Free NCLEX-RN practice
Free NCLEX-RN Management of Care Practice Questions
Free NCLEX-RN management of care practice questions with rationales — delegation, prioritization, advocacy, and coordination of care.
16 management of care practice questions with rationales
A client with a valid do-not-resuscitate (DNR) order is awake and says, "I can't breathe." The oxygen saturation is 84% on room air, and the client's adult child says, "Do not do anything. There is a DNR." What should the nurse do?
Correct answer: B
A DNR order limits cardiopulmonary resuscitation if the client has cardiac or respiratory arrest; it does not mean do not treat. Because this client is awake and in respiratory distress, the nurse treats the dyspnea by applying oxygen, positioning upright, assessing the respiratory status, and notifying the provider. Family members do not decide which nonresuscitative treatments are allowed at the bedside, and treatment should not be delayed while the DNR is clarified.
Why the other options are wrong
- A. A DNR limits CPR at arrest; it does not make care comfort-only. Withholding oxygen from an awake, hypoxic client undertreats a reversible problem.
- C. The adult child does not decide whether oxygen is allowed under the client's DNR; the nurse treats current distress within the plan of care.
- D. Waiting for clarification delays needed nonresuscitative treatment. Clarify questions after immediate dyspnea care has started.
Key takeaway
DNR means no CPR during arrest, not no treatment. Treat reversible distress and symptoms while respecting the client's documented limits on resuscitation.
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A home health nurse notices new patterned bruising and poor hygiene on an older adult, and the client's caregiver answers every question and refuses to leave the room. Which actions should the nurse take? Select all that apply.
Correct answers: o1, o2, o3
A nurse is a mandated reporter and reports suspected abuse on reasonable suspicion, not after privately proving the case. The nurse reports to Adult Protective Services, documents objective findings, and creates a private opportunity to assess the client away from the caregiver. Calling family contacts or returning later delays protection and can compromise confidentiality. Warning the caregiver before reporting can escalate the danger to the client.
Why the other options are wrong
- o4. The nurse does not investigate by calling family contacts before reporting; that delays protection and can breach confidentiality.
- o5. Warning the caregiver before reporting can escalate risk and is not required before a mandated report.
- o6. A follow-up visit may be needed, but it does not come before reporting suspected abuse.
Key takeaway
Report suspected abuse on reasonable suspicion, document objectively, and assess the client privately. Do not investigate first, warn the suspected caregiver, or delay reporting for a follow-up visit.
A client who had a stroke is being discharged home with a new swallowing deficit and mild left-sided weakness, and lives alone in a second-floor apartment. Which referral should the nurse initiate first?
Correct answer: A
When several referrals are appropriate, the one addressing the most immediate safety risk goes first. A new swallowing deficit creates an aspiration risk that can cause airway obstruction or pneumonia, so a speech-language pathology swallowing evaluation is the priority. Physical therapy for stairs, occupational therapy for daily activities, and social work for home safety are all appropriate and follow, but they address function and support rather than an immediate airway risk.
Why the other options are wrong
- B. Occupational therapy for daily activities is appropriate but is not the most immediate safety risk.
- C. Physical therapy for gait and stairs matters given the weakness, but aspiration is the more immediate danger.
- D. Social work for home safety fits a client who lives alone, but it does not address the airway risk first.
Key takeaway
When multiple referrals apply, prioritize the most immediate safety risk. A new swallowing deficit (aspiration) outranks mobility and home-safety needs.
An RN caring for several clients needs to delegate one medication administration to an LPN/LVN. Which medication is appropriate for the nurse to delegate?
Correct answer: D
Rule: routine, scheduled medications on established, stable clients can go to the LPN/LVN, while the RN keeps doses that require interpreting a parameter, IV push medications, and first doses that must be evaluated. A scheduled intramuscular vitamin B12 injection for a client with stable pernicious anemia is a standardized administration with a predictable course, which fits LPN/LVN scope. The other three each carry an RN level judgment or route despite looking ordinary.
Why the other options are wrong
- A. An oral pill reads as the easiest task, which is the trap. Deciding whether to give or hold digoxin based on the apical pulse and potassium is nursing judgment, so the RN administers it.
- B. The drug is common, but an IV push medication is outside LPN/LVN scope, and a pressure of 202/114 needs the RN's ongoing evaluation of the response.
- C. A first dose can look like a simple hand off, yet watching a new medication for an allergic reaction is evaluating the client's response, which the RN performs.
Key takeaway
Delegate the medication that is routine, established, and does not hinge on the nurse's interpretation. A scheduled IM injection on a stable client qualifies; parameter based dosing, IV push, and first doses do not.
A nurse on a medical unit receives the change-of-shift report on four clients. Which client should the nurse assess first?
Correct answer: B
A falling trend matters more than a single low number: the client moving away from their own baseline is the one deteriorating. This client's saturation has slipped from 95% to 90% on the same oxygen over 2 hours, a downward trend that points to worsening gas exchange and a breathing threat. That outranks the COPD client sitting at 88%, which is their expected resting baseline, and the post-op pain and febrile chills, which are uncomfortable but expected and already have orders in place.
Why the other options are wrong
- A. Pain of 7/10 feels urgent, but it is expected on the day of surgery and a PRN analgesic already covers it, so it is not the airway threat.
- C. 88% is the lowest number in the group and can look like the worst value, but it is this COPD client's unchanged baseline, not a new problem.
- D. A fever with chills sounds alarming, yet it is an expected response to a known UTI and does not outrank a falling oxygen trend.
Key takeaway
Prioritize the client trending away from their own baseline over a client sitting at a low but unchanged value.
A client scheduled for a laparoscopic cholecystectomy has already signed the surgical consent form. While preparing the client for transport to the operating room, the nurse hears the client say, "I'm glad they're only going to look inside with the camera and I get to keep my gallbladder." Which action should the nurse take?
Correct answer: C
Consent is only valid when the client understands what was agreed to. Disclosing the procedure, its risks, benefits, and alternatives is the provider's legal responsibility; the nurse's job is to confirm the client understands and is consenting voluntarily, witness the signature, and alert the provider when understanding is incomplete. This client believes the gallbladder is being left in place, which is the opposite of the planned procedure, so the signed form does not reflect informed consent. The nurse cannot repair this by teaching the surgical plan herself and must return the issue to the surgeon before the client leaves for the operating room.
Why the other options are wrong
- A. The client's statement is direct evidence that the consent does not match the planned surgery, so transporting now means operating without truly informed consent. A signed form is not the same as an informed decision.
- B. Providing the primary explanation of the procedure is the surgeon's duty, not the nurse's. Nurses clarify and reinforce, but stepping in to disclose the surgery still leaves an invalid consent and oversteps the role boundary.
- D. A competent adult must understand and consent for himself, and the spouse cannot supply that understanding. This delays fixing the real problem and risks acting on a decision that is not the client's.
Key takeaway
The provider obtains informed consent by disclosing the procedure, risks, and alternatives; the nurse confirms understanding and voluntariness, witnesses the signature, and notifies the provider when the client's understanding is incomplete.
A charge nurse is making assignments on a medical-surgical unit. One RN has floated from the postpartum unit and has not worked on this unit before. Which client is best to assign to the float nurse?
Correct answer: D
A float nurse should receive a stable, predictable client whose care does not require unit-specific equipment, complex assessment, or new teaching. The client recovering from laparoscopic cholecystectomy with controlled pain and routine oral medications is the safest match. Continuous bladder irrigation, a new tracheostomy with teaching, and a chest tube system that was disrupted require nurses familiar with those assessments and complications.
Why the other options are wrong
- A. Continuous bladder irrigation and bladder spasms require assessment for obstruction, bleeding, and irrigation flow; this is not the best assignment for an unfamiliar float nurse.
- B. A new tracheostomy with suctioning and discharge teaching needs airway-specific assessment and teaching, so it is not the best float assignment.
- C. A chest tube drainage system that was knocked over needs focused assessment of the system and the client, so it should stay with a nurse familiar with chest tube management.
Key takeaway
Assign the float nurse the stable, predictable client with routine care. Keep clients with specialized equipment, disrupted devices, new teaching, or high assessment needs with nurses familiar with the unit.
Which tasks can the nurse appropriately delegate to unlicensed assistive personnel (UAP)? Select all that apply.
Correct answers: o1, o2, o3, o5
UAP may perform routine, standardized tasks for stable clients: vital signs, assisting to the bathroom, recording intake and output, and helping with meals. Evaluating whether a medication worked requires nursing judgment, and reinforcing teaching is within the LPN/LVN or RN scope, not UAP.
Why the other options are wrong
- o4. Evaluating medication effectiveness is a nursing evaluation task. Key distinction: The nurse must assess the client's response to medication and determine if further intervention is needed, which requires clinical judgment.
- o6. Reinforcing teaching requires assessing the client's understanding and correcting technique. Key distinction: Only licensed nurses (LPNs or RNs) have the clinical background to reinforce discharge instructions.
Key takeaway
Delegate routine, predictable tasks for stable clients to UAP; keep evaluation and teaching with licensed staff.
A nurse begins the shift after receiving the hand-off report on four clients on a medical unit. Which client should the nurse assess first?
Correct answer: C
Rule: new restlessness or agitation is one of the earliest signs of hypoxia, and it shows up before the oxygen saturation drops or the skin turns dusky. A pneumonia client who becomes newly restless with a respiratory rate of 24 is showing early hypoxia, a breathing threat that comes first. The 9 out of 10 flank pain is severe but expected with a stone and already has an ordered opioid, the low-grade post-op fever is an expected inflammatory response with an intact dressing, and the COPD cough that clears with coughing is this client's unchanged baseline.
Why the other options are wrong
- A. 9 out of 10 pain is the highest number and feels most urgent, but renal colic pain is expected and a PRN opioid already covers it, so pain does not outrank a breathing threat.
- B. A low-grade fever the day after surgery is an expected inflammatory response with a clean, intact dressing, not a new physiologic threat.
- D. A productive cough with coarse rhonchi that clear with coughing is this COPD client's baseline, not a new change that needs first attention.
Key takeaway
New restlessness or agitation is an early sign of hypoxia and outranks expected pain, a low-grade fever, or a chronic respiratory baseline.
A nurse is reviewing the care of a client who is in soft wrist restraints for pulling at a nasogastric tube. Which finding requires the nurse to follow up?
Correct answer: B
Rule: restraints require a time-limited order for a specific episode, and standing or as-needed (PRN) restraint orders are prohibited, because each use must be individually justified and evaluated. The order written 'as needed for agitation' is a PRN restraint order and is not permitted, so the nurse must follow up to obtain a proper time-limited order. Securing the restraint to the movable part of the bed frame with quick-release ties, releasing and providing care every 2 hours, and an in-person provider evaluation are all correct restraint practices that need no correction.
Why the other options are wrong
- A. Tying a restraint anywhere can look unsafe. Securing it with a quick-release tie to the part of the bed frame that moves with the client, not to a side rail, is exactly the correct technique, so this finding needs no follow-up.
- C. Frequent checks might seem to signal a problem. Releasing the restraint and offering range of motion, fluids, and toileting every 2 hours is the required standard of care for a restrained client, so it is appropriate.
- D. A same-day, in-person provider evaluation of a restrained client is appropriate care, and for a nonviolent medical restraint it even exceeds the minimum, so it is not a lapse and does not require follow-up. (The 1-hour face-to-face requirement applies specifically to violent or self-destructive behavior restraints.)
Key takeaway
Restraints need a time-limited order for a specific episode; PRN or standing restraint orders are never allowed. Attaching to the fixed bed frame, releasing with care every 2 hours, and an in-person evaluation are correct practices.
A nurse on a medical unit answers the phone. The caller says she is the client's daughter and asks for an update on the client's condition. Which action should the nurse take?
Correct answer: B
Rule: a family relationship does not by itself grant access to protected health information, and identity cannot be assumed over the phone, so the nurse releases information only to a caller the client has authorized, only after verifying identity, and only the minimum necessary. On admission the client designates who may receive information and a way to confirm the caller, so matching this caller to that identifier and disclosing only what the client approved is the lawful path.
Why the other options are wrong
- A. A concerned daughter can seem entitled to know, but being a relative is not the same as being an authorized recipient, and a voice on the phone is unverified, so disclosing here would breach confidentiality.
- C. Refusing to confirm the client is even present sounds like the safest, most private choice, but it is more restrictive than the law requires. There is an established process to release information to a verified, authorized caller, so shutting down every call is not the standard.
- D. Asking for a date of birth and medical record number looks like real verification, but those identifiers are not secret and can be known or obtained by others, so they do not prove the caller is the person the client authorized. The client-designated identifier is what confirms identity.
Key takeaway
Being family is not authorization. Release information only to a caller the client has authorized, verify identity with the client-designated identifier, and share the minimum necessary.
Which situations require the nurse to make a mandatory report to the appropriate authority? Select all that apply.
Correct answers: o1, o2, o4, o5
Suspected abuse or neglect of a child or older adult and specific communicable diseases such as active tuberculosis and gonorrhea are mandatory reports to public health authorities. A client's request for privacy and a capable adult's refusal of treatment are protected rights, not reportable events.
Why the other options are wrong
- o3. Under HIPAA, a competent adult client has the right to restrict disclosure of their health information to family members unless a specific legal exception applies. Key distinction: Confidentiality must be maintained unless overridden by specific mandatory abuse or public health reporting laws.
- o6. The principle of autonomy grants a competent adult the legal right to refuse medical therapy, even life-saving treatment. Key distinction: Treatment refusal does not by itself trigger a mandatory report when the adult has decision-making capacity.
Key takeaway
Mandatory reporting covers suspected abuse or neglect and specific communicable diseases, not a client's private choices.
A charge nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is appropriate to delegate to a UAP?
Correct answer: A
A UAP may perform standardized assistance for a stable client after the nurse has completed the required assessment and plan. Assisting with a prescribed pureed meal is appropriate after the nurse has verified the swallowing plan. Teaching about a new inhaler, first orthostatic measurements for symptomatic dizziness, and first ambulation after epidural anesthesia all require nursing assessment or teaching and should not be delegated to a UAP.
Why the other options are wrong
- B. Teaching and medication instruction stay with licensed nursing staff; a UAP may remind or report but does not reinforce new inhaler teaching.
- C. A first orthostatic assessment for a symptomatic client requires nursing judgment about dizziness, blood pressure change, and safety.
- D. First ambulation after epidural anesthesia requires the nurse to assess motor return, sensation, and blood pressure before delegating mobility assistance.
Key takeaway
Delegate stable, standardized care only after the nurse has assessed the client and set the plan. Teaching, first-time assessments, and first mobility after a risk-producing procedure stay with the nurse.
A charge nurse on a medical-surgical unit is making shift assignments and has a float RN who normally works on the mother-baby (postpartum) unit. Which client is most appropriate to assign to the float nurse?
Correct answer: C
Rule: assign a float nurse the clients whose care falls within that nurse's demonstrated competency, not automatically the least sick client and not the most complex client just because a float is still an experienced RN. A nurse from the mother-baby unit routinely delivers general postoperative and incisional care, medication administration, and monitoring for expected recovery, so the first-day appendectomy client fits her skill set even with a low-grade fever. Titrating an insulin infusion to hourly glucose values, managing new atrial fibrillation on a monitor, and maintaining a chest tube on water-seal drainage are specialized skills a postpartum nurse has not demonstrated, so they stay with the unit's regular staff.
Why the other options are wrong
- A. Hourly insulin titration can look like a task any RN can follow, but adjusting a high-alert infusion to changing glucose values is a specialized skill the float nurse has not demonstrated, so it belongs to regular staff.
- B. A float is an experienced nurse, so the sickest client can seem like the right assignment, yet new atrial fibrillation on a monitor needs telemetry and cardioversion skills outside routine postpartum practice.
- D. This client is stable and awaiting transfer, so it reads as the safe, easy pick, but a chest tube on water-seal drainage requires specialized respiratory and drainage-system monitoring the float nurse has not demonstrated, so a stable label does not make it appropriate.
Key takeaway
Match a float or agency nurse to clients within the nurse's demonstrated competency. Do not default to the calmest client or hand the float the sickest one just because she is an RN.
A 78-year-old client who lives alone is scheduled for discharge home today after treatment for a fall. The discharge plan includes a new front-wheeled walker and new home oxygen. During discharge preparation the nurse notes that the client cannot demonstrate safe walker use after two teaching sessions, states the only bathroom is up a flight of stairs, and says, 'My daughter usually helps me but she is out of the country for two weeks.' The provider has written the discharge order. Which action should the nurse take first?
Correct answer: B
Rule: a nurse should not carry out a discharge into an environment the client cannot manage, even when a discharge order exists; when the whole plan will not keep the client safe, the nurse stops and involves the provider and case manager so the disposition can be changed, for example to short-term rehabilitation. Three cues stack up here: the client cannot demonstrate safe walker use after two sessions, the only bathroom is up a flight of stairs, and the usual caregiver is away for two weeks, all with new home oxygen. Oxygen teaching, a physical therapy reassessment, and a single same-day home health visit each fix one fragment, but the client would still go home today unable to walk safely, unable to reach the bathroom, and alone with new oxygen. Only reassessing the plan and arranging a different disposition addresses the whole picture.
Why the other options are wrong
- A. Teach-back is best practice and can feel responsible. Oxygen teaching fixes only one gap and does nothing about the client's inability to walk safely or reach the bathroom, so completing it would still send the client home in an unmanageable setting.
- C. A physical therapy reassessment addresses gait and stairs, and it feels thorough, but it still ends with the client going home today alone, and one reassessment does not make an upstairs-only bathroom reachable or replace the absent caregiver.
- D. Same-day home health and a brief transport delay sound like solid continuity planning, but a single visit does not cover the first night and beyond alone with new oxygen, stairs, and an unsteady gait, so the core safety problem remains.
Key takeaway
A discharge order does not obligate the nurse to send a client home when the plan will not keep them safe. Reassess and change the disposition through the provider and case manager rather than layering on piecemeal tasks.
A provider prescribes an anticoagulant dose that the nurse believes is unsafe for the client. The nurse contacts the provider to express the concern, but the provider insists the dose be given as written. Which action should the nurse take next?
Correct answer: C
When a nurse believes an order is unsafe, the duty to the client does not end after questioning the provider. If the provider insists and the concern remains, the nurse withholds the dose and moves up to the charge nurse or nursing supervisor. The nurse never carries out an order believed to be unsafe and never rewrites the dose independently, because prescribing is outside the RN scope. Option C both protects the client by holding the dose and pursues resolution through the proper authority.
Why the other options are wrong
- A. Giving the dose because the provider reviewed and confirmed it makes the nurse responsible for administering a medication the nurse believes will harm the client. Confirmation of an order does not relieve the nurse of the independent duty to refuse to carry out an unsafe order.
- B. Adjusting the dose to what the nurse judges safe is prescribing, which is outside the RN scope of practice. Altering an order unilaterally replaces one unsafe act with another and bypasses the prescriber entirely.
- D. Documenting the concern is appropriate, but holding the drug without notifying anyone leaves the problem unresolved and the client without needed therapy. Escalate to the proper authority to reach a safe decision.
Key takeaway
If a provider insists on an order you believe is unsafe, hold it and escalate to the charge nurse or nursing supervisor. Do not administer it, and do not change it yourself.