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.
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.
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 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.
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.
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.
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.