NCLEX Prioritization, Delegation, and Assignment Practice Test

These questions are part of the practice quiz. Start practicing

• As the charge nurse, you are reviewing the charts of clients who were assigned to the care of a newly graduated RN. The RN has correctly charted dose and time of medication, but there is no documentation regarding nonpharmacological measures. What action should you take first?
• Which scenario demonstrates appropriate delegation to UAP?
• Which task could be appropriately assigned to the UAP working with you at the obstetric clinic?
• Which patient is at greatest risk for pancreatic cancer?
• A patient with conversion disorder experiences sudden blindness after witnessing a violent event. Which is the priority therapeutic approach?
• After teaching a patient a new medication regimen, who should assess whether the patient learned and understands the regimen?
• Who should provide home-care wound management instructions after discharge?
• A nursing student is teaching a client with a seizure disorder before discharge. Which statement should you intervene?
• Which action requires the RN license rather than the LPN, given an adult patient with respiratory issues?
• A patient has a respiratory rate of 6 breaths per minute. What is the nurse’s priority action?
• When assigning care for a patient with acute admission safety concerns, what is the best staffing approach?
• A client with facial burns develops sudden difficulty breathing and stridor. What is the highest priority action?
• Who approves changes to safety devices and implements the plan of care?
• A patient is being discharged with newly prescribed antihypertensive therapy. Who should provide discharge teaching?
• On a medical-surgical unit, a patient who is hostile and belligerent has been difficult for staff. Which approach best supports his care?
• After undergoing a modified radical mastectomy, a client is transferred to the PACU. Which nursing action is best to delegate to an experienced LPN/LVN?
• As the nurse manager in a public health department, you are implementing a plan to reduce the incidence of infection with human immunodeficiency virus (HIV) in the community. Which nursing action will you delegate to health assistants working for the agency?
• Who should provide education on insulin management after a new diagnosis?
• During a treadmill stress test, which finding would require the most immediate action to stop the test?
• Which order takes priority for a client with Excess Fluid Volume who presents with crackles and edema on exam?
• For a patient with persistent health anxiety, which team member is most appropriate to involve to manage care and reduce symptom preoccupation?
• During a breast examination of a 22-year-old client, which finding is of most concern?
• Regarding TB exposure, which statement is correct?
• As the charge nurse, which assignment should be reassessed due to potential gender-age matching concerns on an acute psychiatric unit?
• As the charge nurse, what is your initial action when a client with chronic pain reports that requests for pain medication have not been responded to?
• A medication error is discovered during a shift. What action is priority?
• In the ED management of a patient with chest pain, which action must be performed by the RN rather than a licensed practical/vocational nurse?
• Which professional is most appropriate to provide sensitive prognosis information and support to a family?
• After interviewing an HIV-positive patient who is considering starting highly active antiretroviral therapy (HAART), which patient information concerns you the most?
• You have just received a change-of-shift report for the burn unit. Which client should you assess first?
• Who should provide medication education at discharge for a patient starting anticoagulant therapy?
• A few minutes after you have given an intradermal injection of an allergen during skin testing, the patient reports feeling anxious, short of breath, and dizzy. Which action included in the emergency protocol should you take first?
• In the delegation framework, which role is primarily accountable for patient safety and supervising delegated tasks?
• You are working in the triage area of an ED, and the following four clients approach the triage desk at the same time. List the order in which you will assess these clients. Ambulatory, dazed 25-year-old man with a bandaged head wound; Irritable infant with fever, petechiae, and nuchal rigidity; 35-year-old jogger with a twisted ankle who has a pedal pulse and no deformity; 50-year-old woman with moderate abdominal pain and occasional vomiting. Which is the correct assessment order?
• Which patient scenario requires an N95 respirator due to airborne transmission risk?
• A patient requires teaching about a new medication with complex dosing. Who should provide the teaching?
• A patient is admitted with possible Graves disease (hyperthyroidism). Which assessment finding supports this diagnosis?
• Which assessment finding in a client with peptic ulcer disease is most serious?
• Who develops the plan of care for a feeding intolerance?
• A patient’s family requests detailed information about the patient’s prognosis. Which professional is appropriate to respond?
• Who is primarily responsible for coordinating a multidisciplinary plan of care for a patient requiring rehabilitation services?
• In the PACU after mastectomy, which action is best performed by an RN rather than an LPN or UAP?
• A patient with a new diagnosis of diabetes asks for dietary counseling. Who should provide the counseling?
• The client also has the nursing diagnosis Decreased Cardiac Output related to decreased plasma volume. Which assessment finding supports this nursing diagnosis?
• Which task should be performed by a licensed nurse rather than a UAP for patients with diabetes?
• Which statement accurately describes the role of UAP in patient education?
• Which task would be inappropriate to delegate to a UAP when preparing a patient for a colonoscopy?
• Who should perform blood glucose monitoring and insulin administration?
• Which assessment is MOST important to monitor in a patient receiving magnesium sulfate for seizure prophylaxis in preeclampsia?
• What is the priority nursing diagnosis for a client experiencing a migraine headache?
• You are the charge nurse in an emergency department (ED) and must assign two staff members to cover the triage area. Which team is the most appropriate for this assignment?
• An 8-year-old child has stomatitis secondary to chemotherapy. Which task would be best to delegate to a UAP?
• As charge nurse, you would assign the nursing care of which patient to an LPN/ LVN, working under the supervision of an RN?
• As the supervising nurse, which instruction would you clearly provide to the RN for an anterior nosebleed?
• You have been floated to the telemetry unit for the day. The monitor watcher informs you that the client has developed prominent U waves. Which laboratory value should you check immediately?
• After performing oral suctioning on a client on contact and airborne precautions, in which order would you remove PPE and perform hand hygiene?
• In prioritizing care on an acute psychiatric unit, which factor should guide decisions when multiple patients require attention?
• Which finding in a patient taking an ACE inhibitor during a home visit would prompt you to contact the provider about changing therapy?
• A 56-year-old patient comes to the walk-in clinic reporting scant rectal bleeding and intermittent diarrhea and constipation for the past several months. There is a history of polyps and a family history of colorectal cancer. While you are trying to teach about colonoscopy, the patient becomes angry and threatens to leave. What is the priority diagnosis?
• A patient receiving chemotherapy has thrombocytopenia. Which action best supports bleeding precautions?
• During a packed red blood cell transfusion, which action requires immediate intervention?
• A client with diabetic neuropathy reports a burning, electrical-type pain in the lower extremities that is worse at night and not responding to nonsteroidal anti-inflammatory drugs. Which medication will you advocate for first?
• After a client has a seizure, which action can be delegated to a UAP?
• In strangulated obstruction with suspected perforation, which intervention is contraindicated initially?
• Which finding is most important to monitor for a patient who has just returned from a colonoscopy with conscious sedation?
• A patient requires suctioning of a tracheostomy. Who should perform?
• A patient with a stable wound requires dressing changes. Who can perform routine wound dressing changes under supervision per policy?
• In a patient with Paget disease, which finding would you notify the physician about first?
• What is the overarching goal of psychosocial interventions for a difficult patient who has persistent behavioral challenges?
• Which sock material is recommended for diabetic foot care?
• Prominent U waves on an ECG most commonly indicate which electrolyte disturbance?
• What is the best method to assess learning effectiveness after education on a new regimen?
• For a patient being discharged with newly prescribed antihypertensive therapy, who should provide the initial discharge teaching?
• Which isolation precaution should be implemented for suspected SARS in the ED?
• During a community HIV prevention initiative, which task is appropriate for health assistants to perform?
• Which patient scenario would be most appropriate for assignment to the nurse with the most experience in a vision specialty clinic?
• While supervising a student performing tracheostomy care, which action would require you to intervene?
• Can a UAP assist with implementing a fall-risk safety plan?
• Which task should be performed by the RN rather than the LPN/LVN for a patient with GI cancer?
• A patient with dehydration and fever has a temperature of 38.5°C. Which task could be delegated to a UAP?
• Who should write the nursing diagnosis and continuum of care after assessment?
• At a community health clinic, you are teaching a community group about the prevention of accidental eye injuries. What is the most important thing to stress?
• You are caring for a client who has just had a squamous cell carcinoma removed from the face. Which activity can you delegate to an experienced LPN/LVN?
• When a primary survey of a trauma client is conducted, what is considered one of the priority actions?
• In a trauma assessment, which of the following is typically considered part of the secondary survey?
• A seizure occurs in the unit. What is the immediate action?
• Which action should be performed first when a patient presents with crushing chest pain and diaphoresis?
• Which statement best explains why repeatedly yielding to a patient's requests can maintain the sick role in hypochondriasis?
• Which action is most appropriate for a nurse to perform with a stable newborn in the immediate postpartum period?
• You encounter a neighbor whose house is on fire and is panicking. What is the best first step?
• How would you characterize the symptoms of a conversion disorder when no organic disease is found?
• In managing a conversion disorder, which intervention best supports the patient in daily living with disability?
• Place the steps for administering TPN through a central line in the correct order.
• The client's nursing diagnosis is Deficient Fluid Volume related to excessive fluid loss. Which action related to fluid management should be delegated to a UAP?
• During a sudden deterioration, which professional is responsible for initiating rapid plan changes and communicating them to the team?
• What is a key action the nurse should take to evaluate understanding of a new regimen?
• Which task is appropriate for a UAP when caring for a patient with chemotherapy-induced stomatitis?
• Which statement best describes the long-term measure of glycemic control?
• The plan of care for a diabetic patient includes all of these interventions. Which intervention should you delegate to a UAP?
• You are preparing to admit a client with a seizure disorder. Which action can be delegated to an LPN/LVN under RN supervision?
• A stable patient is receiving an IV antibiotic infusion. Who can manage the infusion under policy?
• During postoperative recovery, a patient is hemodynamically stable with pain controlled on scheduled analgesia. Which task can be delegated to a UAP?
• A 30-year-old woman with type 1 diabetes mellitus comes to the clinic for preconception care. What is the priority education for her at this time?
• A patient requires a sterile dressing change after wound debridement. Which staff member should perform it?
• A patient is being discharged with a home safety plan after a fall. Who should finalize and explain the plan to the patient and family?
• In planning care for a patient with a stage III pressure ulcer, which action is appropriate to delegate to an LPN/LVN under supervision?
• As the charge nurse, you assign a float nurse from PACU. Which patient is best for this nurse to take?
• Who can reinforce insulin management education after the initial instruction by the RN or certified diabetes educator?
• Which symptom would indicate urgent hypoglycemia in a diabetic patient?
• Which statement is NOT accurate to include in migraine teaching for a newly diagnosed patient?
• When preparing a client for a colonoscopy, which task is most suitable to delegate to the UAP?
• Who should provide wound care instructions after discharge, with involvement of specialty nurses as needed?
• A patient has newly diagnosed type 2 diabetes. Which task should you delegate to a UAP?
• Which statement accurately reflects delegation rules to UAPs?
• If a patient is unstable and requires rapid changes in the care plan, who should lead the reassessment and revise the plan?
• A 6-year-old who had chemotherapy and anorexia is now refusing to eat and throws the dish. Best response?
• An experienced LPN/LVN under the supervision of the RN is caring for a patient with a respiratory problem. Which action is within the LPN's scope of practice?
• Why is it not appropriate to immediately link the trauma to the patient’s sudden blindness in conversion disorder?
• Which finding is most characteristic of Graves disease?
• What is the primary purpose of a negative-pressure room in airborne isolation?
• A client suspected of having severe acute respiratory syndrome (SARS) arrives in the emergency department. What action should you take first?
• Before knee arthroscopy, which complete blood count value is most important to report to the physician?
• A patient with a newly placed feeding tube needs instruction on tube care. Who should provide this instruction?
• Which task requires an RN and cannot be delegated to an LPN?
• A patient being evaluated for interstitial cystitis should have education about the cystoscopy included in the plan. Which statement best fits?
• What assignment strategy most consistently supports a patient with interpersonal difficulties on a psychiatric unit?
• Place the following steps for eyedrop administration in the correct order.
• In evaluating a patient with chronic emphysema receiving oxygen at 5 L/min by nasal cannula, which finding concerns you immediately?
• Which pediatric patient is most appropriate to assign to a newly graduated registered nurse?
• In triage, which patient should be prioritized for immediate assessment due to potential meningitis?
• Under facility policy, who may administer insulin and perform blood glucose monitoring?
• Who should perform transfers for a stable patient with proper assistive devices and supervision?
• A teaching plan for a patient with diabetes who has sensory foot risk should include which key point?
• Which medication is commonly used first for neuropathic pain such as diabetic neuropathy?
• A long-term-care client with a history of benign prostatic hyperplasia presents with several assessment findings. Which finding requires the most immediate action?
• To determine a patient’s compliance with a prescribed diabetes regimen, which laboratory value would you review?
• After collecting staff performance data on how pain is managed for a patient, what is the next best step for supervision?
• Which staff member should perform the neuro assessment in a patient with a new neurologic deficit after a stroke?
• Which cardiovascular risk factor is non-modifiable?
• Which action would best demonstrate evidence-based nursing practice in the care of a patient who is 1 day postpartum and reporting nipple soreness while breast-feeding?
• Which patient scenario would most clearly require an experienced nurse in a vision specialty setting?
• A patient has a new neurologic deficit after a stroke. Which staff member should perform the assessment?
• The nursing care plan for the client with dehydration includes interventions for oral health. Which intervention is outside the scope of practice for an LPN/LVN being supervised by a nurse?
• As charge nurse, you are making assignments for the day shift. Which patient would you assign to the nurse who was floated from the PACU?
• In a scenario where the patient's condition deteriorates rapidly, who should promptly reassess and adjust the care plan?
• Which task is appropriate to be performed by a licensed clinician, not delegated to a UAP?
• You are working with a UAP to care for a client who has had a right breast lumpectomy and axillary lymph node dissection. Which nursing action can you delegate to the UAP?
• A patient on oxygen therapy reports the equipment is not functioning. What is the priority action?
• In triage, which client requires the most rapid action to protect other ED clients from infection?
• Which statement accurately describes the role of a UAP in daily patient care?
• A client presents with severe shortness of breath, cyanosis, and inability to speak. What is the priority action for the nurse?
• You are evaluating an HIV-positive patient who is receiving IV pentamidine (Pentam) as a treatment for Pneumocystis jiroveci (PCP) pneumonia. Which information is most important to communicate to the physician?
• After a seizure, which action should be avoided?
• After the client sits with the head tilted back for eyedrop administration, what is the next step?
• Which client is most likely to receive opioids for extended periods of time?
• A nurse is assigning care for four patients. Which assignment is appropriate to delegate to a UAP?
• Which pain assessment tool is most appropriate for a 3-year-old who cannot reliably describe pain verbally?
• Who is responsible for de-escalation in a mental health crisis?
• Who should lead a multidisciplinary discharge planning conference?
• Which question best assesses the cognitive dimension of a patient's pain experience?
• Which question best addresses the sociocultural dimension of pain when a patient is stoic about pain?
• Who should initiate and coordinate a referral to physical therapy as part of the plan of care?
• A client with disseminated herpes zoster requires PPE prior to assessment. Which equipment is appropriate?
• Among four patients who require attention, which condition has the highest priority?
• A patient is being discharged with newly prescribed anticoagulant therapy. Who should provide medication education?
• As the nurse manager in the burn unit, which client is best to assign to an RN who has floated from the oncology unit?
• A 32-year-old patient with sickle cell crisis has hypoxia on arrival. Which action should you implement first?
• Which combination would cause the greatest immediate concern for a child with cancer?
• Which infection-control measure is essential when caring for a patient with MRSA on contact precautions?
• During care for Paget disease, which action by the LPN/LVN requires the charge nurse's intervention?
• A patient requires a physical therapy referral and plan. Who initiates and coordinates the referral?
• When care assignments are being made for patients with alterations related to gastrointestinal (GI) cancer, which patient would be the most appropriate to assign to an LPN/LVN under the supervision of a team leader RN?
• Which action should be performed first when a patient reports crushing chest pain with diaphoresis?
• A patient with hypochondriasis refuses to believe repeated negative tests and insists he has a brain tumor. Which response is most therapeutic?
• Which of the following is an appropriate task for a UAP?
• In a medical-surgical unit, which patient is at the greatest risk for infection?
• A client is admitted through the ED for treatment of a strangulated intestinal obstruction with perforation. Which initial intervention would you perform first?
• Which staff member is appropriate to delegate routine dressing changes for a stable wound?
• Which IV fluid should be used to prime the tubing when infusing packed red blood cells?
• You are working with a student nurse to care for an HIV-positive patient with severe esophagitis caused by Candida albicans. Which action by the student indicates that you need to intervene most quickly?
• A patient is being admitted to rule out interstitial cystitis. What should your plan of care for this patient include?
• A patient with MRSA is on contact precautions. What is the most important infection-control measure?
• You are providing nursing care for a 24-year-old female patient admitted to the unit with a diagnosis of cystitis. Which intervention should you delegate to the UAP?
• A UAP reports nasal passage discomfort in a patient receiving oxygen at 6 L/min. What intervention should you suggest to improve comfort?
• Which statement about oxygen therapy is true in the management of anaphylaxis?
• During a sterile dressing change for a client with infected deep partial-thickness burns of the chest and abdomen, arrange the steps in the correct order: 1. Apply silver sulfadiazine (Silvadene) ointment. 2. Obtain specimens for aerobic and anaerobic wound cultures. 3. Administer morphine sulfate 10 mg IV. 4. Debride the wound of eschar using gauze sponges. 5. Cover the wound with a sterile gauze dressing.
• Which teaching point is essential to include when teaching a patient with osteoporosis about fall prevention?
• Which laboratory test is most useful in determining whether to initiate an acute coronary syndrome protocol for a patient with chest pain?
• The health care provider has written all of these orders for a client with a diagnosis of Excess Fluid Volume. The client's morning assessment reveals bounding peripheral pulses, weight gain of 2 lb, pitting ankle edema, and moist crackles bilaterally. Which order takes priority at this time?
• You would be most concerned about a TPN fat emulsion order for a client with which condition?
• Which role leads daily review of patient safety concerns and adjusts delegated tasks accordingly?
• Who can perform non-sterile wound care and dressing changes?
• You are caring for a patient with esophageal cancer. Which task could be delegated to a UAP?
• A patient is hospitalized with adrenocortical insufficiency. Which nursing activity should you delegate to a UAP?
• A 56-year-old client comes to the triage area with left-sided chest pain, diaphoresis, and dizziness. What is the priority action?
• A newly admitted client with increasing dyspnea and dehydration has possible avian influenza (bird flu). Which action should you implement first?
• You are working in the obstetric triage area, and several patients have just come in. Which patient should you assess first?
• Which task is appropriate to delegate to an LPN/LVN who is functioning under the supervision of an RN in an ophthalmology setting?
• In migraine management, rebound headache is best described as a potential side effect of medications.
• In discharge planning for home safety, which professional ensures that the patient and family understand the plan?
• Which team member is typically responsible for ensuring sterile technique during dressing changes?
• As charge nurse, which patient requires an RN assessment rather than delegated staff?
• Which laboratory result is of most concern to you for an adult patient with cystitis?
• Which statement about postpartum lactation support is correct?
• As the shift begins, you are assigned to care for the following patients. Which patient should you assess first?
• Why is it important to ensure that TPN fat emulsions are not infused too rapidly?
• You are in ambulatory care and a client reports redness of the sclera, itching, and tearing for several hours. What should you direct the caller to do first?
• A patient has a new order for potassium replacement. Who should verify and administer?
• Which discharge planning intervention is most important for a patient with cardiovascular risk related to smoking?
• Which statement about congenital anomalies risk with diabetes is correct?
• For a patient with osteoporosis and risk for falls, which task is appropriate to delegate to a UAP?
• Which action is most appropriate to delegate to a UAP in the postpartum unit when supporting a mother who is breastfeeding?
• Why is morphine often withheld initially in suspected strangulated obstruction with perforation?
• When guiding a panicked patient in a dangerous environment, what is the rationale for making eye contact and holding a hand before giving safety directions?
• An LPN/LVN's assessment of two diabetic patients reveals all of these findings. Which would you instruct the LPN/LVN to report immediately?
• In the management of suspected acute coronary syndrome, which medication should be given to reduce platelet aggregation?
• When delegating tasks to unlicensed assistive personnel (UAPs), which statement reflects a fundamental principle?
• A nurse must assign care for four stable patients. Which task is appropriate to delegate to a UAP?
• During an initial history for obesity surgery, which finding should be called to the surgeon’s attention first?
• Which task is appropriate to delegate to an LPN/LVN working under an RN when caring for a burn patient?
• Which statement correctly describes a safety practice when administering TPN via a central line?
• You are the charge nurse in a long-term care (LTC) facility that employs RNs, LPNs/LVNs, and UAPs. When you are planning care for a resident with a stage III sacral pressure ulcer, which nursing intervention is best to delegate to an LPN/ LVN?
• Which task is appropriate to delegate to a UAP?
• Which staff action is essential for infection isolation precautions?
• For a patient with hyperthyroidism, which task will you delegate to an experienced UAP?
• Who completes a fall-risk assessment and develops a safety plan for a patient?
• To prevent systemic absorption of an eyedrop, which action should be performed after instillation?
• A postoperative patient reports severe pain not relieved by prescribed analgesia. What is the priority action?
• You are admitting a 66-year-old male patient suspected of having a urinary tract infection (UTI). Which piece of the patient's medical history supports this diagnosis?
• Which professional should evaluate and fit a patient with osteoporosis for a new walker?
• Which factor is most associated with an increased risk of pancreatic cancer?
• A client receiving pentamidine therapy has a blood glucose level of 55 mg/dL. Which action is most appropriate?
• Who is primarily responsible for ensuring the patient's comprehension of home safety steps after discharge planning?
• You obtain the following assessment data about your client who has had a transurethral resection of the prostate (TURP) and has continuous bladder irrigation. Which finding indicates the most immediate need for nursing intervention?
• In delegation, which statement best describes the RN’s responsibility?
• Which activity can be delegated to an experienced UAP for a hospitalized patient with anemia and GI bleeding?
• Which member is responsible for approving changes to safety devices and implementing the plan of care?