NCLEX RN Management of Care
Practice Exam 5 100 Questions And
Correct Answers (Verified Answers)
Plus Rationales 2026 Q&A Instant
Download Pdf
Question 1
The nurse is caring for four clients. Which client should the nurse assess first?
A. A client with chronic heart failure who has 2+ bilateral ankle edema
B. A client 1 day after surgery reporting incisional pain of 6/10
C. A client with pneumonia who has a respiratory rate of 32/min and oxygen
saturation of 88%
D. A client with diabetes whose blood glucose is 210 mg/dL
Answer: C. A client with pneumonia who has a respiratory rate of 32/min and
oxygen saturation of 88%
Rationale: Airway and breathing problems take priority. Tachypnea and an
oxygen saturation of 88% indicate impaired oxygenation requiring immediate
assessment and intervention.
Question 2
The nurse is delegating tasks to an experienced unlicensed assistive personnel
(UAP). Which task is appropriate to delegate?
A. Assessing a newly admitted client's skin integrity
B. Teaching a client how to use an incentive spirometer
C. Obtaining vital signs for a stable client
D. Evaluating a client's response to pain medication
Answer: C. Obtaining vital signs for a stable client
,Rationale: Routine vital-sign measurement for a stable client is within the
UAP's scope when the nurse provides appropriate direction. Assessment,
teaching, and evaluation remain nursing responsibilities.
Question 3
A nurse receives a prescription that appears unsafe because the medication
dose is much higher than the usual dose. What should the nurse do first?
A. Administer the medication as prescribed
B. Ask another nurse to verify the prescription
C. Contact the prescribing provider to clarify the prescription
D. Document that the dose appears excessive
Answer: C. Contact the prescribing provider to clarify the prescription
Rationale: The nurse has a responsibility to clarify prescriptions that appear
unsafe before administering them. The medication should not be given until
the concern is resolved.
Question 4
Which client is most appropriate for assignment to an experienced LPN/LVN?
A. A client requiring initial assessment after admission
B. A stable client requiring routine dressing changes
C. A client experiencing acute respiratory distress
D. A client requiring discharge teaching about a new diagnosis
Answer: B. A stable client requiring routine dressing changes
Rationale: LPN/LVN assignments generally include stable clients with
predictable outcomes and routine procedures. Initial assessment, unstable
conditions, and comprehensive teaching are RN responsibilities.
Question 5
A nurse is caring for a client who refuses a blood transfusion for religious
reasons. Which action is most appropriate?
A. Ask the family to convince the client
B. Administer the transfusion because it is medically necessary
,C. Respect the client's decision and notify the provider
D. Obtain a court order immediately
Answer: C. Respect the client's decision and notify the provider
Rationale: Competent adults have the right to refuse treatment, even when
refusal may result in serious harm or death. The nurse should respect
autonomy and notify the healthcare team.
Question 6
Which action by the nurse best demonstrates advocacy?
A. Following every provider prescription without question
B. Speaking up when a client's safety or rights may be compromised
C. Allowing family members to make all healthcare decisions
D. Avoiding involvement in ethical disagreements
Answer: B. Speaking up when a client's safety or rights may be compromised
Rationale: Advocacy involves protecting the client's rights, preferences,
safety, and access to appropriate care.
Question 7
A client falls while attempting to walk to the bathroom. What is the nurse's
priority action?
A. Complete an incident report
B. Notify the client's family
C. Assess the client for injury
D. Document the fall in the medical record
Answer: C. Assess the client for injury
Rationale: Immediate assessment of the client's condition takes priority.
Documentation and incident reporting occur after the client has been
assessed and stabilized.
Question 8
Which statement by a nurse demonstrates appropriate informed-consent
practice?
, A. "I will explain all risks and benefits of the procedure to you."
B. "You must sign this form before I explain anything."
C. "The provider will obtain consent, and I will witness your signature."
D. "Signing the form means you cannot change your mind."
Answer: C. "The provider will obtain consent, and I will witness your
signature."
Rationale: The provider performing the procedure is responsible for
explaining the procedure, risks, benefits, and alternatives. The nurse may
witness the client's voluntary signature and verify that the client appears
informed and competent.
Question 9
A nurse is caring for a client with a newly inserted central venous catheter.
Which finding requires immediate action?
A. Mild tenderness at the insertion site
B. Oxygen saturation decreases with sudden dyspnea
C. Small amount of dried blood at the dressing
D. Client reports discomfort when moving the arm
Answer: B. Oxygen saturation decreases with sudden dyspnea
Rationale: Sudden dyspnea and decreased oxygen saturation after central-
line insertion may indicate a pneumothorax, which requires immediate
intervention.
Question 10
Which assignment is appropriate for a newly licensed RN?
A. Caring for a client with unstable septic shock
B. Managing a client receiving complex titrated vasoactive medications
C. Caring for a stable client recovering from an uncomplicated procedure
D. Supervising all nursing staff on a complex medical unit
Answer: C. Caring for a stable client recovering from an uncomplicated
procedure
Practice Exam 5 100 Questions And
Correct Answers (Verified Answers)
Plus Rationales 2026 Q&A Instant
Download Pdf
Question 1
The nurse is caring for four clients. Which client should the nurse assess first?
A. A client with chronic heart failure who has 2+ bilateral ankle edema
B. A client 1 day after surgery reporting incisional pain of 6/10
C. A client with pneumonia who has a respiratory rate of 32/min and oxygen
saturation of 88%
D. A client with diabetes whose blood glucose is 210 mg/dL
Answer: C. A client with pneumonia who has a respiratory rate of 32/min and
oxygen saturation of 88%
Rationale: Airway and breathing problems take priority. Tachypnea and an
oxygen saturation of 88% indicate impaired oxygenation requiring immediate
assessment and intervention.
Question 2
The nurse is delegating tasks to an experienced unlicensed assistive personnel
(UAP). Which task is appropriate to delegate?
A. Assessing a newly admitted client's skin integrity
B. Teaching a client how to use an incentive spirometer
C. Obtaining vital signs for a stable client
D. Evaluating a client's response to pain medication
Answer: C. Obtaining vital signs for a stable client
,Rationale: Routine vital-sign measurement for a stable client is within the
UAP's scope when the nurse provides appropriate direction. Assessment,
teaching, and evaluation remain nursing responsibilities.
Question 3
A nurse receives a prescription that appears unsafe because the medication
dose is much higher than the usual dose. What should the nurse do first?
A. Administer the medication as prescribed
B. Ask another nurse to verify the prescription
C. Contact the prescribing provider to clarify the prescription
D. Document that the dose appears excessive
Answer: C. Contact the prescribing provider to clarify the prescription
Rationale: The nurse has a responsibility to clarify prescriptions that appear
unsafe before administering them. The medication should not be given until
the concern is resolved.
Question 4
Which client is most appropriate for assignment to an experienced LPN/LVN?
A. A client requiring initial assessment after admission
B. A stable client requiring routine dressing changes
C. A client experiencing acute respiratory distress
D. A client requiring discharge teaching about a new diagnosis
Answer: B. A stable client requiring routine dressing changes
Rationale: LPN/LVN assignments generally include stable clients with
predictable outcomes and routine procedures. Initial assessment, unstable
conditions, and comprehensive teaching are RN responsibilities.
Question 5
A nurse is caring for a client who refuses a blood transfusion for religious
reasons. Which action is most appropriate?
A. Ask the family to convince the client
B. Administer the transfusion because it is medically necessary
,C. Respect the client's decision and notify the provider
D. Obtain a court order immediately
Answer: C. Respect the client's decision and notify the provider
Rationale: Competent adults have the right to refuse treatment, even when
refusal may result in serious harm or death. The nurse should respect
autonomy and notify the healthcare team.
Question 6
Which action by the nurse best demonstrates advocacy?
A. Following every provider prescription without question
B. Speaking up when a client's safety or rights may be compromised
C. Allowing family members to make all healthcare decisions
D. Avoiding involvement in ethical disagreements
Answer: B. Speaking up when a client's safety or rights may be compromised
Rationale: Advocacy involves protecting the client's rights, preferences,
safety, and access to appropriate care.
Question 7
A client falls while attempting to walk to the bathroom. What is the nurse's
priority action?
A. Complete an incident report
B. Notify the client's family
C. Assess the client for injury
D. Document the fall in the medical record
Answer: C. Assess the client for injury
Rationale: Immediate assessment of the client's condition takes priority.
Documentation and incident reporting occur after the client has been
assessed and stabilized.
Question 8
Which statement by a nurse demonstrates appropriate informed-consent
practice?
, A. "I will explain all risks and benefits of the procedure to you."
B. "You must sign this form before I explain anything."
C. "The provider will obtain consent, and I will witness your signature."
D. "Signing the form means you cannot change your mind."
Answer: C. "The provider will obtain consent, and I will witness your
signature."
Rationale: The provider performing the procedure is responsible for
explaining the procedure, risks, benefits, and alternatives. The nurse may
witness the client's voluntary signature and verify that the client appears
informed and competent.
Question 9
A nurse is caring for a client with a newly inserted central venous catheter.
Which finding requires immediate action?
A. Mild tenderness at the insertion site
B. Oxygen saturation decreases with sudden dyspnea
C. Small amount of dried blood at the dressing
D. Client reports discomfort when moving the arm
Answer: B. Oxygen saturation decreases with sudden dyspnea
Rationale: Sudden dyspnea and decreased oxygen saturation after central-
line insertion may indicate a pneumothorax, which requires immediate
intervention.
Question 10
Which assignment is appropriate for a newly licensed RN?
A. Caring for a client with unstable septic shock
B. Managing a client receiving complex titrated vasoactive medications
C. Caring for a stable client recovering from an uncomplicated procedure
D. Supervising all nursing staff on a complex medical unit
Answer: C. Caring for a stable client recovering from an uncomplicated
procedure
