NCLEX-RN Management of Care practice questions

Question 1

A charge nurse on a medical-surgical unit is making client assignments for the day shift and must assign one client to a licensed practical nurse (LPN) working under RN supervision. Which client is most appropriate for this assignment?

1. A A 74-year-old client newly admitted with chest pain who requires an admission history and physical.
2. B A 68-year-old client with a stable colostomy who needs a pouch change and abdominal assessment.
3. C A 45-year-old client receiving a first unit of packed red blood cells for symptomatic anemia.
4. D A 52-year-old client who is 2 hours postoperative from bowel resection and needs first ambulation.

Question 2

A quality improvement team on a medical-surgical unit reviews data showing that 12% of clients with indwelling urinary catheters develop a catheter-associated urinary tract infection (CAUTI) within 72 hours. The team implements a new protocol requiring daily nurse assessment of catheter necessity and removal of catheters that are no longer indicated. Which outcome measure best indicates that this intervention is effective?

1. A A reduction in the CAUTI rate to 4% over the next 3 months.
2. B A higher rate of client satisfaction scores on nursing communication.
3. C An increase in the number of catheter kits ordered by the unit each month.
4. D A decrease in the average length of stay for all hospitalized clients.

Question 3

The RN on a medical-surgical unit is planning to delegate tasks to an unlicensed assistive personnel (UAP) for a stable client recovering from an appendectomy. Which task is appropriate to delegate to the UAP?

1. A Teaching the client about incision care prior to discharge
2. B Assisting the client to ambulate to the bathroom
3. C Administering the client's scheduled dose of intravenous antibiotic
4. D Assessing the client's bowel sounds and abdominal distention

Question 4

A nurse is working at a clinic and receives a phone call from a person who identifies themselves as the spouse of a client. The caller asks for the client's laboratory results. The client has not signed a release of information form. Which response by the nurse is most appropriate?

1. A Explain that the information cannot be disclosed without the client's written authorization.
2. B Ask the caller to come to the clinic in person to receive the information.
3. C Provide the results because the caller is the client's spouse and has a right to know.
4. D Transfer the call to the client's healthcare provider for further discussion.

Question 5

A 58-year-old client with acute respiratory failure is on a mechanical ventilator in the intensive care unit. The nurse notes the fraction of inspired oxygen is 0.70 and the arterial blood gas shows a partial pressure of oxygen of 55 mm Hg. The respiratory therapist recommends increasing positive end-expiratory pressure. Which interprofessional collaboration action should the nurse take first?

1. A Implement the respiratory therapist's recommendation after documenting the current settings.
2. B Adjust the ventilator per the respiratory therapist's recommendation and reassess in 15 minutes.
3. C Request a chest x-ray before making any changes to the ventilator settings.
4. D Contact the attending physician to discuss the recommended change in ventilator settings.

Question 6

A registered nurse who normally works on a postpartum unit is floated to a pediatric intensive care unit because of a staffing shortage. The charge nurse assigns the float nurse to care for a 2-year-old client on a ventilator. The float nurse has no pediatric critical care experience. Which action is the float nurse's legal responsibility?

1. A Complete the assignment while avoiding all ventilator-specific nursing tasks.
2. B Refuse to work the shift because the assignment exceeds current competency.
3. C Accept the assignment and ask another nurse to double-check all care given.
4. D Notify the charge nurse of the lack of pediatric critical care experience.

Question 7

A registered nurse is delegating tasks to a nursing assistant on a busy medical unit. Which task should the RN delegate to the nursing assistant?

1. A Feeding a client with dysphagia who requires thickened liquids and has a known aspiration risk.
2. B Changing the dressing on a central line insertion site that has a small amount of serous drainage.
3. C Assisting a client with a history of falls to ambulate to the bathroom using a gait belt.
4. D Measuring the blood pressure of a client who just received a dose of intravenous hydralazine for hypertension.

Question 8

A nurse is working on a surgical unit and receives a phone call from a person who states they are the client's spouse and asks for the client's laboratory results. The client's medical record lists the spouse as an emergency contact, but the client has not signed a release of information for the spouse. Which response by the nurse is most appropriate?

1. A Ask for the spouse's name and date of birth, then provide the results if they match
2. B Explain that the information cannot be disclosed without the client's written consent
3. C Transfer the call to the client's room so the spouse can speak directly with the client
4. D Provide the laboratory results since the caller is the emergency contact

Question 9

A 42-year-old client is admitted with a suspected deep vein thrombosis. The provider orders a heparin infusion at 1000 units/hr. The nurse notes that the client's weight is 85 kg and the recommended starting dose is 18 units/kg/hr. The prescribed dose is below the protocol. Which action should the nurse take?

1. A Increase the infusion rate to 1530 units/hr per the protocol
2. B Administer the prescribed dose and document the protocol deviation
3. C Hold the infusion and notify the provider of the discrepancy
4. D Administer the prescribed dose and monitor for bleeding

Question 10

A mass casualty incident occurs when a bus collides with a tanker truck, releasing an unknown chemical. Four clients arrive at the emergency department simultaneously. Which client should the triage nurse assign the highest priority (red tag) for immediate treatment?

1. A A 45-year-old with a palpable radial pulse, respiratory rate 28/min, and a deep laceration to the forearm with moderate bleeding.
2. B A 52-year-old who is awake and oriented, with a respiratory rate of 22/min, and a simple fracture of the left tibia.
3. C A 30-year-old with a respiratory rate of 32/min, capillary refill less than 2 seconds, and a large contusion on the chest.
4. D A 60-year-old with no spontaneous breathing, no palpable carotid pulse, and fixed and dilated pupils.