DrillRNDownload

Management of Care

NCLEX Delegation Practice Questions

Quick answer

Delegation questions ask who can safely do which task, and what the RN still owns after handing it off. They sit inside Management of Care, the largest NCLEX category at 15 to 21 percent of the exam, and delegation and assignment questions make up a big slice of that.

  • 10 practice questions
  • Full rationales
  • Free

Delegation is one of the few NCLEX topics where students with years of experience as a nursing assistant do worse than they expect. On a real unit, a good UAP might take a first set of vitals on a fresh postop, or an LPN might start a blood transfusion because "that is how we do it here." The exam does not care how your unit does it. It tests the textbook rule: the RN keeps assessment, teaching, evaluation, care planning and anything involving an unstable client, and hands off only predictable, routine tasks on stable clients. The trap most students fall into is picking the option that sounds efficient instead of the one that is legal. If a task needs nursing judgment at any point, it stays with the RN, no matter how busy the shift is. The questions below drill the lines between UAP, LPN/LVN and RN work, plus the supervision part that students forget: delegating a task never delegates the responsibility for it.

Practice questions

1

A registered nurse on a medical unit is caring for four clients and has one unlicensed assistive personnel (UAP) assigned to help. Which task is appropriate for the nurse to delegate to the UAP?

  1. AChecking the blood glucose of a stable client with type 2 diabetes before lunch
  2. BTaking the first set of vital signs on a client who returned from surgery 10 minutes ago
  3. CTeaching a client how to use an incentive spirometer
  4. DAssessing the pain level of a client who was just given oral oxycodone
Show answer

Answer: A

A fingerstick glucose on a stable, predictable client is a routine task with a clear procedure and a clear reporting line. UAP can perform it, and the nurse reads and acts on the number.

Why the others are wrong

The first vital signs after surgery (B) are part of the postoperative assessment, and the client is not yet proven stable, so the RN does them. Teaching (C) requires nursing knowledge and judgment and cannot be delegated. Checking pain after a medication (D) is evaluation of a treatment, which is an RN responsibility, even though a UAP can report what a client says.

2

A charge nurse is reviewing the five rights of delegation with a new RN. Which statement by the new RN shows that the teaching was effective?

  1. A"Once I delegate a task, the responsibility for the outcome belongs to the person who did it."
  2. B"I should match the task to the person's training and to how stable the client is, then tell them exactly what to report back."
  3. C"I can delegate any task the UAP has done before as long as I am on the unit."
  4. D"The five rights apply to UAP only, not to LPNs, because LPNs are licensed."
Show answer

Answer: B

The five rights are right task, right circumstance, right person, right direction and communication, and right supervision. Choosing a routine task, confirming the client is stable, picking someone competent, giving clear instructions with reporting parameters, and following up covers all five.

Why the others are wrong

The RN keeps accountability for the delegated task and its outcome (A). Prior experience does not make a task delegable if the client's condition has changed or the task now needs judgment (C). The five rights apply to every delegation, including tasks assigned to LPNs (D).

3

An RN is making an assignment on a stable medical unit. Which client is the most appropriate to assign to a licensed practical nurse (LPN)?

  1. AA client admitted 2 hours ago with chest pain who is awaiting a cardiology consult
  2. BA client who needs the initial teaching session for newly started insulin
  3. CA client 3 days after a hip replacement who needs scheduled oral pain medication and a dressing change
  4. DA client receiving a blood transfusion who is in the first 15 minutes of the infusion
Show answer

Answer: C

The LPN scope covers stable clients with predictable outcomes, including scheduled medications, dressing changes, and reinforcement of teaching that the RN has already done. A client 3 days out from a routine joint replacement fits.

Why the others are wrong

A new chest pain admission (A) is not yet stable and needs RN assessment. Initial teaching (B) belongs to the RN; the LPN can reinforce it afterward. The first 15 minutes of a transfusion (D) is the highest risk window for a reaction and requires RN monitoring in most states and facilities.

4

A client on a surgical unit is 1 day postoperative and has a peripheral IV. Which task should the RN keep rather than assign to an LPN who works on the unit?

  1. AHanging a maintenance bag of 0.9 percent sodium chloride through the existing IV
  2. BGiving an IV push dose of hydromorphone for breakthrough pain
  3. CChanging the dressing over a peripheral IV site
  4. DFlushing a saline lock with normal saline
Show answer

Answer: B

IV push medications, especially opioids and other high alert drugs, require continuous assessment during and after the dose and are kept by the RN. Most state boards and facility policies do not allow LPNs to give IV push medications, and the NCLEX follows that line.

Why the others are wrong

In many states an LPN with IV certification may hang maintenance fluids (A), care for a peripheral site (C) and flush a saline lock (D). These are routine IV tasks on a stable client and do not involve the moment to moment judgment of a push medication.

5

A UAP tells the RN, "The client in room 12 said her chest feels tight and her blood pressure is 88/50. It was 128/76 this morning." Which action should the RN take first?

  1. AAsk the UAP to recheck the blood pressure with a manual cuff
  2. BGo to the client's room and assess her
  3. CCall the provider and report the vital signs
  4. DDocument the UAP's report in the client's chart
Show answer

Answer: B

A new report of chest tightness with a blood pressure drop of 40 points is a change in condition, and assessment of a change in condition is an RN task that cannot be handed back to the UAP. The RN goes to the bedside now.

Why the others are wrong

Sending the UAP back to recheck (A) delays assessment of a potentially unstable client and delegates part of the assessment. Calling the provider (C) comes after the RN has assessed the client and has something to report. Documentation (D) never comes before the client.

6

A nurse delegated the task of ambulating a client in the hallway to a UAP. Thirty minutes later the nurse sees the client still in bed and the UAP charting at the desk. Which response by the nurse is best?

  1. AAmbulate the client herself and write the UAP up for not completing the task
  2. BSay nothing now and mention it on the UAP's annual evaluation
  3. CAsk the UAP privately why the client has not been walked and set a time for it to be done
  4. DTell the charge nurse that the UAP is refusing assignments
Show answer

Answer: C

The right supervision includes checking on delegated tasks and giving direct, private feedback when something is not done. Asking first gives the UAP a chance to explain (the client may have refused, or a bed alarm may have gone off) and sets a clear expectation for completion.

Why the others are wrong

Taking the task back and writing the UAP up (A) skips the conversation and does not solve the problem for the next shift. Saving it for an annual evaluation (B) leaves the client in bed today. Escalating to the charge nurse (D) is premature before the nurse has spoken to the UAP.

7

A float nurse from a pediatric unit is sent to an adult medical surgical floor for the shift. Which client is the most appropriate for the charge nurse to assign to the float nurse?

  1. AA client with an acute stroke who needs neurological checks every hour and swallowing precautions
  2. BA client who needs a new tracheostomy suctioned and a tube feeding started
  3. CA client 2 days after an appendectomy who is tolerating a regular diet and is expected to go home tomorrow
  4. DA client on a heparin infusion with an activated partial thromboplastin time due in 1 hour
Show answer

Answer: C

A float nurse should get the most stable, most predictable clients whose care uses general nursing skills the float nurse already has. A recovering appendectomy client who is nearly ready for discharge fits.

Why the others are wrong

The stroke client (A) is unstable and needs specialty neuro assessment. The new tracheostomy (B) requires unit specific skills and the client is at high risk. The heparin infusion (D) requires titration based on a lab value, which demands familiarity with the unit's protocol and an experienced adult medical surgical nurse.

8

A charge nurse on a busy telemetry unit is making assignments for the oncoming shift, which includes a nurse who graduated 6 weeks ago and finished orientation last week. Which assignment is most appropriate for the new graduate?

  1. AA client in new onset atrial fibrillation who is starting a diltiazem drip, plus a client with stable angina
  2. BTwo clients with stable heart failure who are being diuresed and walked in the hallway, plus one client awaiting discharge
  3. CA client who has just returned from a cardiac catheterization with an arterial sheath still in place
  4. DA client whose family is meeting the palliative care team today to decide on withdrawing treatment
Show answer

Answer: B

New graduates should be assigned stable clients with predictable needs so they can build skills and time management without putting anyone at risk. Stable heart failure clients and a discharge fit that description.

Why the others are wrong

A new drip for new atrial fibrillation (A) requires rapid titration and experience with rhythm changes. A client with a sheath in place (C) can bleed or lose a pulse quickly and needs a nurse experienced in post catheterization care. A withdrawal of treatment meeting (D) involves complex family communication and ethical issues that an experienced nurse should lead.

9

An RN arrives for a night shift and is told she has eight clients, including two who were just transferred from the intensive care unit on vasoactive drips. The nurse believes the assignment is unsafe. Which action should the nurse take?

  1. AAccept the assignment and do the best she can, then file an incident report in the morning
  2. BRefuse the assignment and leave the unit
  3. CTell the charge nurse the assignment is unsafe, explain why, ask for it to be changed, and document the concern in writing if it is not
  4. DCall the nursing supervisor at home and refuse to start until the supervisor arrives
Show answer

Answer: C

The correct route is to raise the concern with the charge nurse immediately, be specific about what makes the assignment unsafe, and request a change. If the assignment stands, the nurse documents the objection through the facility's process (often called an assignment despite objection form) and continues to provide care so no client is abandoned.

Why the others are wrong

Accepting silently and reporting it later (A) does nothing to protect the clients tonight. Leaving the unit after accepting report (B) is client abandonment and can cost the nurse her license. Refusing to begin care (D) also leaves clients without a nurse; the supervisor can be called, but care does not stop while the issue is sorted out.

10

An RN delegates to a UAP the task of measuring intake and output every 4 hours for a client who is receiving IV fluids after a day of vomiting. The UAP is experienced and the client is stable. Which action by the RN is still required?

  1. ANo further action, because the UAP is experienced and the task was delegated correctly
  2. BReview the recorded totals at the end of each 4 hour period and assess the client for signs of fluid overload or deficit
  3. CStay in the room while the UAP empties and measures the urinal
  4. DAsk the UAP to decide whether the IV rate needs to be changed based on the totals
Show answer

Answer: B

Delegating correctly does not end the RN's work. The RN must check that the task was done, interpret the results, and assess the client, because interpreting intake and output and acting on it requires nursing judgment.

Why the others are wrong

"No further action" (A) ignores the right supervision; the RN stays accountable. Standing in the room (C) is not required for a routine task given to a competent UAP and wastes RN time. Deciding on IV rate changes (D) is a clinical judgment and cannot be given to a UAP.

Quick tips

  • Sort every option into three bins before you answer: UAP (routine tasks on stable clients: vitals, hygiene, feeding, ambulating, I and O, glucose checks), LPN/LVN (stable clients, oral and most injected meds, dressing changes, reinforcing teaching, some IV tasks depending on the state), RN (assessment, planning, initial teaching, evaluation, unstable clients, IV push meds, blood in the first minutes).
  • Watch for the word "first" or "new" in the stem. First vitals after surgery, first dose of a new medication, first ambulation after a stroke, new admission, new symptom: all of these belong to the RN.
  • A UAP can collect data (a number, a statement, an observation), but only the RN can decide what the data means. Any option where the UAP interprets, decides, or teaches is wrong.
  • When the question asks what the RN does after delegating, the answer is almost always some form of follow up: check that it was done, review the result, and assess the client.
  • Unsafe assignment questions are about process. Speak up to the charge nurse right away, be specific, document the objection, and never walk out on clients you have already accepted.

Related topics

FAQ

what can a UAP do on the NCLEX

Routine, repetitive tasks on stable clients with predictable outcomes: vital signs, hygiene, turning and positioning, ambulation, feeding, measuring intake and output, and glucose checks in most settings. The UAP reports findings back to the RN but never assesses, teaches, or decides what to do with a result.

can an LPN hang IV fluids or give IV meds

It depends on the state and the facility, which is why the exam keeps it general. On the NCLEX, assume an LPN can care for stable clients, hang maintenance IV fluids and flush lines in many states, but cannot give IV push medications, start blood, or take on a client who is unstable.

who is responsible if a delegated task goes wrong

The RN who delegated it stays accountable for deciding the task was appropriate and for supervising it. The person who performed the task is responsible for doing it correctly. That is why the exam keeps asking what the RN must still do after delegating: the follow up is part of the job, not an extra.

Practice 10 free NCLEX questions every day in the DrillRN app

Every question comes with a full rationale that explains the right answer and why each wrong option is wrong.

Download on the App Store