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 new graduate nurse asks the charge nurse to review the five rights of delegation. Which statements correctly describe these rights? Select all that apply.
- A.The right task is one that can safely be delegated for a specific client
- B.The right person is both qualified and competent to perform the task
- C.The right communication includes clear directions and expected outcomes
- D.Once a task is delegated, the RN no longer holds accountability for the outcome
- E.The right supervision includes monitoring, intervening, and giving feedback
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Correct answers: A, B, C, E
The five rights of delegation are right task, right circumstance, right person, right communication, and right supervision. The delegating RN stays accountable for the overall outcome even after handing off the task; that accountability never transfers. Right communication means clear, specific directions with expected results, and right supervision means the RN monitors, steps in if needed, and follows up with feedback. The one false statement is the belief that delegation ends the nurse's accountability.
Why the other options are wrong
- D. The RN always retains accountability for the delegation decision and outcome; only the task itself is handed off.
Key takeaway: Delegation transfers the task but never the RN's accountability for the outcome.
Four clients call out needs at the start of the shift. Which client should the RN assess first?
- A.A client requesting PRN pain medication for a headache rated 4 out of 10
- B.A client reporting new shortness of breath and audible wheezing
- C.A client asking for help to the bathroom
- D.A client wanting to discuss discharge plans for tomorrow
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Correct answer: B
Airway and breathing come before everything else. New shortness of breath with audible wheezing is an acute airway/breathing problem that can deteriorate fast, so see this client first. The other needs are real but lower priority: pain at 4 out of 10, a routine mobility request, and discharge teaching can all wait minutes. When prioritizing, an acute physiologic threat outranks comfort, safety-of-falls, and teaching needs.
Why the other options are wrong
- A. Moderate pain is a comfort need that can wait briefly behind an airway threat.
- C. A bathroom request is a safety/mobility need but not life-threatening; delegate or address after.
- D. Discharge teaching is planned, non-urgent, and can be scheduled later.
Key takeaway: A new airway or breathing problem beats pain, mobility, and teaching needs every time.
A charge nurse is determining which tasks may be delegated to a UAP. Select all tasks that are appropriate to delegate.
- A.Assisting a stable client with a bed bath
- B.Ambulating a stable client in the hallway
- C.Collecting a routine clean-catch urine specimen
- D.Adjusting the rate of a continuous IV infusion based on the client's blood pressure
- E.Developing the nursing plan of care for a new admission
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Correct answers: A, B, C
Delegate routine, standardized tasks with predictable outcomes for stable clients. Bed baths, ambulating a stable client, and collecting a routine specimen are all activities of daily living or simple data collection that UAP are trained to perform. Titrating IV fluids requires assessment and judgment, and creating a plan of care is part of the nursing process. Both of those stay with the RN because they depend on clinical reasoning, not a fixed procedure.
Why the other options are wrong
- D. Adjusting an infusion based on blood pressure is titration requiring nursing judgment, never delegated to UAP.
- E. Developing the plan of care is part of the nursing process and is an RN-only function.
Key takeaway: UAP handle ADLs and routine data collection; anything needing assessment or the nursing process stays with the RN.
A charge nurse is assigning tasks on a medical-surgical unit. Which task is most appropriate to delegate to unlicensed assistive personnel (UAP)?
- A.Recording the intake and output for a stable client recovering from elective surgery
- B.Performing the admission assessment on a newly arrived client
- C.Teaching a client how to use an incentive spirometer
- D.Evaluating whether a PRN pain medication was effective
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Correct answer: A
Delegate tasks that are routine, standardized, and have a predictable outcome for a stable client. Recording intake and output fits: it's data collection on a stable post-op client, no clinical judgment required. The other three demand the RN's assessment, teaching, or evaluation skills. UAP can gather objective measurements, but interpreting them and acting on them stays with the licensed nurse.
Why the other options are wrong
- B. Admission assessment is the initial assessment, an RN-only responsibility that cannot be delegated.
- C. Client teaching requires the nurse's knowledge base and cannot be delegated to UAP.
- D. Evaluating medication effectiveness is judgment and outcome evaluation, which the RN retains.
Key takeaway: Delegate routine, predictable tasks for stable clients; keep assessment, teaching, and evaluation with the RN.
During a sudden surge of admissions with limited staff, a charge nurse must manage resources safely. Which actions reflect appropriate resource management and prioritization? Select all that apply.
- A.Assign the most unstable clients to the most experienced RNs
- B.Notify the nursing supervisor of the staffing shortfall and request additional help
- C.Delegate stable, routine care tasks to UAPs to free RN time for complex clients
- D.Assign a newly oriented nurse to the two most critically unstable clients
- E.Reassess client acuity and reprioritize assignments as conditions change
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Correct answers: A, B, C, E
Match competence to acuity and escalate when resources fall short. Pairing unstable clients with experienced RNs (A), alerting the supervisor and requesting help (B), delegating routine care to UAPs to protect RN time (C), and continuously reassessing acuity to reprioritize (E) all stretch limited resources safely. Assigning a newly oriented nurse to the two most critical clients (D) mismatches skill to acuity and endangers those clients; novices should take the more stable assignments while experienced staff cover the highest-risk clients.
Why the other options are wrong
- D. Mismatches a novice's skill to the highest-acuity clients, creating unsafe assignments.
Key takeaway: Safe resource management matches skill to acuity, escalates shortfalls, and reprioritizes as conditions change.
A nurse is caring for a client who states, "I want to leave the hospital now. I know it's against my doctor's advice, but I'm going home." The client is alert, oriented, and has decision-making capacity. What is the nurse's best initial action?
- A.Notify security to prevent the client from leaving the unit
- B.Explain the risks of leaving and confirm the client understands them before he goes
- C.Tell the client he cannot leave until the provider discharges him
- D.Remove the client's IV and walk him to the exit without further discussion
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Correct answer: B
A capacitated adult has the right to refuse care and leave, but the duty is to ensure the choice is informed. So the nurse explains the risks of leaving and confirms the client understands them (B), then notifies the provider and documents the against-medical-advice process. Preventing a competent client from leaving with security (A) or telling him he cannot go (C) is false imprisonment. Pulling the IV and rushing him out (D) skips the required risk disclosure and safe-discharge steps.
Why the other options are wrong
- A. Detaining a competent client is false imprisonment and violates his rights.
- C. He can leave; saying otherwise unlawfully restricts a capacitated client.
- D. Skips the mandatory informed-risk discussion and safe-discharge procedure.
Key takeaway: A client with capacity may leave AMA; the nurse ensures the decision is informed and documents it.
A nurse is reviewing the rights guaranteed to clients under the patient bill of rights. Which statements accurately reflect a client's rights? Select all that apply.
- A.The client may refuse treatment, including life-sustaining measures
- B.The client is entitled to confidentiality of personal health information
- C.The client may request to review and obtain a copy of the medical record
- D.The client must accept any treatment ordered by the attending provider
- E.The client has the right to receive information needed to give informed consent
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Correct answers: A, B, C, E
Client rights center on autonomy, privacy, and information. A competent client may refuse any treatment, even life-sustaining care (A); is entitled to confidentiality (B); may access and copy the medical record (C); and must receive the information needed for informed consent (E). The claim that a client must accept whatever the provider orders (D) is the opposite of these rights: clients cannot be forced to accept treatment, so this statement contradicts the principle of autonomy that underlies the bill of rights.
Why the other options are wrong
- D. Contradicts autonomy; a client can never be forced to accept ordered treatment.
Key takeaway: Client rights protect autonomy, privacy, record access, and informed consent, not provider control.
A charge nurse on a medical-surgical unit is making assignments for the shift. Which task is most appropriate to delegate to a licensed practical/vocational nurse (LPN/LVN)?
- A.Develop the discharge teaching plan for a newly diagnosed diabetic client
- B.Reinforce previously taught wound-care instructions for a stable post-operative client
- C.Complete the initial admission assessment for a client arriving from the emergency department
- D.Administer the first dose of intravenous push hydromorphone to a client in pain
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Correct answer: B
Match the task to the license: LPN/LVNs care for stable clients with predictable outcomes and may reinforce teaching the RN has already started, but the RN owns assessment, initial teaching, and unstable situations. Reinforcing established wound-care instructions for a stable post-op client (B) fits that scope perfectly. Developing a teaching plan (A) and the initial admission assessment (C) require RN-level assessment and planning. IV push of a high-alert opioid as a first dose (D) involves evaluating an unpredictable response and, in most states, exceeds LPN scope.
Why the other options are wrong
- A. Tempting because LPNs do teach, but creating the plan is initial teaching and RN-only.
- C. Initial assessment and care planning cannot be delegated; only the RN may perform them.
- D. First-dose IV push opioids require RN assessment of response and exceed typical LPN scope.
Key takeaway: LPN/LVNs work with stable clients and reinforce teaching; RNs keep assessment, initial teaching, and unstable care.
A nurse witnesses a colleague accidentally drop a client's oral medication on the floor, pick it up, and administer it. What is the nurse's priority action?
- A.Assess the client for any adverse effects and notify the provider as indicated
- B.Complete an incident report describing the event in objective terms
- C.Tell the colleague the medication should have been discarded and re-dosed
- D.Document in the client's chart that an incident report was filed
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Correct answer: A
After any error, the client comes first: assess for harm before any paperwork or peer feedback. A contaminated medication can introduce pathogens, so monitoring the client and alerting the provider (A) protects the person at risk. The incident report (B) and the conversation with the colleague (C) follow once the client is safe. Never chart that an incident report was filed (D); the report is an internal risk-management document and referencing it in the medical record can compromise its confidentiality.
Why the other options are wrong
- B. Important, but the report comes after ensuring the client is unharmed.
- C. Peer correction matters but is not the immediate priority over client assessment.
- D. Never reference an incident report in the chart; it breaks its protected status.
Key takeaway: After an error, assess and protect the client first; documentation and feedback come after.
A nurse is reviewing tasks that may be delegated to unlicensed assistive personnel (UAP) on a busy unit. Which tasks are appropriate to delegate to the UAP? Select all that apply.
- A.Measuring and recording vital signs on a stable client
- B.Assisting a stable client with ambulation in the hallway
- C.Evaluating whether a client's pain has decreased after medication
- D.Providing perineal care to an incontinent client
- E.Obtaining a clean-catch urine specimen from a cooperative client
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Correct answers: A, B, D, E
Delegate the routine and standardized, never the nursing judgment. UAPs may collect data and perform standard care: vital signs on a stable client (A), assisting with ambulation (B), hygiene such as perineal care (D), and routine specimen collection (E). What stays with the nurse is assessment, evaluation, teaching, and judgment. Evaluating whether pain has decreased (C) is an evaluation of a treatment's effectiveness and requires nursing judgment, so it cannot be delegated even though the UAP could relay what the client says.
Why the other options are wrong
- C. Evaluating treatment effectiveness is nursing judgment and cannot be delegated to a UAP.
Key takeaway: Delegate routine, standardized data collection and care to UAPs; keep assessment, evaluation, teaching, and judgment.
A client with decision-making capacity has a valid do-not-resuscitate (DNR) order in the chart. The client's adult daughter arrives and tells the nurse, "If his heart stops, I want everything done." How should the nurse respond?
- A.Honor the daughter's wishes and update the code status to full code
- B.Explain that the client's own valid DNR directs care while he has capacity, and offer to facilitate a conversation
- C.Tell the daughter the order cannot be changed and end the discussion
- D.Ask the provider to override the DNR based on the family's request
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Correct answer: B
A competent client's own directive governs; family preference does not override an autonomous decision. Because this client has capacity and a valid DNR, his wishes stand, so the nurse upholds the order while supporting the distressed daughter and offering to facilitate a conversation with the client and team (B). Changing the status for the family (A) or having the provider override it (D) violates the client's autonomy. Flatly shutting the daughter down (C) honors the order but abandons the family and closes communication.
Why the other options are wrong
- A. Family cannot override a capacitated client's own valid directive.
- C. Technically correct but dismissive; it cuts off needed support and communication.
- D. A provider cannot override a competent client's autonomous DNR at family request.
Key takeaway: A capacitated client's own advance directive overrides family wishes; support the family without changing the order.
A nurse is coordinating discharge for a client recovering from a stroke who will need ongoing speech therapy, home modifications, and help arranging medical equipment. Which interdisciplinary referral should the nurse prioritize to coordinate these services?
- A.Case manager
- B.Speech-language pathologist
- C.Occupational therapist
- D.Home health aide
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Correct answer: A
When needs span multiple services and resources, the coordinator role comes first. The case manager arranges and integrates referrals, equipment, and financing across the continuum, so naming the case manager (A) addresses the whole picture. The speech-language pathologist (B) and occupational therapist (C) each handle one discrete need and will be looped in, but they do not coordinate the overall plan. A home health aide (D) provides personal care, not service coordination. The question asks who coordinates, which is the broadest, most encompassing answer.
Why the other options are wrong
- B. Addresses only speech needs, not the broader coordination requested.
- C. Handles home modifications and ADLs but does not coordinate all services.
- D. Provides hands-on personal care, not referral and resource coordination.
Key takeaway: When multiple services and resources are needed, the case manager is the coordinating referral.