NCLEX-RN Management of Care
2026/2027 Practice Exam
40 Original Questions, Answer Key & Detailed Rationales
Focus areas: prioritization, delegation, assignment, informed consent, ethics, confidentiality,
incident reporting, disaster triage, continuity of care, and leadership.
How to use this guide
Choose the best answer before reading the highlighted answer and rationale. Apply airway-breathing-circulation,
safety, acuity, stability, scope of practice, and client-rights principles. Local laws and facility policies always govern
practice.
Originality and scope notice
All scenarios and explanations in this paper were newly written for educational practice. This is not an official NCLEX product, not a
recalled exam, and does not guarantee a result. NCLEX is a registered trademark of the National Council of State Boards of Nursing,
which does not sponsor or endorse this material.
Original educational practice material - not an actual or recalled examination Page 1
, Practice Questions with Answers and Rationales
1. The charge nurse receives four updates. Which situation should be addressed first?
A. A client awaiting routine discharge teaching
B. A client with new inspiratory stridor after thyroid surgery
C. A client requesting a sleep aid
D. A client whose family wants a care conference
Answer: B
Rationale: New stridor after neck surgery signals possible airway obstruction. Airway threats take priority over routine
teaching, comfort requests, and scheduling.
2. Which task is appropriate to delegate to an experienced unlicensed assistive personnel (UAP)?
A. Reinforce teaching about a new insulin pen
B. Assess pain 30 minutes after IV morphine
C. Obtain and record intake and output for a stable client
D. Decide whether a client may ambulate without assistance
Answer: C
Rationale: Measuring and recording routine data for a stable client is within the UAP role. Teaching, assessment, and
clinical decisions remain with the licensed nurse.
Original educational practice material - not an actual or recalled examination Page 2
, 3. A nurse is assigning clients to an LPN/LVN. Which client is most appropriate?
A. A client admitted 10 minutes ago with chest pressure
B. A stable client needing a scheduled sterile dressing change
C. A client receiving the first unit of packed red blood cells
D. A client with sudden confusion and oxygen saturation of 86%
Answer: B
Rationale: A stable client with a predictable outcome and an established plan of care is appropriate for the LPN/LVN.
New, unstable, and high-risk situations require RN assessment.
4. A client refuses a recommended blood transfusion for religious reasons. What is the nurse's best first
action?
A. Ask the family to persuade the client
B. Notify security
C. Assess the client's understanding and decision-making capacity
D. Obtain a court order
Answer: C
Rationale: The nurse first verifies informed understanding and capacity. A capable adult may refuse treatment, even
when refusal increases risk.
Original educational practice material - not an actual or recalled examination Page 3
2026/2027 Practice Exam
40 Original Questions, Answer Key & Detailed Rationales
Focus areas: prioritization, delegation, assignment, informed consent, ethics, confidentiality,
incident reporting, disaster triage, continuity of care, and leadership.
How to use this guide
Choose the best answer before reading the highlighted answer and rationale. Apply airway-breathing-circulation,
safety, acuity, stability, scope of practice, and client-rights principles. Local laws and facility policies always govern
practice.
Originality and scope notice
All scenarios and explanations in this paper were newly written for educational practice. This is not an official NCLEX product, not a
recalled exam, and does not guarantee a result. NCLEX is a registered trademark of the National Council of State Boards of Nursing,
which does not sponsor or endorse this material.
Original educational practice material - not an actual or recalled examination Page 1
, Practice Questions with Answers and Rationales
1. The charge nurse receives four updates. Which situation should be addressed first?
A. A client awaiting routine discharge teaching
B. A client with new inspiratory stridor after thyroid surgery
C. A client requesting a sleep aid
D. A client whose family wants a care conference
Answer: B
Rationale: New stridor after neck surgery signals possible airway obstruction. Airway threats take priority over routine
teaching, comfort requests, and scheduling.
2. Which task is appropriate to delegate to an experienced unlicensed assistive personnel (UAP)?
A. Reinforce teaching about a new insulin pen
B. Assess pain 30 minutes after IV morphine
C. Obtain and record intake and output for a stable client
D. Decide whether a client may ambulate without assistance
Answer: C
Rationale: Measuring and recording routine data for a stable client is within the UAP role. Teaching, assessment, and
clinical decisions remain with the licensed nurse.
Original educational practice material - not an actual or recalled examination Page 2
, 3. A nurse is assigning clients to an LPN/LVN. Which client is most appropriate?
A. A client admitted 10 minutes ago with chest pressure
B. A stable client needing a scheduled sterile dressing change
C. A client receiving the first unit of packed red blood cells
D. A client with sudden confusion and oxygen saturation of 86%
Answer: B
Rationale: A stable client with a predictable outcome and an established plan of care is appropriate for the LPN/LVN.
New, unstable, and high-risk situations require RN assessment.
4. A client refuses a recommended blood transfusion for religious reasons. What is the nurse's best first
action?
A. Ask the family to persuade the client
B. Notify security
C. Assess the client's understanding and decision-making capacity
D. Obtain a court order
Answer: C
Rationale: The nurse first verifies informed understanding and capacity. A capable adult may refuse treatment, even
when refusal increases risk.
Original educational practice material - not an actual or recalled examination Page 3
