NGN Case Study Simulation: Advanced Management of Care Practice Questions
& Detailed Explanations
Subject: Nursing / Next Generation NCLEX (NGN) Case Study Simulation
Subtopic: Advanced Management of Care (Prioritization, Delegation, and
Ethical Decision Making)
Question 1: A charge nurse is coordinating care for a group of clients on a medical-surgical unit.
Which of the following client assignments is the most appropriate to delegate to an Unlicensed
Assistive Personnel (UAP)?
A) Measuring and documenting the hourly output from a multi-lumen central venous catheter for
a client in septic shock.
B) Assisting a client who has a suspected spinal cord injury with an initial transfer from the bed
to a specialized tilt table.
C) Performing oral care for a client who is two hours post-extubation and requires frequent
suctioning.
D) Obtaining orthostatic vital signs for a client who has a history of syncope and was admitted
for unexplained dizziness.
Correct Answer: D) Obtaining orthostatic vital signs for a client who has a history of
syncope and was admitted for unexplained dizziness.
Explanation: The UAP has the skills to obtain vital signs, including orthostatic measurements,
provided the nurse has assessed the client's stability and determined that it is safe for the UAP to
perform this task. Assessing output from a central line requires specialized nursing knowledge
regarding line patency and fluid management. Transferring a client with a spinal cord injury
requires the assessment and stabilization skills of a registered nurse to prevent further
neurological compromise. A client who is post-extubation is at high risk for aspiration and
airway obstruction, requiring the ongoing assessment of a licensed nurse, particularly during
procedures like oral care.
Question 2: An RN is working with a Licensed Practical Nurse (LPN) and a UAP on a busy
surgical unit. Which of the following tasks is the most appropriate for the RN to assign to the
LPN?
A) Developing the initial plan of care for a client who has been admitted with a new diagnosis of
type 1 diabetes mellitus.
B) Administering a prescribed intravenous piggyback dose of vancomycin to a client who has a
peripherally inserted central catheter (PICC).
,C) Providing discharge teaching for a client who is going home with a complex wound vac
dressing.
D) Monitoring the drainage from a Hemovac drain for a client who is two days post-op after a
total knee arthroplasty.
Correct Answer: D) Monitoring the drainage from a Hemovac drain for a client who is two
days post-op after a total knee arthroplasty.
Explanation: LPNs can perform focused assessments and monitor stable clients with predictable
outcomes, such as a client who is two days post-op. Developing an initial plan of care and
providing complex discharge teaching require the critical thinking and assessment skills of an
RN. In most jurisdictions, while LPNs may be able to administer IV medications depending on
their scope of practice and state regulations, they are typically restricted from administering
vesicants or managing complex intravenous therapy like vancomycin via a central line, making
monitoring drainage the safest and most appropriate task listed.
Question 3: A nurse is managing a client with a do-not-resuscitate (DNR) order who is nearing
the end of life. The client’s spouse demands that the nurse perform CPR if the client stops
breathing. Which of the following actions should the nurse take?
A) Call the facility’s ethics committee immediately to resolve the dispute.
B) Perform CPR as requested by the spouse to avoid legal liability.
C) Explain the DNR order to the spouse and reiterate the client’s previously stated wishes.
D) Tell the spouse that the nurse cannot override the physician's order but that the spouse can
perform CPR themselves.
Correct Answer: C) Explain the DNR order to the spouse and reiterate the client’s
previously stated wishes.
Explanation: The nurse must advocate for the client’s autonomy and ensure that their end-of-life
wishes are honored. A DNR order is a medical order based on the client’s informed consent. The
nurse must provide education and support to the spouse, clarifying that the order reflects the
client's own decision. Performing CPR against a valid DNR order is considered battery. The
nurse should facilitate a conversation with the physician or palliative care team if the spouse
remains distressed, but the primary goal is to adhere to the client's wishes.
Question 4: A nurse is caring for four clients. Which of the following clients should the nurse
assess first?
A) A client with chronic heart failure who has 2+ pitting edema in the lower extremities and a
weight gain of 0.5 kg overnight.
,B) A client with type 2 diabetes mellitus who reports a blood glucose level of 180 mg/dL before
lunch.
C) A client who is one day post-thyroidectomy and reports tingling in the fingers and circumoral
numbness.
D) A client with pneumonia who has a productive cough and a resting respiratory rate of 22
breaths/minute.
Correct Answer: C) A client who is one day post-thyroidectomy and reports tingling in the
fingers and circumoral numbness.
Explanation: The client post-thyroidectomy is exhibiting classic symptoms of hypocalcemia,
which can occur due to accidental damage or removal of the parathyroid glands. Hypocalcemia
can lead to life-threatening laryngospasm and seizures. This is the highest priority, as it involves
a potential airway and neurological emergency. The other clients represent chronic conditions
or stable post-op/respiratory findings that require attention but are not immediately life-
threatening compared to the risk of airway obstruction.
Question 5: A nurse is caring for a client who has been admitted for an acute exacerbation of
chronic obstructive pulmonary disease (COPD). The client is currently receiving oxygen at 2
L/min via nasal cannula. Which of the following assessment findings should the nurse report to
the provider immediately?
A) A blood pressure of 130/80 mm Hg.
B) An arterial blood gas (ABG) result showing a PaCO2 of 65 mm Hg and a pH of 7.30.
C) A respiratory rate of 24 breaths/minute.
D) A client-reported rating of 4/10 for dyspnea.
Correct Answer: B) An arterial blood gas (ABG) result showing a PaCO2 of 65 mm Hg and
a pH of 7.30.
Explanation: The client’s ABG values indicate uncompensated respiratory acidosis. While
COPD clients often have chronic hypercapnia, a significant drop in pH to 7.30 suggests acute
respiratory failure or decompensation. This requires immediate medical intervention to improve
ventilation and prevent further deterioration. While tachypnea and dyspnea are expected in a
COPD exacerbation, the ABG values indicate a critical physiological status change.
Question 6: A nurse is assigned to care for a client who is being treated for a deep vein
thrombosis (DVT). The nurse notes that the client is receiving a continuous heparin infusion.
Which of the following labs should the nurse monitor most closely for a potential life-threatening
complication?
, A) Serum potassium
B) Prothrombin time (PT)
C) Platelet count
D) Blood urea nitrogen (BUN)
Correct Answer: C) Platelet count
Explanation: The most serious life-threatening complication of heparin therapy is Heparin-
Induced Thrombocytopenia (HIT), an immune-mediated reaction that causes a paradoxical
increase in thrombotic risk and a significant drop in platelet count. Monitoring the platelet count
is essential to detect this condition early. PT is monitored for warfarin therapy, and while BUN
and potassium are important, they are not specific to the unique, urgent complications of heparin
therapy.
Question 7: A nurse is delegating tasks to an LPN for a group of clients. Which of the following
clients is most appropriate for the LPN to care for independently?
A) A client who is experiencing an acute myocardial infarction and requires titration of a
nitroglycerin drip.
B) A client who has a fractured hip and requires a daily dressing change for a surgical site.
C) A client who is receiving chemotherapy and requires assessment for neutropenic fever.
D) A client who has been newly admitted with an unstable blood pressure and unclear
neurological baseline.
Correct Answer: B) A client who has a fractured hip and requires a daily dressing change
for a surgical site.
Explanation: The client with a stable surgical site from a hip fracture is the most predictable and
stable client listed. LPNs can safely care for clients with predictable outcomes. Titrating
vasoactive drugs (nitroglycerin), assessing clients with potentially life-threatening conditions
(neutropenic fever), and caring for clients with unstable hemodynamics/neurological status are
tasks that require the higher-level assessment and clinical decision-making skills of an RN.
Question 8: A nurse is caring for a client who has just been informed of a terminal cancer
diagnosis. The client states, "I cannot believe this is happening to me. There must be some
mistake." Which of the following is the most appropriate response by the nurse?
A) "I am so sorry, but the tests are very accurate."
B) "Tell me what you are feeling right now."
& Detailed Explanations
Subject: Nursing / Next Generation NCLEX (NGN) Case Study Simulation
Subtopic: Advanced Management of Care (Prioritization, Delegation, and
Ethical Decision Making)
Question 1: A charge nurse is coordinating care for a group of clients on a medical-surgical unit.
Which of the following client assignments is the most appropriate to delegate to an Unlicensed
Assistive Personnel (UAP)?
A) Measuring and documenting the hourly output from a multi-lumen central venous catheter for
a client in septic shock.
B) Assisting a client who has a suspected spinal cord injury with an initial transfer from the bed
to a specialized tilt table.
C) Performing oral care for a client who is two hours post-extubation and requires frequent
suctioning.
D) Obtaining orthostatic vital signs for a client who has a history of syncope and was admitted
for unexplained dizziness.
Correct Answer: D) Obtaining orthostatic vital signs for a client who has a history of
syncope and was admitted for unexplained dizziness.
Explanation: The UAP has the skills to obtain vital signs, including orthostatic measurements,
provided the nurse has assessed the client's stability and determined that it is safe for the UAP to
perform this task. Assessing output from a central line requires specialized nursing knowledge
regarding line patency and fluid management. Transferring a client with a spinal cord injury
requires the assessment and stabilization skills of a registered nurse to prevent further
neurological compromise. A client who is post-extubation is at high risk for aspiration and
airway obstruction, requiring the ongoing assessment of a licensed nurse, particularly during
procedures like oral care.
Question 2: An RN is working with a Licensed Practical Nurse (LPN) and a UAP on a busy
surgical unit. Which of the following tasks is the most appropriate for the RN to assign to the
LPN?
A) Developing the initial plan of care for a client who has been admitted with a new diagnosis of
type 1 diabetes mellitus.
B) Administering a prescribed intravenous piggyback dose of vancomycin to a client who has a
peripherally inserted central catheter (PICC).
,C) Providing discharge teaching for a client who is going home with a complex wound vac
dressing.
D) Monitoring the drainage from a Hemovac drain for a client who is two days post-op after a
total knee arthroplasty.
Correct Answer: D) Monitoring the drainage from a Hemovac drain for a client who is two
days post-op after a total knee arthroplasty.
Explanation: LPNs can perform focused assessments and monitor stable clients with predictable
outcomes, such as a client who is two days post-op. Developing an initial plan of care and
providing complex discharge teaching require the critical thinking and assessment skills of an
RN. In most jurisdictions, while LPNs may be able to administer IV medications depending on
their scope of practice and state regulations, they are typically restricted from administering
vesicants or managing complex intravenous therapy like vancomycin via a central line, making
monitoring drainage the safest and most appropriate task listed.
Question 3: A nurse is managing a client with a do-not-resuscitate (DNR) order who is nearing
the end of life. The client’s spouse demands that the nurse perform CPR if the client stops
breathing. Which of the following actions should the nurse take?
A) Call the facility’s ethics committee immediately to resolve the dispute.
B) Perform CPR as requested by the spouse to avoid legal liability.
C) Explain the DNR order to the spouse and reiterate the client’s previously stated wishes.
D) Tell the spouse that the nurse cannot override the physician's order but that the spouse can
perform CPR themselves.
Correct Answer: C) Explain the DNR order to the spouse and reiterate the client’s
previously stated wishes.
Explanation: The nurse must advocate for the client’s autonomy and ensure that their end-of-life
wishes are honored. A DNR order is a medical order based on the client’s informed consent. The
nurse must provide education and support to the spouse, clarifying that the order reflects the
client's own decision. Performing CPR against a valid DNR order is considered battery. The
nurse should facilitate a conversation with the physician or palliative care team if the spouse
remains distressed, but the primary goal is to adhere to the client's wishes.
Question 4: A nurse is caring for four clients. Which of the following clients should the nurse
assess first?
A) A client with chronic heart failure who has 2+ pitting edema in the lower extremities and a
weight gain of 0.5 kg overnight.
,B) A client with type 2 diabetes mellitus who reports a blood glucose level of 180 mg/dL before
lunch.
C) A client who is one day post-thyroidectomy and reports tingling in the fingers and circumoral
numbness.
D) A client with pneumonia who has a productive cough and a resting respiratory rate of 22
breaths/minute.
Correct Answer: C) A client who is one day post-thyroidectomy and reports tingling in the
fingers and circumoral numbness.
Explanation: The client post-thyroidectomy is exhibiting classic symptoms of hypocalcemia,
which can occur due to accidental damage or removal of the parathyroid glands. Hypocalcemia
can lead to life-threatening laryngospasm and seizures. This is the highest priority, as it involves
a potential airway and neurological emergency. The other clients represent chronic conditions
or stable post-op/respiratory findings that require attention but are not immediately life-
threatening compared to the risk of airway obstruction.
Question 5: A nurse is caring for a client who has been admitted for an acute exacerbation of
chronic obstructive pulmonary disease (COPD). The client is currently receiving oxygen at 2
L/min via nasal cannula. Which of the following assessment findings should the nurse report to
the provider immediately?
A) A blood pressure of 130/80 mm Hg.
B) An arterial blood gas (ABG) result showing a PaCO2 of 65 mm Hg and a pH of 7.30.
C) A respiratory rate of 24 breaths/minute.
D) A client-reported rating of 4/10 for dyspnea.
Correct Answer: B) An arterial blood gas (ABG) result showing a PaCO2 of 65 mm Hg and
a pH of 7.30.
Explanation: The client’s ABG values indicate uncompensated respiratory acidosis. While
COPD clients often have chronic hypercapnia, a significant drop in pH to 7.30 suggests acute
respiratory failure or decompensation. This requires immediate medical intervention to improve
ventilation and prevent further deterioration. While tachypnea and dyspnea are expected in a
COPD exacerbation, the ABG values indicate a critical physiological status change.
Question 6: A nurse is assigned to care for a client who is being treated for a deep vein
thrombosis (DVT). The nurse notes that the client is receiving a continuous heparin infusion.
Which of the following labs should the nurse monitor most closely for a potential life-threatening
complication?
, A) Serum potassium
B) Prothrombin time (PT)
C) Platelet count
D) Blood urea nitrogen (BUN)
Correct Answer: C) Platelet count
Explanation: The most serious life-threatening complication of heparin therapy is Heparin-
Induced Thrombocytopenia (HIT), an immune-mediated reaction that causes a paradoxical
increase in thrombotic risk and a significant drop in platelet count. Monitoring the platelet count
is essential to detect this condition early. PT is monitored for warfarin therapy, and while BUN
and potassium are important, they are not specific to the unique, urgent complications of heparin
therapy.
Question 7: A nurse is delegating tasks to an LPN for a group of clients. Which of the following
clients is most appropriate for the LPN to care for independently?
A) A client who is experiencing an acute myocardial infarction and requires titration of a
nitroglycerin drip.
B) A client who has a fractured hip and requires a daily dressing change for a surgical site.
C) A client who is receiving chemotherapy and requires assessment for neutropenic fever.
D) A client who has been newly admitted with an unstable blood pressure and unclear
neurological baseline.
Correct Answer: B) A client who has a fractured hip and requires a daily dressing change
for a surgical site.
Explanation: The client with a stable surgical site from a hip fracture is the most predictable and
stable client listed. LPNs can safely care for clients with predictable outcomes. Titrating
vasoactive drugs (nitroglycerin), assessing clients with potentially life-threatening conditions
(neutropenic fever), and caring for clients with unstable hemodynamics/neurological status are
tasks that require the higher-level assessment and clinical decision-making skills of an RN.
Question 8: A nurse is caring for a client who has just been informed of a terminal cancer
diagnosis. The client states, "I cannot believe this is happening to me. There must be some
mistake." Which of the following is the most appropriate response by the nurse?
A) "I am so sorry, but the tests are very accurate."
B) "Tell me what you are feeling right now."
