NCLEX Readiness: Management of Care
Examination Preparation Document
NCLEX-RN Exam Preparation | Management of Care Category | 57 Verified Multiple-Choice
Questions & Solutions
Section 1: Delegation, Supervision & Assignment (Questions 1–
15)
1. A registered nurse (RN) is planning client assignments on a medical-surgical unit.
Which task is most appropriate to delegate to a licensed practical nurse (LPN/LVN)?
A) Performing the initial admission physical assessment for a newly admitted client
B) Administering a scheduled subcutaneous insulin injection to a stable client
C) Creating a discharge teaching plan for a client returning home after a stroke
D) Evaluating the effectiveness of a newly prescribed IV antihypertensive medication
Correct Answer: B) Administering a scheduled subcutaneous insulin injection to a
stable client
LPNs can safely administer routine scheduled medications, including subcutaneous
insulin, to stable clients. Initial assessments, discharge planning, and evaluating response
to brand-new IV medications require complex clinical judgment reserved solely for the RN.
2. An RN working on a telemetry floor delegates vital sign measurement to an
unlicensed assistive personnel (UAP). Which action by the RN reflects proper
application of the five rights of delegation?
A) Telling the UAP to measure and record vital signs for all stable clients and report any
systolic blood pressure below 90 mmHg
B) Asking the UAP to assess whether a client's chest pain has improved after receiving
sublingual nitroglycerin
C) Instructing the UAP to decide which client should be bathed first based on priority of
care
D) Delegating blood glucose monitoring for a client who just returned from cardiac
catheterization and is unstable
Correct Answer: A) Telling the UAP to measure and record vital signs for all stable
clients and report any systolic blood pressure below 90 mmHg
Clear communication with specific parameters gives the UAP an explicit boundary for
when to report back. Assessment, evaluation of pain relief, and care for unstable post-
,procedure clients require RN-level evaluation and cannot be delegated.
3. Which task should the nurse assign to a UAP assisting with a client who had a
total hip replacement 2 days ago?
A) Assessing the surgical incision site for signs of infection
B) Teaching the client how to use an abduction pillow properly
C) Assisting the client with ambulation using a walker after the physical therapist has
cleared the client
D) Adjusting the settings on a continuous passive motion machine
Correct Answer: C) Assisting the client with ambulation using a walker after the
physical therapist has cleared the client
Once a client is cleared by physical therapy and the initial gait assessment is complete,
assisting with routine ambulation is a standard task for a UAP. Incision assessments,
teaching, and equipment adjustments require nursing judgment.
4. An RN receives a change-of-shift report for four clients. Which client should the
nurse assign to a float RN from the pediatric unit who is working on the adult
orthopedic floor for the first time?
A) A client with a fresh compound leg fracture who requires neurovascular checks every
15 minutes
B) A client with skeletal traction who is complaining of sudden dyspnea and chest pain
C) A client 3 days post-op from a total knee arthroplasty who needs routine wound care
and oral analgesics
D) A client scheduled for an emergency compartment syndrome fasciotomy within the
hour
Correct Answer: C) A client 3 days post-op from a total knee arthroplasty who needs
routine wound care and oral analgesics
Float nurses should be assigned stable clients with predictable outcomes and standard
nursing care needs. Clients with unstable respiratory symptoms, emergency surgical
needs, or frequent high-acuity checks require experienced unit staff.
5. A charge nurse is making shift assignments on a busy surgical unit. Which task
must remain the responsibility of the RN and cannot be delegated to an LPN?
A) Changing a sterile dry dressing on a 2-day-old surgical wound
B) Inserting an indwelling urinary catheter into an adult client
C) Formulating the initial plan of care and identifying nursing diagnoses for a new
admission
, D) Administering a bolus enteral feeding through a gastrostomy tube
Correct Answer: C) Formulating the initial plan of care and identifying nursing
diagnoses for a new admission
Care planning, diagnostic reasoning, and initial assessments are fundamental nursing
responsibilities that cannot be delegated to LPNs or UAPs. LPNs can perform sterile
catheterizations, dressing changes, and tube feedings in most jurisdictions.
6. An LPN reports to the RN that a client's surgical drain has collected 150 mL of
bright red blood over the past 2 hours. Which action should the RN take first?
A) Instruct the LPN to empty the drain and recheck it in 4 hours
B) Go to the client's room immediately to assess the client and surgical site
C) Call the surgeon to request a blood transfusion order before seeing the client
D) Delegate vital signs measurement to the UAP and check back after medication
administration
Correct Answer: B) Go to the client's room immediately to assess the client and
surgical site
Bright red (sanguineous) output of 150 mL in 2 hours suggests active bleeding. The RN
must personally assess the client's hemodynamic status and wound site before calling the
provider or delegating further tasks.
7. Which principle should guide a nurse when supervising a UAP who was newly
hired 2 weeks ago?
A) Assume the UAP is competent in all clinical tasks listed on the job description
B) Validate the UAP's skill competency directly or confirm training completion before
delegating complex tasks
C) Allow the UAP to work completely independently to build confidence
D) Avoid assigning the UAP any physical care duties during the first month
Correct Answer: B) Validate the UAP's skill competency directly or confirm training
completion before delegating complex tasks
Supervision requires confirming that the delegated staff member has demonstrated
competence in the specific task. Assuming competence without verification puts client
safety at risk.
8. An RN delegates tap water enema administration for a constipated client to an
experienced UAP. During the procedure, the UAP reports that the client complains of
severe abdominal cramping. What should the RN instruct the UAP to do?
A) Raise the enema bag higher to finish the procedure faster
Examination Preparation Document
NCLEX-RN Exam Preparation | Management of Care Category | 57 Verified Multiple-Choice
Questions & Solutions
Section 1: Delegation, Supervision & Assignment (Questions 1–
15)
1. A registered nurse (RN) is planning client assignments on a medical-surgical unit.
Which task is most appropriate to delegate to a licensed practical nurse (LPN/LVN)?
A) Performing the initial admission physical assessment for a newly admitted client
B) Administering a scheduled subcutaneous insulin injection to a stable client
C) Creating a discharge teaching plan for a client returning home after a stroke
D) Evaluating the effectiveness of a newly prescribed IV antihypertensive medication
Correct Answer: B) Administering a scheduled subcutaneous insulin injection to a
stable client
LPNs can safely administer routine scheduled medications, including subcutaneous
insulin, to stable clients. Initial assessments, discharge planning, and evaluating response
to brand-new IV medications require complex clinical judgment reserved solely for the RN.
2. An RN working on a telemetry floor delegates vital sign measurement to an
unlicensed assistive personnel (UAP). Which action by the RN reflects proper
application of the five rights of delegation?
A) Telling the UAP to measure and record vital signs for all stable clients and report any
systolic blood pressure below 90 mmHg
B) Asking the UAP to assess whether a client's chest pain has improved after receiving
sublingual nitroglycerin
C) Instructing the UAP to decide which client should be bathed first based on priority of
care
D) Delegating blood glucose monitoring for a client who just returned from cardiac
catheterization and is unstable
Correct Answer: A) Telling the UAP to measure and record vital signs for all stable
clients and report any systolic blood pressure below 90 mmHg
Clear communication with specific parameters gives the UAP an explicit boundary for
when to report back. Assessment, evaluation of pain relief, and care for unstable post-
,procedure clients require RN-level evaluation and cannot be delegated.
3. Which task should the nurse assign to a UAP assisting with a client who had a
total hip replacement 2 days ago?
A) Assessing the surgical incision site for signs of infection
B) Teaching the client how to use an abduction pillow properly
C) Assisting the client with ambulation using a walker after the physical therapist has
cleared the client
D) Adjusting the settings on a continuous passive motion machine
Correct Answer: C) Assisting the client with ambulation using a walker after the
physical therapist has cleared the client
Once a client is cleared by physical therapy and the initial gait assessment is complete,
assisting with routine ambulation is a standard task for a UAP. Incision assessments,
teaching, and equipment adjustments require nursing judgment.
4. An RN receives a change-of-shift report for four clients. Which client should the
nurse assign to a float RN from the pediatric unit who is working on the adult
orthopedic floor for the first time?
A) A client with a fresh compound leg fracture who requires neurovascular checks every
15 minutes
B) A client with skeletal traction who is complaining of sudden dyspnea and chest pain
C) A client 3 days post-op from a total knee arthroplasty who needs routine wound care
and oral analgesics
D) A client scheduled for an emergency compartment syndrome fasciotomy within the
hour
Correct Answer: C) A client 3 days post-op from a total knee arthroplasty who needs
routine wound care and oral analgesics
Float nurses should be assigned stable clients with predictable outcomes and standard
nursing care needs. Clients with unstable respiratory symptoms, emergency surgical
needs, or frequent high-acuity checks require experienced unit staff.
5. A charge nurse is making shift assignments on a busy surgical unit. Which task
must remain the responsibility of the RN and cannot be delegated to an LPN?
A) Changing a sterile dry dressing on a 2-day-old surgical wound
B) Inserting an indwelling urinary catheter into an adult client
C) Formulating the initial plan of care and identifying nursing diagnoses for a new
admission
, D) Administering a bolus enteral feeding through a gastrostomy tube
Correct Answer: C) Formulating the initial plan of care and identifying nursing
diagnoses for a new admission
Care planning, diagnostic reasoning, and initial assessments are fundamental nursing
responsibilities that cannot be delegated to LPNs or UAPs. LPNs can perform sterile
catheterizations, dressing changes, and tube feedings in most jurisdictions.
6. An LPN reports to the RN that a client's surgical drain has collected 150 mL of
bright red blood over the past 2 hours. Which action should the RN take first?
A) Instruct the LPN to empty the drain and recheck it in 4 hours
B) Go to the client's room immediately to assess the client and surgical site
C) Call the surgeon to request a blood transfusion order before seeing the client
D) Delegate vital signs measurement to the UAP and check back after medication
administration
Correct Answer: B) Go to the client's room immediately to assess the client and
surgical site
Bright red (sanguineous) output of 150 mL in 2 hours suggests active bleeding. The RN
must personally assess the client's hemodynamic status and wound site before calling the
provider or delegating further tasks.
7. Which principle should guide a nurse when supervising a UAP who was newly
hired 2 weeks ago?
A) Assume the UAP is competent in all clinical tasks listed on the job description
B) Validate the UAP's skill competency directly or confirm training completion before
delegating complex tasks
C) Allow the UAP to work completely independently to build confidence
D) Avoid assigning the UAP any physical care duties during the first month
Correct Answer: B) Validate the UAP's skill competency directly or confirm training
completion before delegating complex tasks
Supervision requires confirming that the delegated staff member has demonstrated
competence in the specific task. Assuming competence without verification puts client
safety at risk.
8. An RN delegates tap water enema administration for a constipated client to an
experienced UAP. During the procedure, the UAP reports that the client complains of
severe abdominal cramping. What should the RN instruct the UAP to do?
A) Raise the enema bag higher to finish the procedure faster
