NCLEX-RN Management of Care Practice Test

25 practice questions

Choose an answer, then check it under Show answer.

1. Question 1 of 25Hard

   A nurse is managing care for an intubated client with a severe traumatic brain injury who requires frequent position changes. Which action may the nurse delegate to unlicensed assistive personnel (UAP) for this client?

   1. AA. Assisting the nurse to log-roll the client while maintaining neutral head alignment
   2. BB. Suctioning the endotracheal tube when airway secretions become visible
   3. CC. Adjusting the zero reference level of the external ventricular drainage transducer
   4. DD. Assessing bilateral pupillary reactions and spontaneous motor movement
   Show answer to question 1

   Answer: A. Assisting the nurse to log-roll the client while maintaining neutral head alignment

   UAP may assist the licensed nurse with turning and log-rolling a complex or unstable client under the nurse's direct guidance and hands-on supervision. Neurologic assessments, endotracheal suctioning of an intubated client, and calibrating or leveling invasive intracranial monitoring systems require advanced clinical expertise and cannot be delegated to assistive personnel.

2. Question 2 of 25Hard

   A client with severe delirium was placed in bilateral wrist restraints after repeatedly attempting to pull out a central venous catheter. Two hours later, the nurse notes that the client is calm, fully oriented to person, place, and time, and cooperatively following commands. What is the nurse's priority action?

   1. AA. Remove the restraints and continuously evaluate the client's behavior.
   2. BB. Loosen the restraints and assess skin integrity and distal pulses every 2 hours.
   3. CC. Contact the healthcare provider to request an order to decrease restraint intensity.
   4. DD. Keep the restraints secured until the original time-limited prescription expires.
   Show answer to question 2

   Answer: A. Remove the restraints and continuously evaluate the client's behavior.

   Clients have the fundamental right to care in the least restrictive environment, meaning restraints must be discontinued at the earliest possible time once the unsafe behavior resolves. Because the client is now calm, oriented, and cooperative, the nurse must release the restraints immediately and monitor behavior closely. Restraints should never be maintained merely because the time limit on the provider's order has not expired.

3. Question 3 of 25Medium

   A nurse is planning discharge for a client newly diagnosed with type 2 diabetes who reports an inability to afford prescribed insulin. What is the priority nursing action when coordinating a referral to a community-based prescription assistance program?

   1. AA. Instruct the family to assume legal responsibility for medication costs
   2. BB. Authorize the dispensing pharmacy to supply a free 90-day medication supply
   3. CC. Complete and submit the formal application without client involvement
   4. DD. Obtain the client's consent and willingness to participate in the program
   Show answer to question 3

   Answer: D. Obtain the client's consent and willingness to participate in the program

   Client engagement and autonomy are essential prerequisites for successful community referrals; the nurse must verify the client's willingness to participate and obtain consent before sharing personal information with external agencies. Submitting applications without client involvement undermines self-efficacy and may breach privacy regulations. Nurses do not have the authority to compel family members to assume financial responsibility or direct pharmacies to provide free medications.

4. Question 4 of 25Medium

   A nurse must transmit a client's electronic laboratory report to an outpatient specialist's office via facsimile (fax). Which action should the nurse take to protect electronic health information?

   1. AA. Remove the client's name and medical record number from the document
   2. BB. Confirm the recipient's fax number and include a standardized confidentiality cover sheet
   3. CC. Batch the transmission with other client records at the end of the shift
   4. DD. Instruct the specialist's office to shred the document immediately upon receipt
   Show answer to question 4

   Answer: B. Confirm the recipient's fax number and include a standardized confidentiality cover sheet

   Verifying the destination fax number prior to transmission reduces the risk of misdirected protected health information, and attaching a confidentiality cover sheet alerts unintended recipients to notify the sender and destroy the document. Removing identifying information prevents the receiving specialist from associating the lab results with the correct client. Delaying transmission or asking the specialist to immediately destroy needed clinical records impairs client care.

5. Question 5 of 25Medium

   Two assistive personnel (AP) are arguing loudly in the hallway about how bath assignments were divided, and visitors are watching. Which action should the charge nurse take first?

   1. AA. Tell both AP to stop and finish the discussion after the shift ends
   2. BB. Report both AP to the nurse manager for unprofessional conduct on the unit
   3. CC. Reassign the baths so the AP who complained has fewer assignments
   4. DD. Move the discussion to a private area and listen to each AP's concerns
   Show answer to question 5

   Answer: D. Move the discussion to a private area and listen to each AP's concerns

   The first step in managing staff conflict is to stop the public disruption and give both people a private setting to explain their views. Listening to both sides lets the charge nurse understand the problem and work toward a fair solution.

   Why the other options are wrong

   • APostponing the discussion leaves the conflict unresolved and may affect client care during the shift.
   • BSending the conflict upward before trying to resolve it at the unit level is premature.
   • CChanging the assignment without hearing both sides favors one person and may create new conflict.

6. Question 6 of 25Easy

   An older adult client admitted to the medical unit expresses frustration because assistive personnel (AP) insist on providing a complete bed bath at 0600 every morning. The client states, "I have taken my shower in the evening before bed my entire life." What is the nurse's best action?

   1. AA. Instruct the client to adapt to the morning hygiene schedule while hospitalized.
   2. BB. Instruct the AP to omit bathing assistance entirely until the client is discharged.
   3. CC. Explain to the client that hospital staffing schedules necessitate morning hygiene care.
   4. DD. Update the nursing plan of care to schedule hygiene assistance in the evening.
   Show answer to question 6

   Answer: D. Update the nursing plan of care to schedule hygiene assistance in the evening.

   Client advocacy involves respecting personal values, habits, and daily routines to deliver individualized, client-centered care whenever safe and feasible. The nurse should update the care plan and communicate the preferred evening schedule to the healthcare team. Compelling a client to adapt to rigid institutional workflows ignores client autonomy and undermines the therapeutic relationship.

7. Question 7 of 25Easy

   A nurse educator is planning an annual competency assessment for nursing staff regarding emergency defibrillator use. Which evaluation method provides the best evidence of clinical psychomotor competency?

   1. AA. Requiring staff to complete a twenty-question multiple-choice post-test.
   2. BB. Observing staff operate the equipment during a simulated cardiac arrest scenario.
   3. CC. Asking staff to submit a self-assessment survey rating their confidence levels.
   4. DD. Having staff attend a one-hour lecture on advanced cardiac life support.
   Show answer to question 7

   Answer: B. Observing staff operate the equipment during a simulated cardiac arrest scenario.

   Direct observation of a return demonstration during a simulated scenario provides direct, objective verification of psychomotor skill competency. Written examinations and didactic lectures evaluate cognitive knowledge rather than physical performance, while self-assessment surveys reflect subjective confidence instead of verified competence.

8. Question 8 of 25Easy

   A nurse discovers that an intravenous infusion of regular insulin was accidentally programmed to run at twice the prescribed rate over the past two hours. After stopping the infusion, which action should the nurse take first?

   1. AA. Obtain a point-of-care blood glucose reading and assess client responsiveness.
   2. BB. Notify the prescribing health care provider about the excessive dose.
   3. CC. Contact the risk management department to initiate a safety investigation.
   4. DD. Complete an electronic incident report regarding the infusion pump error.
   Show answer to question 8

   Answer: A. Obtain a point-of-care blood glucose reading and assess client responsiveness.

   When an adverse event or medication error occurs, the nurse's first priority is always immediate assessment and stabilization of the client. Obtaining a capillary blood glucose measurement directly evaluates the client for severe, life-threatening hypoglycemia so appropriate interventions can be initiated without delay. Contacting the provider and filing an incident report are mandatory subsequent actions, but client safety and assessment take precedence.

9. Question 9 of 25Medium

   A registered nurse (RN) on a medical-surgical unit is delegating tasks to a licensed practical nurse (LPN) and a nursing assistant (NA). Which task should the RN assign to the LPN?

   1. AA. Assist a client with ambulation using a walker for the first time after hip surgery.
   2. BB. Administer a scheduled dose of metoprolol 25 mg orally to a client with stable vital signs.
   3. CC. Document the intake and output for a client who is on strict fluid monitoring.
   4. DD. Transport a client to the radiology department for a scheduled chest x-ray.
   Show answer to question 9

   Answer: B. Administer a scheduled dose of metoprolol 25 mg orally to a client with stable vital signs.

   Giving a scheduled oral medication to a client with stable vital signs is within the LPN's scope, because the client is stable and the task follows an established plan of care.

   Why the other options are wrong

   • AThe first ambulation after hip surgery requires assessment of tolerance and safety, so the RN should perform it.
   • CRecording intake and output is a routine task best delegated to the nursing assistant.
   • DTransporting a stable client to radiology is an appropriate task for the nursing assistant.

10. Question 10 of 25Medium

    An acute care hospital implements an evidence-based care bundle to eliminate central line-associated bloodstream infections (CLABSIs). Surveillance data collected 3 months post-implementation shows no reduction in infection rates. Which action should the quality improvement team prioritize first?

    1. AA. Extend the current surveillance period for an additional twelve months prior to analyzing adherence patterns
    2. BB. Audit clinical compliance with each individual step of the established bundle protocol across all units
    3. CC. Replace the existing evidence-based central line insertion bundle with an alternative commercial product line
    4. DD. Issue administrative warnings to staff working on the nursing units reporting persistent infection clusters
    Show answer to question 10

    Answer: B. Audit clinical compliance with each individual step of the established bundle protocol across all units

    When an evidence-based quality initiative fails to achieve expected targets, the team must first evaluate protocol fidelity by auditing staff adherence to each bundle component to identify whether the breakdown is due to execution failure or other workflow barriers. Discarding an evidence-based bundle without assessing compliance incurs unnecessary costs and fails to resolve execution deficits, while issuing punitive warnings damages the safety culture.

11. Question 11 of 25Medium

    A home health nurse visits an 82-year-old client with moderate vascular dementia who lives with an adult child caregiver. The nurse discovers that the client is lying in soiled bedding, has a stage 3 sacral pressure injury that has not been treated, and has lost 12 pounds over the past month. The caregiver appears frustrated and says, 'I cannot handle this care anymore.' Which action must the nurse take?

    1. AA. Request an immediate prescription for high-calorie nutritional supplements
    2. BB. Instruct the caregiver on proper repositioning and hygiene schedules
    3. CC. Report suspected elder neglect to adult protective services
    4. DD. Arrange for transfer of the client to an assisted living facility
    Show answer to question 11

    Answer: C. Report suspected elder neglect to adult protective services

    The nurse is legally required to report suspected vulnerable adult or elder abuse and neglect to adult protective services or the designated state regulatory body. Clinical manifestations such as advanced untreated pressure injuries, severe weight loss, poor hygiene, and signs of caregiver strain represent neglect that warrants statutory reporting. While caregiver education and clinical interventions are important, they do not fulfill or replace the legal obligation to report suspected neglect.

12. Question 12 of 25Medium

    A nurse on a medical unit has just completed morning handoff report. Which client should the nurse plan to evaluate first?

    1. AA. A client with multiple sclerosis who reports severe fatigue and persistent numbness in the lower extremities
    2. BB. A client with Guillain-Barré syndrome who reports difficulty clearing secretions and has shallow respirations
    3. CC. A client with Parkinson disease who has a resting hand tremor and cogwheel rigidity during assessment
    4. DD. A client who had an ischemic stroke 3 days ago and has persistent right-sided hemiparesis and facial droop
    Show answer to question 12

    Answer: B. A client with Guillain-Barré syndrome who reports difficulty clearing secretions and has shallow respirations

    Guillain-Barré syndrome involves ascending paralysis that can affect the respiratory muscles, and difficulty clearing secretions alongside shallow respirations indicates impending respiratory failure requiring urgent airway evaluation and support. Resting tremors and cogwheel rigidity in Parkinson disease, fatigue and paresthesias in multiple sclerosis, and established hemiparesis following an ischemic stroke are expected manifestations of these chronic or stabilizing conditions. None of the other clients present with an imminent threat to airway, breathing, or circulation.

13. Question 13 of 25Medium

    During multidisciplinary discharge rounds, the team discusses a client recovering from bilateral wrist fractures who lives alone. The client can ambulate independently but struggles with buttoning shirts, opening medication bottles, and preparing simple meals. Which team referral is most appropriate to promote functional independence?

    1. AA. Physical therapy
    2. BB. Speech-language pathology
    3. CC. Unlicensed assistive personnel
    4. DD. Occupational therapy
    Show answer to question 13

    Answer: D. Occupational therapy

    Occupational therapy focuses on improving fine motor skills and regaining independence in activities of daily living, such as dressing, eating, and self-care. Physical therapy primarily targets gross motor function, strength, and mobility such as ambulation and transfer techniques.

14. Question 14 of 25Hard

    A home health nurse is planning the order of visits for the day. Which client should the nurse visit first?

    1. AA. A client with a venous leg ulcer who is due today for the scheduled weekly dressing change
    2. BB. A client discharged yesterday after hip surgery who needs a first home safety evaluation
    3. CC. A client with type 2 diabetes who needs a recertification visit to continue home services
    4. DD. A client with a central line for IV antibiotics who reports chills and a fever of 101.8°F (38.8°C)
    Show answer to question 14

    Answer: D. A client with a central line for IV antibiotics who reports chills and a fever of 101.8°F (38.8°C)

    Fever and chills in a client with a central venous catheter suggest a catheter-related bloodstream infection that can progress to sepsis. This is an actual, potentially life-threatening problem, so the client needs to be seen first and the health care provider notified.

    Why the other options are wrong

    • AA scheduled dressing change for a chronic wound is routine and can be done later in the day.
    • BA home safety evaluation addresses a potential risk and can follow the visit to the client with fever.
    • CA recertification visit is administrative and not time-critical.

15. Question 15 of 25Hard

    A 38-year-old client was admitted involuntarily to a psychiatric unit because of danger to self. The client has not been found legally incompetent, is calm, and understands that an oral surgeon recommends extracting an abscessed tooth. Which statement about consent for the extraction is accurate?

    1. AA. The client keeps the right to consent to or refuse the extraction
    2. BB. The psychiatrist may consent because the admission was involuntary
    3. CC. The client's next of kin must sign because of the involuntary status
    4. DD. The court that ordered the admission must approve the extraction
    Show answer to question 15

    Answer: A. The client keeps the right to consent to or refuse the extraction

    Involuntary admission does not mean a client is legally incompetent. A client who has decision-making capacity and has not been declared incompetent by a court keeps the right to consent to or refuse unrelated medical and dental treatment.

    Why the other options are wrong

    • BThe psychiatrist cannot consent for a capable adult simply because the admission was involuntary.
    • CNext of kin have no authority to consent for an adult who can make the decision.
    • DThe commitment order authorizes the admission; it does not transfer decisions about unrelated care to the court.

16. Question 16 of 25Easy

    An alert, competent client admitted with severe cellulitis insists on leaving the hospital against medical advice (AMA) to care for a pet at home. The health care provider and nurse explain the substantial risks of untreated infection, including sepsis and amputation, but the client persists. Which action should the nurse take next?

    1. AA. Request hospital security to detain the client until a family member can arrive.
    2. BB. Have the client sign the against medical advice form and remove the intravenous access.
    3. CC. Administer a prescribed sedative to calm the client and prevent discharge.
    4. DD. Contact adult protective services to report the client for self-neglect.
    Show answer to question 16

    Answer: B. Have the client sign the against medical advice form and remove the intravenous access.

    Competent adult clients retain the right to self-determination, which encompasses leaving a health care facility against medical advice even when the decision carries grave health risks. The nurse must ensure informed refusal, provide the AMA documentation for signature, and safely remove medical devices such as intravenous catheters to prevent harm. Detaining the client or administering chemical restraints to prevent departure violates the client's autonomy and constitutes false imprisonment.

17. Question 17 of 25Easy

    The charge nurse on a medical unit is allocating inpatient rooms during peak respiratory viral season. All private negative-pressure and single rooms are occupied. Which two clients can the nurse safely cohort in a semi-private room?

    1. AA. A client with suspected tuberculosis and a client with confirmed bacterial pneumonia
    2. BB. A client colonized with vancomycin-resistant enterococci and a neutropenic client
    3. CC. Two clients who both have laboratory-confirmed influenza A infection
    4. DD. A client with confirmed influenza A and a client with confirmed respiratory syncytial virus
    Show answer to question 17

    Answer: C. Two clients who both have laboratory-confirmed influenza A infection

    Cohorting requires placing clients infected with the exact same pathogen together when private rooms are unavailable, provided neither client has a co-infection. Cohorting clients with different viral infections, such as influenza and respiratory syncytial virus, risks severe cross-transmission and viral superinfection. Placing an immunocompromised or uninfected client with an infectious or colonized client is unsafe and violates basic infection-control standards.

18. Question 18 of 25Medium

    An unresponsive client admitted after a motor vehicle collision requires an emergent surgical intervention. The client's legal durable power of attorney for health care document designates an unmarried domestic partner as the health care proxy. The client's estranged spouse arrives and demands to make all treatment decisions. Which action should the nurse take?

    1. AA. Recognize the domestic partner as the legal decision-maker for the client.
    2. BB. Defer decision-making to the estranged spouse as the legal next of kin.
    3. CC. Instruct the partner and spouse that both must sign mutual consent forms.
    4. DD. Require the domestic partner to obtain a court order before consenting.
    Show answer to question 18

    Answer: A. Recognize the domestic partner as the legal decision-maker for the client.

    A legally designated durable power of attorney for health care (health care proxy) supersedes statutory next-of-kin, including a legal spouse. The designated domestic partner retains the legal authority to give informed consent for the incapacitated client. Deferring to the estranged spouse ignores the valid legal designation made by the client.

19. Question 19 of 25Medium

    A case manager is tracking clinical pathway milestones for a client who had a total hip arthroplasty 2 days ago. Which finding indicates a negative clinical pathway variance that requires intervention?

    1. AA. Achieving unassisted ambulation 24 hours earlier than projected by the protocol
    2. BB. Transitioning from intravenous opioids to oral analgesics on postoperative day 1
    3. CC. Refusing physical therapy due to uncontrolled surgical site pain rated 9 out of 10
    4. DD. Tolerating a regular oral diet and producing adequate urine output by day 2
    Show answer to question 19

    Answer: C. Refusing physical therapy due to uncontrolled surgical site pain rated 9 out of 10

    A variance is any deviation from the expected timeline or outcome of a standardized clinical pathway; severe pain preventing scheduled mobilization represents a negative clinical variance that risks prolonged hospitalization and functional decline. Achieving ambulation early is considered a positive variance because the client surpassed the expected milestone. Transitioning to oral analgesics and tolerating a diet on schedule are expected pathway goals, not variances.

20. Question 20 of 25Easy

    The charge nurse is assigning duties to team members on an orthopedic unit. Which client care activity is most appropriate to assign to an assistive personnel (AP)?

    1. AA. Evaluating the effectiveness of an oral analgesic thirty minutes after nurse administration.
    2. BB. Instructing a client who had a total hip replacement on the proper use of an abduction pillow.
    3. CC. Applying prescribed pneumatic compression stockings to a stable client following knee arthroplasty.
    4. DD. Measuring bilateral calf circumferences and inspecting the incision on an operative extremity.
    Show answer to question 20

    Answer: C. Applying prescribed pneumatic compression stockings to a stable client following knee arthroplasty.

    Assistive personnel may be assigned non-invasive, standard procedures that do not involve clinical assessment, client teaching, or evaluation. Applying pneumatic compression devices to a stable postoperative client is a routine mechanical task that falls within the training of assistive personnel. Inspecting surgical incisions, educating the client on post-surgical positioning devices, and evaluating pain responses are nursing responsibilities requiring professional clinical judgment.

21. Question 21 of 25Hard

    A hospital unit identifies a higher-than-expected rate of catheter-associated urinary tract infections (CAUTI) over the past quarter. The nurse manager forms a quality improvement team. Which initial step should the team take?

    1. AA. Review current evidence-based guidelines for urinary catheter insertion and maintenance.
    2. BB. Audit the electronic health records to determine which providers inserted the catheters.
    3. CC. Implement a new protocol for daily chlorhexidine perineal care for all catheterized clients.
    4. DD. Retrain all nursing staff on proper catheter insertion technique and sterile field setup.
    Show answer to question 21

    Answer: A. Review current evidence-based guidelines for urinary catheter insertion and maintenance.

    Quality improvement begins by establishing the evidence-based standard for catheter insertion and maintenance. Comparing current practice with that standard reveals the gaps the team needs to fix.

    Why the other options are wrong

    • BIdentifying who inserted the catheters is blame-focused and does not reveal process problems.
    • CStarting a new protocol before reviewing evidence is premature, and routine antiseptic perineal care is not a recommended CAUTI measure.
    • DRetraining may be needed, but only after the gaps in practice are identified.

22. Question 22 of 25Hard

    A hospital nurse is conducting a telephone transfer report to the receiving home health nurse for a client with an open surgical wound requiring complex packing. Which information is most critical to communicate to ensure safe continuity of care?

    1. AA. The client's preferred meal schedule and preferred daily waking time
    2. BB. The client's original admitting diagnosis and remote surgical history
    3. CC. The hospital room number and the attending physician's office address
    4. DD. The specific wound supplies sent home and the time of the last dressing change
    Show answer to question 22

    Answer: D. The specific wound supplies sent home and the time of the last dressing change

    Safe transitions require specific, actionable clinical data such as the exact timing of recent treatments and the availability of supplies so that care is not omitted or duplicated upon arrival home. Background admitting diagnoses and facility logistics do not provide the immediate operational details necessary to perform the next scheduled wound care safely.

23. Question 23 of 25Medium

    A competent adult client receiving intravenous antibiotics for cellulitis decides to leave the hospital before completing therapy. Which action should the nurse take first?

    1. AA. Remove the client's peripheral intravenous catheter.
    2. BB. Request that the client sign an against medical advice form.
    3. CC. Explain the potential risks and complications of leaving without finishing therapy.
    4. DD. Contact hospital security to prevent the client from leaving the unit.
    Show answer to question 23

    Answer: C. Explain the potential risks and complications of leaving without finishing therapy.

    When an alert, competent client decides to leave against medical advice, the nurse must first ensure the refusal of care is fully informed by explaining the specific medical risks, such as worsening infection and sepsis. After the client is informed of the risks, the nurse should request the signature on the against medical advice form and remove invasive lines before departure. Preventing the client from leaving or detaining them against their will constitutes false imprisonment.

24. Question 24 of 25Easy

    A charge nurse is auditing electronic health record documentation on a medical-surgical unit. Which documentation practice poses the greatest risk to accurate care coordination and client safety?

    1. AA. Entering late entries with the current date, time, and reference to the original event.
    2. BB. Using standardized institutional flowsheets to document routine vital signs and intake.
    3. CC. Copying and pasting the previous shift's assessment note into the current record.
    4. DD. Recording physical assessment findings at the bedside immediately after examination.
    Show answer to question 24

    Answer: C. Copying and pasting the previous shift's assessment note into the current record.

    Copying and pasting clinical documentation (cloning) carries a high risk of propagating outdated, inaccurate, or misleading clinical information across multidisciplinary teams. Point-of-care charting and standardized flowsheets promote timely and clear communication among providers. Making properly labeled late entries is an accepted legal documentation standard when real-time entry is impossible.

25. Question 25 of 25Hard

    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. AA. A 45-year-old with a palpable radial pulse, respiratory rate 28/min, and a deep laceration to the forearm with moderate bleeding.
    2. BB. 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. CC. 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. DD. A 60-year-old with no spontaneous breathing, no palpable carotid pulse, and fixed and dilated pupils.
    Show answer to question 25

    Answer: 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.

    In mass casualty triage, red tags go to clients with life-threatening but survivable conditions. A respiratory rate above 30/min meets START criteria for immediate care, and the chest contusion raises concern for pulmonary contusion or pneumothorax.

    Why the other options are wrong

    • AWith a respiratory rate under 30, a palpable radial pulse and moderate bleeding that pressure can control, this client can wait briefly for care.
    • BAn alert client with a near-normal respiratory rate and a simple tibial fracture is stable and can wait for treatment.
    • DA client who is apneic and pulseless with fixed, dilated pupils is classified as expectant in mass casualty triage, so resources go to survivable injuries.

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