**The Leadership and Management Excellence
Capstone: Nursing Administration, Delegation,
and Healthcare Systems for the NCLEX-RN**
1. A charge nurse is making shift assignments on a medical-surgical unit. Which client should be assigned
to a registered nurse (RN) who is floating from the postpartum unit?
A. A client with pneumonia requiring IV antibiotics every 6 hours.
B. A client with a newly placed ileostomy needing stoma care teaching.
C. A client with chronic kidney disease receiving hemodialysis three times weekly.
D. A client with a hip fracture awaiting surgical repair.
💫RATIONALE✔️✔️: The floated RN has skills in maternal-newborn care but can safely manage stable,
predictable clients. The client with pneumonia has a common medical diagnosis and routine IV meds,
appropriate for a float RN with orientation to the unit.
💫ANSWER✔️✔️: A. A client with pneumonia requiring IV antibiotics every 6 hours.
---
2. A nurse manager is reviewing informed consent with the staff. Which situation indicates a violation of
informed consent?
A. A client signs a consent form for a colonoscopy after the provider explains the risks.
B. A client's spouse signs the consent for an emergency appendectomy because the client is
unconscious.
C. A client with dementia signs a consent form for a hip surgery after the nurse explains the procedure.
D. A client signs a consent form for a blood transfusion after being told it is required.
💫RATIONALE✔️✔️: A client with dementia likely lacks the capacity to give informed consent. A legal
guardian or healthcare power of attorney must sign, not the client.
💫ANSWER✔️✔️: C. A client with dementia signs a consent form for a hip surgery after the nurse
explains the procedure.
,---
3. A charge nurse is evaluating a newly licensed nurse's understanding of fire safety. Which action by the
new nurse requires immediate correction?
A. The nurse pulls the fire alarm when smoke is seen in a client's room.
B. The nurse attempts to extinguish a small fire in a trash can with an extinguisher.
C. The nurse closes all doors to client rooms while evacuating.
D. The nurse uses an elevator to evacuate a client from the 5th floor.
💫RATIONALE✔️✔️: Elevators should never be used during a fire due to risk of entrapment, smoke
inhalation, and the "chimney effect." Evacuate using stairs.
💫ANSWER✔️✔️: D. The nurse uses an elevator to evacuate a client from the 5th floor.
---
4. A nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which task is appropriate for
the UAP?
A. Obtaining a clean-catch urine specimen from a client with a UTI.
B. Feeding a client with dysphagia who is on thickened liquids.
C. Measuring the blood pressure of a client receiving a dopamine infusion.
D. Checking the capillary blood glucose of a client who is unconscious.
💫RATIONALE✔️✔️: Obtaining a clean-catch urine specimen is a non-invasive, routine task that can be
delegated to a UAP after proper instruction. The other tasks require nursing judgment.
💫ANSWER✔️✔️: A. Obtaining a clean-catch urine specimen from a client with a UTI.
---
5. A charge nurse is making assignments for a nurse who is 6 months pregnant. Which client should the
charge nurse avoid assigning to this nurse?
A. A client with methicillin-resistant Staphylococcus aureus (MRSA) wound infection.
B. A client receiving IV ribavirin for respiratory syncytial virus (RSV).
C. A client with Clostridioides difficile on contact precautions.
D. A client with tuberculosis in airborne isolation.
💫RATIONALE✔️✔️: Ribavirin is a category X drug that is teratogenic. Pregnant healthcare workers
should not administer ribavirin or care for clients receiving it via aerosol.
, 💫ANSWER✔️✔️: B. A client receiving IV ribavirin for respiratory syncytial virus (RSV).
---
6. A nurse manager is reviewing a client's advance directive. The client has a living will but no designated
healthcare power of attorney. The client becomes acutely ill and is unable to make decisions. Who
should make treatment decisions?
A. The client's spouse.
B. The client's oldest adult child.
C. The hospital ethics committee.
D. The living will provides instructions; no surrogate is needed.
💫RATIONALE✔️✔️: A living will provides instructions about end-of-life treatments but may not cover all
situations. If no healthcare power of attorney is designated, the default surrogate (typically spouse, then
adult children) makes decisions per state law.
💫ANSWER✔️✔️: A. The client's spouse.
---
7. A charge nurse is observing a nurse administer a subcutaneous injection of heparin. Which action
requires the charge nurse to intervene?
A. The nurse selects the abdomen as the injection site.
B. The nurse cleans the site with an alcohol swab and allows it to dry.
C. The nurse injects the medication without aspirating.
D. The nurse massages the injection site after removing the needle.
💫RATIONALE✔️✔️: Massaging the injection site after heparin administration increases the risk of
hematoma formation. The site should be left undisturbed.
💫ANSWER✔️✔️: D. The nurse massages the injection site after removing the needle.
---
8. A nurse is providing handoff report using the I-PASS format. The nurse states, "I am concerned
because the client's oxygen requirement has increased from 2 L to 4 L over the last 2 hours." This
statement belongs in which section?
A. Illness severity.
Capstone: Nursing Administration, Delegation,
and Healthcare Systems for the NCLEX-RN**
1. A charge nurse is making shift assignments on a medical-surgical unit. Which client should be assigned
to a registered nurse (RN) who is floating from the postpartum unit?
A. A client with pneumonia requiring IV antibiotics every 6 hours.
B. A client with a newly placed ileostomy needing stoma care teaching.
C. A client with chronic kidney disease receiving hemodialysis three times weekly.
D. A client with a hip fracture awaiting surgical repair.
💫RATIONALE✔️✔️: The floated RN has skills in maternal-newborn care but can safely manage stable,
predictable clients. The client with pneumonia has a common medical diagnosis and routine IV meds,
appropriate for a float RN with orientation to the unit.
💫ANSWER✔️✔️: A. A client with pneumonia requiring IV antibiotics every 6 hours.
---
2. A nurse manager is reviewing informed consent with the staff. Which situation indicates a violation of
informed consent?
A. A client signs a consent form for a colonoscopy after the provider explains the risks.
B. A client's spouse signs the consent for an emergency appendectomy because the client is
unconscious.
C. A client with dementia signs a consent form for a hip surgery after the nurse explains the procedure.
D. A client signs a consent form for a blood transfusion after being told it is required.
💫RATIONALE✔️✔️: A client with dementia likely lacks the capacity to give informed consent. A legal
guardian or healthcare power of attorney must sign, not the client.
💫ANSWER✔️✔️: C. A client with dementia signs a consent form for a hip surgery after the nurse
explains the procedure.
,---
3. A charge nurse is evaluating a newly licensed nurse's understanding of fire safety. Which action by the
new nurse requires immediate correction?
A. The nurse pulls the fire alarm when smoke is seen in a client's room.
B. The nurse attempts to extinguish a small fire in a trash can with an extinguisher.
C. The nurse closes all doors to client rooms while evacuating.
D. The nurse uses an elevator to evacuate a client from the 5th floor.
💫RATIONALE✔️✔️: Elevators should never be used during a fire due to risk of entrapment, smoke
inhalation, and the "chimney effect." Evacuate using stairs.
💫ANSWER✔️✔️: D. The nurse uses an elevator to evacuate a client from the 5th floor.
---
4. A nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which task is appropriate for
the UAP?
A. Obtaining a clean-catch urine specimen from a client with a UTI.
B. Feeding a client with dysphagia who is on thickened liquids.
C. Measuring the blood pressure of a client receiving a dopamine infusion.
D. Checking the capillary blood glucose of a client who is unconscious.
💫RATIONALE✔️✔️: Obtaining a clean-catch urine specimen is a non-invasive, routine task that can be
delegated to a UAP after proper instruction. The other tasks require nursing judgment.
💫ANSWER✔️✔️: A. Obtaining a clean-catch urine specimen from a client with a UTI.
---
5. A charge nurse is making assignments for a nurse who is 6 months pregnant. Which client should the
charge nurse avoid assigning to this nurse?
A. A client with methicillin-resistant Staphylococcus aureus (MRSA) wound infection.
B. A client receiving IV ribavirin for respiratory syncytial virus (RSV).
C. A client with Clostridioides difficile on contact precautions.
D. A client with tuberculosis in airborne isolation.
💫RATIONALE✔️✔️: Ribavirin is a category X drug that is teratogenic. Pregnant healthcare workers
should not administer ribavirin or care for clients receiving it via aerosol.
, 💫ANSWER✔️✔️: B. A client receiving IV ribavirin for respiratory syncytial virus (RSV).
---
6. A nurse manager is reviewing a client's advance directive. The client has a living will but no designated
healthcare power of attorney. The client becomes acutely ill and is unable to make decisions. Who
should make treatment decisions?
A. The client's spouse.
B. The client's oldest adult child.
C. The hospital ethics committee.
D. The living will provides instructions; no surrogate is needed.
💫RATIONALE✔️✔️: A living will provides instructions about end-of-life treatments but may not cover all
situations. If no healthcare power of attorney is designated, the default surrogate (typically spouse, then
adult children) makes decisions per state law.
💫ANSWER✔️✔️: A. The client's spouse.
---
7. A charge nurse is observing a nurse administer a subcutaneous injection of heparin. Which action
requires the charge nurse to intervene?
A. The nurse selects the abdomen as the injection site.
B. The nurse cleans the site with an alcohol swab and allows it to dry.
C. The nurse injects the medication without aspirating.
D. The nurse massages the injection site after removing the needle.
💫RATIONALE✔️✔️: Massaging the injection site after heparin administration increases the risk of
hematoma formation. The site should be left undisturbed.
💫ANSWER✔️✔️: D. The nurse massages the injection site after removing the needle.
---
8. A nurse is providing handoff report using the I-PASS format. The nurse states, "I am concerned
because the client's oxygen requirement has increased from 2 L to 4 L over the last 2 hours." This
statement belongs in which section?
A. Illness severity.
