NCLEX Management of Care Practice Test
What is in this test
| Topic | Focus | Items |
|---|---|---|
| Prioritisation of Care | Deciding who and what comes first | 7 |
| Delegation and Supervision | Who can do what, and what stays with you | 6 |
| Legal and Ethical Practice | Confidentiality, reporting, and professional boundaries | 5 |
| Case Management and Continuity | Referrals, handoff, and discharge planning | 3 |
| Quality Improvement and Performance | Reporting, near misses, and systems thinking | 3 |
| Advocacy and Informed Consent | Whose signature, whose explanation | 2 |
Item formats in this test: Multiple choice, Fill in the blank, Select all that apply, Ordered response. This is test 1 of 9 — there is one for every client-need category.
The 26 questions
A charge nurse is distributing work on a medical unit. Which task is appropriate to delegate to unlicensed assistive personnel?
Show answer and rationale
Correct answer: A. Recording the intake and output of a client who is two days post-operative and stable
Recording intake and output for a stable client is a routine, predictable task with a clear standard, and it does not require nursing judgement. It falls squarely within the role of unlicensed assistive personnel.
Why the other options are wrong
- B. Auscultating lung sounds is an assessment. Assessment always stays with the registered nurse.
- C. Initial teaching requires nursing judgement about readiness and comprehension and cannot be delegated to unlicensed personnel.
- D. Judging a client’s response to an intervention is evaluation, the final step of the nursing process, and stays with the nurse.
A client received a double dose of an oral medication because of a transcription error. After assessing the client, which action should the nurse take next?
Show answer and rationale
Correct answer: B. Notify the prescribing provider of the error and the client’s status
After assessing the client, the provider is notified so that monitoring or treatment can be ordered. The incident report follows, and it documents facts for quality improvement.
Why the other options are wrong
- A. The client record never references the incident report. It contains only the clinical facts and the client’s response.
- C. The person who discovers the error completes the report; it is not passed to the person who made it.
- D. Delaying notification risks preventable harm and is never appropriate after a known error.
A client recovering from a stroke coughs and sounds wet after every sip of water. Which referral is most appropriate?
Show answer and rationale
Correct answer: C. Speech-language pathology
Speech-language pathologists evaluate and manage swallowing as well as communication. Coughing and a wet voice after swallowing suggest aspiration risk and require a formal swallow evaluation.
Why the other options are wrong
- A. Physical therapy addresses mobility, strength and gait, not swallowing.
- B. Occupational therapy addresses activities of daily living and adaptive equipment.
- D. Social work addresses financial, housing and community resource needs.
A nurse notices that two look-alike medication vials are stored next to each other in the automated dispensing cabinet and nearly selects the wrong one. No medication was given. Which action is most appropriate?
Show answer and rationale
Correct answer: C. Submit a safety report describing the storage problem
A near miss reveals a system flaw that has not yet caused harm, which makes it exactly the event worth reporting. A formal safety report allows the storage arrangement to be corrected for everyone.
Why the other options are wrong
- A. The absence of harm is luck, not safety. The hazard remains for the next nurse.
- B. A verbal mention does not create a record or trigger a system fix.
- D. Client records document client care. A storage hazard belongs in a safety report.
A client who speaks limited English is scheduled for a procedure requiring consent. The client’s teenage daughter offers to translate. Which action should the nurse take?
Show answer and rationale
Correct answer: B. Arrange for a trained medical interpreter
Consent requires accurate transmission of clinical information. A trained medical interpreter has the vocabulary and the neutrality that a family member or untrained staff member does not, and using a child places an unfair burden on them.
Why the other options are wrong
- A. A minor should never interpret clinical information, and family members may filter or soften information.
- C. Written materials do not allow the client to ask questions, which consent requires.
- D. Bilingual staff without interpreter training may lack the clinical vocabulary and are not authorised for consent.
A quality committee is reviewing an unexpected event that resulted in serious permanent harm to a client. This category of event is known as a ______ event. Type the single word.
Show answer and rationale
Answer: sentinel
A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk of one. It triggers an immediate investigation and a root cause analysis.
A registered nurse is assigning clients to a licensed practical nurse. Which client is most appropriate for the licensed practical nurse to care for?
Show answer and rationale
Correct answer: B. A client with a chronic venous ulcer who requires a scheduled dressing change
A chronic wound with a scheduled dressing change is a stable client with a predictable outcome, which is exactly the scope of a licensed practical nurse.
Why the other options are wrong
- A. A newly admitted client with a new dysrhythmia is unstable and requires the registered nurse’s initial assessment.
- C. A client arriving from recovery needs a full admission assessment by the registered nurse.
- D. A first dose carries the risk of an allergic reaction, so the registered nurse monitors it.
A nurse is preparing to delegate care tasks during a busy shift. Which actions demonstrate appropriate delegation? Select all that apply.
- ATelling assistive personnel exactly what to report and when
- BConfirming the assistive personnel have performed the task before
- CDelegating an admission assessment because the unit is short staffed
- DFollowing up during the shift to verify the task was completed as expected
- EAsking assistive personnel to teach a client to use an incentive spirometer
Show answer and rationale
Correct answers: A. Telling assistive personnel exactly what to report and when; B. Confirming the assistive personnel have performed the task before; D. Following up during the shift to verify the task was completed as expected
Clear direction, verifying competence, and supervising the outcome are three of the five rights of delegation. Together with the right task and the right circumstance, they make the delegation safe.
Why the other options are wrong
- C. Staffing pressure never changes scope of practice. An admission assessment is a registered nurse function regardless of workload.
- E. Teaching a client a new skill is not within the scope of unlicensed assistive personnel.
A nurse receives handoff on four clients. Which client should the nurse assess first?
Show answer and rationale
Correct answer: C. A client with a peanut allergy who has developed lip swelling and a hoarse voice after lunch
Lip swelling with a hoarse voice after a known allergen exposure signals developing airway oedema. Airway compromise outranks every other finding and can progress to complete obstruction within minutes.
Why the other options are wrong
- A. A saturation of 91 percent on oxygen in a client with pneumonia is low but consistent with the diagnosis and is not the immediate threat.
- B. Pain rated 7 out of 10 the day after surgery needs prompt attention but is expected and not life-threatening.
- D. A 1 kilogram gain in heart failure is reportable but does not compete with an airway threat.
A nurse begins a shift with four tasks waiting. Place the tasks in the order the nurse should perform them, from first to last.
- AAssess the client who is reporting new shortness of breath
- BAdminister the scheduled 0800 insulin before the client’s breakfast tray arrives
- CChange the dressing on a chronic wound scheduled for this morning
- DComplete the discharge teaching for a client leaving this afternoon
Show answer and rationale
Correct order: 1) A. Assess the client who is reporting new shortness of breath 2) B. Administer the scheduled 0800 insulin before the client’s breakfast tray arrives 3) C. Change the dressing on a chronic wound scheduled for this morning 4) D. Complete the discharge teaching for a client leaving this afternoon
New shortness of breath is a potential airway and breathing problem and comes first. Insulin is time-critical because it must be coordinated with the meal. The scheduled dressing change is important but not time-sensitive. Discharge teaching for an afternoon departure can be done last.
A nurse enters a client’s room to witness the signature on a surgical consent form. The client says, "I signed the paper, but I am honestly not sure what they are going to remove." Which action should the nurse take?
Show answer and rationale
Correct answer: C. Notify the surgeon that the client needs further explanation before proceeding
Informed consent requires that the client understands the procedure, its risks, benefits and alternatives. Only the provider performing the procedure can supply that information, so the nurse stops the process and notifies the surgeon.
Why the other options are wrong
- A. Explaining the procedure is outside the nurse’s role in consent and does not satisfy the legal requirement.
- B. This is false reassurance and does nothing to address the missing information.
- D. A family member cannot substitute for the provider’s explanation, and this delegates a legal duty inappropriately.
A nurse is reviewing confidentiality requirements with new staff. Which situations require the nurse to disclose client information without the client’s authorisation? Select all that apply.
- AA newly diagnosed reportable communicable disease
- BA client’s spouse asking about the results of today’s blood work
- CSuspected physical abuse of a dependent older adult
- DA gunshot wound treated in the emergency department
- EA colleague on another unit asking about a mutual friend who was admitted
Show answer and rationale
Correct answers: A. A newly diagnosed reportable communicable disease; C. Suspected physical abuse of a dependent older adult; D. A gunshot wound treated in the emergency department
Reportable communicable disease, suspected abuse of a vulnerable person, and gunshot or stab wounds are legally mandated disclosures. They are the recognised exceptions to confidentiality.
Why the other options are wrong
- B. A spouse is not automatically authorised. The client decides who receives their information.
- E. Curiosity, professional relationship or friendship never authorises access to a record.
A nurse is working with a float nurse who does not usually work on the medical unit. Which client is most appropriate to assign to the float nurse?
Show answer and rationale
Correct answer: B. A client with cellulitis receiving scheduled intravenous antibiotics
Scheduled antibiotics for cellulitis represent a stable client with a predictable course, appropriate for a nurse who is unfamiliar with the unit’s specialised routines.
Why the other options are wrong
- A. A titrated infusion of a high-alert medication requires familiarity with unit protocols.
- C. A new tracheostomy carries airway risk and requires unit-specific competence.
- D. A first transfusion requires close monitoring and knowledge of the facility’s transfusion procedure.
A client who lives alone in a second-floor flat is preparing for discharge after a total knee replacement. Which statement by the client most requires nursing follow-up?
Show answer and rationale
Correct answer: C. "There is no handrail on my stairs, but I will manage by holding the wall."
Stairs without a handrail in a client who has just had knee surgery and lives alone is a significant fall hazard. This requires a home safety assessment and possibly a physical therapy or occupational therapy referral before discharge.
Why the other options are wrong
- A. Continuing the walker until cleared is correct and shows understanding.
- B. Arranging help with prescriptions is appropriate use of a support network.
- D. Continuing the prescribed exercise programme is exactly what is wanted.
An alert and oriented client with end-stage kidney disease refuses the scheduled dialysis session. Which response by the nurse is most appropriate?
Show answer and rationale
Correct answer: B. "Tell me more about what is making you want to skip today’s treatment."
A competent adult may refuse any treatment. The nurse explores the reason for the refusal, which both respects autonomy and often uncovers a fixable problem such as pain, fear, transport or a misunderstanding.
Why the other options are wrong
- A. Coercion and threat violate autonomy and shut down the conversation.
- C. Recruiting family to pressure the client is coercive and breaches the client’s control over their own information.
- D. Documenting the refusal is necessary eventually, but doing it without exploring the reason abandons the client.
A nurse observes unlicensed assistive personnel preparing to take a blood pressure reading on the arm of a client who has an arteriovenous fistula. Which action should the nurse take first?
Show answer and rationale
Correct answer: B. Stop the assistive personnel before the cuff is inflated
Inflating a cuff over an arteriovenous fistula can damage or occlude the access. The nurse intervenes immediately to prevent harm, then teaches and follows up.
Why the other options are wrong
- A. Documentation does not prevent the imminent harm.
- C. Reporting may follow, but it does not stop the cuff from inflating right now.
- D. Exploring the reasoning comes after the client is protected.
A nurse is giving handoff on a client admitted with heart failure. Which information is most important to include?
Show answer and rationale
Correct answer: B. That the client’s weight has increased 1.5 kilograms since admission and the provider has been notified
Handoff communicates what changed and what needs watching. A weight gain in heart failure signals fluid retention and directly shapes the next shift’s assessment and interventions.
Why the other options are wrong
- A. Background detail with no bearing on the plan of care for the next shift.
- C. A preference worth knowing, but not the priority handoff item.
- D. Administrative information that does not guide clinical care.
Which tasks may a nurse appropriately delegate to unlicensed assistive personnel for a stable client? Select all that apply.
- AAssisting with a bed bath
- BAmbulating the client in the corridor
- CApplying anti-embolism stockings
- DAdjusting the rate of an intravenous infusion
- EEmptying a urinary drainage bag and recording the volume
Show answer and rationale
Correct answers: A. Assisting with a bed bath; B. Ambulating the client in the corridor; C. Applying anti-embolism stockings; E. Emptying a urinary drainage bag and recording the volume
Hygiene, ambulation of a stable client, applying stockings, and measuring and recording drainage are all routine tasks with clear standards that do not require nursing judgement.
Why the other options are wrong
- D. Adjusting an infusion rate is a medication administration decision and requires a licensed nurse.
A client with a valid advance directive specifying no cardiopulmonary resuscitation becomes unresponsive and pulseless. The client’s adult son arrives and demands that resuscitation be started. Which action should the nurse take?
Show answer and rationale
Correct answer: B. Honour the advance directive and support the son
A valid advance directive expresses the client’s own wishes and takes precedence over family preference. The nurse honours the directive while providing emotional support to the son, who is experiencing an acute loss.
Why the other options are wrong
- A. Family preference does not override a competent client’s documented decision.
- C. Delaying while a pulseless client’s directive is in force does not change the outcome and abandons the family.
- D. A family member cannot revoke the client’s advance directive.
A nurse is planning care for a client newly admitted with a diagnosis of cancer. All of the following needs are present. Which should the nurse address first?
Show answer and rationale
Correct answer: B. The client’s report of nausea and inability to keep fluids down
Nausea preventing fluid intake is a physiological need with a direct risk of dehydration and electrolyte disturbance. Under Maslow, physiological needs are addressed before psychosocial ones.
Why the other options are wrong
- A. Fear about family is an important psychosocial need but ranks below a physiological problem.
- C. Information needs are addressed once the client is physically comfortable enough to learn.
- D. Practical and financial concerns are real but not the first priority.
A nurse delegates vital sign measurement for several stable clients to unlicensed assistive personnel. Which instruction best fulfils the right direction and communication?
Show answer and rationale
Correct answer: B. "Take vital signs on rooms 2 through 6 by 0900 and tell me immediately if any systolic pressure is below 100 or any heart rate is above 110."
The right direction and communication means specifying the task, the clients, the timeframe and the exact parameters to report. Option b does all four, leaving no judgement call to the assistive personnel.
Why the other options are wrong
- A. No timeframe and no reporting parameters.
- C. No timeframe and no direct reporting to the nurse.
- D. Asking unlicensed personnel to judge what is unusual asks them to perform an assessment.
A nurse is caring for four clients on a surgical unit. Which finding requires the most immediate follow-up?
Show answer and rationale
Correct answer: B. A client with a colostomy created yesterday whose stoma is dusky grey
A healthy stoma is pink or red and moist. A dusky grey stoma indicates compromised perfusion and possible necrosis, which can lead to stomal death and require surgical revision. It is reported immediately.
Why the other options are wrong
- A. Sixty millilitres of serosanguineous drainage in the first hours after joint replacement is within the expected range.
- C. A mild sore throat after thyroidectomy is expected from intubation and surgical manipulation. Stridor or a change in voice would be different.
- D. A temperature of 37.6 degrees Celsius on the third post-operative day is a low-grade elevation and is monitored, not escalated ahead of a threatened stoma.
A nurse believes a newly written medication order is unsafe for the client. The prescribing provider has been contacted and insists the order stands. Which action should the nurse take?
Show answer and rationale
Correct answer: C. Withhold the medication and escalate the concern to the nursing supervisor
A nurse who believes an order is unsafe does not carry it out. After clarifying with the prescriber without resolution, the concern is escalated through the chain of command, which typically means the charge nurse and then the nursing supervisor.
Why the other options are wrong
- A. Confirmation by the prescriber does not transfer accountability. The nurse who administers is responsible for the safety of what they give.
- B. Documenting a concern and then acting against it does not protect the client or the nurse.
- D. Passing an unsafe order to a colleague simply relocates the harm.
A nurse is reviewing a group of clients at the start of a shift. Which findings require assessment before the routine morning medication round? Select all that apply.
- AA client one day post-operative whose urine output has been 20 millilitres per hour for the last three hours
- BA client with a chest tube whose water seal chamber shows gentle tidalling
- CA client whose oxygen saturation has fallen from 96 to 88 percent over one hour
- DA client with type 2 diabetes whose fasting glucose is 138 milligrams per decilitre
- EA client who became confused overnight and was previously alert and oriented
Show answer and rationale
Correct answers: A. A client one day post-operative whose urine output has been 20 millilitres per hour for the last three hours; C. A client whose oxygen saturation has fallen from 96 to 88 percent over one hour; E. A client who became confused overnight and was previously alert and oriented
Urine output under 30 millilitres per hour signals inadequate perfusion or renal compromise. A falling oxygen saturation is a breathing problem. New confusion is a sensitive early indicator of hypoxia, infection or a medication effect. All three need assessment before routine tasks.
Why the other options are wrong
- B. Gentle tidalling with respiration is the expected finding in a functioning chest drainage system.
- D. A fasting glucose of 138 in a client with type 2 diabetes is elevated but not urgent.
Four clients arrive in an emergency department at the same time. Which client should be seen first?
Show answer and rationale
Correct answer: A. A 60-year-old with crushing chest pain radiating to the jaw, diaphoretic and pale
Crushing chest pain with radiation, diaphoresis and pallor is a presentation of acute coronary syndrome. Time to reperfusion determines the amount of myocardium saved, making this the most time-critical presentation.
Why the other options are wrong
- B. A deformed forearm with intact distal circulation is urgent but not immediately life-threatening.
- C. Severe abdominal pain with stable vital signs needs prompt evaluation but ranks behind a probable myocardial infarction.
- D. Cough and fever over two days suggests infection needing treatment, but not within minutes.
A nurse notices that a colleague’s speech is slurred, that the colleague smells of alcohol, and that several controlled substance counts have been inaccurate on their shifts. Which action should the nurse take?
Show answer and rationale
Correct answer: B. Report the observations to the nurse manager immediately
An impaired nurse is an immediate danger to clients. The observations are reported through the chain of command right away so that the colleague is removed from client care and offered help.
Why the other options are wrong
- A. Covering the assignment allows an impaired nurse to remain in the building and delays intervention.
- C. Waiting exposes clients to a nurse who may be impaired on the very next shift.
- D. Discussing with peers is gossip, not reporting, and delays action.
What to do with your score
A single 26-item set is too short to predict a pass, so treat the number as a pointer rather than a verdict. What is worth acting on is the pattern: go back through every item you missed, and write down whether you lacked the fact, misread what the item asked for, or knew the fact and still picked second-best. Those three failures need three different fixes — more content review, slower reading, or priority-framework drilling.
Read the rationale on the items you got right too. On a well-written item you can arrive at the correct option for the wrong reason, and that will not survive a harder version of the same question.
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