Tennessee RN: Safe and Effective Care Environment Practice Test

The interactive test above draws from this bank in random order. Every question also has its own page with the full explanation.

1. A nurse is caring for four clients. Which client should the nurse assess first?

   • A client who is 1 hour postoperative and reports increasing surgical-site pain rated 6/10
   • A client requesting pain medication for chronic back pain
   • A client receiving routine IV antibiotics
   • A client with new-onset shortness of breath and oxygen saturation of 88% ✓

   Priority assessment follows the ABCs (Airway, Breathing, Circulation) and Maslow's hierarchy of needs. Physiological needs come first, and within physiological needs, airway and breathing concerns take priority. The client with new-onset shortness of breath and O2 saturation of 88% has an acute resp… Full explanation →

2. Which action by a nurse demonstrates appropriate use of the chain of command?

   • Discussing the concern in a public area
   • Calling the physician directly with a non-urgent question without notifying the charge nurse
   • Refusing to speak to the physician at any time
   • Reporting a concern about a physician's order first to the charge nurse, then escalating to the nurse manager and through the medical chain if the concern is not addressed ✓

   The chain of command is the hierarchical structure used to escalate clinical concerns when standard channels do not resolve them. Proper sequence: bring the concern to the immediate supervisor first (charge nurse), then to the nurse manager, then to higher administrative or medical authorities (nurs… Full explanation →

3. The RN is delegating tasks to a UAP (Unlicensed Assistive Personnel). Which task is appropriate to delegate?

   • Teaching a client about a new medication
   • Initial assessment of a newly admitted client
   • Taking routine vital signs on a stable postoperative client ✓
   • Evaluating the effectiveness of pain medication

   Delegation to UAPs (CNAs, patient care techs) follows the 'Five Rights of Delegation' from the NCSBN: right task, right circumstances, right person, right direction/communication, right supervision. UAPs can perform routine, repetitive tasks for stable clients — bathing, feeding, ambulating, vital s… Full explanation →

4. An RN is supervising an LPN (Licensed Practical Nurse). Which task can the LPN perform?

   • Perform the initial admission assessment
   • Administer IV push medications to a critically ill client
   • Administer oral medications and reinforce client teaching ✓
   • Develop the nursing care plan for a newly admitted client

   LPN scope of practice varies by state but generally includes: administering oral, IM, and subcutaneous medications; reinforcing teaching done by the RN (not initial teaching); performing routine dressing changes; collecting data (but not initial comprehensive assessment in most states); providing ba… Full explanation →

5. A client with a terminal illness has signed a 'Do Not Resuscitate' (DNR) order. What does this order mean?

   • The client refuses cardiopulmonary resuscitation (CPR) and related interventions in the event of cardiac or respiratory arrest — other treatments continue as ordered ✓
   • The order only applies after the client's death
   • The client refuses all medical treatment
   • The client's care will be withdrawn entirely

   A DNR order specifically directs that CPR (chest compressions, defibrillation, intubation, advanced cardiac medications) will not be performed if the client experiences cardiac or respiratory arrest. The order does NOT mean: no treatment at all (the client continues to receive all other ordered trea… Full explanation →

6. What is a 'durable power of attorney for healthcare'?

   • Hospital admission paperwork
   • Authority over the client's finances
   • A legal document authorizing a designated person (healthcare proxy) to make healthcare decisions for the client if the client becomes unable to do so ✓
   • A document that takes effect only after death

   A durable power of attorney for healthcare (also called a healthcare proxy or healthcare surrogate) is a legal document in which a competent adult designates another person to make healthcare decisions if the client becomes incapacitated and unable to make decisions themselves. The 'durable' aspect … Full explanation →

7. What is the most important infection-control measure?

   • Wearing gloves at all times
   • Wearing N95 respirators routinely
   • Hand hygiene (washing with soap and water or using alcohol-based hand rub) — performed before and after every patient contact ✓
   • Isolation of all clients

   Hand hygiene is the single most important intervention to prevent healthcare-associated infections (HAIs). CDC guidelines specify when to perform hand hygiene: before patient contact, before aseptic procedures, after body fluid exposure risk, after patient contact, and after contact with patient sur… Full explanation →

8. A client with active tuberculosis (TB) is admitted. What type of isolation precautions are required?

   • Contact precautions
   • Airborne precautions: private negative-pressure room, N95 respirator for caregivers, mask for client during transport ✓
   • Standard precautions only
   • Droplet precautions

   Airborne precautions are required for diseases transmitted by small droplet nuclei (under 5 microns) that remain suspended in the air for extended periods. Examples: tuberculosis (TB), measles, varicella (chickenpox), disseminated zoster. Requirements: (1) Private negative-pressure room (Airborne In… Full explanation →

9. What are the 'rights' of safe medication administration?

   • Just verify the medication name
   • Right physician and right diagnosis
   • Right pharmacy and right insurance
   • Right patient, right medication, right dose, right route, right time, right documentation — with some sources adding right reason, right response, right to refuse ✓

   The traditional 'Five Rights' of medication administration are right patient, right medication, right dose, right route, right time. Modern practice has added: right documentation (chart immediately after administration, not before), right reason (the medication should be appropriate for the indicat… Full explanation →

10. A nurse notices an error in a previously documented medication administration. What is the appropriate action?

    • Tear out the page
    • Leave the error and add a contradicting note elsewhere
    • Draw a single line through the error, write 'error' or 'mistaken entry', initial and date the correction, then make the correct entry — do not obscure the original ✓
    • Erase or white out the entry

    Proper documentation correction maintains the legal integrity of the medical record. The correct procedure: draw a single line through the incorrect entry so it remains readable; write 'error' or 'mistaken entry' near the line; initial and date the correction; make the correct entry. Never erase, wh… Full explanation →

11. What is the proper sequence for donning (putting on) and doffing (removing) personal protective equipment (PPE)?

    • Same sequence for both
    • Random order is fine
    • Donning: gown, mask/respirator, goggles, gloves. Doffing: gloves, goggles, gown, mask/respirator. The principle is to minimize self-contamination during removal ✓
    • Mask first, then everything else simultaneously

    PPE sequence is critical to prevent self-contamination. Donning (clean to contaminated): (1) Perform hand hygiene; (2) Gown — tied at neck and waist; (3) Mask or respirator — secure with ties or elastic; (4) Goggles or face shield — over the eyes; (5) Gloves — extending over gown cuffs. Doffing (con… Full explanation →

12. A nurse finds an unresponsive client without a pulse. What is the first action?

    • Wait for the rapid response team
    • Call the physician
    • Activate the emergency response system (code blue) and begin CPR with chest compressions ✓
    • Document the finding

    Cardiac arrest requires immediate action. The current AHA Basic Life Support sequence (C-A-B): (1) Check for responsiveness; (2) Activate emergency response (call code blue, ask for AED if available); (3) Begin chest compressions immediately — 100-120 per minute, 2-2.4 inches deep on adults, allowin… Full explanation →

13. What is the proper response if a fire is discovered in a healthcare facility?

    • Use the RACE acronym: Rescue clients in danger, Alarm/activate the fire alert, Contain the fire by closing doors, Extinguish or Evacuate as appropriate ✓
    • Call administration first
    • Run to the exit
    • Open windows for ventilation

    The RACE acronym is the standard fire response in healthcare facilities: R — Rescue any client in immediate danger; A — Activate the fire alarm (pull station) or call the emergency code; C — Contain the fire by closing doors and windows to limit oxygen and smoke spread; E — Extinguish the fire if sm… Full explanation →

14. What is the safest method of identifying a client before any procedure or medication administration?

    • Look at the chart only
    • Recognize the client by face
    • Use at least two patient identifiers: typically the client's full name and date of birth, verified against the wristband and the chart ✓
    • Ask the client their room number

    The Joint Commission's National Patient Safety Goals require using at least two patient identifiers before any procedure, medication administration, blood transfusion, specimen collection, or any other patient-specific intervention. Acceptable identifiers: full name (first and last), date of birth, … Full explanation →

15. What is the correct procedure if a client refuses a prescribed medication?

    • Respect the client's right to refuse, explore the reason for refusal, educate about the medication's purpose, document the refusal, and notify the prescriber ✓
    • Force the client to take it
    • Document that it was given
    • Hide it in food

    Competent adults have the right to refuse any medical treatment, including medications. The nurse must respect this right while ensuring informed decision-making. Steps: (1) Acknowledge the refusal calmly; (2) Explore the reason — concerns about side effects, religious beliefs, distrust, misundersta… Full explanation →

16. What is 'informed consent' in healthcare?

    • Family agreement
    • The process of providing the client with information about a proposed treatment (nature, purpose, risks, benefits, alternatives, consequences of refusal) and obtaining their voluntary agreement before proceeding ✓
    • Only signing a form
    • Any verbal agreement

    Informed consent is both an ethical and legal requirement before most medical interventions. Elements that must be communicated: nature of the proposed treatment; purpose and expected benefits; significant risks and complications; reasonable alternatives (including no treatment); consequences of ref… Full explanation →

17. What is the most appropriate action to prevent client falls?

    • Use side rails only
    • Assess fall risk on admission and at intervals; implement individualized interventions based on risk factors — bed in low position, call light within reach, non-slip footwear, scheduled toileting, environmental safety ✓
    • Keep clients in bed
    • Restrain all clients

    Fall prevention is multifactorial and individualized. Standard practice: (1) Assess fall risk on admission and at regular intervals using a validated tool (Morse Fall Scale, STRATIFY, Hendrich II); (2) Identify specific risk factors — age, history of falls, gait/balance issues, vision problems, medi… Full explanation →

18. Which task must be performed by the RN and cannot be delegated?

    • Helping a client to the bathroom
    • Bathing a stable client
    • Administering a flu vaccine
    • Performing the initial nursing assessment of a newly admitted client ✓

    The initial nursing assessment cannot be delegated — it requires the comprehensive judgment and analysis only an RN can provide. The initial assessment establishes the baseline, identifies acute and chronic issues, develops the nursing diagnoses, and is the foundation of the care plan. This is a nur… Full explanation →

19. A client is experiencing an anaphylactic reaction. What is the priority intervention?

    • Stop the precipitating agent (if applicable), maintain the airway, administer epinephrine intramuscularly per protocol, call for help, prepare for possible intubation ✓
    • Give oral antihistamines
    • Document the reaction
    • Place the client in a chair

    Anaphylaxis is a life-threatening systemic allergic reaction requiring immediate action. Signs: hives, urticaria, swelling (face, lips, tongue, throat), wheezing, stridor, hypotension, shock. Priority interventions: (1) Stop the offending agent — discontinue IV infusion, remove contact; (2) Assess a… Full explanation →

20. A nurse is asked to care for clients in a unit where they have no training or experience. What is the most appropriate response?

    • Refuse the assignment entirely and leave
    • Discuss the concern with the supervisor, identify which tasks they are competent to perform, and request supervision or training for unfamiliar tasks — document the conversation ✓
    • Accept the assignment and do their best
    • Wait for orders without acting

    Nurses have an obligation to practice only within their competency. The American Nurses Association Code of Ethics and most state nurse practice acts require this. When faced with an unfamiliar assignment: communicate concerns to the charge nurse or supervisor; identify specific tasks within the nur… Full explanation →

21. Which is the safest action when receiving a verbal medication order from a physician?

    • Write down the order, then read it back to the physician for verification (read-back), and ensure the physician confirms the order is correct ✓
    • Implement the order from memory
    • Write down the order without confirming
    • Refuse all verbal orders

    Verbal and telephone orders are error-prone because of misheard medications, similar-sounding drug names, and number confusion. The safest practice is the 'read-back' procedure: (1) The nurse writes down the order as it is given; (2) The nurse reads back the complete order to the physician — drug na… Full explanation →

22. A client has C. difficile (C. diff). Which precaution is most important for hand hygiene?

    • Only at the start and end of the shift
    • Hand hygiene is not required
    • Alcohol-based hand rub is sufficient
    • Soap and water must be used because alcohol-based products do not kill C. difficile spores ✓

    Clostridioides difficile (C. diff) is unique among healthcare pathogens because it forms spores that are resistant to alcohol-based hand sanitizers. Alcohol does not kill C. diff spores. Hand hygiene after caring for C. diff clients (or any patient with suspected infectious diarrhea) must use soap a… Full explanation →

23. Who has the authority to consent to medical treatment for an unconscious adult client without advance directives?

    • Any family member who arrives first
    • Anyone present
    • The hospital administrator
    • The legal next of kin or designated healthcare proxy, following the state's hierarchy of surrogate decision-makers — typically spouse, adult children, parents, adult siblings — or by court order if no surrogate is available ✓

    When an adult client is unable to consent due to incapacity and has no advance directive identifying a healthcare proxy, state law establishes a hierarchy of surrogate decision-makers. The typical order: spouse, adult children, parents, adult siblings, other relatives, close friends, court-appointed… Full explanation →

24. What is the first action a nurse should take when responding to a disaster or mass casualty event?

    • Begin treating clients immediately based on order of arrival
    • Wait for all clients to arrive
    • Refer all clients elsewhere
    • Triage clients using a standard system (e.g., START) to categorize based on severity and survivability, then treat in priority order ✓

    Mass casualty events overwhelm normal resources and require triage — sorting clients to allocate limited care effectively. The START (Simple Triage and Rapid Treatment) system is widely used: clients are categorized in less than 60 seconds each into four groups identified by colored tags: Red (Immed… Full explanation →

25. What is HIPAA, and what does it require of nurses?

    • A workplace safety law
    • Federal law (Health Insurance Portability and Accountability Act) protecting patient health information; nurses must not share protected health information (PHI) without authorization except for treatment, payment, and healthcare operations ✓
    • A type of insurance
    • A nursing licensing exam

    HIPAA (Health Insurance Portability and Accountability Act of 1996) Privacy Rule protects Protected Health Information (PHI) — any individually identifiable health information. Nurse responsibilities: (1) Access PHI only for legitimate work purposes; (2) Discuss PHI only in private settings with peo… Full explanation →

26. A nurse receives a verbal order from a physician by telephone. What is the correct procedure?

    • Repeat the order back to the physician completely (read-back), document it as a verbal order with the prescriber's name, date, time, and nurse's signature, then ensure the physician countersigns within the facility's required timeframe ✓
    • Only accept verbal orders from attending physicians, never residents
    • Write the order and implement it without reading it back
    • Refuse to accept verbal orders under any circumstances

    VERBAL AND TELEPHONE ORDER SAFETY is a Joint Commission National Patient Safety Goal specifically because miscommunication of verbal orders is a leading cause of medication errors. THE REQUIRED PROCESS: (1) RECEIVE the order; write it down simultaneously; (2) READ BACK the complete order word-for-wo… Full explanation →

27. A nurse is caring for a client who is confused and attempts to climb out of bed. Which restraint alternative should the nurse try FIRST?

    • Restrain only the legs
    • Sedate the client with a PRN benzodiazepine
    • Try non-restraint alternatives first: reorientation, keeping the call light within reach, moving the client closer to the nursing station, asking a family member to stay, providing familiar objects, ensuring the environment is safe (bed in lowest position, side rails up), and addressing unmet needs (pain, need to void, hunger) ✓
    • Apply wrist restraints immediately

    RESTRAINT ALTERNATIVES must be exhausted before physical restraints are applied. Restraints are a last resort because they carry significant risks: increased agitation, aspiration, pressure injuries, psychological trauma, and death. JOINT COMMISSION and CMS standards require documentation that alter… Full explanation →

28. Which of the following tasks can an RN appropriately delegate to a licensed practical nurse (LPN)?

    • Performing an initial admission assessment on a newly admitted complex client
    • Administering a scheduled oral medication to a stable client with no known allergies to that medication ✓
    • Developing a nursing care plan for a newly diagnosed client
    • Providing education to a client newly diagnosed with insulin-dependent diabetes

    DELEGATION TO LPN/LVN is governed by the RN's judgment, state practice act, and the 5 Rights of Delegation. Understanding the LPN/LVN SCOPE OF PRACTICE is essential. LPN/LVNs CAN typically do: Administer routine oral, IM, SubQ, and topical medications to stable clients; Perform straightforward asses… Full explanation →

29. A nurse is preparing to administer IV vancomycin to a client. Which laboratory value must be checked BEFORE administration?

    • Serum creatinine and/or BUN — vancomycin is nephrotoxic (kidney-toxic) and is renally cleared; impaired renal function causes drug accumulation and increased toxicity risk; dosing is adjusted based on renal function and monitored via trough serum levels ✓
    • Serum glucose
    • Hemoglobin
    • Serum potassium

    VANCOMYCIN is a glycopeptide antibiotic used primarily for MRSA and other gram-positive organisms. It is one of the most important antibiotics to monitor because of significant toxicity risks. NEPHROTOXICITY — RENAL MONITORING: Vancomycin is eliminated by the kidneys; impaired renal function causes … Full explanation →

30. A client develops a sudden onset of chest pain, shortness of breath, and hypotension after a central line placement. The nurse suspects a pneumothorax. What is the PRIORITY action?

    • Increase IV fluid rate
    • Stay with the client, call for immediate help (activate rapid response team or code team), administer supplemental oxygen, and notify the physician immediately — this is a life-threatening emergency that cannot wait for X-ray confirmation ✓
    • Obtain a portable chest X-ray before notifying the physician
    • Have the client take deep breaths to re-expand the lung

    TENSION PNEUMOTHORAX is a potentially fatal complication of central line placement (and other thoracic procedures). It occurs when air enters the pleural space and cannot escape, progressively compressing the lung and eventually shifting the mediastinum (tension). CLINICAL PRESENTATION: Sudden chest… Full explanation →

31. Which step in hand washing technique is MOST critical for effective reduction of microorganism transmission?

    • Using antibacterial soap exclusively
    • Rinsing before applying soap
    • Using hot water
    • Mechanical friction for a minimum of 20 seconds covering all surfaces — including between fingers, under nails, and wrists — friction physically removes microorganisms regardless of water temperature ✓

    HAND HYGIENE is the single most effective intervention to prevent healthcare-associated infections (HAIs). The 5 MOMENTS FOR HAND HYGIENE (WHO standard): BEFORE touching a patient; BEFORE a clean/aseptic procedure; AFTER body fluid exposure risk; AFTER touching a patient; AFTER touching the patient'… Full explanation →

32. A client who has an advance directive designating 'no heroic measures' is admitted through the ED in cardiac arrest. What should the healthcare team do?

    • Initiate resuscitation if the advance directive is not immediately available or has not been converted to a current POLST/DNR physician order; verify the advance directive status as quickly as possible and adjust care accordingly ✓
    • Family members have the final say, not the advance directive
    • Only the attending physician decides, ignoring all advance directives
    • Automatically withhold all resuscitation efforts

    ADVANCE DIRECTIVES AND EMERGENCY RESUSCITATION create a complex situation when a client arrives in extremis and the advance directive is not immediately available as a formal medical order. KEY PRINCIPLES: AN ADVANCE DIRECTIVE is a legal document expressing the patient's wishes, but it must be CONVE… Full explanation →

33. A nurse suspects a colleague is coming to work under the influence of alcohol. What is the most appropriate action?

    • Report the concern to the charge nurse or nursing supervisor immediately — patient safety is paramount; most states have nurse assistance programs (diversion programs) for nurses with substance use disorders that prioritize recovery over punishment ✓
    • Confront the colleague in front of patients
    • Manage the colleague's patients yourself without reporting
    • Say nothing to avoid conflict

    IMPAIRED HEALTHCARE PROVIDER reporting is both a professional obligation and an ethical duty. The consequences of an impaired nurse providing care can include: medication errors (calculation errors, administering wrong drugs); falls and inadequate supervision; failure to recognize patient deteriorat… Full explanation →

34. Which client is at HIGHEST RISK for developing a healthcare-associated infection (HAI)?

    • A healthy 25-year-old admitted for an elective hernia repair
    • A 68-year-old diabetic client with a Foley catheter, central venous catheter, and mechanical ventilator following major abdominal surgery ✓
    • A 35-year-old with a simple laceration repair
    • A 50-year-old admitted for a colonoscopy

    HAI RISK FACTORS are additive — the more risk factors present, the higher the risk. The 68-year-old in Option B has multiple major risk factors compounding each other. RISK FACTOR ANALYSIS: AGE (>65): Immune senescence — reduced immune response; less reserve to fight infection; thinner, more fragile… Full explanation →

35. A nurse is preparing to administer two different IV medications through the same IV line. Which step must be performed between medications?

    • Nothing — IV drugs in the same line mix harmlessly
    • Change the entire IV tubing set
    • Flush the IV line with compatible flush solution (usually normal saline) between medications to prevent drug incompatibilities in the line that could cause precipitation, altered drug activity, or patient harm ✓
    • Only flush if the drugs are antibiotics

    IV DRUG COMPATIBILITY and proper flushing between medications is a patient safety requirement, not an optional step. WHY FLUSHING MATTERS: Many IV drugs are INCOMPATIBLE with each other — when they mix in the IV tubing, they can: precipitate (form a solid that can cause emboli); inactivate each othe… Full explanation →

36. A nurse discloses a client's HIV status to the client's employer without the client's consent. What is this an example of?

    • Acceptable if the nurse believed it was for public health
    • Normal information sharing between healthcare and community
    • A HIPAA violation — unauthorized disclosure of protected health information (PHI) to a non-authorized party; the client did not consent and the employer has no legal right to this information ✓
    • Only a problem if the client finds out

    THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) PRIVACY RULE protects all individually identifiable health information (Protected Health Information, PHI). An employer is NOT an authorized recipient of health information without specific patient authorization or a legally defined exc… Full explanation →

37. When activating a rapid response team (RRT), which clinical changes most justify calling?

    • Acute changes in mental status, respiratory rate outside 8-30 breaths/min, heart rate outside 40-130 bpm, systolic BP below 90 mmHg, oxygen saturation below 90%, or a nurse's 'gut feeling' that something is wrong — early activation saves lives ✓
    • Only after the attending physician is notified and unavailable
    • Only changes visible on the ECG monitor
    • Vital sign changes only if outside normal range for 4+ hours

    RAPID RESPONSE TEAMS (RRTs) exist to bring critical care expertise to deteriorating patients on general wards BEFORE they progress to cardiac arrest. Research consistently shows that most in-hospital cardiac arrests are preceded by 6-8 hours of deteriorating vital signs and clinical condition that w… Full explanation →

38. When delegating care to a UAP for an unstable client whose condition has been changing, which action is MOST important?

    • Delegate completely and trust the UAP's judgment
    • Clearly specify what changes or findings to report immediately, give specific parameters (e.g., 'call me right away if heart rate is above 110 or blood pressure drops below 90/60'), and check back frequently — the nurse retains full responsibility for the unstable client ✓
    • Avoid delegating anything to any UAP for any reason
    • Delegate the task and check back only at the end of the shift

    DELEGATION FOR UNSTABLE CLIENTS requires heightened communication and supervision because the stakes of missed information are high. While some tasks may be appropriately delegated even for unstable clients (basic hygiene, feeding), the nurse must maintain very close oversight. THE MOST IMPORTANT EL… Full explanation →

39. A nurse discovers they administered a medication to the wrong patient. After taking immediate steps to assess the patient and notify the provider, what must the nurse do?

    • Complete a medication error report (incident/occurrence report) per facility policy, document the error in the medical record factually, and notify the charge nurse — transparency and reporting prevent future errors and protect the patient ✓
    • Discuss it only with a trusted colleague
    • Document only if the patient has an adverse reaction
    • Document it as 'medication given as ordered' to avoid consequences

    MEDICATION ERROR REPORTING is mandatory for patient safety, quality improvement, and legal protection. It is also an ethical obligation. IMMEDIATE ACTIONS AFTER A MED ERROR: (1) ASSESS the patient for harm — vital signs, symptoms, allergic reactions; (2) NOTIFY the prescriber immediately — they need… Full explanation →

40. Which statement accurately describes the nurse's accountability when tasks are delegated to assistive personnel?

    • The RN retains accountability for the outcome of delegated tasks — delegation transfers RESPONSIBILITY for the task to the delegate, but the RN's accountability for overall care management, supervision, and outcome remains ✓
    • The RN is only accountable for tasks personally performed
    • Once delegated, accountability transfers completely to the UAP
    • Accountability transfers to the charge nurse once any task is delegated

    DELEGATION AND ACCOUNTABILITY is a critically tested NCLEX concept that many candidates confuse. THE CORE PRINCIPLE: Delegation transfers the RESPONSIBILITY for performing the specific task to the delegatee. Delegation does NOT transfer the RN's ACCOUNTABILITY for the overall care outcomes, supervis… Full explanation →

41. A nurse is caring for a client with active tuberculosis (TB). Which type of precaution and personal protective equipment is required?

    • Droplet precautions with a surgical mask
    • Airborne precautions with a fit-tested N95 respirator and a negative-pressure room ✓
    • Contact precautions with gown and gloves
    • Standard precautions only

    AIRBORNE PRECAUTIONS are required for tuberculosis. TB spreads via small airborne droplet nuclei that remain suspended in air, so the nurse needs: a fit-tested N95 RESPIRATOR (or higher); a NEGATIVE-PRESSURE (airborne infection isolation) room with the door closed; the client wears a surgical mask i… Full explanation →

42. Before administering a medication, the nurse should verify the 'rights' of medication administration. Which of the following is one of these rights?

    • Right nurse
    • Right color
    • Right brand name only
    • Right client (verified using two identifiers) ✓

    The RIGHTS OF MEDICATION ADMINISTRATION include: RIGHT CLIENT (verified using TWO identifiers, such as name and date of birth — never the room number alone); RIGHT MEDICATION; RIGHT DOSE; RIGHT ROUTE; RIGHT TIME; plus often Right Documentation, Right Reason, Right Response. NCLEX safe care/medicatio… Full explanation →

43. According to the principles of delegation, which task is MOST appropriate for a registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)?

    • Developing the nursing care plan
    • Assisting a stable client with bathing and ambulation ✓
    • Performing the admission assessment
    • Administering IV medications

    Appropriate tasks to delegate to UAP (unlicensed assistive personnel) are ROUTINE, STANDARDIZED tasks for STABLE clients with PREDICTABLE outcomes — such as assisting a stable client with BATHING, AMBULATION, feeding, vital signs, and hygiene (activities of daily living). NCLEX safe care/delegation.… Full explanation →

44. A nurse is implementing fall precautions for an older adult client at high risk for falls. Which intervention is appropriate?

    • Keep the room dark to encourage rest
    • Leave the client unattended in the bathroom
    • Keep the bed in the lowest position, ensure the call light is within reach, and provide nonskid footwear ✓
    • Keep all four side rails up at all times

    FALL PRECAUTIONS for a high-risk client include: keeping the BED in the LOWEST position with wheels locked; CALL LIGHT and personal items within REACH; NONSKID footwear; adequate LIGHTING (including night lights); clear pathways (remove clutter); assist with ambulation/toileting; frequent rounding; … Full explanation →

45. What is the single most effective method for preventing the spread of infection in healthcare settings?

    • Administering antibiotics
    • Wearing gloves at all times
    • Isolating all clients
    • Proper hand hygiene (handwashing or alcohol-based hand rub) ✓

    PROPER HAND HYGIENE — handwashing with soap and water OR using an alcohol-based hand rub — is the SINGLE MOST EFFECTIVE method for preventing the spread of infection. NCLEX safe care/infection control. Perform hand hygiene: before and after client contact, before aseptic procedures, after exposure t… Full explanation →

46. A nurse receives a verbal order from a physician during an emergency. What is the correct procedure for safety?

    • Write down the order, read it back to the physician for confirmation, and ensure it is signed within the required timeframe ✓
    • Ask another nurse to remember it
    • Ignore the order until it is written
    • Carry it out from memory without documentation

    For VERBAL/TELEPHONE ORDERS, the safe procedure is: WRITE DOWN the order (or enter it), then READ IT BACK to the prescriber for verification (read-back/'repeat-back'), and confirm it is correct; the prescriber must SIGN/authenticate the order within the facility's required timeframe (often 24 hours)… Full explanation →

47. A nurse discovers a fire in a client's room. Using the RACE protocol, what is the FIRST action?

    • Open the windows
    • Extinguish the fire
    • Rescue/remove the client from immediate danger ✓
    • Call the fire department

    The RACE fire protocol prioritizes actions in order: R — RESCUE (remove anyone in immediate danger FIRST); A — ALARM (activate the fire alarm/call for help); C — CONTAIN (close doors and windows to contain the fire/smoke); E — EXTINGUISH (use a fire extinguisher if safe) or EVACUATE. NCLEX safe care… Full explanation →

48. A nurse is preparing to administer a 'high-alert' medication such as heparin or insulin. What additional safety measure is recommended?

    • Administer it faster to save time
    • Skip the usual checks since it is urgent
    • No special measures are needed
    • Have a second nurse independently verify the medication and dose before administration ✓

    HIGH-ALERT medications (those with a heightened risk of causing significant harm if used in error) — such as HEPARIN, INSULIN, opioids, chemotherapy, and concentrated electrolytes (e.g., potassium chloride) — require additional safeguards, including an INDEPENDENT DOUBLE-CHECK by a SECOND NURSE who … Full explanation →

49. When using restraints on a client (as a last resort), which nursing action is essential for safe care?

    • Tie restraints to the side rails
    • Obtain a provider's order, use the least restrictive type, and frequently monitor the client (circulation, skin, needs) per policy, releasing/repositioning regularly ✓
    • Apply them and check once per shift
    • Use restraints for staff convenience

    RESTRAINTS are a LAST RESORT after less restrictive measures fail, used only to protect the client or others. SAFE USE requires: a PROVIDER'S ORDER (time-limited; cannot be PRN/standing; emergency application requires an order ASAP); the LEAST RESTRICTIVE type effective; FREQUENT MONITORING per poli… Full explanation →

50. A charge nurse is making client assignments. Which client should be assigned to the most experienced registered nurse?

    • A stable client awaiting discharge
    • A client with stable chronic conditions
    • An unstable client requiring frequent assessment and complex care ✓
    • A client needing assistance with morning hygiene

    The MOST EXPERIENCED/skilled RN should be assigned the UNSTABLE client requiring frequent assessment, complex care, and clinical judgment — because this client has the greatest risk and the most unpredictable needs. NCLEX safe care/management of care. PRINCIPLE: match the acuity and complexity of th… Full explanation →

51. A nurse is prioritizing care for four clients. Using the ABC framework, which client should be assessed first?

    • A client requesting pain medication
    • A client asking about discharge
    • A client who needs help to the bathroom
    • A client with an oxygen saturation of 84% and labored breathing ✓

    Using the ABC framework (AIRWAY, BREATHING, CIRCULATION), the client with an OXYGEN SATURATION of 84% and LABORED BREATHING is the priority — this is a BREATHING/airway problem that is immediately life-threatening. NCLEX safe care/prioritization. PRIORITIZATION FRAMEWORKS: ABCs (airway and breathing… Full explanation →

52. A client asks to see their own medical record. What is the nurse's best response?

    • Recognize the client's right to access their medical record, and follow facility policy/procedure to facilitate the request ✓
    • Tell the client records are confidential from them
    • Give a copy without any documentation
    • Refuse, as records belong only to the facility

    Clients have a RIGHT to ACCESS their own medical records (under HIPAA and patient rights). The nurse should recognize this right and FOLLOW FACILITY POLICY/PROCEDURE to facilitate the request (which may involve a formal request, a designated process, and the provider/medical records department). NCL… Full explanation →

53. A nurse is caring for a client with Clostridioides difficile (C. diff). Which infection control measure is essential?

    • Use airborne precautions
    • No special precautions needed
    • Use contact precautions and wash hands with soap and water (alcohol-based sanitizer does not kill C. diff spores) ✓
    • Use alcohol-based hand sanitizer only

    For C. DIFFICILE (C. diff — causes severe diarrhea, spread by spores): use CONTACT PRECAUTIONS (gown and gloves) AND wash hands with SOAP AND WATER — because alcohol-based hand sanitizer does NOT kill C. diff SPORES (the mechanical action of soap and water physically removes them). NCLEX safe care/i… Full explanation →

54. A registered nurse is supervising a licensed practical nurse (LPN/LVN). Which task is appropriate to assign to the LPN?

    • Developing the initial plan of care
    • Performing the initial admission assessment
    • Administering IV push medications (in most facilities)
    • Administering oral and certain other medications to a stable client and reinforcing teaching ✓

    Appropriate tasks for an LPN/LVN (within their scope, varies by state/facility): administering ORAL and many other MEDICATIONS to STABLE clients; performing routine, stable procedures; REINFORCING teaching the RN initiated; monitoring stable clients; wound care; collecting data (contributing to asse… Full explanation →

55. A nurse is preparing to administer a blood transfusion. What is an essential safety step before starting the transfusion?

    • Start it quickly without checks
    • Verify the blood product and client identity with a second qualified person (two-person verification of the right blood for the right client), and obtain baseline vital signs ✓
    • Skip vital signs
    • Use the fastest infusion rate possible from the start

    Before a BLOOD TRANSFUSION, essential safety steps include: TWO-PERSON VERIFICATION (two qualified staff independently check) of the client's identity (two identifiers), the blood product (type, Rh, unit number), the order, and the crossmatch — matching the RIGHT blood to the RIGHT client (a mismatc… Full explanation →

56. A nurse receives a client returning from surgery. What is the priority assessment?

    • Airway, breathing, and circulation (ABCs) — including respiratory status, vital signs, and level of consciousness ✓
    • The client's insurance information
    • The client's visiting schedule
    • The client's dietary preferences

    For a POST-OPERATIVE client, the priority assessment follows the ABCs: AIRWAY (patent? — risk of obstruction from sedation/anesthesia), BREATHING (respiratory rate, depth, oxygen saturation — anesthesia depresses respiration), CIRCULATION (vital signs, bleeding, perfusion), and level of consciousnes… Full explanation →

57. Which situation is an example of a nurse obtaining 'informed consent' correctly?

    • Consent is assumed without discussion
    • The provider explains the procedure, risks, benefits, and alternatives to the client, and the nurse witnesses the client's voluntary signature and verifies understanding ✓
    • The nurse explains the surgery and risks and obtains the signature
    • The nurse signs for the client

    INFORMED CONSENT is the responsibility of the PROVIDER performing the procedure (physician/surgeon), who must explain: the PROCEDURE, its RISKS, BENEFITS, and ALTERNATIVES (including the option of no treatment), in terms the client understands. The NURSE'S ROLE: WITNESS the client's VOLUNTARY signat… Full explanation →

58. A nurse notes that a medication order reads 'give 10U insulin.' Why is this order potentially unsafe?

    • Insulin is never given
    • The abbreviation 'U' for units can be misread (e.g., as a zero, making it '100'); 'units' should be written out to prevent dosing errors ✓
    • The dose is too low to matter
    • It is perfectly clear

    The abbreviation 'U' for UNITS is on the 'DO NOT USE' list because it can be MISREAD — 'U' can look like a 0 (making '10U' read as '100') or a 4, leading to dangerous dosing errors. The word 'UNITS' should be written out in full. NCLEX safe care/medication safety. OTHER ERROR-PRONE ABBREVIATIONS to … Full explanation →

59. When should a nurse perform hand hygiene according to the principles of standard precautions?

    • Only when hands look dirty
    • Only after caring for a client
    • Only once per shift
    • Before and after client contact, before aseptic procedures, after exposure to body fluids, and after touching the client's environment ✓

    Hand hygiene should be performed at the WHO 'FIVE MOMENTS': (1) BEFORE touching a client; (2) BEFORE an aseptic/clean procedure; (3) AFTER body fluid exposure risk; (4) AFTER touching a client; (5) AFTER touching the client's SURROUNDINGS/environment. NCLEX safe care/infection control. Also: before … Full explanation →

60. A nurse is caring for a client on seizure precautions. Which intervention is appropriate?

    • Pad the side rails, keep the bed in low position, have suction and oxygen available, and during a seizure protect the head and turn the client to the side — do not restrain or put anything in the mouth ✓
    • Hold the client down firmly
    • Restrain the client during a seizure
    • Insert a tongue blade during a seizure

    SEIZURE PRECAUTIONS and care: PREPARE the environment — pad side rails, keep the bed in LOW position, have SUCTION and OXYGEN available, remove hazards. DURING a seizure: PROTECT the client (cushion/protect the head, turn the client to the SIDE to maintain the airway and prevent aspiration, loosen t… Full explanation →

61. Using Maslow's hierarchy of needs to prioritize, which client need would generally be addressed first?

    • A client's need for self-esteem
    • A client's need for spiritual fulfillment
    • A client's physiological need such as oxygen, food, or fluids ✓
    • A client's need for social interaction

    Using MASLOW'S HIERARCHY OF NEEDS to prioritize, PHYSIOLOGICAL needs (oxygen, food, water, elimination, sleep, shelter) are addressed FIRST — they are the most basic and essential for survival. NCLEX safe care/prioritization. MASLOW'S HIERARCHY (bottom to top): (1) PHYSIOLOGICAL (most basic — air, w… Full explanation →

62. A nurse is administering a medication through a feeding tube. What is an important safety practice?

    • Never flush the tube
    • Give all medications at maximum speed
    • Verify each medication can be crushed/given via tube (do not crush enteric-coated or extended-release forms), flush the tube before, between, and after medications, and check tube placement ✓
    • Crush all medications together and give enteric-coated tablets crushed

    Administering medications via FEEDING TUBE safety practices: VERIFY each medication is appropriate for tube administration — do NOT crush ENTERIC-COATED or EXTENDED-RELEASE (sustained-release) medications (crushing destroys the protective coating/timing, risking overdose or stomach irritation — use … Full explanation →

63. A nurse witnesses another nurse diverting (stealing) controlled substances. What is the nurse's ethical and legal obligation?

    • Report the suspected diversion through the proper channels (supervisor/manager) per facility policy and legal requirements ✓
    • Confront the nurse and handle it privately only
    • Take the medications to investigate
    • Ignore it to avoid conflict

    A nurse who witnesses or suspects drug DIVERSION (theft of controlled substances) by a coworker has an ETHICAL and LEGAL obligation to REPORT it through proper channels (supervisor/manager, per facility policy; reporting to the board of nursing/authorities may be required). NCLEX safe care/legal-eth… Full explanation →

64. A nurse is caring for a client with a new prescription. The dose seems unusually high. What should the nurse do?

    • Ask another nurse to give it instead
    • Question/clarify the order with the prescriber before administering — the nurse is responsible for safe administration and should not give a dose that appears unsafe ✓
    • Administer half the dose
    • Administer it as written since the provider ordered it

    If a medication dose appears UNUSUALLY HIGH or unsafe, the nurse must QUESTION/CLARIFY the order with the PRESCRIBER before administering. NCLEX safe care/medication safety. THE NURSE'S RESPONSIBILITY: nurses are legally and ethically responsible for SAFE medication administration — 'the provider or… Full explanation →

65. A nurse is putting on personal protective equipment (PPE) for a client on contact and droplet precautions. What is the correct order for DONNING (putting on) PPE?

    • Gown, mask/respirator, goggles/face shield, then gloves ✓
    • There is no correct order
    • Mask, gloves, gown, goggles
    • Gloves, gown, mask, goggles

    The correct order for DONNING (putting on) PPE is: (1) GOWN; (2) MASK or respirator; (3) GOGGLES or face shield; (4) GLOVES (last, pulled over the gown cuffs). NCLEX safe care/infection control. Memory: 'gown, mask, goggles, gloves.' For DOFFING (removing) PPE, the order is essentially reversed and … Full explanation →