essential before use.
7 A patient on a medical-surgical unit has a Morse Fall Scale score of 55. Which intervention is MOST important
to include in the plan of care?
A) Place the patient in a room near the nurses' station
B) Apply a bed exit alarm and keep the bed in low position
C) Assist the patient to the bathroom every 2 hours
D) Use a gait belt when ambulating the patient
Answer: B
Rationale: A Morse score "e 45 indicates high fall risk. Bed exit alarms and low bed position are evidence-based
interventions for high-risk patients. While all options are helpful, the alarm and low bed are most critical for
preventing unassisted falls. Room proximity is less effective.
8 A nurse is preparing to administer a blood transfusion. The patient's vital signs are stable, and the IV site is
patent. After starting the transfusion, the patient develops urticaria and itching. What is the nurse's priority
action?
A) Stop the transfusion immediately and maintain IV access
B) Slow the transfusion rate and administer diphenhydramine
C) Flush the IV line with normal saline and continue at a slower rate
D) Stop the transfusion and remove the IV catheter
,Answer: A
Rationale: Urticaria and itching indicate an allergic transfusion reaction (mild). The priority is to stop the
transfusion to prevent progression, but maintain IV access for potential medications. Slowing the rate is
inappropriate; the transfusion must be stopped. Removing the IV would lose access.
9 A patient is receiving vancomycin 1 g IV every 12 hours. The nurse obtains a trough level 30 minutes before the
third dose. The result is 25 mcg/mL (therapeutic range 10-20 mcg/mL). Which action is MOST appropriate?
A) Administer the dose as scheduled and monitor for nephrotoxicity
B) Hold the dose and notify the provider of the elevated trough
C) Increase the infusion rate to reduce peak concentration
D) Obtain a peak level 1 hour after infusion before administering
Answer: B
Rationale: A trough > 20 mcg/mL increases risk of nephrotoxicity and ototoxicity. The dose should be held and the
provider notified for dose adjustment. Administering as scheduled is unsafe. Peak levels are not routinely
monitored for vancomycin.
10 A nurse is reviewing a patient's medication administration record and notes that a dose of furosemide was given
at 0800. The patient's potassium level at 0600 was 3.2 mEq/L. Which is the MOST appropriate nursing action?
A) Administer potassium chloride 20 mEq oral as a one-time dose
B) Notify the provider of the low potassium and hold the next furosemide dose
C) Document the potassium level and continue monitoring
D) Encourage the patient to eat potassium-rich foods
Answer: B
Rationale: A potassium of 3.2 mEq/L is moderate hypokalemia. Furosemide causes potassium loss. The provider
should be notified to consider potassium replacement and hold or adjust the diuretic. Administering potassium
without an order is unsafe. Dietary changes are insufficient for acute management.
11 A patient on a mechanical ventilator in the ICU has a sudden drop in oxygen saturation from 95% to 82% and
an increase in peak airway pressure from 25 cmH2O to 45 cmH2O. The nurse immediately performs a quick
assessment. Which of the following is the most likely cause of this acute change?
A) Pulmonary embolism
B) Disconnection of the ventilator circuit
C) Secretions obstructing the endotracheal tube
D) Pneumothorax
Answer: C
Rationale: Secretions obstructing the endotracheal tube cause increased airway resistance, leading to elevated peak
inspiratory pressure and hypoxemia. Disconnection would cause loss of pressure, not increase. Pneumothorax and
pulmonary embolism may cause hypoxemia but not typically the sudden increase in peak pressure.
12 A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute respiratory
failure. The provider orders oxygen therapy at 2 L/min via nasal cannula. Which of the following physiological
mechanisms best explains why high-flow oxygen is contraindicated in this patient?
A) High-flow oxygen increases the risk of oxygen toxicity in COPD patients
B) High-flow oxygen suppresses the hypoxic drive, leading to hypoventilation and carbon dioxide retention
C) High-flow oxygen causes bronchospasm due to drying of the airways
D) High-flow oxygen promotes absorption atelectasis, worsening ventilation-perfusion mismatch
Answer: B
, Rationale: In COPD patients with chronic hypercapnia, the primary respiratory drive is hypoxemia. High-flow
oxygen can blunt this drive, resulting in hypoventilation and worsening hypercapnia. While oxygen toxicity and
absorption atelectasis are concerns, the hypoxic drive mechanism is the most critical acute contraindication.
13 A patient is receiving a continuous infusion of heparin for the treatment of deep vein thrombosis. The nurse
notes that the patient's activated partial thromboplastin time (aPTT) is 95 seconds (therapeutic range: 60-80
seconds). Which of the following actions should the nurse take first?
A) Stop the heparin infusion immediately
B) Administer protamine sulfate as per protocol
C) Hold the heparin infusion and notify the provider
D) Decrease the heparin infusion rate by 50%
Answer: C
Rationale: An aPTT above therapeutic range increases bleeding risk. The appropriate first action is to hold the
infusion and notify the provider for dose adjustment. Stopping abruptly without notification may lead to loss of
therapeutic effect. Protamine is reserved for reversal of severe bleeding, not for asymptomatic supratherapeutic
aPTT.
14 A patient with a history of heart failure is admitted with acute pulmonary edema. The nurse administers
furosemide 40 mg intravenously. One hour later, the patient's urine output is 50 mL. Which of the following
assessments is most important for the nurse to evaluate to determine the effectiveness of the furosemide?
A) Serum potassium level
B) Blood pressure and heart rate
C) Respiratory rate and oxygen saturation
D) Daily weight
Answer: C
Rationale: The primary goal of furosemide in acute pulmonary edema is to reduce preload and improve
oxygenation. While urine output indicates diuresis, the most direct measure of effectiveness is improvement in
respiratory status (decreased respiratory rate, increased oxygen saturation). Electrolytes and daily weight are
important but not immediate indicators of response.
15 A patient is prescribed an indwelling urinary catheter for strict intake and output monitoring. Which of the
following actions by the nurse demonstrates the correct technique to prevent catheter-associated urinary tract
infection (CAUTI)?
A) Use sterile technique for insertion and maintain a closed drainage system
B) Irrigate the catheter daily with normal saline to prevent obstruction
C) Replace the catheter every 48 hours to reduce biofilm formation
D) Hang the drainage bag at the level of the bladder to prevent reflux
Answer: A
Rationale: Sterile technique during insertion and maintaining a closed drainage system are key evidence-based
practices to prevent CAUTI. Routine irrigation is not recommended and may introduce infection. Catheters are not
replaced at fixed intervals unless clinically indicated. The drainage bag should be kept below the level of the
bladder to prevent backflow.
Section 2: Infection Control (Questions 16-30)
Answers/ Arkansas NHA Exam Prep Test Bank (Newest!) - 149
Questions
Section 1: Patient Care and Safety (Questions 1-15)
1 A patient with a history of recurrent Clostridioides difficile infection is admitted with diarrhea. The nurse
implements contact precautions. Which additional measure is MOST critical to prevent transmission to other
patients?
A) Use of alcohol-based hand rub after glove removal
B) Dedicating equipment such as stethoscopes to the patient
C) Placing the patient in a negative pressure room
D) Requiring visitors to wear N95 masks
Answer: B
Rationale: C. difficile spores are resistant to alcohol-based hand rubs; hand washing with soap and water is
recommended. Dedicating non-critical equipment minimizes fomite transmission. Negative pressure is for airborne
pathogens, and N95 masks are not indicated for contact precautions.
2 A healthcare organization is implementing a Just Culture model to address a medication error where a nurse
administered a high-alert drug via the wrong route. Which outcome is MOST consistent with this model?
A) Termination of the nurse for violating policy
B) Retraining the nurse without punitive action if the error was unintentional
C) Disciplinary action based on the severity of patient harm
D) Reporting the nurse to the state board of nursing
Answer: B
Rationale: Just Culture differentiates between human error, at-risk behavior, and reckless behavior. Unintentional
errors warrant system improvements and retraining, not punishment. Disciplinary action is reserved for reckless
behavior. Severity of harm alone does not determine culpability.
3 During a root cause analysis of a wrong-site surgery, the team identifies that the preoperative checklist was
completed but the surgeon did not pause for a time-out. Which of the following is the MOST effective
system-level intervention?
A) Requiring the surgeon to sign the surgical site with a marker
B) Implementing a mandatory independent double-check of the consent form
C) Redesigning the checklist to include a forced pause before incision
D) Providing additional training on the importance of time-outs
Answer: C
Rationale: System-level interventions that force behavior (e.g., electronic prompts, mandatory pauses) are more
effective than training or voluntary compliance. Signing the site is already standard; the issue is the lack of a pause.
Redesigning the checklist to require a pause addresses the latent failure.
4 A patient is receiving a continuous heparin infusion. The nurse notes the aPTT is 120 seconds (therapeutic range
60-80 seconds). The infusion is running at 14 mL/hr. The pharmacy supplies heparin 25,000 units in 500 mL
D5W. How many units of heparin is the patient receiving per hour? (Round to the nearest whole unit.)
A) 500 units/hr
,B) 600 units/hr
C) 700 units/hr
D) 800 units/hr
Answer: C
Rationale: Concentration: 25,000 units / 500 mL = 50 units/mL. Rate: 14 mL/hr × 50 units/mL = 700 units/hr. The
aPTT is supratherapeutic, but the question asks for the current dose, not an adjustment.
5 A patient develops sudden dyspnea, chest pain, and hypotension after central line insertion. The nurse suspects
an air embolism. Which immediate action is MOST appropriate?
A) Place the patient in Trendelenburg position on the left side
B) Administer 100% oxygen via non-rebreather mask
C) Clamp the central line and aspirate from the catheter
D) Lower the head of the bed and call for a chest X-ray
Answer: A
Rationale: Trendelenburg with left lateral positioning (Durant maneuver) traps air in the right ventricle, preventing
outflow obstruction. Oxygen is secondary. Clamping may be done but aspiration is unlikely to remove large air
volumes. Chest X-ray is not immediate.
6 A nurse is caring for a patient with a nasogastric tube set to low intermittent suction. The nurse notes that the
drainage is green and the pH is 3. What is the MOST appropriate interpretation?
A) The tube is in the stomach; continue current management
B) The tube has migrated into the duodenum; notify the provider
C) The tube is in the respiratory tract; remove immediately
D) The drainage indicates a gastrointestinal bleed; test for occult blood
Answer: A
Rationale: Green aspirate with pH "d 5 indicates gastric placement. Duodenal aspirate is typically bile-stained
(yellow-green) with pH > 6. Respiratory aspirate is clear and pH > 7. No signs of bleeding. Confirmation of
placement is essential before use.
7 A patient on a medical-surgical unit has a Morse Fall Scale score of 55. Which intervention is MOST important
to include in the plan of care?
A) Place the patient in a room near the nurses' station
B) Apply a bed exit alarm and keep the bed in low position
C) Assist the patient to the bathroom every 2 hours
D) Use a gait belt when ambulating the patient
Answer: B
Rationale: A Morse score "e 45 indicates high fall risk. Bed exit alarms and low bed position are evidence-based
interventions for high-risk patients. While all options are helpful, the alarm and low bed are most critical for
preventing unassisted falls. Room proximity is less effective.
8 A nurse is preparing to administer a blood transfusion. The patient's vital signs are stable, and the IV site is
patent. After starting the transfusion, the patient develops urticaria and itching. What is the nurse's priority
action?
A) Stop the transfusion immediately and maintain IV access
B) Slow the transfusion rate and administer diphenhydramine
C) Flush the IV line with normal saline and continue at a slower rate
D) Stop the transfusion and remove the IV catheter
,Answer: A
Rationale: Urticaria and itching indicate an allergic transfusion reaction (mild). The priority is to stop the
transfusion to prevent progression, but maintain IV access for potential medications. Slowing the rate is
inappropriate; the transfusion must be stopped. Removing the IV would lose access.
9 A patient is receiving vancomycin 1 g IV every 12 hours. The nurse obtains a trough level 30 minutes before the
third dose. The result is 25 mcg/mL (therapeutic range 10-20 mcg/mL). Which action is MOST appropriate?
A) Administer the dose as scheduled and monitor for nephrotoxicity
B) Hold the dose and notify the provider of the elevated trough
C) Increase the infusion rate to reduce peak concentration
D) Obtain a peak level 1 hour after infusion before administering
Answer: B
Rationale: A trough > 20 mcg/mL increases risk of nephrotoxicity and ototoxicity. The dose should be held and the
provider notified for dose adjustment. Administering as scheduled is unsafe. Peak levels are not routinely
monitored for vancomycin.
10 A nurse is reviewing a patient's medication administration record and notes that a dose of furosemide was given
at 0800. The patient's potassium level at 0600 was 3.2 mEq/L. Which is the MOST appropriate nursing action?
A) Administer potassium chloride 20 mEq oral as a one-time dose
B) Notify the provider of the low potassium and hold the next furosemide dose
C) Document the potassium level and continue monitoring
D) Encourage the patient to eat potassium-rich foods
Answer: B
Rationale: A potassium of 3.2 mEq/L is moderate hypokalemia. Furosemide causes potassium loss. The provider
should be notified to consider potassium replacement and hold or adjust the diuretic. Administering potassium
without an order is unsafe. Dietary changes are insufficient for acute management.
11 A patient on a mechanical ventilator in the ICU has a sudden drop in oxygen saturation from 95% to 82% and
an increase in peak airway pressure from 25 cmH2O to 45 cmH2O. The nurse immediately performs a quick
assessment. Which of the following is the most likely cause of this acute change?
A) Pulmonary embolism
B) Disconnection of the ventilator circuit
C) Secretions obstructing the endotracheal tube
D) Pneumothorax
Answer: C
Rationale: Secretions obstructing the endotracheal tube cause increased airway resistance, leading to elevated peak
inspiratory pressure and hypoxemia. Disconnection would cause loss of pressure, not increase. Pneumothorax and
pulmonary embolism may cause hypoxemia but not typically the sudden increase in peak pressure.
12 A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute respiratory
failure. The provider orders oxygen therapy at 2 L/min via nasal cannula. Which of the following physiological
mechanisms best explains why high-flow oxygen is contraindicated in this patient?
A) High-flow oxygen increases the risk of oxygen toxicity in COPD patients
B) High-flow oxygen suppresses the hypoxic drive, leading to hypoventilation and carbon dioxide retention
C) High-flow oxygen causes bronchospasm due to drying of the airways
D) High-flow oxygen promotes absorption atelectasis, worsening ventilation-perfusion mismatch
Answer: B
, Rationale: In COPD patients with chronic hypercapnia, the primary respiratory drive is hypoxemia. High-flow
oxygen can blunt this drive, resulting in hypoventilation and worsening hypercapnia. While oxygen toxicity and
absorption atelectasis are concerns, the hypoxic drive mechanism is the most critical acute contraindication.
13 A patient is receiving a continuous infusion of heparin for the treatment of deep vein thrombosis. The nurse
notes that the patient's activated partial thromboplastin time (aPTT) is 95 seconds (therapeutic range: 60-80
seconds). Which of the following actions should the nurse take first?
A) Stop the heparin infusion immediately
B) Administer protamine sulfate as per protocol
C) Hold the heparin infusion and notify the provider
D) Decrease the heparin infusion rate by 50%
Answer: C
Rationale: An aPTT above therapeutic range increases bleeding risk. The appropriate first action is to hold the
infusion and notify the provider for dose adjustment. Stopping abruptly without notification may lead to loss of
therapeutic effect. Protamine is reserved for reversal of severe bleeding, not for asymptomatic supratherapeutic
aPTT.
14 A patient with a history of heart failure is admitted with acute pulmonary edema. The nurse administers
furosemide 40 mg intravenously. One hour later, the patient's urine output is 50 mL. Which of the following
assessments is most important for the nurse to evaluate to determine the effectiveness of the furosemide?
A) Serum potassium level
B) Blood pressure and heart rate
C) Respiratory rate and oxygen saturation
D) Daily weight
Answer: C
Rationale: The primary goal of furosemide in acute pulmonary edema is to reduce preload and improve
oxygenation. While urine output indicates diuresis, the most direct measure of effectiveness is improvement in
respiratory status (decreased respiratory rate, increased oxygen saturation). Electrolytes and daily weight are
important but not immediate indicators of response.
15 A patient is prescribed an indwelling urinary catheter for strict intake and output monitoring. Which of the
following actions by the nurse demonstrates the correct technique to prevent catheter-associated urinary tract
infection (CAUTI)?
A) Use sterile technique for insertion and maintain a closed drainage system
B) Irrigate the catheter daily with normal saline to prevent obstruction
C) Replace the catheter every 48 hours to reduce biofilm formation
D) Hang the drainage bag at the level of the bladder to prevent reflux
Answer: A
Rationale: Sterile technique during insertion and maintaining a closed drainage system are key evidence-based
practices to prevent CAUTI. Routine irrigation is not recommended and may introduce infection. Catheters are not
replaced at fixed intervals unless clinically indicated. The drainage bag should be kept below the level of the
bladder to prevent backflow.
Section 2: Infection Control (Questions 16-30)
