NCLEX-RN Management of Care Practice Questions

Coordinating care, delegation, advocacy, and client rights — the largest single area of the NCLEX-RN. It sits under Safe and Effective Care Environment on the NCLEX-RN test plan and carries an approximate weight of 20% of the exam.

Below are 12 practice questions for this domain — 7 multiple-choice and 5 select-all-that-apply. Every item gives a rationale for each option, not just the correct one: on the NCLEX-RN the distractors are usually plausible actions that are simply lower priority, so knowing why an answer is wrong is worth as much as knowing why one is right.

How to use this page. Read the vignette, commit to an answer, and only then open “Show the answer and rationales”. Reading the worked answer first feels productive and teaches almost nothing — the recall attempt is what makes it stick.

Select-all-that-apply items are graded all-or-nothing: partial credit does not exist, so a single missed option loses the whole question.

Easy Select all that apply

1. Advance directives — admission responsibilities

A nurse is completing the admission of an older adult client to a medical unit. The client mentions having a living will and a durable power of attorney for healthcare.

Which actions should the nurse take regarding advance directives? Select all that apply.

  1. Ask whether the client has an advance directive and document the response in the medical record.
  2. Place a copy of the directive in the chart and communicate its existence to the care team.
  3. Inform the client that the directive can be changed or revoked at any time.
  4. Explain that the healthcare power of attorney makes decisions only if the client loses the ability to decide.
  5. Require the client to complete a new living will before treatment can begin.
  6. Tell the client that a spouse can override the directive if the family disagrees with it.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . The Patient Self-Determination Act requires facilities to ask about advance directives on admission and document whether one exists.
  • B. Correct . A directive protects the client only if the team can find and follow it — the nurse ensures it is in the record and known to everyone involved in care.
  • C. Correct . A client with decision-making capacity may revise or revoke an advance directive whenever they choose — current wishes always take precedence.
  • D. Correct . Advance directives activate only when the client can no longer make or communicate decisions — while capable, the client speaks for themself.
  • E. Incorrect . Facilities may not require an advance directive as a condition of care — completing one is always voluntary under the Patient Self-Determination Act.
  • F. Incorrect . Family members cannot override a valid advance directive — the document exists precisely to preserve the client's own wishes when they cannot speak.

Reference: Patient Self-Determination Act of 1990; StatPearls — Patient Self-Determination Act

Easy Multiple choice

2. Delegation — choosing a task for the AP

A nurse on a medical-surgical unit is working with an experienced assistive personnel (AP). The nurse is deciding which care activities can be delegated.

Which task is appropriate for the nurse to delegate to the AP?

  1. Ambulating a stable client who is 2 days postoperative and has walked with assistance several times.
  2. Performing the admission skin assessment for a newly admitted client.
  3. Teaching a client how to use an incentive spirometer.
  4. Evaluating whether a client's pain improved after an oral analgesic.
Show the answer and rationales

Correct answer: A

  • A. Correct . Ambulating a stable client with a predictable course is a routine task within the AP scope — it meets the right task, right circumstance, and right person criteria of the five rights of delegation.
  • B. Incorrect . Assessment is a nursing responsibility that cannot be delegated to assistive personnel — the RN must complete admission and initial assessments.
  • C. Incorrect . Client teaching requires nursing judgment and evaluation of understanding, so it stays with the RN and is never delegated to an AP.
  • D. Incorrect . Evaluating the client's response to an intervention is part of the nursing process and must be performed by the RN, not delegated.

Reference: NCSBN and ANA National Guidelines for Nursing Delegation (2019); StatPearls — Five Rights of Nursing Delegation

Medium Multiple choice

3. Charge nurse — assigning a client to the LPN

A charge nurse on a medical-surgical unit is making assignments for the oncoming shift. The team includes a registered nurse, a licensed practical nurse (LPN), and an assistive personnel.

Which client is most appropriate for the charge nurse to assign to the LPN?

  1. A client 3 days after a colon resection with stable vital signs who needs a scheduled dressing change and oral medications.
  2. A client newly admitted in diabetic ketoacidosis receiving an IV insulin infusion with hourly glucose checks.
  3. A client who just arrived on the unit from the post-anesthesia care unit.
  4. A client beginning the first unit of packed red blood cells.
Show the answer and rationales

Correct answer: A

  • A. Correct . This client is stable with a predictable course, and dressing changes plus oral medication administration fall within the LPN scope of practice — the best match of acuity to skill level.
  • B. Incorrect . This client is unstable and requires ongoing assessment and titration of a continuous IV insulin infusion, which is RN-level care.
  • C. Incorrect . A client newly transferred from PACU needs an initial postoperative assessment, and initial assessments cannot be assigned to the LPN.
  • D. Incorrect . Initiating a transfusion and monitoring during the critical first period require RN assessment because of the risk of acute transfusion reactions.

Reference: NCSBN and ANA National Guidelines for Nursing Delegation (2019)

Medium Multiple choice

4. Disaster triage — immediate category

A nurse is among the first responders at a multiple-vehicle crash with many casualties and limited resources. Using the START triage method, the nurse rapidly assesses four adults.

Which client should the nurse prioritize for immediate treatment?

  1. A client breathing 36/min with a capillary refill of 3 seconds.
  2. A client walking around the scene with abrasions, asking how to help.
  3. A client who remains apneic after one attempt to reposition the airway.
  4. A client with a closed forearm fracture breathing 18/min who follows commands and has capillary refill under 2 seconds.
Show the answer and rationales

Correct answer: A

  • A. Correct . Under START, respirations above 30/min or capillary refill longer than 2 seconds classify a client as immediate (red) — this client has a survivable life threat and is treated first.
  • B. Incorrect . Clients who can walk are triaged minimal (green) — they can wait for care without serious deterioration.
  • C. Incorrect . In mass-casualty triage, a client who does not resume breathing after the airway is opened is tagged expectant (black) so that scarce resources go to salvageable clients.
  • D. Incorrect . Normal respirations, perfusion, and mental status with a non-walking injury classify this client as delayed (yellow) — care can safely wait.

Reference: START triage algorithm (RPM-30-2-Can Do); StatPearls — EMS Mass Casualty Triage

Medium Select all that apply

5. Informed consent — the nurse's role

A client is scheduled for a laparoscopic cholecystectomy. The provider has explained the procedure, its risks and benefits, and the alternatives. The nurse brings the consent form to the client to sign.

Which actions by the nurse are appropriate? Select all that apply.

  1. Witness the client signing the consent form.
  2. Ask the client to describe in their own words what the procedure involves.
  3. Notify the provider if the client says they do not understand the risks.
  4. Confirm that the client is signing voluntarily, without pressure from family or staff.
  5. Explain the surgical risks and the alternatives to the procedure.
  6. Have the client's adult child sign the form because the client appears anxious.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Witnessing the signature is the nurse's role — it attests that the client signed voluntarily and appeared competent, not that the nurse explained the procedure.
  • B. Correct . Confirming understanding is part of verifying that consent is truly informed — if the client cannot describe the procedure, the nurse stops and contacts the provider.
  • C. Correct . Only the provider can fill gaps in the explanation of risks, benefits, and alternatives, so the nurse advocates by halting the process and notifying the provider.
  • D. Correct . Consent is valid only when voluntary — screening for coercion is part of the nurse's advocacy role in the consent process.
  • E. Incorrect . Explaining risks, benefits, and alternatives is the provider's legal responsibility when obtaining consent — it is outside the nurse's role.
  • F. Incorrect . Anxiety is not incapacity. A competent adult signs their own consent — a family member cannot sign in their place.

Reference: ANA Code of Ethics for Nurses; AORN informed consent guidance (provider obtains consent; nurse witnesses and verifies understanding)

Medium Select all that apply

6. Medication error — appropriate response

A nurse realizes a client received metoprolol 100 mg PO when the prescription was for 50 mg. The client is alert, the blood pressure is 96/58 mm Hg, and the heart rate is 56/min.

Which actions should the nurse take? Select all that apply.

  1. Assess the client, including vital signs and level of consciousness.
  2. Notify the provider of the error.
  3. Complete an incident report according to facility policy.
  4. Document the medication and dose actually given and the client's response in the medical record.
  5. Note in the medical record that an incident report was completed.
  6. Chart that short staffing on the unit caused the error to occur.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . The client comes first after any error — a double dose of a beta blocker can cause bradycardia and hypotension, so ongoing assessment guides the response.
  • B. Correct . The provider must be told so monitoring orders or interventions can be prescribed — failing to report an error compounds the harm and the liability.
  • C. Correct . Incident reports are internal quality-improvement tools that allow the facility to analyze why the error occurred and prevent recurrence.
  • D. Correct . The chart must factually reflect what the client received, the assessment findings, and that the provider was notified — objective facts only.
  • E. Incorrect . The chart never references the incident report — mentioning it makes the confidential internal review document discoverable and is contrary to risk-management practice.
  • F. Incorrect . Speculation about blame or causes does not belong in the medical record — documentation must remain objective and factual; system issues are addressed through the incident report.

Reference: AHRQ patient safety guidance on error reporting and disclosure; standard risk-management documentation practice

Medium Multiple choice

7. Prioritization — which client to assess first

A nurse receives the shift report on four assigned clients on a medical-surgical unit.

Which client should the nurse assess first?

  1. A client with an asthma exacerbation whose wheezing has stopped and who is now speaking in single words.
  2. A client with type 1 diabetes whose fingerstick glucose is 250 mg/dL before lunch.
  3. A client reporting incisional pain of 7 on a 0 to 10 scale two days after surgery.
  4. A client with pneumonia and a temperature of 100.9 F whose IV antibiotic dose is due.
Show the answer and rationales

Correct answer: A

  • A. Correct . A silent chest with inability to speak in full sentences signals airflow so limited the client can no longer wheeze — an ominous sign of impending respiratory failure. Airway and breathing come first under the ABC framework.
  • B. Incorrect . Hyperglycemia of 250 mg/dL needs insulin coverage but is not immediately life-threatening — it does not outrank a deteriorating airway.
  • C. Incorrect . Pain is a priority symptom that deserves prompt treatment, but a physiologic airway threat takes precedence over comfort needs.
  • D. Incorrect . A low-grade fever with a due medication is an expected finding in pneumonia — this client is stable and can safely be seen after the client in respiratory distress.

Reference: NCLEX priority frameworks (ABCs, Maslow); Medscape and NCBI references on silent chest in severe asthma

Medium Select all that apply

8. Stroke discharge — planning and referrals

A nurse is caring for a client recovering from an ischemic stroke with residual right-sided weakness and mild dysphagia. The client will be discharged home in several days with a spouse as the primary caregiver.

Which actions by the nurse are appropriate? Select all that apply.

  1. Initiate referrals to physical and occupational therapy to address mobility and self-care needs at home.
  2. Request a speech-language pathology consult to guide safe swallowing strategies.
  3. Collaborate with the case manager about durable medical equipment and caregiver support for the home.
  4. Begin teaching the client and spouse about medications and stroke warning signs now, before the day of discharge.
  5. Postpone all discharge teaching until the day of discharge so the information stays fresh.
  6. Instruct the spouse to stop the thickened-liquid diet once the client is settled at home.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Coordinating rehabilitation referrals is a core RN role — arranging therapy before discharge prevents gaps in recovery and reduces readmission.
  • B. Correct . Stroke guidelines call for speech-language pathology involvement for dysphagia — the SLP evaluates swallowing and prescribes the diet texture and strategies the client needs.
  • C. Correct . Interdisciplinary collaboration with case management or social work secures equipment, home health, and community resources before the client leaves.
  • D. Correct . Discharge teaching is most effective when it starts early and is reinforced over time — waiting until the last day overwhelms the client and caregiver.
  • E. Incorrect . Discharge planning and teaching begin at admission, not at the end — cramming education into the final day leaves no time to assess understanding or answer questions.
  • F. Incorrect . Diet texture is advanced only after reevaluation by the speech-language pathologist — stopping aspiration precautions without clearance risks aspiration pneumonia.

Reference: AHA/ASA Guidelines for Adult Stroke Rehabilitation and Recovery (swallowing assessment before oral intake; SLP referral for dysphagia)

Medium Select all that apply

9. Supervising the AP — when to intervene

A nurse has delegated routine care tasks to an experienced assistive personnel (AP) on a medical-surgical unit. While making rounds, the nurse observes the AP providing care.

Which observations require the nurse to intervene? Select all that apply.

  1. The AP wraps a blood pressure cuff around the arm that has an arteriovenous fistula.
  2. The AP lowers the head of the bed flat to bathe a client receiving a continuous enteral tube feeding.
  3. The AP assists a client recovering from a posterior total hip arthroplasty to sit with the legs crossed.
  4. The AP uses a gait belt while ambulating a stable client in the hallway.
  5. The AP empties the urinary drainage bag and records the output before the end of the shift.
  6. The AP applies prescribed sequential compression devices to a client on bed rest.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . Blood pressure measurements, venipuncture, and IVs are never done on the fistula arm — cuff compression can clot or damage the dialysis access, so the nurse must stop the AP immediately.
  • B. Correct . The head of the bed stays at 30 to 45 degrees during continuous feedings to prevent reflux and aspiration — the nurse intervenes and has the feeding paused or the head raised before care continues.
  • C. Correct . Crossing the legs adducts the hip and risks dislocating the new joint — posterior hip precautions prohibit leg crossing, hip flexion beyond 90 degrees, and internal rotation.
  • D. Incorrect . Using a gait belt for ambulation is correct, safe technique and an appropriate delegated task — no intervention is needed.
  • E. Incorrect . Measuring and recording output is within the AP scope and is being done correctly — the nurse simply reviews the totals.
  • F. Incorrect . Applying ordered compression devices to a stable client is an appropriate delegated task performed correctly here — no intervention is required.

Reference: AACN practice alert on aspiration prevention (head of bed 30 to 45 degrees); MedlinePlus hip replacement precautions; hemodialysis access protection guidance (no BP or venipuncture on the fistula arm)

Medium Multiple choice

10. Transfusion refusal — respecting autonomy

A client with a gastrointestinal bleed has a hemoglobin of 6.4 g/dL. The provider recommends a transfusion of packed red blood cells and explains the risks of refusing, including death. The client, who is alert and oriented, declines the transfusion because of religious beliefs.

Which action should the nurse take?

  1. Support the client's decision, notify the provider, and document the informed refusal.
  2. Ask the client's spouse to sign the consent form for the transfusion.
  3. Request a psychiatric consult to evaluate the client's decision-making capacity.
  4. Explain that refusing the transfusion means care at the hospital cannot continue.
Show the answer and rationales

Correct answer: A

  • A. Correct . A competent adult has the right to refuse any treatment, even one that is life-saving. The nurse respects the informed refusal, keeps the provider informed, and documents the decision and the education provided.
  • B. Incorrect . A spouse cannot consent on behalf of a competent adult — doing so would violate the client's right to self-determination, and transfusing against the client's will could constitute battery.
  • C. Incorrect . Refusing recommended treatment is not, by itself, evidence of impaired capacity. This client is alert, oriented, and has received and understood the risks.
  • D. Incorrect . This statement is false and coercive — clients who refuse one intervention still receive all other appropriate care, and threatening abandonment violates the nursing code of ethics.

Reference: ANA Code of Ethics for Nurses (autonomy, informed refusal); AABB 2023 red blood cell transfusion guidelines

Hard Multiple choice

11. Float nurse — assignment beyond competency

A medical-surgical nurse is floated to the telemetry unit because of a staffing shortage. The assignment includes a client who requires titration of a continuous diltiazem infusion, which the nurse has not been trained to manage.

Which action should the nurse take first?

  1. Inform the charge nurse of the lack of training and request an assignment limited to tasks within the nurse's demonstrated competence.
  2. Decline the float assignment and return to the home unit.
  3. Accept the full assignment and rely on the unit protocol book to guide the unfamiliar infusion.
  4. Complete an assignment-despite-objection form and assume the full assignment without discussing changes.
Show the answer and rationales

Correct answer: A

  • A. Correct . A floated nurse is expected to take an assignment but must speak up about competency gaps so the assignment can be adjusted — for example, caring for stable clients while a telemetry-trained nurse manages the titration. This protects clients while meeting the staffing need.
  • B. Incorrect . Refusing to float at all, rather than negotiating a safe assignment, can be treated as insubordination and may leave clients without coverage — the concern is the specific task, not the float itself.
  • C. Incorrect . Written protocols do not substitute for demonstrated competence with high-alert titratable infusions — accepting care beyond one's competency endangers the client and the nurse's license.
  • D. Incorrect . Documenting an objection creates a record but does not resolve the safety problem — the first step is direct communication with the charge nurse to modify the assignment.

Reference: ANA guidance on unsafe nurse staffing assignments (accept, reject, or object in writing; negotiate competency-based float assignments)

Hard Multiple choice

12. Questioning an unsafe potassium order

A client admitted with persistent vomiting has a serum potassium of 2.8 mEq/L (normal 3.5 to 5.0 mEq/L). The provider gives a telephone order for potassium chloride 20 mEq IV push now.

Which action should the nurse take?

  1. Question the order with the provider and request a diluted IV infusion administered by pump.
  2. Administer the dose slowly over five minutes through the IV port.
  3. Dilute the dose in 50 mL of normal saline and infuse it over 15 minutes without contacting the provider.
  4. Hold the medication and document the potassium level in the chart.
Show the answer and rationales

Correct answer: A

  • A. Correct . Potassium chloride is never given IV push — rapid administration can cause fatal cardiac arrest. It must be diluted and infused by pump, generally no faster than 10 mEq/hr through a peripheral line. The nurse who carries out an unsafe order shares legal liability, so the order must be questioned before anything is given.
  • B. Incorrect . Even a slow IV push delivers potassium far faster than the safe hourly limit and can trigger lethal dysrhythmias — slowing the push does not make the route safe.
  • C. Incorrect . This still delivers potassium at roughly 80 mEq/hr, far above the safe peripheral rate, and changing a prescribed route or rate without a new order is practicing outside the nursing scope.
  • D. Incorrect . Holding the dose without notifying the provider leaves significant hypokalemia untreated and the dangerous order unaddressed — the nurse must close the loop with the provider.

Reference: GlobalRPH IV potassium chloride dilution reference (never IV push; max 10 mEq/hr peripheral, infusion pump required)

Keep practising

These same questions are mixed into the interactive quizzes for this domain, where they are graded and feed your spaced-repetition schedule. The timed mock exam draws from every domain at its real test-plan weight.

Study sets in this domain