Free practice questions · Delegation
Delegation and assignment questions.
Ten questions from the Leadership and Management section of the NCLEX-RN bank: what a registered nurse may delegate to a practical nurse or assistive personnel, what stays with the RN, and how to assign a shift. Each rationale states the scope rule it turns on.
1Multiple choice, single answerLeadership and Management
The charge nurse on a medical unit has one private room left and four new admissions. Which client should be placed in the private room?
A client with pneumonia caused by Streptococcus pneumoniae who is coughing up rust-colored sputum
A client with a urinary tract infection caused by Escherichia coli who has an indwelling catheter
A client with cellulitis of the left leg and intact skin who is receiving IV cefazolin
A client with suspected bacterial meningitis who has a fever, a stiff neck and a petechial rash
Answer it, then check it.
Answer and rationale
Answer
- D: A client with suspected bacterial meningitis who has a fever, a stiff neck and a petechial rash
The key, and why
A fever, stiff neck and petechial rash suggest meningitis caused by Neisseria meningitidis, which spreads by large droplets. The client needs a private room and droplet precautions until 24 hours of effective antibiotic therapy have been given. The other clients do not need a private room under standard precautions.
Each distractor
Option A has pneumococcal pneumonia, which is managed with standard precautions and does not require isolation.
Option B has a urinary tract infection, which needs standard precautions and catheter care.
Option C has cellulitis with intact skin and no drainage, which is managed with standard precautions.
The teaching point
MENINGOCOCCAL meningitis (fever, stiff neck, PETECHIAL rash) = PRIVATE room + DROPLET precautions until 24 hours of antibiotics.
2Multiple choice, single answerLeadership and Management
The registered nurse (RN) is supervising a licensed practical nurse (LPN) who is caring for four clients on a surgical unit. Which statement by the LPN requires immediate follow-up by the RN?
"I reinforced the incentive spirometer teaching with the client in room 12 this morning."
"I gave the client in room 14 the oral acetaminophen that was due at 1000."
"The blood for room 16 is here, so I'll start it once I finish my vital signs."
"I emptied the Jackson-Pratt drain in room 18 and recorded 40 mL of fluid."
Answer it, then check it.
Answer and rationale
Answer
- C: "The blood for room 16 is here, so I'll start it once I finish my vital signs."
The key, and why
Starting a blood transfusion belongs to the RN. The RN verifies the product and the client with a second licensed nurse, takes baseline vital signs and stays with the client for the first 15 minutes, which is when most acute hemolytic reactions show up. Blood also has to be started within 30 minutes of leaving the blood bank, so the RN needs to step in now rather than after the LPN finishes vital signs.
Each distractor
Option A is within LPN scope. Reinforcing teaching that the RN has already given is exactly what an LPN does.
Option B is within LPN scope. Giving a scheduled oral medication to a stable client is routine LPN care.
Option D is within LPN scope. Emptying a surgical drain and recording the amount is data collection. The RN reviews whether the amount and color are expected.
The teaching point
Blood transfusion = RN. Verify with a second nurse, baseline vital signs, STAY with the client for the FIRST 15 minutes, start within 30 minutes of pickup.
3Multiple choice, single answerLeadership and Management
While walking past a room on a long-term care unit, the nurse hears the unlicensed assistive personnel (UAP) threaten to leave a resident with dementia in the chair all night if the resident keeps yelling. What action should the nurse take first?
Report the UAP's comment to the nurse manager at the end of the shift for follow-up
Complete a safety event report describing what the nurse overheard
Enter the room, make sure the resident is safe, and relieve the UAP of the resident's care
Remind the UAP privately to use a calm and respectful tone with the resident
Answer it, then check it.
Answer and rationale
Answer
- C: Enter the room, make sure the resident is safe, and relieve the UAP of the resident's care
The key, and why
A threat to withhold care is emotional and psychological abuse of a vulnerable adult. The nurse's first duty is to protect the resident: the nurse intervenes at once, makes sure the resident is safe and calm, and removes the UAP from the resident's care. The nurse then reports the event to the supervisor and follows the facility's abuse policy, which includes reporting to the state agency as required by law.
Each distractor
Option A waits until the end of the shift and leaves the resident with the person who threatened the resident.
Option B is needed, but paperwork comes after the resident is protected.
Option D treats abuse as a minor conduct problem and leaves the UAP in charge of the resident.
The teaching point
Suspected ABUSE of a resident = PROTECT the resident NOW, REMOVE the staff member, REPORT per policy and state law.
4Multiple choice, single answerLeadership and Management
The nurse is supervising an unlicensed assistive personnel (UAP) caring for an 88-year-old client with dementia who has a high fall risk score and a bed alarm in place. Which statement by the UAP requires follow-up?
"Now that the bed alarm is on, I can check on him every 3 hours instead of hourly."
"I will offer him the urinal and a drink each time I leave his room tonight."
"I will keep his call light, glasses, and water where he can reach them in bed."
"I will reset the bed alarm every time I help him back into bed after toileting."
Answer it, then check it.
Answer and rationale
Answer
- A: "Now that the bed alarm is on, I can check on him every 3 hours instead of hourly."
The key, and why
A bed alarm sounds only after the client has started to get up, so by the time staff arrive the client may already be on the floor. It is a tool that adds to a fall prevention plan, not a replacement for staff. Hourly rounding, with toileting, pain checks, positioning, and items in reach, prevents the needs that make clients get up alone in the first place.
The UAP's plan to check every 3 hours instead of hourly treats the alarm as a substitute for rounding. The nurse corrects this, explains why rounding continues, and checks later that hourly rounds are happening.
Each distractor
Option B is correct. Offering the urinal and fluids meets the needs that most often cause a night-time fall.
Option C is correct. A call light, glasses, and water within reach mean the client does not have to get up or reach for them.
Option D is correct. An alarm that is not reset after each use gives no warning the next time the client gets up.
The teaching point
BED ALARM = an AID, not a SUBSTITUTE. Hourly ROUNDING continues. Rounding = toileting, pain, position, POSSESSIONS in reach.
5Multiple choice, single answerLeadership and Management
The charge nurse on a pediatric unit is making assignments for the day shift. A 4-month-old infant with respiratory syncytial virus (RSV) is receiving aerosolized ribavirin through an oxygen hood. Which nurse should the charge nurse avoid assigning to this infant?
The nurse who has seasonal allergies and takes a daily antihistamine
The nurse who transferred from a medical-surgical unit last month
The nurse who is also caring for a child recovering from a tonsillectomy
The nurse who is 16 weeks pregnant
Answer it, then check it.
Answer and rationale
Answer
- D: The nurse who is 16 weeks pregnant
The key, and why
Ribavirin is an antiviral that is sometimes given as an aerosol to infants with severe RSV infection. It is teratogenic, which means it can harm a developing fetus. When it is aerosolized, droplets escape into the room air, especially when the hood or tent is opened for care.
A pregnant staff member should not care for a client receiving aerosolized ribavirin, and pregnant visitors are kept out of the room as well. The charge nurse assigns this infant to another nurse and gives the pregnant nurse a different client.
Each distractor
Option A has no reason to avoid the infant. Seasonal allergies and an antihistamine do not change the risk from ribavirin.
Option B is a newer pediatric nurse but can safely care for the infant with support. Experience on another unit does not create a hazard.
Option C has a postoperative child who is not immunosuppressed. The nurse uses contact precautions and hand hygiene with the RSV infant to avoid carrying the virus between clients.
The teaching point
Aerosolized RIBAVIRIN = TERATOGENIC. No PREGNANT staff or visitors. Other exposures to avoid in pregnancy = radioactive implants or radioactive iodine, some chemotherapy, clients shedding CMV or rubella. RSV = contact precautions, plus droplet in many facilities.
6Multiple choice, single answerLeadership and Management
A 48-year-old client on the oncology unit has a sealed low-dose-rate radiation implant for cervical cancer. The charge nurse learns that the staff nurse scheduled to care for this client is 12 weeks pregnant. Which action should the charge nurse take?
Allow the staff nurse to give care while wearing a lead apron in the room
Limit the staff nurse's time in the client's room to 30 minutes per shift
Have the staff nurse wear a dosimeter badge and stay 6 feet from the bed
Reassign the client's care for this shift to a nurse who is not pregnant
Answer it, then check it.
Answer and rationale
Answer
- D: Reassign the client's care for this shift to a nurse who is not pregnant
The key, and why
Pregnant staff and visitors are not allowed to care for or visit a client with a sealed radiation implant, because ionizing radiation can harm the developing fetus, especially early in pregnancy. The charge nurse moves this client to a nurse who is not pregnant and gives the pregnant nurse another client. For staff who do care for the client, time is limited, distance is kept, shielding is used and a dosimeter badge is worn.
Each distractor
Option A gives false protection. A standard lead apron does not reliably block the gamma rays from an implant, and the fetus should have no avoidable exposure.
Option B applies the time limit used for staff who are not pregnant. A pregnant nurse should not be exposed at all.
Option C measures exposure but does not prevent it, and a nurse giving care cannot stay 6 feet away.
The teaching point
SEALED RADIATION IMPLANT = NO PREGNANT staff or visitors. NO children under 18. Others use TIME, DISTANCE, SHIELDING and a DOSIMETER badge.
7Multiple choice, single answerLeadership and Management
A 4-year-old child with chickenpox (varicella) is admitted with dehydration. Which staff member should the charge nurse avoid assigning to care for the child?
A nurse with a positive varicella titer after chickenpox in childhood
A nurse who received two doses of varicella vaccine during nursing school
A nurse who had shingles 3 years ago and has since recovered completely
A nurse who is 10 weeks pregnant and has no record of varicella immunity
Answer it, then check it.
Answer and rationale
Answer
- D: A nurse who is 10 weeks pregnant and has no record of varicella immunity
The key, and why
Varicella spreads by the airborne route and by contact with lesions. Staff without evidence of immunity should not care for the client, and the risk is highest for a pregnant nurse, because varicella in pregnancy can cause severe maternal pneumonia and congenital varicella syndrome. The child needs airborne and contact precautions in an airborne infection isolation room.
Each distractor
Option A has laboratory evidence of immunity. A remembered history of chickenpox alone does not count as proof of immunity for health care staff.
Option B has immunity from two doses of vaccine.
Option C has immunity, since shingles is a reactivation of a past varicella infection.
The teaching point
VARICELLA = AIRBORNE + CONTACT precautions. Only IMMUNE staff provide care. Non-immune PREGNANT staff never.
8Multiple choice, single answerLeadership and Management
A charge nurse is assigning a client to a nurse who has floated from the pediatric unit to an adult medical unit for one shift. The nurse has completed the unit's cross-training. Which statement by the float nurse requires the charge nurse to follow up?
"I'll check the unit's medication policies before giving my first IV push medication."
"I've never set up a continuous bladder irrigation, but I'll figure it out at the bedside."
"Please show me where you keep the emergency cart and the rapid response phone number."
"I'd like a resource nurse I can call if I have any questions about adult medication dosing."
Answer it, then check it.
Answer and rationale
Answer
- B: "I've never set up a continuous bladder irrigation, but I'll figure it out at the bedside."
The key, and why
Nurses are accountable for practicing within their competence. A float nurse who has never performed a procedure should ask for help or teaching rather than attempt it alone at the bedside. The charge nurse follows up by arranging help, such as having a resource nurse assist with the irrigation, or adjusting the assignment.
Each distractor
Option A shows safe practice. Checking unit policies before an unfamiliar task is appropriate.
Option C shows safe practice. Knowing where emergency equipment is located is part of orientation to a new unit.
Option D shows safe practice. Asking for a resource person supports safe care.
The teaching point
FLOAT nurse = practice within COMPETENCE. Unfamiliar procedure = ASK for help, never "figure it out" at the bedside.
9Multiple choice, single answerLeadership and Management
The charge nurse is reviewing the care of a 58-year-old client in alcohol withdrawal who has soft wrist restraints after trying repeatedly to pull out a central venous catheter. Which action by the staff nurse requires the charge nurse to intervene?
Securing each strap to the movable part of the bed frame with a quick-release knot
Applying restraints under a prescription that reads "wrist restraints as needed"
Releasing one wrist at a time to perform range-of-motion exercises every 2 hours
Checking color, warmth and capillary refill in both hands during each safety check
Answer it, then check it.
Answer and rationale
Answer
- B: Applying restraints under a prescription that reads "wrist restraints as needed"
The key, and why
A restraint prescription must be written for a specific episode and a limited period, and it is renewed according to policy and federal rules (for example, every 4 hours for an adult restrained for violent behavior, and by facility policy, often every 24 hours, for non-violent restraint). A restraint prescription may never be written "as needed." The nurse needs a time-limited prescription based on a current assessment, so the charge nurse should stop the practice and have the nurse obtain a proper prescription.
Each distractor
Option A is correct practice. The strap goes on the part of the frame that moves with the bed, never on the side rail, and a quick-release knot allows fast removal in an emergency.
Option C is correct practice. Releasing one limb at a time keeps control of the catheter while preventing stiffness and skin injury.
Option D is correct practice. Frequent checks of circulation in the restrained limbs pick up a strap that is too tight.
The teaching point
Restraints NEVER as needed (PRN). A prescription is TIME-LIMITED and RENEWED per policy. Tie to the BED FRAME with a QUICK-RELEASE knot. Release EVERY 2 HOURS.
10Multiple choice, single answerLeadership and Management
A client admitted with cellulitis of the leg is found to have head lice, and the first permethrin treatment is applied at 1100. The charge nurse is reviewing infection control with assistive personnel (AP) assigned to the client. Which instruction should the charge nurse give?
"Standard precautions are enough, because head lice cannot jump or fly between people."
"Wear a gown and gloves for contact with the client until 24 hours after the treatment."
"Keep the client on contact precautions until every nit has been combed out of the hair."
"Wear a surgical mask and gloves whenever you are within 3 feet of the client's head."
Answer it, then check it.
Answer and rationale
Answer
- B: "Wear a gown and gloves for contact with the client until 24 hours after the treatment."
The key, and why
Head lice spread by direct contact with the hair and, less often, by shared items such as pillows, linens and combs. In the hospital, a client with head lice is placed on contact precautions, with gown and gloves for contact with the client and the client's bed and linens. According to CDC guidance, contact precautions can be stopped 24 hours after effective treatment. Linens are bagged and handled as contaminated, and the client's comb and brush are not shared.
Each distractor
Option A is partly true, since lice crawl and do not jump or fly, but standard precautions do not protect staff whose arms and uniforms touch the hair, pillow and linens.
Option C ties the end of precautions to nit removal. Nits can remain for weeks after the lice are dead, and the CDC time limit is 24 hours after effective treatment.
Option D uses droplet protection. Lice are not spread through the air, and a mask without a gown leaves the uniform exposed.
The teaching point
HEAD LICE in the hospital = CONTACT PRECAUTIONS (GOWN and GLOVES). STOP 24 HOURS after EFFECTIVE TREATMENT, not when every nit is gone.
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