Safe and Effective Care Environment (25 Questions)
Subcategories: Management of Care (17–23% of exam),
Safety and Infection Control (9–15%) (Wikipedia)
Management of Care (13 Questions)
1. A nurse is delegating tasks to a UAP. Which task
is appropriate to assign?
A. Administer oral medications to a post-op patient
B. Monitor intake and output for a client on fluid
restriction
C. Perform discharge teaching for a diabetic client
D. Assess lung sounds every 2 hours for a client with
pneumonia
Answer: B
Rationale: UAPs can measure and record
intake/output under supervision; medication
administration, teaching, and assessments require
licensed nurses.
2. During a staffing shortage, the charge nurse
assigns a float nurse to the ICU who has never
worked there. The charge nurse should:
A. Allow the nurse to manage one stable ventilator
patient with close supervision
B. Assign the nurse two unstable post-op patients
C. Remove all complex tasks and only have the nurse
observe
D. Send the nurse back to float to a different unit
, Answer: A
Rationale: Safe staffing requires appropriate
assignment with supervision; matching competence to
patient acuity maintains safety.
3. A nurse manager is planning in-service education
on NGN items. Which outcome demonstrates
improved clinical judgment?
A. Increased correct responses on multiple-choice
pharmacology questions
B. Ability to sequence steps in a prioritization scenario
C. Higher scores on knowledge-recall questions
D. Faster completion times on medication calculation
items
Answer: B
Rationale: NGN focuses on analysis, prioritization,
and decision-making through innovative item types
(NCLEX).
4. A client with advanced directives “Do Not
Resuscitate” codes. The nurse’s first action is to:
A. Notify the physician
B. Verify the DNR order in the chart
C. Place the client in high-Fowler’s position
D. Call the family to the bedside
Answer: B
Rationale: Always verify directives before initiating or
withholding interventions.
5. Which intervention best demonstrates case
management?
, A. Discharging a client without complications
B. Coordinating home health services for a client
post-stroke
C. Administering daily insulin injections
D. Teaching a client to self-catheterize
Answer: B
Rationale: Case management involves arranging and
coordinating long-term resources.
6. A client refuses a blood transfusion on religious
grounds. The nurse should:
A. Document refusal and withhold transfusion
B. Attempt to persuade the client to accept
C. Notify the ethics committee immediately
D. Ask family to convince the client
Answer: A
Rationale: Respect client autonomy; refusal must be
documented and honored.
7. A nurse floats to the telemetry unit. Which patient
assignment is appropriate?
A. One client with new onset atrial fibrillation requiring
urgent cardioversion
B. One stable client with a history of SVT, on oral
medications
C. Two clients with chest tubes and hemodynamic
instability
D. One client immediately post-MI on multiple drips
Answer: B
, Rationale: Choose a patient with stable rhythm and
familiar medications for a float nurse.
8. A nurse notes a colleague charting before
performing interventions. The nurse’s best action
is to:
A. Confront the colleague in private and remind them
of policy
B. Report the behavior to the unit manager
C. Document the behavior in the incident report
D. Continue with own duties and observe further
Answer: A
Rationale: First, address lapse in private to reinforce
standards; escalate if behavior persists.
9. Which action demonstrates advocacy?
A. Turning a client Q 2 hours to prevent skin
breakdown
B. Requesting a translator for a client who speaks
little English
C. Administering pain medication early as PRN
D. Refusing to float off unit
Answer: B
Rationale: Ensuring clients’ rights to effective
communication exemplifies advocacy.
10. During change-of-shift report, the nurse
overhears personal gossip about a client. The
nurse should:
A. Join in to support the colleague
B. Report the colleague for violating confidentiality
Subcategories: Management of Care (17–23% of exam),
Safety and Infection Control (9–15%) (Wikipedia)
Management of Care (13 Questions)
1. A nurse is delegating tasks to a UAP. Which task
is appropriate to assign?
A. Administer oral medications to a post-op patient
B. Monitor intake and output for a client on fluid
restriction
C. Perform discharge teaching for a diabetic client
D. Assess lung sounds every 2 hours for a client with
pneumonia
Answer: B
Rationale: UAPs can measure and record
intake/output under supervision; medication
administration, teaching, and assessments require
licensed nurses.
2. During a staffing shortage, the charge nurse
assigns a float nurse to the ICU who has never
worked there. The charge nurse should:
A. Allow the nurse to manage one stable ventilator
patient with close supervision
B. Assign the nurse two unstable post-op patients
C. Remove all complex tasks and only have the nurse
observe
D. Send the nurse back to float to a different unit
, Answer: A
Rationale: Safe staffing requires appropriate
assignment with supervision; matching competence to
patient acuity maintains safety.
3. A nurse manager is planning in-service education
on NGN items. Which outcome demonstrates
improved clinical judgment?
A. Increased correct responses on multiple-choice
pharmacology questions
B. Ability to sequence steps in a prioritization scenario
C. Higher scores on knowledge-recall questions
D. Faster completion times on medication calculation
items
Answer: B
Rationale: NGN focuses on analysis, prioritization,
and decision-making through innovative item types
(NCLEX).
4. A client with advanced directives “Do Not
Resuscitate” codes. The nurse’s first action is to:
A. Notify the physician
B. Verify the DNR order in the chart
C. Place the client in high-Fowler’s position
D. Call the family to the bedside
Answer: B
Rationale: Always verify directives before initiating or
withholding interventions.
5. Which intervention best demonstrates case
management?
, A. Discharging a client without complications
B. Coordinating home health services for a client
post-stroke
C. Administering daily insulin injections
D. Teaching a client to self-catheterize
Answer: B
Rationale: Case management involves arranging and
coordinating long-term resources.
6. A client refuses a blood transfusion on religious
grounds. The nurse should:
A. Document refusal and withhold transfusion
B. Attempt to persuade the client to accept
C. Notify the ethics committee immediately
D. Ask family to convince the client
Answer: A
Rationale: Respect client autonomy; refusal must be
documented and honored.
7. A nurse floats to the telemetry unit. Which patient
assignment is appropriate?
A. One client with new onset atrial fibrillation requiring
urgent cardioversion
B. One stable client with a history of SVT, on oral
medications
C. Two clients with chest tubes and hemodynamic
instability
D. One client immediately post-MI on multiple drips
Answer: B
, Rationale: Choose a patient with stable rhythm and
familiar medications for a float nurse.
8. A nurse notes a colleague charting before
performing interventions. The nurse’s best action
is to:
A. Confront the colleague in private and remind them
of policy
B. Report the behavior to the unit manager
C. Document the behavior in the incident report
D. Continue with own duties and observe further
Answer: A
Rationale: First, address lapse in private to reinforce
standards; escalate if behavior persists.
9. Which action demonstrates advocacy?
A. Turning a client Q 2 hours to prevent skin
breakdown
B. Requesting a translator for a client who speaks
little English
C. Administering pain medication early as PRN
D. Refusing to float off unit
Answer: B
Rationale: Ensuring clients’ rights to effective
communication exemplifies advocacy.
10. During change-of-shift report, the nurse
overhears personal gossip about a client. The
nurse should:
A. Join in to support the colleague
B. Report the colleague for violating confidentiality
