Nursing Delagation Questions For NCLEX-RN

Question 1
The measurement and documentation of vital signs is expected for clients in a long term facility. Which staff type would it be a priority to delegate these tasks to?
A) Practical nurse (PN)
B) Registered Nurse (RN)
C) Unlicensed assistive personnel (UAP)
D) Volunteer

Review Information: The correct answer is C: Unlicensed assistive personnel (UAP)
The measurement and recording of vital signs may be delegated to UAP. This falls under the umbrella of routine task with stable clients. Other considerations for delegation of care to UAP would be: Who is capable and is the least expensive worker to do each task?

Question 2
Which client data should the nurse act upon when a home health aide calls the nurse from the client's home to report these items?
A) "The client has complaints of not sleeping well for the past week"
B) "The family wants to discontinue the home meal service, meals on wheels"
C) "The urine in the urinary catheter bag is of a deeper amber, almost brown color"
D) "The partner says the client has slower days every other day"

Review Information: The correct answer is C: "The urine in the urinary catheter bag is of a deeper amber, almost brown color"
Home health aides need to report diverse information to nurses through phone calls and documentation. The nurse who develops the plan of care for a specific client, and supervises the aide, must identify potential danger signs which require immediate action and follow-up. The color of the urine requires follow-up evaluation.



Question 3
A 25 year-old client, unresponsive after a motor vehicle accident, is being transferred from the hospital to a long term care facility. To which staff member should the charge nurse assign the client?
A) Unlicensed assistive personnel (UAP)
B) Senior nursing student
C) PN
D) RN

Review Information: The correct answer is D: RN
The RN is responsible for teaching and assessment associated with discharge and these activities cannot be delegated to the others listed.

Question 4
A practical nurse (PN) from the pediatric unit is assigned to work in a critical care unit. Which client assignment would be appropriate?
A) A client admitted with multiple trauma with a history of a newly implanted pacemaker
B) A new admission with left-sided weakness from a stroke and mild confusion
C) A 53 year-old client diagnosed with cardiac arrest from a suspected myocardial infarction
D) A 35 year-old client in balanced traction admitted 6 days ago after a motor vehicle accident

Review Information: The correct answer is D: A 35 year-old client in balanced traction admitted 6 days ago after a motor vehicle accident
This client is the most stable with a predictable outcome.

Question 5
A client has had a tracheostomy for 2 weeks after a motor vehicle accident. Which task could the RN safely delegate to unlicensed assistive personnel (UAP)?
A) Teach the client how to cough up secretions
B) Changes the tracheostomy trach ties
C) Monitor if client has shortness of breath
D) Perform routine tracheostomy dressing care

Review Information: The correct answer is D: Perform routine tracheostomy dressing care
Unlicensed assistive personnel should be able to perform routine tracheostomy care.

Question 6
An unlicensed assistive personnel (UAP), who usually works in pediatrics is assigned to work on a medical-surgical unit. Which one of the questions by the charge nurse would be most appropriate prior to making delegation decisions?
A) "How long have you been a UAP?”
B) "What type of care did you give in pediatrics?”
C) "Do you have your competency checklist that we can review?”
D) "How comfortable are you to care for adult clients?”

Review Information: The correct answer is C: "Do you have your competency checklist that we can review?”
The UAP must be competent to accept the delegated task. Further assessment of the qualifications of the UAP is important in order to assign the right task.

Question 7
An RN from the women’s health clinic is temporarily reassigned to a medical-surgical unit. Which of these client assignments would be most appropriate for this nurse?
A) A newly diagnosed client with type 2 diabetes mellitus who is learning foot care
B) A client from a motor vehicle accident with an external fixation device on the leg
C) A client admitted for a barium swallow after a transient ischemic attack
D) A newly admitted client with a diagnosis of pancreatic cancer

Review Information: The correct answer is B: A client from a motor vehicle accident with an external fixation device on the leg
This client is the most stable, requires basic safety measures and has a predictable outcome.

Question 8
The RN delegates the task of taking vital signs of all the clients on the medical-surgical unit to an unlicensed assistive personnel (UAP). Specific written and verbal instructions are given to not take a post-mastectomy client’s blood pressure on the left arm. Later as the RN is making rounds, the nurse finds the blood pressure cuff on that client’s left arm. Which of these statements is most immediately accurate?
A) The RN has no accountability for this situation
B) The RN did not delegate appropriately
C) The UAP is covered by the RN’s license
D) The UAP is responsible for following instructions

Review Information: The correct answer is D: The UAP is responsible for following instructions
The UAP is responsible for carrying out the activity correctly once directions have been clearly communicated especially if given verbally and in writing.

Question 9
The nurse in a same-day surgery unit assigns the unlicensed assistive personnel (UAP) to provide a hernia patient with a lunch tray. Which statement by the nurse is most appropriate?
A) "Tell the family they can bring in a pizza if the patient would prefer that."
B) "Make sure the patient gets at least 2 cartons of milk."
C) "Stop the IV if the patient is able to eat solid food."
D) "Encourage the patient to eat slowly to prevent gas."

Review Information: The correct answer is D: "Encourage the patient to eat slowly to prevent gas."
The professional nurse can delegate tasks with an expected outcome. The UAP is given adequate information about the task and how to promote the best outcome.

Question 10
A staff nurse complains to the nurse manager that an unlicensed assistive personnel (UAP) consistently leaves the work area untidy and does not restock supplies. The best initial response by the nurse manager is which of these statements?
A) "I will arrange for a conference with you and the UAP within the next week"
B) "I can assure you that I will look into the matter"
C) "I would like for you to approach the UAP about the problem the next time it occurs"
D) I will add this concern to the agenda for the next unit meeting

Review Information: The correct answer is C: "I would like for you to approach the UAP about the problem the next time it occurs"
Helping staff manage conflict is part of the manager''s role. It is appropriate to urge the nurse to confront the other staff member to work out problems without a manager''s intervention when possible.

Question 11
The home care nurse has been managing a client for 6 weeks. What is the best method to determine the quality of care provided by a home health care aide assigned to assist with the care of this client?
A) Ask the client and family if they are satisfied with the care given
B) Determine if the home health aide's care is consistent with the plan of care
C) Investigate if the home health aide is prompt and stays an appropriate length of time for care
D) Check the documentation of the aide for appropriateness and comprehensiveness

Review Information: The correct answer is B: Determine if the home health aide''s care is consistent with the plan of care
Although the nurse must complete all of the above responsibilities, evaluation of an adherence to the plan of care is the first priority. The plan of care is based on the reason for referral, provider''s orders, the initial nursing assessment, the client’s responses to the planned interventions, and the client''s and family''s feedback or inquires. The other possible answers represent aspects of accomplishing “B”.

Question 12
The nurse assigns an unlicensed assistive personnel (UAP) to care for a client with a musculoskeletal disorder. The client ambulates with a leg splint. Which task requires supervision of the UAP?
A) Report signs of redness overlying a joint
B) Monitor the client's response to ambulatory activity
C) Encouragement for the independence in self-care
D) Assist the client to transfer from a bed to a chair

Review Information: The correct answer is B: Monitor the client''s response to ambulatory activity
Monitoring the client’s response to interventions requires assessment, a task to be performed by an RN.

Question 13
The care of which of the following clients can the nurse safely delegate to an unlicensed assistive personnel (UAP)?
A) A client with peripheral vascular disease and an ulceration of the lower leg.
B) A pre-operative client awaiting adrenalectomy with a history of asthma
C) An elderly client with hypertension and self-reported non-compliance
D) A new admission with a history of transient ischemic attacks and dizziness

Review Information: The correct answer is A: A client with peripheral vascular disease and an ulceration of the lower leg.
This client is stable with no risk of instability as compared to the other clients. And this client has a chronic condition, needs supportive care.

Question 14
A charge nurse working in a long term care facility is making out assignments. Which assignment made by a registered nurse to an unlicensed assistive personnel (UAP) requires intervention by the supervisor?
A) Provide decubitus ulcer care and apply a dry dressing
B) Bathe and feed a client on bed rest
C) Oral suctioning of an unresponsive elderly client
D) Teaching a family intermittent (bolus) feedings via G-tube before discharge

Review Information: The correct answer is D: Teaching a family intermittent (bolus) feedings via G-tube before discharge. Initial teaching can not be delegated to a UAP or a PN and must be done by RNs.


Question 15
As the RN responsible for a client in isolation, which can be delegated to the practical nurse (PN)?
A) Reinforcement of isolation precautions
B) Assessment of the client's attitude about infection control
C) Evaluation of staffs' compliance with control measures
D) Observation of the client's total environment for risks

Review Information: The correct answer is A: Reinforcement of isolation precautions
PNs and UAPs can reinforce information that was originally given by the RN.

Question 16
When walking past a client’s room, the nurse hears 1 unlicensed assistive personnel (UAP) talking to another UAP. Which statement requires follow-up intervention?
A) "If we work together we can get all of the client care completed."
B) "Since I am late for lunch, would you do this one client's glucose test?"
C) "This client seems confused, we need to watch monitor closely."
D) "I’ll come back and make the bed after I go to the lab."

Review Information: The correct answer is B: "Since I am late for lunch, would you do this one client''s glucose test?"
Only the RN and PN can delegate to UAPs. One UAP can not delegate a task to another UAP. The RN or PN is legally accountable for the nursing care.

Question 17
Which of these clients would be appropriate to assign to a practical nurse (PN)?
A) A trauma victim with multiple lacerations and requires complex dressings
B) An elderly client with cystitis and an indwelling urethral catheter
C) A confused client whose family complains about the nursing care 2 days after surgery
D) A client admitted for possible transient ischemic attack with unstable neurological signs

Review Information: The correct answer is B: An elderly client with cystitis and an indwelling urethral catheter
This is a stable client, with predictable outcome and care and minimal risk for complications.

Question 18
Which of these clients would be most appropriate to assign to a practical nurse (PN)?
A) A trauma victim with quadriplegia and a client 1 day post-op radical neck dissection
B) A client with newly diagnosed type 2 diabetes mellitus and a client with a history of AIDS admitted for pneumonia
C) A client with hemiplegia is fed by a nasogastric tube and client with a left leg amputation in rehabilitation
D) A client with a history of schizophrenia in alcohol withdrawal and a client with chronic renal failure

Review Information: The correct answer is C: A client with hemiplegia is fed by a nasogastric tube and client with a left leg amputation in rehabilitation
This client requires supportive care and interventions within the scope of practice of a PN. This client is stable with little risk of complications or instability.

Question 19
The charge nurse on a cardiac step-down unit makes assignments for the team consisting of a registered nurse (RN), a practical nurse (PN), and an unlicensed assistive personnel (UAP). Which client should be assigned to the PN?
A) A 49 year-old with new onset atrial fibrillation with a rapid ventricular response
B) A 58 year-old hypertensive with possible angina
C) A 35 year-old scheduled for cardiac catheterization
D) A 65 year-old for discharge after angioplasty and stent placement

Review Information: The correct answer is B: A 58 year-old hypertensive with possible angina
This is the most stable client. The clients in options C and D require initial teaching. The client in option A is considered unstable since the dysrhythmia is a new onset.

Question 20
Which task for a client with anemia and confusion could the nurse delegate to the unlicensed assistive personnel (UAP)?
A) Assess and document skin turgor and color changes
B) Test stool for occult blood and urine for glucose and report results
C) Suggest foods high in iron and those easily consumed
D) Report mental status changes and the degree of mental clarity

Review Information: The correct answer is B: Test stool for occult blood and urine for glucose and report results
The UAP can do standard, unchanging procedures that require no decision making.

Question 21
During the interview of a prospective employee who just completed the agency orientation, which approach would be the best for the nurse manager to use to assess competence?
A) "What degree of supervision for basic care do you think you need?"
B) "Let’s review your skills check-list for type and level of skill"
C) "Are you comfortable working independently?"
D) "What client care tasks or assignments do you prefer?"

Review Information: The correct answer is B: "Let’s review your skills check-list for type and level of skill"
The nurse needs to know that the employee has competence in certain tasks. One way to do this is to do mutual review of documented skills.

Question 22
A client is receiving an intravenous (IV) infusion for pain control. When caring for this client, which one of these actions can the RN safely assign to an unlicensed assistive personnel (UAP)?
A) Ask the client the degree of relief and document the client’s response
B) Decrease the set rate on the pump by 2 ml/minute
C) Check the IV site for drainage and loose tape
D) Assist the client with ambulation and a gown change with supervision

Review Information: The correct answer is D: Assist the client with ambulation and a gown change with supervision
When directing the UAP, communicate clearly and specifically what the task is and what should be reported to the nurse. Implementation of routine tasks should be delegated since they do not require independent judgment.

Question 23
Which one of these tasks can be safely delegated to a practical nurse (PN)?
A) Assess the function of a newly created ileostomy
B) Care for a client with a recent complicated double barrel colostomy
C) Provide stoma care for a client with a well functioning ostomy
D) Teach ostomy care to a client and their family members

Review Information: The correct answer is C: Provide stoma care for a client with a well functioning ostomy
The care of a mature stoma and the application of an ostomy appliance may be delegated to a PN. This client has minimal risk of instability of the situation.

Question 24
Which statement by the nurse is appropriate when giving an assignment to an unlicensed assistive personnel (UAP) to help a client ambulate for the first time after a colon resection?
A) "Have the client sit on the side of the bed before helping the client to walk."
B) "If the client is dizzy ask the client to take some slow, deep breaths."
C) "Help the client to walk in the room as often as the client wishes."
D) "When you help the client to walk, ask if any pain occurs."

Review Information: The correct answer is A: "Have the client sit on the side of the bed before helping the client to walk."
This statement gives clear directions to the UAP about the task and is most closely associated with the information provided in the stem that this is the client''s first time out of bed after surgery.

Question 25
Two people call in sick on the medical-surgical unit and no additional help is available. The team consists of an RN, an LPN and an unlicensed assistive personnel (UAP). Which of these activities should the nurse assign to the UAP?
A) Assist with plans for any clients discharged
B) Provide basic hygiene care to all clients on the unit
C) Assess a client after an acute myocardial infarction
D) Gather the vital signs of all clients on the unit

Review Information: The correct answer is B: Provide basic hygiene care to all clients on the unit
Basic client care, which is routine, should be delegated to a UAP since the unit is short on help. The vital signs can be done by the RN and PN as they make rounds since this data is more critical to making decisions about the care of the clients.

1 comment:

bim said...

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