A mother is 1 day after an uncomplicated vaginal birth. Which part of her care is suitable for the assistive personnel?

Helping her take a sitz bath for perineal comfort

Teaching her how to latch the baby to breastfeed

Evaluating her newborn's feeding and weight loss

Checking her fundal firmness and amount of lochia

Which instruction to the AP about a client's incentive spirometer after abdominal surgery is appropriate?

Remind the client to use it 10 times every hour while awake

Decide whether the client needs to use the device more often today

Listen to breath sounds after the client uses it

Teach the client how to use the spirometer correctly

At 1000 the RN reviews the flow sheet and sees 0800 vital signs charted by the AP for Ms. L. Ms. L says, "No one has checked my blood pressure today." What should the RN do first?

Measure Ms. L's vital signs now

Report the AP to the nurse manager

Complete an incident report on the event

Discuss the charted values with the AP

The RN sees an AP about to take a rectal temperature on a client with neutropenia from chemotherapy. The RN should:

Stop the AP and ask for an oral or temporal reading

Let the AP finish and review the route at end of shift

Complete an incident report and reassign the AP's clients

Report the AP to the nurse manager before speaking to them

Delegation, assignment and supervision

60 NCLEX-RN practice questions on Delegation, assignment and supervision, part of Management of Care. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A mother is 1 day after an uncomplicated vaginal birth. Which part of her care is suitable for the assistive personnel?
1. ATeaching her how to latch the baby to breastfeed
2. BEvaluating her newborn's feeding and weight loss
3. CHelping her take a sitz bath for perineal comfort
4. DChecking her fundal firmness and amount of lochia
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Answer: C · Helping her take a sitz bath for perineal comfort
Helping a stable client with a sitz bath is routine hygiene with a predictable outcome. Fundal and lochia checks are assessment for haemorrhage, breastfeeding instruction is teaching, and judging infant feeding is evaluation, all of which the RN keeps. The AP reports any heavy bleeding or dizziness during the bath. This tests the take-action step.
- A: Teaching breastfeeding is an RN function.
- B: Evaluating newborn feeding and weight loss needs nursing judgment.
- D: Fundal and lochia checks are assessment for postpartum haemorrhage.
Question 2 · Medium
Which instruction to the AP about a client's incentive spirometer after abdominal surgery is appropriate?
1. ADecide whether the client needs to use the device more often today
2. BListen to breath sounds after the client uses it
3. CTeach the client how to use the spirometer correctly
4. DRemind the client to use it 10 times every hour while awake
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Answer: D · Remind the client to use it 10 times every hour while awake
AP may remind and encourage a client to carry out a plan the RN has set and taught. Teaching technique, listening to breath sounds and deciding on frequency are teaching, assessment and judgment, which the RN keeps. The AP reports if the client cannot or will not use the device. This tests the take-action step.
- A: Changing the frequency is a nursing judgment.
- B: Listening to breath sounds is assessment, which AP cannot do.
- C: Teaching how to use a device is an RN function.
Question 3 · Easy
Under the five rights of delegation, checking that the assistive personnel (AP) has been trained in a task and has shown competence in it addresses the right:
1. ACircumstance
2. BSupervision and evaluation
3. CTask
4. DPerson
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Answer: D · Person
The right person means the task goes to a delegatee whose training, competence and role fit that task, and the RN must confirm this before delegating. Right task asks whether the activity itself may be delegated, and right circumstance asks whether the client and setting are stable enough. Supervision and evaluation follow after the task is handed over. This item tests the take-action step of clinical judgment: choosing a safe delegatee.
- A: Right circumstance concerns client stability and setting, not the delegatee's skills.
- B: Supervision and evaluation are the RN's follow-up after the task is handed over.
- C: Right task asks whether the activity can be delegated at all, not whether this AP is competent.
Question 4 · Hard
At 1000 the RN reviews the flow sheet and sees 0800 vital signs charted by the AP for Ms. L. Ms. L says, "No one has checked my blood pressure today." What should the RN do first?
1. AMeasure Ms. L's vital signs now
2. BReport the AP to the nurse manager
3. CComplete an incident report on the event
4. DDiscuss the charted values with the AP
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Answer: A · Measure Ms. L's vital signs now
Client safety comes first: the charted values may be false, so the RN measures Ms. L's vital signs at once to know her real condition. The RN then speaks privately with the AP, and if falsification is confirmed it is reported through the chain of command and an incident report is completed per policy. Acting on the staff issue first leaves the client's status unknown. This tests the prioritise-hypotheses step.
- B: Reporting comes after the client's status is known and the facts are checked.
- C: Incident reporting follows the immediate safety action.
- D: Talking with the AP matters but comes after confirming the client is safe.
Question 5 · Medium
The RN sees an AP about to take a rectal temperature on a client with neutropenia from chemotherapy. The RN should:
1. ALet the AP finish and review the route at end of shift
2. BComplete an incident report and reassign the AP's clients
3. CReport the AP to the nurse manager before speaking to them
4. DStop the AP and ask for an oral or temporal reading
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Answer: D · Stop the AP and ask for an oral or temporal reading
Rectal temperatures are avoided in neutropenia because mucosal injury can cause bleeding and infection. When an RN sees delegated care being done unsafely, the RN intervenes at once to protect the client, then explains the reason. Later feedback or reports do not prevent the harm. This tests the take-action step of supervision.
- A: Waiting until the end of the shift lets the unsafe act go ahead.
- B: No error has happened yet, and reassignment does not protect this client now.
- C: Reporting first delays the action that protects the client now.
Question 6 · Hard
The RN was told at handoff that a client was given first-time insulin teaching yesterday by an RN. Which task today should the RN assign to the LPN/VN?
1. AAmbulating the client in the hallway twice this shift
2. BReinforcing the client's insulin injection technique
3. CGiving the client discharge teaching on all new medications
4. DAssessing the client's new stage 2 pressure injury
Answer and explanation in LearnFree account
Question 7 · Hard
A new graduate RN is reviewing delegation with the preceptor. Which statement by the new graduate shows a need for further teaching?
1. A"I stay accountable for my decision about which tasks to delegate."
2. B"I can delegate the admission assessment if the LPN/VN is experienced."
3. C"An AP may decline a task they have not been trained to perform."
4. D"I should tell the AP exactly what findings to report back to me."
Answer and explanation in LearnFree account
Question 8 · Medium
At 1000 an AP reports that a client's blood pressure is 88/50 mm Hg; at 0600 it was 124/78 mm Hg. What should the RN do first?
1. AAsk the AP to recheck the pressure in 1 hour
2. BNotify the health care provider of the reading
3. CDocument the reading and continue medication rounds
4. DGo to the bedside and assess the client
Answer and explanation in LearnFree account
Question 9 · Medium
Which task on a medical unit should the RN keep rather than assign to an LPN/VN?
1. AGiving the scheduled oral medications to a stable client with pneumonia
2. BReinforcing teaching on a low-sodium diet already begun
3. CThe first assessment of a client just transferred from the ICU
4. DChanging a dry sterile dressing on a healing incision
Answer and explanation in LearnFree account
Question 10 · Medium
After delegating ambulation of a client to the AP, which RN action best fulfils the right of supervision and evaluation?
1. AAsk how the client managed the walk and check the client afterward
2. BTell the AP to walk the client again if there is time later
3. CDocument that the AP completed training in safe ambulation
4. DGive the AP the distance goal for the walk before it starts
Answer and explanation in LearnFree account
Question 11 · Medium
An RN asks the AP to "keep an eye on" the vital signs of a client 4 hours after a bowel resection. Which revised instruction best meets the right of directions and communication?
1. ATake vital signs every hour and call the provider if any value is abnormal
2. BTake vital signs every hour and tell me at once if systolic pressure is under 100
3. CTake vital signs every hour and decide if the client needs pain medicine
4. DTake vital signs whenever you have time and chart them in the record
Answer and explanation in LearnFree account
Question 12 · Medium
An RN asks an AP to check a client's capillary blood glucose. The AP says they have not yet been trained on the unit's new meter. The best RN action is to:
1. ADo the check and arrange training before delegating it again
2. BInsist the AP do the check because it is in the job description
3. CExplain the steps quickly and ask the AP to try it now
4. DAsk the AP to watch another AP once and then do it alone
Answer and explanation in LearnFree account
Question 13 · Easy
Which activity may the RN delegate to assistive personnel (AP) for a stable client on a medical unit?
1. ACompleting the admission skin and pressure-injury assessment
2. BTeaching the client to use an incentive spirometer
3. CMeasuring and recording oral intake and urine output
4. DEvaluating the client's pain after an oral opioid
Answer and explanation in LearnFree account
Question 14 · Medium
An agency RN who has never worked on the unit arrives for a 12-hour shift. Before giving this nurse a client assignment, the charge nurse should first:
1. AAssign the most stable clients and let the nurse learn the unit
2. BConfirm orientation to unit policies, equipment and emergency procedures
3. CGive the nurse only the new admissions because there is no prior history
4. DAsk the agency nurse to shadow the AP for the first hours
Answer and explanation in LearnFree account
Question 15 · Easy
Which task is within the usual scope of practice of an LPN/VN caring for a stable client?
1. APerforming the full nursing admission assessment on arrival
2. BGiving a scheduled subcutaneous enoxaparin injection
3. CDeveloping the client's initial nursing care plan
4. DGiving first-time teaching on a new insulin regimen
Answer and explanation in LearnFree account
Question 16 · Easy
When an RN delegates a task to assistive personnel, accountability for the decision to delegate rests with the:
1. ACharge nurse on the shift
2. BAssistive personnel who accepts it
3. CNurse manager of the unit
4. DDelegating registered nurse
Answer and explanation in LearnFree account
Question 17 · Medium
On a team of an RN, an LPN/VN and an AP, which client should the charge nurse assign to the RN rather than the LPN/VN?
1. AA client with chronic COPD awaiting transfer to rehabilitation
2. BA client with heart failure who has new crackles and needs oxygen
3. CA client with a stable colostomy who needs a pouch change
4. DA client with type 2 diabetes who needs scheduled insulin
Answer and explanation in LearnFree account
Question 18 · Hard
A 4-year-old returned from a tonsillectomy 6 hours ago and is awake and comfortable. Which part of the child's care is suitable for the AP?
1. AInspecting the throat with a penlight for bleeding
2. BOffering cool, clear, non-red fluids and recording intake
3. CTeaching the parents to avoid straws for two weeks
4. DDeciding when the child needs the next PRN analgesic
Answer and explanation in LearnFree account
Question 19 · Medium
For clients with urinary catheters, which activity falls within the role of assistive personnel?
1. ATeaching clean intermittent self-catheterisation
2. BPerineal care for a client with an indwelling catheter
3. CJudging whether urine output is adequate after surgery
4. DDeciding whether a catheter can be removed today
Answer and explanation in LearnFree account
Question 20 · Medium
Four nursing activities are due at 0900 on a surgical ward. The RN should give which one to assistive personnel?
1. AFeeding a client with dysphagia who had a stroke yesterday
2. BTaking the vital signs of a client who returned from surgery 15 minutes ago
3. CChecking an IV site that the client says is newly swollen
4. DCollecting a clean-catch urine specimen from a client with dysuria
Answer and explanation in LearnFree account
Question 21 · Medium
Which change makes it inappropriate for the RN to keep delegating morning care of a client with COPD to the AP?
1. AThe client would now prefer a bed bath to a shower in the bathroom
2. BThe client's oxygen saturation fell to 87% during yesterday's bath
3. CThe AP has cared for this client on two earlier shifts
4. DThe client asks to have the bath later in the morning
Answer and explanation in LearnFree account
Question 22 · Hard
Shift report at 0700 on a team of an RN, an LPN/VN and an AP: Client A: 4 hours after thyroidectomy, voice now hoarse. Client B: stable COPD, discharge planned tomorrow. Client C: dementia, needs help with bathing and meals; swallow normal. Client D: heparin infusion, aPTT due at 0800. Which assignment is most appropriate?
1. ARN: A; LPN/VN: B and D; AP: C
2. BRN: D; LPN/VN: A and B; AP: C
3. CRN: A and D; LPN/VN: B; AP: C
4. DRN: B and D; LPN/VN: C; AP: A
Answer and explanation in LearnFree account
Question 23 · Medium
A charge nurse gives an LPN/VN a group of stable clients whose care falls within LPN/VN scope. Under the national delegation guidelines, this is best described as:
1. AA referral to another level of care
2. BA transfer of accountability for outcomes
3. CA delegation of an advanced skill
4. DAn assignment of routine care
Answer and explanation in LearnFree account
Question 24 · Hard
An RN from the pediatric unit is floated to an adult medical-surgical unit. Which client is the most appropriate assignment for this nurse?
1. AA 58-year-old with a new tracheostomy on mechanical ventilation
2. BA 66-year-old who received IV alteplase for a stroke 1 hour ago
3. CA 70-year-old with a left ventricular assist device placed 3 days ago
4. DA 20-year-old in sickle cell crisis on IV fluids and oral analgesics
Answer and explanation in LearnFree account
Question 25 · Hard
An RN floated from the critical care unit to a medical unit for the shift. Which client is the best use of this nurse's skills?
1. AA client with diabetic ketoacidosis on an insulin infusion and hourly glucose
2. BA client with Alzheimer disease who needs help with meals and bathing
3. CA client with stable hypertension awaiting discharge this afternoon
4. DA client 3 days after appendectomy who needs a dry dressing changed
Answer and explanation in LearnFree account

35 more Delegation, assignment and supervision questions

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Study Management of Care

Delegation, assignment and supervision

A mother is 1 day after an uncomplicated vaginal birth. Which part of her care is suitable for the assistive personnel?

Which instruction to the AP about a client's incentive spirometer after abdominal surgery is appropriate?

Under the five rights of delegation, checking that the assistive personnel (AP) has been trained in a task and has shown competence in it addresses the right:

At 1000 the RN reviews the flow sheet and sees 0800 vital signs charted by the AP for Ms. L. Ms. L says, "No one has checked my blood pressure today." What should the RN do first?

The RN sees an AP about to take a rectal temperature on a client with neutropenia from chemotherapy. The RN should:

The RN was told at handoff that a client was given first-time insulin teaching yesterday by an RN. Which task today should the RN assign to the LPN/VN?

A new graduate RN is reviewing delegation with the preceptor. Which statement by the new graduate shows a need for further teaching?

At 1000 an AP reports that a client's blood pressure is 88/50 mm Hg; at 0600 it was 124/78 mm Hg. What should the RN do first?

Which task on a medical unit should the RN keep rather than assign to an LPN/VN?

After delegating ambulation of a client to the AP, which RN action best fulfils the right of supervision and evaluation?

An RN asks the AP to "keep an eye on" the vital signs of a client 4 hours after a bowel resection. Which revised instruction best meets the right of directions and communication?

An RN asks an AP to check a client's capillary blood glucose. The AP says they have not yet been trained on the unit's new meter. The best RN action is to:

Which activity may the RN delegate to assistive personnel (AP) for a stable client on a medical unit?

An agency RN who has never worked on the unit arrives for a 12-hour shift. Before giving this nurse a client assignment, the charge nurse should first:

Which task is within the usual scope of practice of an LPN/VN caring for a stable client?

When an RN delegates a task to assistive personnel, accountability for the decision to delegate rests with the:

On a team of an RN, an LPN/VN and an AP, which client should the charge nurse assign to the RN rather than the LPN/VN?

A 4-year-old returned from a tonsillectomy 6 hours ago and is awake and comfortable. Which part of the child's care is suitable for the AP?

For clients with urinary catheters, which activity falls within the role of assistive personnel?

Four nursing activities are due at 0900 on a surgical ward. The RN should give which one to assistive personnel?

Which change makes it inappropriate for the RN to keep delegating morning care of a client with COPD to the AP?

A charge nurse gives an LPN/VN a group of stable clients whose care falls within LPN/VN scope. Under the national delegation guidelines, this is best described as:

An RN from the pediatric unit is floated to an adult medical-surgical unit. Which client is the most appropriate assignment for this nurse?

An RN floated from the critical care unit to a medical unit for the shift. Which client is the best use of this nurse's skills?