Role of the nurse
A nurse is practicing within their scope of practice. Which action best reflects this?
A. Performing an assessment and developing a nursing diagnosis
B. Prescribing medication for pain
C. Changing the patient’s treatment plan without consulting the provider
D. Interpreting diagnostic imaging results independently
A Rationale: Assessment and nursing diagnosis are within the RN scope.
A nurse collects objective data. Which finding qualifies as objective?
A. “I feel dizzy.”
B. Nausea reported by the patient
C. Respiratory rate of 28/min
D. “My pain is a 7.”
C Rationale: Objective data are measurable.
Which entry follows effective documentation guidelines?
A. “Patient seems fine today.”
B. “Patient states, ‘My chest hurts.’ HR 112, RR 28.”
C. “Patient probably has anxiety.”
D. “Patient is doing better.”
B Rationale: Documentation must be factual and objective.
A nurse uses therapeutic communication. Which response is appropriate?
A. “You shouldn’t feel that way
B. “Tell me more about what worries you.”
C. “Let’s talk later; I’m busy.”
D. “Why did you do that?”
B Rationale: Encourages exploration.
Teaching a patient to self‑administer insulin addresses which learning domain?
A. Cognitive
B. Affective
C. Psychomotor
D. Emotional
Answer: C Rationale: Psychomotor involves physical skills.
Which behavior best reflects professional identity in nursing?
A. Completing tasks quickly to avoid delays
B. Advocating for a patient’s safety despite resistance
C. Delegating all communication to the charge nurse
D. Avoiding collaboration to maintain independence
B Rationale: Advocacy, integrity, and accountability are core components of professional identity.
Which nursing diagnosis is correctly written?
A. Pain related to surgery
B. Risk for falls related to impaired mobility
C. Impaired skin integrity
D. Anxiety
B Rationale: Proper diagnosis includes problem + related factor
Which charting method organizes information by patient problems?
A. Narrative
B. PIE
C. SOAP
D. POMR
D Rationale: POMR structures documentation around problems.
Which is a barrier to communication?
A. Active listening
B. Open‑ended questions
C. False reassurance
D. Eye contact
Answer: C Rationale: False reassurance blocks expression.
Which action best evaluates patient learning?
A. Asking, “Do you understand?”
B. Having the patient demonstrate the skill
C. Providing written instructions
D. Asking the family to explain
Answer: B Rationale: Return demonstration is strongest.
A nurse uses Tanner’s Clinical Judgment Model. Which action reflects the “Noticing” phase?
A. Evaluating whether the intervention was effective
B. Recognizing a subtle change in breathing
C. Prioritizing interventions based on goals
D. Reflecting on the outcome after discharge
B Rationale: “Noticing” involves identifying cues.
B Rationale: Proper diagnosis includes problem + related factor.
Question 3
Which goal is written using the SMART format?
A. “The patient will walk more.”
B. “The patient will ambulate 50 feet with a walker by noon today.”
C. “The patient will improve mobility soon.”
D. “The patient will feel better after therapy.”
B Rationale: Specific, measurable, time‑bound
Which action demonstrates proper computerized charting?
A. Sharing login credentials
B. Documenting care immediately
C. Printing records for personal study
D. Leaving workstation unlocked
Answer: B Rationale: Timely documentation improves accuracy.
Standing 2 feet from a patient reflects which proxemic zone?
A. Intimate
B. Personal
C. Social
D. Public
Answer: B Rationale: Personal space is 18 inches to 4 feet.
A culturally competent nurse caring for a patient with limited English proficiency should:
A. Use a trained medical interpreter
B. Ask family to translate
C. Speak loudly and slowly
D. Avoid teaching until discharge
Answer: A Rationale: Professional interpreters ensure accuracy.
Which QSEN competency is demonstrated when a nurse seeks out the latest evidence before implementing a new wound‑care technique?
A. Informatics
B. Safety
C. Evidence‑based practice
D. Quality improvement
C Rationale: Evidence‑based practice integrates current research.
Which intervention is independent?
A. Administering prescribed antibiotics
B. Inserting a Foley catheter
C. Teaching deep breathing exercises
D. Changing the IV rate
C Rationale: Independent interventions require no provider order
Which statement reflects the purpose of documentation?
A. “To protect the nurse legally.”
B. “To provide a permanent record of care.”
C. “To reduce communication needs.”
D. “To replace verbal handoff reports.”
Answer: B Rationale: Documentation ensures continuity.
During which phase is trust established?
A. Orientation
B. Working
C. Termination
D. Pre‑interaction
Answer: A Rationale: Orientation builds trust.
Which barrier most affects access to care?
A. Lack of transportation
B. Patient motivation
C. Nurse workload
D. Family involvement
Answer: A Rationale: Transportation is a major determinant.
Which blended competency is demonstrated when a nurse uses therapeutic communication to calm an anxious patient?
A. Technical
B. Cognitive
C. Ethical/legal
D. Interpersonal
D Rationale: Interpersonal competency involves communication and empathy.
A nurse evaluates a goal and determines it was partially met. What is the next step?
A. Discontinue the plan
B. Revise interventions or timeline
C. Document the failure
D. Repeat the same interventions
B Rationale: Evaluation leads to modification.
Which entry should be corrected immediately?
A. “Patient refused medication.”
B. “Medication given at 0900.”
C. “Error: wrong dose given.”
D. “Patient ambulated 20 feet.”
Answer: C Rationale: Errors must be corrected per policy.
Which technique is most effective when a patient is crying?
A. Changing the subject
B. Offering tissues and sitting quietly
C. Asking multiple questions
D. Providing advice immediately
Answer: B Rationale: Presence promotes emotional expression.
Which action demonstrates effective interprofessional collaboration?
A. Nurse independently changes care plan
B. Nurse consults PT for mobility recommendations
C. Nurse avoids contacting other disciplines
D. Nurse delegates assessment to UAP
Answer: B Rationale: Collaboration involves coordinating with other professionals.