NCJ RENR

During a sterile dressing change for a Jamaica RENR-style scenario, which action best maintains asepsis before touching the sterile field?

• APerform hand hygiene and open supplies without reaching over the field
• BPut on clean gloves and adjust the sterile field by hand
• CPlace used forceps on the sterile towel for reuse
• DTalk over the open wound while arranging supplies

A patient receiving IV fluid reports burning at the cannula site and the tissue is cool and swollen. What should the nurse do first?

• AIncrease the flow rate to clear the vein
• BStop the infusion and assess the IV site
• CApply a tight pressure bandage and continue the infusion
• DDocument the finding at the end of the shift only

Which intervention most directly reduces pressure-injury risk for an immobile adult patient?

• AKeeping the head of bed high at all times
• BMassaging reddened bony prominences firmly
• CRepositioning on a regular schedule with skin inspection
• DLimiting oral fluids to reduce incontinence

A nurse caring for a patient with an indwelling urinary catheter should prioritise which practice?

• ADisconnect the tubing each shift to empty residual urine
• BClamp the catheter overnight to train the bladder
• CPlace the bag on the bed during transfers
• DKeep the drainage bag below bladder level without touching the floor

Before administering oral digoxin, which assessment is most important?

• ACheck the apical pulse according to local policy
• BAsk whether the patient prefers tablets or liquid
• CMeasure the patient height again
• DAssess the colour of the medicine cup

A conscious patient with diabetes is sweating, trembling and confused before lunch. What is the best immediate nursing action?

• AGive the scheduled long-acting insulin immediately
• BCheck capillary glucose and give fast-acting carbohydrate if hypoglycaemia is confirmed o…
• CRestrict fluids and place the patient in bed
• DDelay care until the next routine medication round

Ten minutes after a blood transfusion starts, a patient develops fever, chills and back pain. What is the priority action?

• ASlow the transfusion and reassess after 30 minutes
• BAdminister the next unit to maintain blood volume
• CStop the transfusion and keep IV access open with normal saline
• DDiscard the blood bag before notifying anyone

Which patient has the highest immediate falls risk on a medical ward?

• AA young adult reading discharge papers
• BA patient with a visitor at the bedside and no mobility problem
• CA patient whose vital signs are stable after breakfast
• DAn older adult who received a sedative and needs help to toilet

After thyroid surgery, which finding requires urgent nursing escalation?

• ANoisy breathing with swelling at the neck dressing
• BMild sore throat after intubation
• CSmall amount of serous drainage on the dressing
• DPatient asks for help changing position

A patient with acute asthma is unable to speak full sentences and has audible wheeze. Which action comes first?

• AOffer a large meal to improve energy
• BSit the patient upright, assess oxygenation and activate urgent bronchodilator/medical re…
• CEncourage the patient to lie flat and sleep
• DDelay assessment until peak flow equipment is found

A child with diarrhoea has dry mucous membranes and reduced urine output but is alert and drinking. Which nursing action is most appropriate?

• AWithhold all fluids for four hours
• BGive an adult antidiarrhoeal medicine
• CBegin oral rehydration solution and monitor intake/output
• DEncourage only sweet carbonated drinks

A patient admitted after stroke coughs when given water. What should the nurse do?

• AEncourage faster drinking to strengthen the swallow
• BGive tablets whole with water
• CDocument normal swallowing because the patient is alert
• DStop oral intake and request swallow assessment before further fluids

Which assessment finding best suggests worsening heart failure?

• ANew dyspnoea at rest with bilateral crackles
• BWarm dry skin after bathing
• CImproved appetite at breakfast
• DPain only when moving a sprained ankle

A breathless patient with COPD is most comfortable in which position?

• AFlat supine with arms above the head
• BSitting upright leaning slightly forward with supported arms
• CTrendelenburg position
• DProne with the head turned to the wall

A patient is suspected of pulmonary tuberculosis. Which precaution is most appropriate while awaiting review?

• ANo isolation because cough is common
• BOnly gloves for all staff and visitors
• CAirborne precautions according to facility policy
• DShared room with an immunocompromised patient

After using a needle, what is the safest nursing action?

• ARecap it using both hands before disposal
• BLeave it on the medication trolley until rounds end
• CPlace it in a regular waste bin if capped
• DDispose of it immediately in an approved sharps container

A patient receiving end-of-life care has noisy respiratory secretions and appears comfortable. Which nursing action is appropriate?

• AReposition gently and provide family explanation and prescribed comfort measures
• BPerform repeated deep suctioning without indication
• CTell the family the patient is choking
• DStop all mouth care because death is near

A patient says they developed facial swelling after penicillin. What should the nurse do before giving a new antibiotic?

• AGive the dose because the new medicine name is different
• BHold administration and verify allergy information with the prescriber/pharmacist
• CRecord the allergy after the medication is finished
• DAsk another patient if the drug is safe

A patient on IV fluids develops new crackles and increasing shortness of breath. What should the nurse do first?

• AIncrease the infusion to complete the bag
• BEncourage oral fluids to dilute secretions
• CSlow or stop the infusion as ordered by protocol and seek urgent review while assessing o…
• DRemove the IV cannula and send the patient home

Which action helps prevent hypothermia immediately after birth?

• ADelay drying until after weighing
• BPlace the newborn near an open window
• CBathe the newborn before airway assessment
• DDry the newborn thoroughly and provide skin-to-skin warmth if stable

A postpartum patient has heavy bleeding and a soft, boggy uterus. Which intervention is first?

• AMassage the fundus and call for help according to protocol
• BEncourage the patient to walk to the bathroom alone
• CGive oral iron and reassess tomorrow
• DApply a cold pack to the perineum only

A febrile toddler is prescribed paracetamol. Which nursing action is safest?

• AUse the adult dose divided in half
• BCalculate the dose using the child weight and prescribed concentration
• CGive an extra dose if the fever returns early
• DAvoid documenting the dose if the parent is present

Which meal choice best supports healing for a patient with a large wound?

• AOnly tea and crackers until the wound closes
• BA very low-protein diet
• CProtein-rich foods with adequate calories and fluids
• DSkipping meals to prevent nausea

A patient with hallucinations says voices are telling them to harm another person. What is the priority nursing action?

• ATell the patient the voices are imaginary and walk away
• BPromise not to tell anyone
• CAsk the patient to wait until visiting hours
• DMaintain safety and seek urgent mental health review

While irrigating a wound, which technique is safest?

• AUse prescribed solution with gentle pressure and protect surrounding skin
• BForcefully scrape all granulation tissue
• CReuse leftover irrigation solution from another patient
• DIrrigate toward the nurse face to observe better

A patient receiving oxygen wants to use petroleum jelly on dry lips. What should the nurse recommend?

• AUse petroleum jelly because oxygen keeps it moist
• BUse a water-based lubricant if needed
• CRemove oxygen until the lips heal
• DApply alcohol-based gel to the lips

What is most important when labelling a blood specimen?

• APre-label tubes before entering the room
• BAsk the roommate to confirm the name
• CLabel at the bedside after confirming patient identity
• DLabel later from memory to save time

Before first ambulation after surgery, which nursing action is most appropriate?

• ASend the patient alone to encourage independence
• BRemove all dressings to reduce weight
• CSkip assessment if the patient is young
• DAssess pain, blood pressure, lines and assistance needs

A pregnant patient reports severe headache, visual changes and right upper quadrant pain. What should the nurse suspect?

• APossible pre-eclampsia requiring urgent assessment
• BNormal discomfort of late pregnancy only
• CUncomplicated heartburn needing antacid only
• DExpected symptoms after taking vitamins

Which practice best reduces cross-contamination when moving between patients?

• AUse the same gloves if no blood is visible
• BPerform hand hygiene before and after each patient contact
• CCarry used supplies in uniform pockets
• DClean hands only at the start of the shift

A neighbour asks a nurse about a patient admitted to the ward. What is the best response?

• AConfirm the diagnosis if the neighbour is worried
• BShare only the room number and medications
• CExplain that patient information cannot be discussed and direct them to approved channels
• DAsk another patient to answer the question

Before a non-emergency procedure, a patient says they do not understand why it is needed. What should the nurse do?

• ATell the patient to sign because the doctor ordered it
• BSign the form as witness without further discussion
• CProceed because nursing time is limited
• DPause and arrange for the provider to explain so informed consent can be supported

Which chart entry is most professional?

• A"Patient reports pain 7/10 at incision; prescribed analgesic given at 10:05."
• B"Patient dramatic again."
• C"Seems fine, no need to chart details."
• D"Family annoying; medicine probably given."

A nurse gives a medication one hour late and no harm is apparent. What is the best action?

• AHide the delay because no harm occurred
• BAssess the patient, document accurately and report according to policy
• CChange the administration time to appear correct
• DAsk the patient not to mention it

Which task is appropriate to delegate to trained support staff while retaining nurse accountability?

• AInitial assessment of chest pain
• BClinical judgement about IV opioid dosing
• CAssisting a stable patient with hygiene after clear instructions
• DTeaching a new insulin regimen independently

A nurse is asked to perform a procedure outside their competence. What should they do?

• APerform it to avoid embarrassment
• BAsk a student to do it instead
• CDocument that the procedure was completed without doing it
• DDecline to perform alone and seek appropriate supervision or trained support