Practice Management of Care questions for the National Council Licensure Examination — RN. Every question includes a full explanation of why the correct answer is right and why the tempting distractors are wrong.
78 questions available · medium difficulty · NCLEX-RN · Free, no registration required
10 example questions with full explanations. Use the interactive practice above to work through the complete set.
Question 1hard
A charge nurse on a medical-surgical unit receives report on four patients. Which patient should the nurse assess FIRST?
- A.A 45-year-old with heart failure who had 800 mL urine output over the last 8 hours and is now reporting sudden onset shortness of breath and confusion✓
- B.A 66-year-old with diabetes whose morning blood glucose is 215 mg/dL and who is awaiting an insulin sliding scale dose
- C.A 72-year-old post-operative day 1 hip replacement who is requesting pain medication and reports a pain level of 8/10
- D.A 58-year-old with COPD on 2L nasal cannula whose oxygen saturation dropped from 94% to 91% over the past hour
Correct answer: A
The 45-year-old with heart failure presenting with sudden onset shortness of breath AND confusion represents an acute, potentially life-threatening change in cardiopulmonary and neurological status that must be assessed first using the ABC framework — both airway/breathing compromise and altered perfusion to the brain are present simultaneously. The COPD patient's oxygen saturation decline is concerning but represents a gradual change in a known chronic condition and remains above critical threshold. The post-operative patient's pain, while significant, is not immediately life-threatening. The hyperglycemic diabetic patient is stable enough to safely await a brief delay for insulin administration.
Question 2hard
An RN is caring for a 79-year-old patient with moderate dementia who has been admitted for hip fracture repair. The patient's adult child, who holds durable power of attorney for healthcare, insists that the surgical team proceed with the operation. However, when the surgeon explains the procedure to the patient, the patient clearly states, 'I do not want surgery. Leave me alone.' The nurse's BEST action is to:
- A.Reassure the patient that the surgery is in their best interest and obtain verbal agreement before proceeding
- B.Contact the hospital ethics committee and place a hold on the surgical consent process pending a formal capacity evaluation by the appropriate clinical team✓
- C.Proceed with surgical preparation because the healthcare proxy has legal authority to override the patient's refusal
- D.Document the patient's statement, defer to the healthcare proxy's decision, and inform the charge nurse that the patient verbally refused
Correct answer: B
A healthcare proxy's authority is only invoked when the patient lacks decision-making capacity — capacity is not the same as a dementia diagnosis.Apatient with moderate dementia may still retain the capacity to make a specific decision if they can understand, appreciate, reason about, and communicate a choice. The patient's clear, unambiguous refusal requires a formal capacity evaluation before the proxy's authority can supersede the patient's own stated wishes, which upholds the ethical principle of autonomy. Simply deferring to the proxy without a capacity determination violates the patient's autonomy and could expose the team to legal liability. Reassuring the patient and seeking agreement under pressure does not constitute valid informed consent. Involving the ethics committee and halting consent pending evaluation is the correct protective action that balances autonomy, beneficence, and legal safeguards.
Question 3hard
A nurse working in an outpatient mental health clinic is seeing a client who discloses during a therapy session that they have been physically abusing their 8-year-old child at home. The client then states, 'Please don't tell anyone — this is private information shared in confidence.' Which response by the nurse reflects the correct legal and ethical obligation?
- A.Consult with the supervising physician before making any report to determine whether mandatory reporting applies in this situation
- B.Document the disclosure in the client's chart and notify the clinic administrator, allowing administration to determine whether a report is required
- C.File a mandatory report with the appropriate child protective agency because suspected child abuse supersedes the duty of confidentiality✓
- D.Honor the client's request for confidentiality because the therapeutic relationship depends on trust and privacy
Correct answer: C
Mandatory reporting of child abuse is a legal obligation in all U.S. jurisdictions that supersedes the nurse's duty of confidentiality to the client. When a nurse has reasonable cause to suspect child abuse, they are required by law to report it to the appropriate protective services agency — this is not discretionary and does not require physician consultation or administrative approval. Honoring the client's confidentiality request in this context would be a breach of the nurse's legal duty and would place a child at continued risk of harm. Delegating the decision to administration transfers responsibility that belongs to the nurse as a mandated reporter. The correct action is to file the report directly and promptly.
Question 4hard
An RN is preparing to delegate tasks to a licensed practical nurse (LPN) and an unlicensed assistive personnel (UAP) at the start of a busy shift. Which assignment reflects the appropriate application of delegation principles?
- A.Assign the LPN to evaluate whether a diabetic patient's understanding of insulin self-injection technique has improved following teaching conducted by the RN earlier in the shift
- B.Ask the UAP to reinforce discharge teaching about wound care for a patient whose RN-developed teaching plan has been in place for two days and was verified effective yesterday
- C.Assign the LPN to perform a comprehensive admission assessment on a newly admitted patient with unstable angina and document nursing diagnoses
- D.Ask the UAP to monitor and record intake and output for a stable post-operative patient and report values to the RN✓
Correct answer: D
Monitoring and recording intake and output for a stable patient is a routine, non-judgmental task that falls within UAP scope of practice under the RN's supervision, and reporting findings to the RN maintains appropriate oversight. Option B is incorrect because teaching — even reinforcement — requires nursing judgment and is not within UAP scope of practice. Option C is incorrect because comprehensive assessment, formulation of nursing diagnoses, and care planning are exclusively RN functions that cannot be delegated to an LPN. Option A is incorrect because evaluation of patient outcomes and learning is a critical component of the nursing process that cannot be delegated — the RN must evaluate whether teaching was effective. The five rights of delegation (right task, right circumstance, right person, right direction, right supervision) are all satisfied only in Option D.
Question 5medium
A nurse is preparing to transfer a postoperative patient from the surgical unit to the medical-surgical floor. Using SBAR communication, the nurse states: 'The patient is a 58-year-old male, two days post-op right hemicolectomy, currently on IV morphine for pain control.' Which component of SBAR does this statement represent?
- A.Background✓
- B.Assessment
- C.Situation
- D.Recommendation
Correct answer: A
The Background component of SBAR includes pertinent historical and contextual information about the patient, such as diagnosis, surgical history, and current treatments — all of which are present in this statement. Situation describes the immediate problem or reason for the communication (e.g., 'I am calling because the patient's blood pressure has dropped'). Assessment reflects the nurse's clinical judgment about what is happening (e.g., 'I think the patient may be bleeding internally'). Recommendation is the nurse's suggested course of action. Distinguishing between Situation and Background is a common area of confusion; Situation is the 'what is happening right now,' while Background is the 'relevant patient context.'
Question 6medium
A nurse discovers that a colleague administered the wrong dose of insulin to a patient. The patient's blood glucose was monitored, the prescriber was notified, and the patient experienced no harm. Which action should the nurse take next?
- A.Notify the charge nurse verbally and take no further action since the patient was not harmed
- B.Complete an incident report and submit it through the facility's internal reporting system, without referencing the report in the patient's chart✓
- C.File the incident report only if the patient or family requests documentation of the event
- D.Document the medication error and the corrective actions taken in the patient's medical record, including that an incident report was filed
Correct answer: B
An incident report (variance or occurrence report) must be completed for any medication error, regardless of whether harm occurred, and submitted through the facility's internal quality improvement system. Critically, the incident report itself should never be referenced or mentioned in the patient's medical record, as it is an internal risk management document protected from legal discovery. The medical record should contain only objective clinical documentation: what happened to the patient, assessments performed, and interventions taken. Option B is incorrect because charting that an incident report was filed is a standard violation of incident reporting policy. Option A is insufficient because verbal notification alone does not fulfill reporting requirements. Option D is incorrect because incident reporting is not contingent on patient or family request.
Question 7medium
A nurse is caring for a 74-year-old patient with end-stage COPD who has a living will stating she does not want mechanical ventilation. The patient is now obtunded and her oxygen saturation is 82% on 4L nasal cannula. Her adult daughter, who is not the designated healthcare proxy, insists the nurse 'do everything possible' including intubation. Which action is most appropriate?
- A.Prepare the patient for intubation because the family member's request overrides the living will when the patient cannot speak for herself
- B.Contact hospital ethics committee before taking any action, since conflicting family input creates a legal obligation to pause all interventions
- C.Honor the living will by withholding intubation and notify the healthcare team to ensure the directive is implemented and comfort measures are provided✓
- D.Defer the decision to the charge nurse, as scope of practice prohibits the bedside nurse from acting on advance directives without supervisor approval
Correct answer: C
A living will is a legally binding advance directive that reflects the patient's autonomous decision-making while she had capacity. When the patient becomes unable to speak for herself, the living will guides care — it does not require a family member's agreement to be honored. The daughter, who is not the designated healthcare proxy, does not have legal authority to override the patient's documented wishes. The nurse's role is to advocate for the patient's expressed wishes, notify the healthcare team, ensure the advance directive is implemented, and facilitate comfort-focused care. Option A is incorrect because family preference does not supersede a valid advance directive. Option D is incorrect because nurses have a professional and ethical obligation to act on and advocate for advance directives. Option B is incorrect because while ethics committee consultation may be appropriate for complex ongoing disputes, it does not pause implementation of a clear, valid directive in an acute situation.
Question 8medium
A charge nurse on a medical-surgical unit is reviewing care assignments. Which task is within the scope of practice for a licensed practical nurse (LPN) and appropriate to assign?
- A.Develop and update the individualized care plan for a patient newly diagnosed with Type 2 diabetes
- B.Provide discharge teaching to a patient being sent home after a myocardial infarction
- C.Perform the initial admission assessment for a newly admitted patient with chest pain
- D.Administer a scheduled oral antihypertensive medication to a stable patient with hypertension✓
Correct answer: D
Administering scheduled medications to stable patients is within the LPN's scope of practice in most states and is an appropriate assignment. LPNs are trained to administer oral, topical, subcutaneous, and intramuscular medications under the supervision of an RN or physician, particularly to patients with predictable, stable conditions. Option C is incorrect because initial assessments require RN-level nursing judgment and cannot be delegated to an LPN. Option A is incorrect because care planning — including developing and updating individualized nursing care plans — is a professional nursing function that requires RN scope of practice. Option B is incorrect because discharge teaching, particularly for a complex condition like post-MI care, requires assessment of learning needs and evaluation of understanding, both of which are RN responsibilities. The key distinction is that LPNs contribute to care but do not perform the full nursing process independently.
Question 9medium
A nurse is working on a quality improvement committee investigating a sentinel event in which a patient received a blood transfusion intended for another patient. Using the PDSA cycle, the committee has identified the root cause and developed a new two-nurse verification protocol. Which phase of the PDSA cycle does implementing this protocol on one unit for 30 days represent?
Correct answer: A
The 'Do' phase of the PDSA (Plan-Do-Study-Act) cycle involves carrying out the planned change on a small scale — in this case, implementing the new verification protocol on a single unit for a defined trial period. This is a controlled, time-limited test of the intervention before broader rollout. The 'Plan' phase (already completed) involved identifying the problem, analyzing root causes, and designing the intervention. The 'Study' phase comes next, during which the committee will analyze data collected during the trial to determine whether the protocol reduced errors. The 'Act' phase follows, where the team decides to adopt, adapt, or abandon the change based on findings. Understanding the sequence and purpose of each PDSA phase is essential for quality improvement questions on the NCLEX.
Question 10hard
A nurse overhears a colleague tell a patient's employer — who called the unit asking about the patient's prognosis — that the patient was admitted for alcohol withdrawal and will be unable to return to work for at least two weeks. The patient has not provided consent for this disclosure. When the nurse reports this to the charge nurse, which response by the charge nurse reflects the highest priority action?
- A.Reassure the patient that their information is protected and no further action is needed
- B.Notify the nurse manager and initiate the facility's HIPAA privacy breach investigation protocol✓
- C.Contact the employer and request that the information not be shared further
- D.Counsel the colleague privately and document the conversation in the patient's medical record
Correct answer: B
An unauthorized disclosure of protected health information (PHI) to an employer without the patient's consent constitutes a HIPAA privacy breach, which triggers mandatory institutional reporting and investigation under federal law. The highest priority action is to notify the nurse manager and activate the facility's breach protocol, which includes documenting the event, assessing the scope of disclosure, notifying the patient, and potentially reporting to the Department of Health and Human Services. Documenting a privacy breach in the medical record (Option D) is incorrect — breach investigations are handled through administrative channels, not the clinical chart. Simply reassuring the patient (Option A) fails to address the breach and is inadequate. Contacting the employer (Option C) does not constitute an official institutional response and may worsen the situation by confirming the disclosure.