Build Exam-Ready Competencies for the CPNRE

The most appropriate initial action is to address the concern directly with the colleague in a professional, non-confrontational manner. Accurate documentation is a fundamental nursing responsibility and a legal requirement. Option A may be necessary if the behaviour continues, but it is not the first step. Option C is unacceptable inaccurate documentation is a professional and legal issue regardless of harm. Option D is never appropriate altering another nurse’s documentation is falsification of a legal record.

For COPD clients, oxygen is titrated to maintain SpO2 between 88% and 92%. At 91%, the client is within the target range. The nurse should maintain the current flow rate and perform a thorough respiratory assessment. Option A is dangerous high-flow oxygen in COPD can suppress the hypoxic drive, causing respiratory depression and CO2 retention. Option C would remove needed oxygen. Option D provides excessive oxygen for a COPD client.

A dietitian should be consulted first for sustained poor nutritional intake. They can assess nutritional status, evaluate caloric needs, and recommend dietary modifications. Option A is appropriate if a medical cause is suspected but initial nutritional assessment falls within the dietitian’s scope. Option C would be needed if there were signs of dysphagia. Option D would apply if psychosocial factors were suspected.

Medication reconciliation requires the nurse to compare home medications with admission orders and resolve discrepancies. The omission may be intentional or accidental. The nurse must notify the prescriber to clarify. Option A ignores the discrepancy. Option B is outside scope — all medications need a prescriber’s order. Option D makes an assumption without verification.

A competent adult has the legal and ethical right to refuse any treatment, including life-sustaining treatment. The nurse ensures the client understands the risks (informed refusal), documents the refusal, and notifies the prescriber. Option A violates autonomy and constitutes assault/battery. Option B breaches confidentiality and autonomy. Option D is coercive and unethical.