NCLEX RN Management of Care Practice
Exam 1 Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
1. A nurse is caring for a client newly diagnosed with terminal cancer. The
client states, “I don’t want any more chemotherapy. I just want to be
comfortable.” The family insists that treatment continue. Which action
should the nurse take first?
A. Encourage the family to accept the client’s decision.
B. Advocate for the client’s right to refuse treatment.
C. Request a psychiatric consultation for the client.
D. Suggest a family meeting with the oncologist.
The nurse’s primary duty is to advocate for the client’s autonomy and right to
make informed decisions regarding their own healthcare, including refusal of
treatment. The client has clearly expressed their wishes. While family meetings
and support are important, the immediate ethical and legal obligation is to
respect the client’s decision. A psychiatric consultation is not indicated because
the client’s decision appears to be a rational expression of their values.
Encouraging the family to accept the decision may be appropriate later, but
advocacy for the client’s stated wishes takes precedence.
2. A charge nurse is making assignments for the upcoming shift. Which patient
should be assigned to the most experienced registered nurse (RN)?
A. A client with diabetes mellitus admitted for insulin pump teaching.
B. A client admitted 2 hours ago after a motor vehicle collision with a
Glasgow Coma Scale score of 9.
C. A client scheduled for discharge later today after an uncomplicated
laparoscopic cholecystectomy.
, D. A client with chronic stable angina who needs reinforcement of dietary
teaching.
The client with a Glasgow Coma Scale of 9 has a neurological injury requiring
frequent assessments and rapid intervention. This patient is the most unstable
and needs the expertise of an experienced RN. The other clients are stable and
predictable: diabetes teaching, discharge education, and dietary reinforcement
can be delegated or managed by less experienced staff under supervision.
3. A nurse is preparing to administer a blood transfusion. The client has signed
the consent form, but now expresses fear and hesitation about receiving
blood. What should the nurse do?
A. Administer the blood as prescribed since consent was already signed.
B. Reassure the client that the transfusion is safe and proceed.
C. Notify the health care provider and withhold the transfusion until the
client’s concerns are resolved.
D. Explain that refusing the transfusion could be fatal and pressure the
client to accept it.
Informed consent is an ongoing process; the client has the right to withdraw
consent at any time. Fear and hesitation indicate that the client may not be fully
comfortable proceeding. The nurse must respect the client’s autonomy, withhold
the blood, and notify the provider for further discussion. Proceeding despite
expressed concerns violates the client’s rights and could constitute battery.
Reassurance without addressing concerns or coercing the client is unethical.
4. A staff nurse suspects a colleague is diverting narcotics. What is the nurse’s
priority action?
A. Confront the colleague directly to clarify the situation.
B. Begin documenting the colleague’s behavior in a personal log.
C. Report the suspicion immediately to the nurse manager or supervisor.
D. Call the state board of nursing to file a complaint.
Nurses have an ethical and legal duty to report suspected impaired practice or
diversion of controlled substances to the appropriate authority within the
,facility, such as the nurse manager, to ensure patient safety and a proper
investigation. Confronting the colleague could compromise the investigation and
safety. A personal log may be evidence but reporting must come first. Filing a
complaint with the state board is typically done by the employer after an
investigation, not as the initial step by a staff nurse.
5. A nurse is caring for a client who is Jehovah’s Witness and is refusing a life-
saving blood transfusion. The client’s spouse insists the nurse administer
the blood. The client is alert and oriented. What is the most appropriate
nursing action?
A. Administer the blood as the spouse is the next of kin.
B. Respect the client’s right to refuse treatment.
C. Request an ethics committee consultation immediately.
D. Seek a court order to overrule the client’s decision.
A competent adult client has the absolute right to refuse treatment, even life-
saving measures, based on religious beliefs. The nurse’s obligation is to respect
this autonomy. The spouse’s wishes do not override the client’s own decision
when the client is capable. An ethics consult may be helpful but does not delay
respecting the refusal. Seeking a court order would violate the client’s rights if
the client is competent.
6. The nurse receives a telephone order from a provider for a new medication.
Which action is required to ensure accuracy?
A. Have another nurse listen to the order on speakerphone.
B. Read back the complete order to the prescriber and obtain
confirmation.
C. Enter the order into the electronic health record immediately.
D. Write the order on the client’s Kardex as a reminder.
The Joint Commission and facility policies require a “read-back” of telephone or
verbal orders to verify accuracy. The nurse writes the order, reads it back, and
gets confirmation. Having another nurse listen is helpful but does not replace
the read-back requirement. Entering the order into the EHR or writing on the
, Kardex must occur after verification. The read-back must be for the complete
order.
7. A nurse manager is evaluating the cost-effectiveness of a fall prevention
program. Which data source would provide the most meaningful
information?
A. Number of falls before and after program implementation.
B. Comparison of fall-related injury costs and program operational costs.
C. Staff satisfaction surveys regarding the new program.
D. Patient satisfaction scores on safety during hospitalization.
Cost-effectiveness analysis compares the costs of an intervention with the
outcomes achieved, measured in monetary terms. Comparing fall-related injury
costs (savings from reduced injuries) with program operational costs directly
reflects cost-effectiveness. The number of falls is an outcome measure but does
not address cost. Satisfaction surveys do not measure economic impact.
8. A nurse is caring for a client who has an advance directive indicating “do not
resuscitate” (DNR). The client’s family demands full resuscitation if the
client’s heart stops. The client is currently unresponsive. What should the
nurse do?
A. Follow the DNR order and support the family.
B. Begin CPR because the family is the decision-maker now.
C. Call the provider to change the code status based on family wishes.
D. Ask the nursing supervisor to suspend the advance directive.
The advance directive reflects the client’s previously expressed wishes and
remains in effect unless the client had revoked it or a legally authorized decision-
maker with proof of powers changes it. The family cannot override the DNR
order for an unresponsive client without legal authority. The nurse must honor
the advance directive and provide emotional support to the family. Ignoring a
valid DNR could result in legal charges of battery.
9. A charge nurse notices a new graduate nurse is preparing to administer an
IV push medication without checking the compatibility with the
Exam 1 Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
1. A nurse is caring for a client newly diagnosed with terminal cancer. The
client states, “I don’t want any more chemotherapy. I just want to be
comfortable.” The family insists that treatment continue. Which action
should the nurse take first?
A. Encourage the family to accept the client’s decision.
B. Advocate for the client’s right to refuse treatment.
C. Request a psychiatric consultation for the client.
D. Suggest a family meeting with the oncologist.
The nurse’s primary duty is to advocate for the client’s autonomy and right to
make informed decisions regarding their own healthcare, including refusal of
treatment. The client has clearly expressed their wishes. While family meetings
and support are important, the immediate ethical and legal obligation is to
respect the client’s decision. A psychiatric consultation is not indicated because
the client’s decision appears to be a rational expression of their values.
Encouraging the family to accept the decision may be appropriate later, but
advocacy for the client’s stated wishes takes precedence.
2. A charge nurse is making assignments for the upcoming shift. Which patient
should be assigned to the most experienced registered nurse (RN)?
A. A client with diabetes mellitus admitted for insulin pump teaching.
B. A client admitted 2 hours ago after a motor vehicle collision with a
Glasgow Coma Scale score of 9.
C. A client scheduled for discharge later today after an uncomplicated
laparoscopic cholecystectomy.
, D. A client with chronic stable angina who needs reinforcement of dietary
teaching.
The client with a Glasgow Coma Scale of 9 has a neurological injury requiring
frequent assessments and rapid intervention. This patient is the most unstable
and needs the expertise of an experienced RN. The other clients are stable and
predictable: diabetes teaching, discharge education, and dietary reinforcement
can be delegated or managed by less experienced staff under supervision.
3. A nurse is preparing to administer a blood transfusion. The client has signed
the consent form, but now expresses fear and hesitation about receiving
blood. What should the nurse do?
A. Administer the blood as prescribed since consent was already signed.
B. Reassure the client that the transfusion is safe and proceed.
C. Notify the health care provider and withhold the transfusion until the
client’s concerns are resolved.
D. Explain that refusing the transfusion could be fatal and pressure the
client to accept it.
Informed consent is an ongoing process; the client has the right to withdraw
consent at any time. Fear and hesitation indicate that the client may not be fully
comfortable proceeding. The nurse must respect the client’s autonomy, withhold
the blood, and notify the provider for further discussion. Proceeding despite
expressed concerns violates the client’s rights and could constitute battery.
Reassurance without addressing concerns or coercing the client is unethical.
4. A staff nurse suspects a colleague is diverting narcotics. What is the nurse’s
priority action?
A. Confront the colleague directly to clarify the situation.
B. Begin documenting the colleague’s behavior in a personal log.
C. Report the suspicion immediately to the nurse manager or supervisor.
D. Call the state board of nursing to file a complaint.
Nurses have an ethical and legal duty to report suspected impaired practice or
diversion of controlled substances to the appropriate authority within the
,facility, such as the nurse manager, to ensure patient safety and a proper
investigation. Confronting the colleague could compromise the investigation and
safety. A personal log may be evidence but reporting must come first. Filing a
complaint with the state board is typically done by the employer after an
investigation, not as the initial step by a staff nurse.
5. A nurse is caring for a client who is Jehovah’s Witness and is refusing a life-
saving blood transfusion. The client’s spouse insists the nurse administer
the blood. The client is alert and oriented. What is the most appropriate
nursing action?
A. Administer the blood as the spouse is the next of kin.
B. Respect the client’s right to refuse treatment.
C. Request an ethics committee consultation immediately.
D. Seek a court order to overrule the client’s decision.
A competent adult client has the absolute right to refuse treatment, even life-
saving measures, based on religious beliefs. The nurse’s obligation is to respect
this autonomy. The spouse’s wishes do not override the client’s own decision
when the client is capable. An ethics consult may be helpful but does not delay
respecting the refusal. Seeking a court order would violate the client’s rights if
the client is competent.
6. The nurse receives a telephone order from a provider for a new medication.
Which action is required to ensure accuracy?
A. Have another nurse listen to the order on speakerphone.
B. Read back the complete order to the prescriber and obtain
confirmation.
C. Enter the order into the electronic health record immediately.
D. Write the order on the client’s Kardex as a reminder.
The Joint Commission and facility policies require a “read-back” of telephone or
verbal orders to verify accuracy. The nurse writes the order, reads it back, and
gets confirmation. Having another nurse listen is helpful but does not replace
the read-back requirement. Entering the order into the EHR or writing on the
, Kardex must occur after verification. The read-back must be for the complete
order.
7. A nurse manager is evaluating the cost-effectiveness of a fall prevention
program. Which data source would provide the most meaningful
information?
A. Number of falls before and after program implementation.
B. Comparison of fall-related injury costs and program operational costs.
C. Staff satisfaction surveys regarding the new program.
D. Patient satisfaction scores on safety during hospitalization.
Cost-effectiveness analysis compares the costs of an intervention with the
outcomes achieved, measured in monetary terms. Comparing fall-related injury
costs (savings from reduced injuries) with program operational costs directly
reflects cost-effectiveness. The number of falls is an outcome measure but does
not address cost. Satisfaction surveys do not measure economic impact.
8. A nurse is caring for a client who has an advance directive indicating “do not
resuscitate” (DNR). The client’s family demands full resuscitation if the
client’s heart stops. The client is currently unresponsive. What should the
nurse do?
A. Follow the DNR order and support the family.
B. Begin CPR because the family is the decision-maker now.
C. Call the provider to change the code status based on family wishes.
D. Ask the nursing supervisor to suspend the advance directive.
The advance directive reflects the client’s previously expressed wishes and
remains in effect unless the client had revoked it or a legally authorized decision-
maker with proof of powers changes it. The family cannot override the DNR
order for an unresponsive client without legal authority. The nurse must honor
the advance directive and provide emotional support to the family. Ignoring a
valid DNR could result in legal charges of battery.
9. A charge nurse notices a new graduate nurse is preparing to administer an
IV push medication without checking the compatibility with the
