Management of Care – RN Practice Questions

Fifteen NCLEX-RN-style practice items on Management of Care. Items include standard multiple-choice and select-all-that-apply (SATA) formats. Answers reference the numbered options as they appear on the page. Review the core article before attempting these.

Question 1

A registered nurse is working on a medical-surgical unit with an assistive personnel (AP). Which task is most appropriate for the nurse to delegate to the AP?

1. Assessing a newly admitted client's risk for pressure injury.
2. Reinforcing teaching about a low-sodium diet with a client who has heart failure.
3. Assisting a stable client on postoperative day 3 to ambulate in the hallway.
4. Obtaining the first set of vital signs on a client who has just returned from the post-anesthesia care unit.

Answer: 3. Assisting a stable client on postoperative day 3 to ambulate in the hallway.

Rationale: Ambulation of a client who is stable, whose activity order is established, and whose response to ambulation is predictable is a standard, unvarying task with minimal risk, which meets the criteria for the right task and right circumstance. Option 1 is an assessment and is never delegated. Option 2 is reinforcement of teaching, which falls to a licensed nurse such as an LPN, not to unlicensed personnel. Option 4 involves a client whose condition is not yet established as stable after anesthesia; the first post-PACU vital signs are part of the receiving nurse's assessment.

Question 2

A registered nurse receives report on four clients. Which client should the nurse assess first?

1. A client 2 days after abdominal hysterectomy who reports incisional pain rated 6 on a 0 to 10 scale.
2. A client with chronic obstructive pulmonary disease whose oxygen saturation is 90% on 2 L/min by nasal cannula.
3. A client with a new tracheostomy who has audible gurgling and a moist, congested cough.
4. A client with type 2 diabetes mellitus whose fasting blood glucose is 168 mg/dL.

Answer: 3. The client with a new tracheostomy who has audible gurgling and a moist, congested cough.

Rationale: Gurgling and a congested cough indicate secretions in the airway. Airway takes precedence over every other finding under the ABC framework, and this client needs suctioning now. Option 1 is expected postoperative pain and can be treated after the airway is addressed. Option 2 is an acceptable saturation for a client with COPD, in whom a target of roughly 88% to 92% is commonly appropriate; this is an expected finding, not a deterioration. Option 4 is an elevated but non-emergent glucose that does not threaten airway, breathing, or circulation.

Question 3

A registered nurse is planning assignments for a licensed practical nurse (LPN) who will care for a group of stable clients. Which tasks are appropriate to assign to the LPN? Select all that apply.

1. Administering an oral antihypertensive medication.
2. Performing a sterile dressing change on a stage 3 pressure injury.
3. Developing the plan of care for a newly admitted client.
4. Inserting an indwelling urinary catheter.
5. Administering intravenous push furosemide.
6. Reinforcing teaching about crutch walking that the registered nurse initiated.

Answer: 1, 2, 4, and 6.

Rationale: Administering oral medications, performing sterile wound care, inserting a urinary catheter, and reinforcing previously initiated teaching are all within the customary LPN scope for a stable client with a predictable outcome. Option 3 is care planning, which requires nursing diagnosis and judgment and belongs to the registered nurse. Option 5 is an intravenous push medication, which in most jurisdictions is outside LPN scope and is reserved for the registered nurse. State nurse practice acts vary, and the nurse must verify scope in the state of licensure.

Question 4

A client scheduled for a laparoscopic cholecystectomy has an unsigned consent form on the chart. When the registered nurse enters the room, the client says, "So they are taking out part of my stomach, right?" Which action should the nurse take?

1. Explain that the gallbladder, not the stomach, will be removed, and then witness the signature.
2. Witness the signature and document the client's statement in the record.
3. Notify the surgeon that the client does not understand the planned procedure.
4. Ask a family member to explain the surgery to the client.

Answer: 3. Notify the surgeon that the client does not understand the planned procedure.

Rationale: The provider performing the procedure is legally responsible for disclosing its nature, risks, benefits, and alternatives. The nurse's role is to witness the signature, confirm that consent is voluntary, and verify that the client understands. When understanding is absent, the nurse stops the process and notifies the provider to complete the disclosure. Option 1 has the nurse assume the provider's disclosure duty. Option 2 obtains a signature the nurse already knows is uninformed. Option 4 delegates disclosure to someone with no clinical or legal standing to give it.

Question 5

A charge nurse is making assignments and has a nurse floated from the postpartum unit to a medical-surgical unit. Which client should the charge nurse assign to the float nurse?

1. A client receiving a continuous heparin infusion requiring hourly titration based on laboratory results.
2. A client 1 day after total knee arthroplasty with stable vital signs who is awaiting physical therapy.
3. A client newly admitted with chest pain whose troponin result is pending.
4. A client with septic shock receiving norepinephrine.

Answer: 2. The client 1 day after total knee arthroplasty with stable vital signs who is awaiting physical therapy.

Rationale: A floated nurse should receive the most stable clients with the most predictable needs, because the nurse's orientation to the unit, its population, and its resources is limited. Options 1, 3, and 4 all involve clients who are unstable or whose status is undetermined and who require specialized medical-surgical or critical care judgment. Floating a nurse is permissible; assigning that nurse to clients whose care exceeds the nurse's demonstrated competence is not, and the charge nurse retains accountability for the assignment.

Question 6

A newly hired registered nurse tells the preceptor, "This client has a do-not-resuscitate order, so I do not think we should give the antibiotic that was ordered for the pneumonia." Which response by the preceptor is best?

1. "You are right. A do-not-resuscitate order means we provide comfort measures only."
2. "A do-not-resuscitate order applies only to resuscitation. The antibiotic should be administered as ordered."
3. "Let us call the provider to find out whether treatment is still appropriate for this client."
4. "The family should decide whether the antibiotic is given."

Answer: 2. "A do-not-resuscitate order applies only to resuscitation. The antibiotic should be administered as ordered."

Rationale: A do-not-resuscitate order directs that cardiopulmonary resuscitation not be performed. It does not withdraw or limit any other indicated treatment, including antibiotics, oxygen, analgesia, nutrition, or wound care, unless those limits are separately documented. Option 1 confuses a do-not-resuscitate order with comfort-measures-only status. Option 3 delays an ordered treatment for a question that already has a clear answer. Option 4 misplaces a treatment decision that has already been ordered and to which the client has not objected.

Question 7

A nursing student asks which elements must be proven for a nurse to be found liable for malpractice. The nurse should identify which elements? Select all that apply.

1. The nurse owed a duty to the client.
2. The nurse breached the accepted standard of care.
3. The nurse intended to cause harm to the client.
4. The breach of duty caused the client's injury.
5. The client sustained actual damages.
6. An incident report was completed.

Answer: 1, 2, 4, and 5.

Rationale: Malpractice is professional negligence and requires all four elements: duty, breach of duty, causation, and damages. If any single element fails, the claim fails. Option 3 describes intent, which is an element of intentional torts such as battery, not of negligence; malpractice can occur with no intent whatsoever. Option 6 describes an internal risk-management document that is neither required for nor determinative of liability, and which is not part of the medical record.

Question 8

A registered nurse receives an order that reads "heparin 25,000 units subcutaneously now" for a client on prophylaxis. Which action should the nurse take first?

1. Administer the dose and monitor the client closely for bleeding.
2. Hold the dose and contact the prescribing provider to clarify the order.
3. Ask a more experienced nurse to administer the medication.
4. Document the order as an error and notify risk management.

Answer: 2. Hold the dose and contact the prescribing provider to clarify the order.

Rationale: A prophylactic subcutaneous heparin dose is typically 5,000 units, and 25,000 units is a recognizable and potentially lethal deviation. A nurse who carries out an order believed to be incorrect shares liability with the prescriber; the presence of an order is never a defense for administering an unsafe dose. The first step is to clarify directly with the prescriber, and if the concern is not resolved, to escalate through the chain of command. Option 1 administers a dose the nurse already suspects is wrong. Option 3 transfers the act but not the problem. Option 4 skips the clarification that may resolve the issue immediately.

Question 9

A client is admitted unresponsive with a valid living will stating that mechanical ventilation is not desired. The client's adult daughter, who is not the named health care proxy, insists that the client be intubated. Which action should the registered nurse take?

1. Honor the daughter's request, since the client is unable to speak.
2. Notify the provider, contact the named health care proxy, and review the advance directive with the care team.
3. Inform the daughter that the directive cannot be discussed and end the conversation.
4. Ask the daughter to sign a consent form for intubation.

Answer: 2. Notify the provider, contact the named health care proxy, and review the advance directive with the care team.

Rationale: A valid advance directive takes effect when the client loses decision-making capacity and expresses that client's own autonomous choice. The named health care proxy, not the most vocal family member, is the authorized decision maker. The nurse advocates for the client by ensuring the directive is known to the team, involving the proxy and the provider, and requesting an ethics consultation if conflict persists. Option 1 substitutes an unauthorized surrogate's wishes for the client's documented wishes. Option 3 abandons a grieving family member who needs support and information. Option 4 seeks consent from a person without authority to give it.

Question 10

A registered nurse is reviewing the care of a client in bilateral soft wrist restraints for violent behavior. Which finding requires immediate intervention?

1. The restraints are secured to the movable portion of the bed frame with quick-release knots.
2. The restraints have been released every 2 hours for range of motion and toileting.
3. The order reads "soft wrist restraints as needed for agitation."
4. A face-to-face evaluation was documented 40 minutes after the restraints were applied.

Answer: 3. The order reads "soft wrist restraints as needed for agitation."

Rationale: As-needed and standing orders for restraint are prohibited. Each episode of restraint requires an individualized, time-limited order, and orders for violent or self-destructive behavior must be renewed at maximum intervals of 4 hours for adults 18 and older, 2 hours for ages 9 through 17, and 1 hour for children under 9. Option 1 describes correct technique: securing to the movable bed frame allows the restraint to move with the bed, and a quick-release knot permits rapid removal. Option 2 reflects appropriate monitoring. Option 4 meets the requirement that a face-to-face evaluation occur within 1 hour of initiation.

Question 11

A registered nurse is performing triage at the scene of a multivehicle collision with limited resources and prolonged transport times. Which client should be tagged as immediate (red)?

1. A 40-year-old with an open tibia fracture who is alert with a strong radial pulse.
2. A 28-year-old with severe dyspnea, absent breath sounds on the right, and tracheal deviation to the left.
3. A 60-year-old with an open head injury, agonal respirations, and fixed, dilated pupils.
4. A 22-year-old with multiple superficial lacerations who is walking around the scene.

Answer: 2. The 28-year-old with severe dyspnea, absent breath sounds on the right, and tracheal deviation to the left.

Rationale: These findings suggest a tension pneumothorax, a life-threatening condition that is rapidly reversible with a simple intervention, which is exactly the profile of an immediate or red tag. Option 1 is a serious injury that can tolerate a short delay and is tagged delayed or yellow. Option 3 describes an injury unlikely to be survivable with available resources and is tagged expectant or black. Option 4 is a walking wounded client tagged minimal or green. The key concept is that disaster triage shifts from doing the most for each individual to achieving the greatest good for the greatest number, which reverses the usual rule that the most critically injured is treated first.

Question 12

A client is found on the floor beside the bed. Which entry in the medical record is most appropriate?

1. "Client fell out of bed because the assistive personnel left the side rail down."
2. "Found client on floor at 0410. Vital signs stable. Provider notified. Incident report completed."
3. "Found client on floor beside bed at 0410. Assessed for injury; no deformity or bleeding noted; vital signs obtained and recorded; provider notified; neurologic checks initiated per protocol."
4. "Client had an unwitnessed fall during the night. Appears no harm was done."

Answer: 3.

Rationale: Documentation must be factual, objective, complete, and timely, and should record what was observed, what was done, and how the client responded. Option 1 records blame and an unwitnessed assumption about cause. Option 2 documents that an incident report was completed; the incident report is an internal risk-management tool and its existence should not be recorded in the medical record. Option 4 is vague and states a conclusion ("appears no harm") rather than assessment findings.

Question 13

A registered nurse is reviewing confidentiality practices on the unit. Which actions represent a breach of client confidentiality? Select all that apply.

1. Discussing a client's laboratory results with the physical therapist who is treating that client.
2. Accessing the electronic record of a coworker who was admitted to the unit but is not assigned to the nurse.
3. Posting a photograph of the unit break room on social media that includes a visible assignment board with client names.
4. Leaving a workstation logged in and unattended at the nurses' station.
5. Giving a verbal handoff report to the oncoming nurse who is assuming care of the client.
6. Telling a client's neighbor who telephones the unit that the client is improving.

Answer: 2, 3, 4, and 6.

Rationale: Protected health information may be disclosed only to those with a legitimate need to know for treatment, payment, or health care operations, and only the minimum necessary. Accessing a record without a care relationship is a breach regardless of intent or curiosity (option 2). Incidental disclosure through a photograph is still disclosure (option 3). An unattended logged-in workstation exposes records to anyone passing by (option 4). A caller with no authorization has no right to any information, including confirmation that the client is present (option 6). Options 1 and 5 are permitted disclosures to members of the treatment team caring for that client.

Question 14

A registered nurse is delegating vital sign monitoring to an assistive personnel for a client who received a new antihypertensive. Which statement best demonstrates the right direction and communication?

1. "Please check vital signs on everyone this morning."
2. "Take Mr. Lopez's blood pressure and heart rate every 2 hours and tell me right away if the systolic pressure is below 100 or the heart rate is above 110."
3. "Keep an eye on Mr. Lopez. He has been a little unstable today."
4. "Get vital signs whenever you have time, and chart them before the end of the shift."

Answer: 2.

Rationale: The right direction and communication requires that the delegation be clear, concise, correct, and complete, specifying the task, the time frame, the expected outcome, and exactly what to report and when. Option 2 names the client, the measurements, the frequency, and specific parameters that trigger an immediate report. Options 1 and 4 lack specificity and urgency. Option 3 gives no measurable task or reporting parameter, and it also describes an unstable client, whose monitoring should not be delegated to unlicensed personnel in the first place.

Question 15

A client recovering from a stroke coughs and develops a wet, gurgling voice after taking sips of water. Which action should the registered nurse take first?

1. Request a referral to the registered dietitian for a thickened-liquid diet.
2. Stop oral intake, notify the provider, and request a swallow evaluation by speech-language pathology.
3. Instruct the assistive personnel to feed the client more slowly.
4. Teach the client to tuck the chin toward the chest while swallowing.

Answer: 2. Stop oral intake, notify the provider, and request a swallow evaluation by speech-language pathology.

Rationale: Coughing and a wet vocal quality after swallowing are signs of aspiration. The immediate priority is to protect the airway by stopping oral intake, then to notify the provider and obtain a formal swallow evaluation, which is the speech-language pathologist's role. Option 1 identifies a useful team member but selects a diet modification before the swallowing deficit has been characterized. Option 3 continues oral intake in a client who is aspirating and delegates feeding of an at-risk client to unlicensed personnel. Option 4 is a compensatory technique that may be appropriate later, but only after evaluation and with the specific strategy recommended for that client.

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