NCLEX delegation practice questions

The RN keeps assessment, teaching, evaluation and care of unstable clients. Stable, predictable tasks can go to LPNs and assistive personnel within their scope and facility policy.

1. Question 1

   A nurse delegated turning every 2 hours for a client with limited mobility. At 1200, the nurse finds the client in the same position as at 0800. The UAP says, "I was too busy." What should the nurse do first?

   • A.Report the UAP to the nurse manager
   • B.Turn the client and assess the skin over pressure points
   • C.Write a formal warning for the UAP's file
   • D.Tell the UAP to document that the client was turned
   Show answer and explanation

   Answer: B

   The RN remains accountable for delegated care. When a task is missed, the RN first meets the client's needs, then discusses the problem with the UAP, helps reorganize priorities, and follows up on performance if needed.

   • A. Reporting may be needed later, but the client's skin needs attention first.
   • B. Correct. The client's safety comes first. The nurse then talks with the UAP about the workload and expectations.
   • C. Discipline is not the first step and does not protect the client.
   • D. Documenting care that was not given is falsification.

   Key concept: When delegated care is missed, care for the client first, then address the delegatee's performance.

   Tip: Client first, coaching second.

2. Question 2

   A nurse asks an unlicensed assistive personnel (UAP) to collect a clean-catch urine specimen from a stable client. The UAP says, "I was never trained to do that." The task is within UAP job duties at this facility. What is the nurse's best response?

   • A."Please read the procedure manual and then collect the specimen."
   • B."Ask the other UAP on the unit to explain it to you."
   • C."I will show you how and watch you do it this time."
   • D."Do the best you can and tell me if there is a problem."
   Show answer and explanation

   Answer: C

   The right person rule requires that the delegatee be competent for the task. When a UAP reports lack of training, the RN provides instruction and supervision or does the task, and informs the manager so formal training can be arranged.

   • A. Reading alone does not confirm the UAP can perform the task correctly.
   • B. The RN is responsible for confirming competence and cannot hand that to another UAP.
   • C. Correct. The nurse makes sure the UAP is competent by demonstrating the task and supervising the first attempt.
   • D. Sending an untrained person to do a task risks an incorrect specimen and does not meet the right person rule.

   Key concept: The RN must confirm a delegatee's competence; untrained staff need teaching and supervision first.

   Tip: Not trained? Show, watch, then delegate.

3. Question 3

   A registered nurse in a long-term care facility is making assignments for a licensed practical nurse (LPN). Which tasks are appropriate to assign to the LPN? Select all that apply.

   Select all that apply.

   • A.Giving scheduled oral medications to residents whose conditions are stable
   • B.Giving a tube feeding through an established gastrostomy tube to a stable resident
   • C.Completing the admission assessment of a resident who arrived today
   • D.Reinforcing foot care teaching that the RN gave a resident with diabetes
   • E.Developing the care plan for a resident with a new pressure injury
   • F.Evaluating a resident who fell 10 minutes ago and now reports hip pain
   Show answer and explanation

   Answer: A, B, D

   LPNs care for stable clients with predictable outcomes. They give most medications, perform procedures such as tube feedings, collect data and reinforce teaching. The RN does initial assessments, care planning, evaluation, and care for clients whose condition has changed or is unstable.

   • A. Correct. Giving routine oral medications to stable residents is within LPN scope of practice.
   • B. Correct. Tube feeding through an established tube is a standard skill within LPN scope for a stable resident.
   • C. The initial admission assessment is an RN responsibility. The LPN can collect data, but the RN must complete and analyze the assessment.
   • D. Correct. LPNs may reinforce teaching that the RN has already started.
   • E. Creating the plan of care requires RN-level assessment and judgment.
   • F. This resident is potentially unstable after a fall and needs an RN assessment right away.

   Key concept: Assign LPNs stable, predictable clients and tasks; keep initial assessment, planning and unstable clients with the RN.

   Tip: LPN = Like Predictable Needs. New, changing or unstable goes to the RN.

4. Question 4

   A registered nurse in a rehabilitation facility is assigning tasks to an experienced licensed practical nurse (LPN). Which tasks are appropriate? Select all that apply.

   Select all that apply.

   • A.Giving scheduled subcutaneous enoxaparin to stable clients
   • B.Collecting data on a wound's size and drainage and reporting it to the RN
   • C.Performing a straight catheterization to check a post-void residual
   • D.Developing the discharge teaching plan for a client going home next week
   • E.Completing the admission assessment for a new client
   • F.Evaluating whether a new pain management plan is effective
   Show answer and explanation

   Answer: A, B, C

   As permitted by state law and facility policy, LPNs give medications, perform procedures and collect data for stable clients. RNs complete admission assessments, plan care and teaching, and evaluate outcomes.

   • A. Correct. Subcutaneous injections for stable clients are within LPN scope.
   • B. Correct. LPNs collect data. The RN interprets it and updates the plan.
   • C. Correct. Straight catheterization is a sterile procedure within LPN scope.
   • D. Planning care and teaching is an RN responsibility.
   • E. The admission assessment is an RN responsibility.
   • F. Evaluation of the plan of care requires RN judgment.

   Key concept: LPNs do, collect and report; RNs assess, plan and evaluate.

   Tip: LPN = hands and eyes; RN = plan and judge.

5. Question 5

   A nursing student asks the staff RN, "Can I give this IV push medication now? My instructor is with another student." The school's policy requires the instructor to supervise all IV push medications given by students. What is the RN's best response?

   • A."Yes, go ahead. I trust you."
   • B."I will give it myself and you can document it."
   • C."You will need to wait for your instructor, or I will give it if it is due now."
   • D."Students are never allowed to give IV medications."
   Show answer and explanation

   Answer: C

   Nursing students practice under their school's policies and their instructor's supervision. The staff RN remains responsible for the client. If the dose is due and the instructor is not available, the RN gives and documents it.

   • A. This ignores the school's supervision policy and risks client safety.
   • B. The person who gives a medication must document it. A student cannot document care they did not give.
   • C. Correct. The RN follows the school's policy and makes sure the client receives the dose on time.
   • D. This is not accurate. Students may give IV medications under the required supervision.

   Key concept: Students work within school policies; the RN remains accountable for the client's care.

   Tip: No instructor, no IV push for the student.