NCLEX-RN 2026
Management of Care Practice Exam - 40 Original Questions with Answers and Rationales
PRIORITY DELEGATION LEGAL COORDINATION QUALITY
10 10 8 7 5
HOW TO USE THIS PAPER
Complete all 40 items before reviewing the answer key. For each miss, identify whether the error involved priority
setting, delegation, scope, advocacy, communication, or documentation. Reattempt missed items after focused
review.
Coverage: prioritization by acuity; assignment; delegation and supervision; informed consent; client rights;
advance directives; handoff; referrals; quality improvement; documentation; and confidentiality.
Important: This independently created practice resource is not affiliated with, sponsored by, or endorsed by
NCSBN, NCLEX, or any nursing school. It contains no copied, recalled, leaked, or actual secure exam questions.
Delegation and scope rules vary by jurisdiction and employer policy.
Suggested time: 50 minutes Target score: 80% or higher
Independent original NCLEX-RN practice resource - educational use only Page 1
, PRIORITIZATION AND ASSIGNMENT
1. The nurse receives report on four clients. Which client should be assessed first?
A. A client with chronic heart failure who requests an extra pillow
B. A client 2 hours after thyroidectomy who has new stridor
C. A client with diabetes whose premeal glucose is 168 mg/dL
D. A client awaiting routine discharge instructions
2. Which client should the emergency department nurse evaluate first?
A. A client with an ankle sprain and intact pulses
B. A client with fever and sore throat for two days
C. A client with chest pressure, diaphoresis, and nausea
D. A client requesting a medication refill
3. Which postoperative finding requires the most immediate action?
A. Pain rated 6 of 10 after ambulation
B. Urine output of 20 mL during the past hour with falling blood pressure
C. Temperature of 37.8 C (100 F)
D. No bowel movement for two days
4. Which client should the nurse assess first after receiving shift report?
A. A client with COPD whose oxygen saturation is 90% at the prescribed baseline
B. A client with pneumonia who is newly confused and has a respiratory rate of 30/min
C. A client with arthritis requesting a warm compress
D. A client with stable angina asking about diet
5. The charge nurse must assign one client to a float nurse from an outpatient clinic. Which assignment is
most appropriate?
A. A client receiving titrated vasoactive medication
B. A client with a new tracheostomy and copious secretions
C. A stable client awaiting discharge after an uncomplicated procedure
D. A client admitted with active gastrointestinal bleeding
6. Which client is most appropriate for a newly licensed RN?
A. A client with unstable ventricular dysrhythmias
B. A client one day after uncomplicated laparoscopic surgery
C. A client requiring rapid-sequence intubation
D. A client with a massive transfusion in progress
7. A nurse has four scheduled tasks. Which should be completed first?
A. Administer a time-critical antibiotic to a client with sepsis
B. Refill a stable client's water pitcher
C. Update a routine care plan
D. Return a nonurgent family phone call
Independent original NCLEX-RN practice resource - educational use only Page 2
Management of Care Practice Exam - 40 Original Questions with Answers and Rationales
PRIORITY DELEGATION LEGAL COORDINATION QUALITY
10 10 8 7 5
HOW TO USE THIS PAPER
Complete all 40 items before reviewing the answer key. For each miss, identify whether the error involved priority
setting, delegation, scope, advocacy, communication, or documentation. Reattempt missed items after focused
review.
Coverage: prioritization by acuity; assignment; delegation and supervision; informed consent; client rights;
advance directives; handoff; referrals; quality improvement; documentation; and confidentiality.
Important: This independently created practice resource is not affiliated with, sponsored by, or endorsed by
NCSBN, NCLEX, or any nursing school. It contains no copied, recalled, leaked, or actual secure exam questions.
Delegation and scope rules vary by jurisdiction and employer policy.
Suggested time: 50 minutes Target score: 80% or higher
Independent original NCLEX-RN practice resource - educational use only Page 1
, PRIORITIZATION AND ASSIGNMENT
1. The nurse receives report on four clients. Which client should be assessed first?
A. A client with chronic heart failure who requests an extra pillow
B. A client 2 hours after thyroidectomy who has new stridor
C. A client with diabetes whose premeal glucose is 168 mg/dL
D. A client awaiting routine discharge instructions
2. Which client should the emergency department nurse evaluate first?
A. A client with an ankle sprain and intact pulses
B. A client with fever and sore throat for two days
C. A client with chest pressure, diaphoresis, and nausea
D. A client requesting a medication refill
3. Which postoperative finding requires the most immediate action?
A. Pain rated 6 of 10 after ambulation
B. Urine output of 20 mL during the past hour with falling blood pressure
C. Temperature of 37.8 C (100 F)
D. No bowel movement for two days
4. Which client should the nurse assess first after receiving shift report?
A. A client with COPD whose oxygen saturation is 90% at the prescribed baseline
B. A client with pneumonia who is newly confused and has a respiratory rate of 30/min
C. A client with arthritis requesting a warm compress
D. A client with stable angina asking about diet
5. The charge nurse must assign one client to a float nurse from an outpatient clinic. Which assignment is
most appropriate?
A. A client receiving titrated vasoactive medication
B. A client with a new tracheostomy and copious secretions
C. A stable client awaiting discharge after an uncomplicated procedure
D. A client admitted with active gastrointestinal bleeding
6. Which client is most appropriate for a newly licensed RN?
A. A client with unstable ventricular dysrhythmias
B. A client one day after uncomplicated laparoscopic surgery
C. A client requiring rapid-sequence intubation
D. A client with a massive transfusion in progress
7. A nurse has four scheduled tasks. Which should be completed first?
A. Administer a time-critical antibiotic to a client with sepsis
B. Refill a stable client's water pitcher
C. Update a routine care plan
D. Return a nonurgent family phone call
Independent original NCLEX-RN practice resource - educational use only Page 2
