VOLUME 4: MANAGEMENT OF CARE & PRIORITIZATION
Next-Gen NCJMM Practice Questions, Rationales & Test-Taking Tips
Document ID: HESI-RN-VOL4-2026/2027 | Core Blueprint Aligned
QUESTION 1: MANAGEMENT OF CARE (CLIENT PRIORITIZATION)
A registered nurse (RN) has received change-of-shift report for four clients on a medical-
surgical unit. Which client should the nurse assess first?
A) A 68-year-old client with chronic obstructive pulmonary disease (COPD) whose
oxygen saturation is 89% on 2 L/min via nasal cannula.
B) A 52-year-old client who underwent an open cholecystectomy 6 hours ago and
reports pain rated as 8 out of 10.
C) A 45-year-old client with a deep vein thrombosis (DVT) who reports a sudden
onset of chest pain and a respiratory rate of 28 breaths per minute.
D) A 78-year-old client with type 2 diabetes mellitus whose fasting blood glucose
level is 145 mg/dL.
Correct Answer: C
HESI Category: Management of Care
Next-Gen NCJMM Rationale:
Why it's correct: The client with a known DVT presenting with sudden chest pain and
tachypnea shows classic signs of a life-threatening pulmonary embolism (PE). This
represents an acute change in status that compromises the respiratory and
circulatory systems, making it the highest priority (ABC framework).
Why others are incorrect: An oxygen saturation of 89% (Option A) is a stable,
chronic, expected finding for a client with severe COPD. Severe post-operative pain
(Option B) requires rapid analgesic administration, but it is not immediately life-
threatening. A blood glucose of 145 mg/dL (Option D) is slightly elevated but stable.
Test-Taking Tip: Always prioritize an acute, unpredictable, life-threatening
complication (like a PE) over expected chronic findings or expected post-operative
pain.
, VOLUME 4: MANAGEMENT OF CARE & PRIORITIZATION
Next-Gen NCJMM Practice Questions, Rationales & Test-Taking Tips
Document ID: HESI-RN-VOL4-2026/2027 | Core Blueprint Aligned
QUESTION 2: MANAGEMENT OF CARE (DELEGATION PROTOCOLS)
A registered nurse (RN) is planning care for a shift and working with a Licensed Practical
Nurse (LPN) and an Unlicensed Assistive Personnel (UAP). Which client task is most
appropriate for the RN to delegate to the LPN?
A) Performing the initial admission assessment on a client transferred from the
intensive care unit.
B) Administering a scheduled subcutaneous dose of insulin glargine to a stable client.
C) Developing a comprehensive home-care teaching plan for a newly diagnosed
diabetic client.
D) Assisting a client who is post-operative day 1 with their initial ambulation down
the hallway.
Correct Answer: B
HESI Category: Management of Care
Next-Gen NCJMM Rationale:
Why it's correct: The administration of scheduled subcutaneous medications to a
stable client falls squarely within the scope of practice for an LPN.
Why others are incorrect: Initial clinical assessments (Option A) and creating primary
educational plans (Option C) require advanced nursing judgment and cannot be
delegated by an RN. Assisting with initial ambulation post-op (Option D) requires
clinical assessment for orthostatic instability and should be initiated by the RN before
being handed off to a UAP for routine assistance.
Test-Taking Tip: Remember the EAT acronym: An RN cannot delegate Evaluation,
Assessment, or Teaching to an LPN or UAP.
QUESTION 3: MANAGEMENT OF CARE (ADVANCE DIRECTIVES)
A client with terminal lung cancer is admitted to the oncology unit. The client is alert and
oriented, and explicitly states, "If my heart stops, I do not want any resuscitation measures
performed." However, there is no written Do-Not-Resuscitate (DNR) order in the medical
chart. Shortly after, the client goes into cardiac arrest. What is the nurse's priority action?
A) Withhold resuscitation measures based on the verbal preference expressed earlier
by the client.
B) Initiate standard cardiopulmonary resuscitation (CPR) measures immediately.
, VOLUME 4: MANAGEMENT OF CARE & PRIORITIZATION
Next-Gen NCJMM Practice Questions, Rationales & Test-Taking Tips
Document ID: HESI-RN-VOL4-2026/2027 | Core Blueprint Aligned
C) Call the hospital ethics committee for an immediate telephone consultation.
D) Locate the client's next of kin to obtain immediate verbal consent to withhold
CPR.
Correct Answer: B
HESI Category: Management of Care
Next-Gen NCJMM Rationale:
Why it's correct: In the absence of a formalized, signed, legally valid written DNR
order in the medical chart, the nurse is legally required to initiate standard life-saving
CPR. Verbal wishes alone do not override standard medical-legal emergency care
mandates.
Why others are incorrect: Withholding CPR without a formal medical order (Option
A) constitutes medical negligence. Calling the ethics committee (Option C) or waiting
to locate family members (Option D) causes critical delays during a cardiac arrest
emergency.
Test-Taking Tip: Without a written, signed provider order for a DNR, the default
nursing standard is always full resuscitation.
QUESTION 4: MANAGEMENT OF CARE (INFORMED CONSENT)
A nurse is witnessing a client's signature on an informed consent form for an elective
abdominal hysterectomy. Which statement by the client indicates that the consent process is
legally valid?
A) "The surgeon explained the procedure, the major risks, and told me I can change
my mind at any time."
B) "I don't really understand what the surgery involves, but the nurse told me it was
necessary."
C) "My family made the decision for me because I was too anxious to listen to the
options."
D) "I am signing this form because I am under the impression that I cannot refuse this
procedure."
Correct Answer: A
HESI Category: Management of Care
Next-Gen NCJMM Rationale:
, VOLUME 4: MANAGEMENT OF CARE & PRIORITIZATION
Next-Gen NCJMM Practice Questions, Rationales & Test-Taking Tips
Document ID: HESI-RN-VOL4-2026/2027 | Core Blueprint Aligned
Why it's correct: Valid informed consent requires that the client is competent, acts
voluntarily, understands the procedure along with its inherent risks and alternatives,
and knows they have the right to refuse care at any point.
Why others are incorrect: If a client does not understand the surgery (Option B),
consent is invalid; the nurse must contact the surgeon to re-explain. Coercion or
having family make decisions for a competent adult (Options C and D) invalidates the
legal process.
Test-Taking Tip: The nurse's role in informed consent is merely to witness the
signature, verify that the client appears competent, and ensure the signature is
voluntary.
QUESTION 5: MANAGEMENT OF CARE (DISASTER TRIAGE)
A community health nurse is triaging victims at the scene of a mass casualty bus accident
using the START (Simple Triage and Rapid Treatment) method. Which victim should the nurse
assign a red (immediate) tag?
A) An alert adult with a compound fracture of the femur who is screaming in pain,
with a respiratory rate of 22/min.
B) An unconscious adult who is apneic, and remains apneic after the nurse manually
opens the airway once.
C) An adult with a severe head injury who is breathing at 34 breaths per minute and
cannot follow simple commands.
D) A conscious adult with multiple superficial lacerations who is walking around the
scene asking to help.
Correct Answer: C
HESI Category: Management of Care
Next-Gen NCJMM Rationale:
Why it's correct: Under the START triage method, a red tag (immediate) is assigned
to victims who have life-threatening injuries but can be saved with rapid
intervention. Criteria include a respiratory rate >30/min, capillary refill >2 seconds, or
an inability to follow simple commands.
Why others are incorrect: The screaming client with a fracture (Option A) has intact
respirations and mental status, warranting a yellow tag (delayed). An apneic victim
who does not breathe after opening the airway (Option B) is tagged black
(expectant/deceased). The walking victim (Option D) is tagged green (minor).
Next-Gen NCJMM Practice Questions, Rationales & Test-Taking Tips
Document ID: HESI-RN-VOL4-2026/2027 | Core Blueprint Aligned
QUESTION 1: MANAGEMENT OF CARE (CLIENT PRIORITIZATION)
A registered nurse (RN) has received change-of-shift report for four clients on a medical-
surgical unit. Which client should the nurse assess first?
A) A 68-year-old client with chronic obstructive pulmonary disease (COPD) whose
oxygen saturation is 89% on 2 L/min via nasal cannula.
B) A 52-year-old client who underwent an open cholecystectomy 6 hours ago and
reports pain rated as 8 out of 10.
C) A 45-year-old client with a deep vein thrombosis (DVT) who reports a sudden
onset of chest pain and a respiratory rate of 28 breaths per minute.
D) A 78-year-old client with type 2 diabetes mellitus whose fasting blood glucose
level is 145 mg/dL.
Correct Answer: C
HESI Category: Management of Care
Next-Gen NCJMM Rationale:
Why it's correct: The client with a known DVT presenting with sudden chest pain and
tachypnea shows classic signs of a life-threatening pulmonary embolism (PE). This
represents an acute change in status that compromises the respiratory and
circulatory systems, making it the highest priority (ABC framework).
Why others are incorrect: An oxygen saturation of 89% (Option A) is a stable,
chronic, expected finding for a client with severe COPD. Severe post-operative pain
(Option B) requires rapid analgesic administration, but it is not immediately life-
threatening. A blood glucose of 145 mg/dL (Option D) is slightly elevated but stable.
Test-Taking Tip: Always prioritize an acute, unpredictable, life-threatening
complication (like a PE) over expected chronic findings or expected post-operative
pain.
, VOLUME 4: MANAGEMENT OF CARE & PRIORITIZATION
Next-Gen NCJMM Practice Questions, Rationales & Test-Taking Tips
Document ID: HESI-RN-VOL4-2026/2027 | Core Blueprint Aligned
QUESTION 2: MANAGEMENT OF CARE (DELEGATION PROTOCOLS)
A registered nurse (RN) is planning care for a shift and working with a Licensed Practical
Nurse (LPN) and an Unlicensed Assistive Personnel (UAP). Which client task is most
appropriate for the RN to delegate to the LPN?
A) Performing the initial admission assessment on a client transferred from the
intensive care unit.
B) Administering a scheduled subcutaneous dose of insulin glargine to a stable client.
C) Developing a comprehensive home-care teaching plan for a newly diagnosed
diabetic client.
D) Assisting a client who is post-operative day 1 with their initial ambulation down
the hallway.
Correct Answer: B
HESI Category: Management of Care
Next-Gen NCJMM Rationale:
Why it's correct: The administration of scheduled subcutaneous medications to a
stable client falls squarely within the scope of practice for an LPN.
Why others are incorrect: Initial clinical assessments (Option A) and creating primary
educational plans (Option C) require advanced nursing judgment and cannot be
delegated by an RN. Assisting with initial ambulation post-op (Option D) requires
clinical assessment for orthostatic instability and should be initiated by the RN before
being handed off to a UAP for routine assistance.
Test-Taking Tip: Remember the EAT acronym: An RN cannot delegate Evaluation,
Assessment, or Teaching to an LPN or UAP.
QUESTION 3: MANAGEMENT OF CARE (ADVANCE DIRECTIVES)
A client with terminal lung cancer is admitted to the oncology unit. The client is alert and
oriented, and explicitly states, "If my heart stops, I do not want any resuscitation measures
performed." However, there is no written Do-Not-Resuscitate (DNR) order in the medical
chart. Shortly after, the client goes into cardiac arrest. What is the nurse's priority action?
A) Withhold resuscitation measures based on the verbal preference expressed earlier
by the client.
B) Initiate standard cardiopulmonary resuscitation (CPR) measures immediately.
, VOLUME 4: MANAGEMENT OF CARE & PRIORITIZATION
Next-Gen NCJMM Practice Questions, Rationales & Test-Taking Tips
Document ID: HESI-RN-VOL4-2026/2027 | Core Blueprint Aligned
C) Call the hospital ethics committee for an immediate telephone consultation.
D) Locate the client's next of kin to obtain immediate verbal consent to withhold
CPR.
Correct Answer: B
HESI Category: Management of Care
Next-Gen NCJMM Rationale:
Why it's correct: In the absence of a formalized, signed, legally valid written DNR
order in the medical chart, the nurse is legally required to initiate standard life-saving
CPR. Verbal wishes alone do not override standard medical-legal emergency care
mandates.
Why others are incorrect: Withholding CPR without a formal medical order (Option
A) constitutes medical negligence. Calling the ethics committee (Option C) or waiting
to locate family members (Option D) causes critical delays during a cardiac arrest
emergency.
Test-Taking Tip: Without a written, signed provider order for a DNR, the default
nursing standard is always full resuscitation.
QUESTION 4: MANAGEMENT OF CARE (INFORMED CONSENT)
A nurse is witnessing a client's signature on an informed consent form for an elective
abdominal hysterectomy. Which statement by the client indicates that the consent process is
legally valid?
A) "The surgeon explained the procedure, the major risks, and told me I can change
my mind at any time."
B) "I don't really understand what the surgery involves, but the nurse told me it was
necessary."
C) "My family made the decision for me because I was too anxious to listen to the
options."
D) "I am signing this form because I am under the impression that I cannot refuse this
procedure."
Correct Answer: A
HESI Category: Management of Care
Next-Gen NCJMM Rationale:
, VOLUME 4: MANAGEMENT OF CARE & PRIORITIZATION
Next-Gen NCJMM Practice Questions, Rationales & Test-Taking Tips
Document ID: HESI-RN-VOL4-2026/2027 | Core Blueprint Aligned
Why it's correct: Valid informed consent requires that the client is competent, acts
voluntarily, understands the procedure along with its inherent risks and alternatives,
and knows they have the right to refuse care at any point.
Why others are incorrect: If a client does not understand the surgery (Option B),
consent is invalid; the nurse must contact the surgeon to re-explain. Coercion or
having family make decisions for a competent adult (Options C and D) invalidates the
legal process.
Test-Taking Tip: The nurse's role in informed consent is merely to witness the
signature, verify that the client appears competent, and ensure the signature is
voluntary.
QUESTION 5: MANAGEMENT OF CARE (DISASTER TRIAGE)
A community health nurse is triaging victims at the scene of a mass casualty bus accident
using the START (Simple Triage and Rapid Treatment) method. Which victim should the nurse
assign a red (immediate) tag?
A) An alert adult with a compound fracture of the femur who is screaming in pain,
with a respiratory rate of 22/min.
B) An unconscious adult who is apneic, and remains apneic after the nurse manually
opens the airway once.
C) An adult with a severe head injury who is breathing at 34 breaths per minute and
cannot follow simple commands.
D) A conscious adult with multiple superficial lacerations who is walking around the
scene asking to help.
Correct Answer: C
HESI Category: Management of Care
Next-Gen NCJMM Rationale:
Why it's correct: Under the START triage method, a red tag (immediate) is assigned
to victims who have life-threatening injuries but can be saved with rapid
intervention. Criteria include a respiratory rate >30/min, capillary refill >2 seconds, or
an inability to follow simple commands.
Why others are incorrect: The screaming client with a fracture (Option A) has intact
respirations and mental status, warranting a yellow tag (delayed). An apneic victim
who does not breathe after opening the airway (Option B) is tagged black
(expectant/deceased). The walking victim (Option D) is tagged green (minor).
