Time management, resources and documentation

26 NCLEX-RN practice questions on Time management, resources and documentation, 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.

1. Question 1 · Medium

   A nurse is unsure how often peripheral IV site dressings should be changed on this unit. Which resource should the nurse use?

   1. AThe routine of the most experienced nurse on shift
   2. BThe practice the nurse learned in nursing school
   3. CA sales representative from the catheter supplier
   4. DThe facility's current policy and procedure manual

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   Answer: D · The facility's current policy and procedure manual

   Facility policies are written from current evidence and standards, and they define the expected practice that the nurse is accountable to follow. Individual habits and older training may be outdated, and vendors may have a commercial bias. When a policy seems out of date, the nurse raises it through the proper committee. This item tests generating solutions with the right resource.

   • A: Personal routines may not match current evidence or policy.
   • B: School teaching may differ from this facility's evidence-based policy.
   • C: A vendor's advice is not the facility's approved standard.

2. Question 2 · Hard

   At 1830 (shift ends at 1900) the nurse still has to hang an IV antibiotic due now, chart intake and output, and teach a client going home tomorrow about wound care. Which plan is best?

   1. ADo the teaching first because it takes the longest to finish
   2. BHand off the antibiotic so all charting is done before 1900
   3. CChart everything first so the record is complete at handoff
   4. DHang the antibiotic, chart the I&O, then hand off the teaching

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   Answer: D · Hang the antibiotic, chart the I&O, then hand off the teaching

   The time-critical task is the antibiotic: delays reduce drug levels and effect. Charting the nurse's own I&O is next, because only the nurse who measured it can record it. Discharge teaching for tomorrow is important but can be safely handed off with a clear report. This item tests prioritising and generating solutions under time pressure.

   • A: Teaching for tomorrow is not time-critical and would delay the antibiotic.
   • B: Passing a due dose to the next shift delays it and is avoidable.
   • C: Charting before a due drug puts paperwork ahead of treatment.

3. Question 3 · Medium

   At 1400 a nurse realises a dressing change done at 1100 was never charted in the electronic record. What should the nurse do?

   1. AEnter it as a late entry, noting both times
   2. BAdd it to the next dressing change note
   3. CBack-date the entry so it appears at 1100
   4. DAsk the oncoming nurse to chart it for her tonight

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   Answer: A · Enter it as a late entry, noting both times

   A late entry is acceptable when it is clearly labelled as late and shows both the time it was written and the time the care was given. Electronic records time-stamp every entry, so back-dating is detectable and is falsification. Only the nurse who gave the care should document it. This item tests taking action with accurate documentation.

   • B: Combining it with a later note loses the true time of care.
   • C: Back-dating misrepresents when the entry was made.
   • D: A nurse must not chart care that someone else gave.

4. Question 4 · Hard

   A client 1 day after hip surgery has new confusion. RR 28/min, SpO2 89% on 2 L/min nasal cannula, HR 118/min. The surgeon was paged 15 minutes ago and has not replied. The nurse has raised the head of the bed. What should the nurse do next?

   1. AAsk the charge nurse to keep paging
   2. BRecheck vital signs in 30 minutes
   3. CPage the surgeon again and wait
   4. DActivate the rapid response team

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   Answer: D · Activate the rapid response team

   New confusion, tachypnea, low oxygen saturation and tachycardia after hip surgery are cues of serious deterioration, such as pulmonary or fat embolism. When the provider cannot be reached and the client is worsening, the nurse uses the resource designed for this: the rapid response team. Further waiting or paging delays expert help. This item tests taking action by using resources.

   • A: Delegating the paging does not bring help faster.
   • B: Waiting 30 minutes is unsafe with these cues.
   • C: Another page repeats a step that already failed while the client worsens.

5. Question 5 · Medium

   At 1000 a client needs vital signs, a dressing change and repositioning. How can the nurse best organise this care?

   1. ALeave the dressing change for the next shift
   2. BDo each task on a separate trip as it comes up
   3. CDo the vital signs now and the other two after lunch
   4. DCluster all three tasks into one visit to the room

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   Answer: D · Cluster all three tasks into one visit to the room

   Clustering care, by gathering supplies and doing related tasks in one visit, saves time, reduces interruptions for the client and allows more rest. It is a core time-management skill. Spreading tasks out wastes trips, and handing off planned care without reason adds to the next shift's load. This item tests generating solutions for workload.

   • A: Delaying planned care without reason shifts work and may harm the wound.
   • B: Separate trips waste time and disturb the client more.
   • C: Splitting the tasks gives no benefit and adds another interruption.

6. Question 6 · Hard

   A unit council asks whether daily chlorhexidine bathing reduces central line infections. Which evidence gives the strongest basis for a practice change?

   1. AA large, well-designed prospective cohort study
   2. BA consensus statement from a national expert panel
   3. CA systematic review and meta-analysis of randomized trials
   4. DA single large multicenter randomized controlled trial

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7. Question 7 · Medium

   The electronic record lets the nurse copy the previous shift's assessment into a new note. What should the nurse do?

   1. ACopy the note and then edit any findings that changed
   2. BChart only findings from the nurse's own assessment
   3. CCopy the note but add initials to show it was reviewed
   4. DCopy the note, since the client's condition is stable

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8. Question 8 · Easy

   A nurse makes an error while writing on a paper flow sheet. The correct way to fix it is to:

   1. ACover the entry with correction fluid and rewrite it
   2. BDraw one line through it, label it an error and initial it
   3. CTear out the page and copy the data onto a new sheet
   4. DScribble over the whole entry until it can no longer be read

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9. Question 9 · Medium

   Which nursing note entry best follows documentation standards?

   1. AClient was uncooperative and refused to eat breakfast.
   2. BPoor appetite at breakfast; encouraged to eat more.
   3. CClient states, "I'm not hungry." Ate 2 bites of breakfast.
   4. DClient seems depressed and did not want breakfast.

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10. Question 10 · Hard

    The hospital updated its policy to require pH testing of aspirate to check nasogastric tube placement. A coworker says, "We always just push air and listen for the whoosh." What should the nurse do?

    1. AFollow the current policy and test the pH of the aspirate
    2. BGive the feeding and ask the provider about it later
    3. CUse both methods and record only the auscultation
    4. DListen for air, since experienced staff still trust it

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11. Question 11 · Hard

    During a busy shift a coworker's login fails. She asks to document her dressing change under the nurse's still-open electronic record session. What should the nurse do?

    1. ALet her chart it, then co-sign the entry as a witness
    2. BAllow it, because she is licensed and gave the care herself
    3. CChart the dressing change under your own name for her
    4. DDecline, and help her get access so she charts her own care

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12. Question 12 · Medium

    A client asks about a newly ordered drug that the nurse does not know. What should the nurse do before giving it?

    1. AHold it until the provider can explain it to him
    2. BCheck a current drug reference or ask the pharmacist
    3. CGive it as ordered, since the provider prescribed it
    4. DAsk the client to look the drug up on his phone

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13. Question 13 · Hard

    At 0215 a client is found sitting on the floor beside her bed. Which nursing note best documents the event?

    1. A0215 client fell, probably due to her sleeping pill. Night nurse aware. No injury.
    2. B0215 client fell while trying to go to the bathroom alone. Seems fine. Will keep watching.
    3. C0215 client fell out of bed because the bed alarm was off. Incident report filed. Provider notified.
    4. D0215 found sitting on floor by bed. States, "I tried to walk to the bathroom." No injury seen. VS stable. Provider notified.

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14. Question 14 · Medium

    In a charting-by-exception system, the nurse documents:

    1. AOnly findings that differ from the defined normal standards
    2. BOnly events that need an incident report to be completed
    3. CEvery finding in full narrative form for each body system
    4. DFindings that the health care provider asks to be charted

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15. Question 15 · Easy

    Which order is written in a form that follows The Joint Commission's Do Not Use list?

    1. AMorphine 2 mg IV every 4 hours as needed
    2. BDigoxin .125 mg by mouth once daily at 0900
    3. CInsulin glargine 10 U subcut at bedtime
    4. DMS 2.0 mg IV every 4 hours as needed

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16. Question 16 · Medium

    A newly graduated nurse is assigned a client with an epidural infusion pump and has not yet been trained on it. What should the nurse do?

    1. ARead the pump manual and manage the client alone
    2. BRefuse the assignment and leave the unit at once
    3. CTell the charge nurse and ask for help or a change
    4. DAsk a nursing assistant who has used the pump to help

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17. Question 17 · Medium · Select all that apply

    A nurse is organising care for a five-client assignment at the start of a shift. Which strategies help the nurse manage the workload?

    1. AReset priorities when a client's condition changes
    2. BDocument care as soon as possible after giving it
    3. CSave all charting for the last hour of the shift
    4. DDelegate suitable tasks early in the shift
    5. ECluster care to reduce trips into each room
    6. FMake a time-ordered worksheet of scheduled drugs and treatments

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18. Question 18 · Hard · Select all that apply

    The electronic health record will be down for four hours of scheduled maintenance. Which actions should the nurse take?

    1. AEnter or scan the paper notes when the system returns, as policy directs
    2. BGive drugs from the printed downtime medication record
    3. CDelay scheduled drugs until the system is back
    4. DChart nothing and rely on memory
    5. EUse the facility's paper downtime forms
    6. FKeep notes on a personal phone to enter later

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19. Question 19 · Hard · Select all that apply

    Halfway through a shift, a client reports new chest pain while another client waits for discharge teaching and scheduled drugs are due for two stable clients. Assistive personnel are free. Which actions should the nurse take?

    1. ATell the discharge client there will be a short delay
    2. BAsk assistive personnel to do the discharge teaching
    3. CAssess the client with chest pain now
    4. DAsk assistive personnel to take vital signs on the stable clients
    5. EAsk the charge nurse for help with the scheduled drugs
    6. FGive the scheduled drugs first so they are not late

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20. Question 20 · Hard · Select all that apply

    A nurse is assigned seven clients, including two who have just returned from surgery, and believes the load is unsafe. Which actions are appropriate?

    1. ALeave the unit at the start of the shift
    2. BIf still assigned, accept and complete an assignment-despite-objection form
    3. CAccept the assignment without saying anything
    4. DRefuse all care until staffing changes
    5. EDiscuss the specific safety concerns with the charge nurse before accepting

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21. Question 21 · Easy · Matrix

    Questions come up during a shift. For each question, indicate the most appropriate resource.

    For each row, choose: Pharmacist / Facility policy / Wound care nurse

    1. When IV tubing must be changed
    2. The maximum rate for an IV potassium infusion
    3. Which dressing suits a deep sacral wound with tunnelling
    4. How often restraint checks must be documented on this unit
    5. Whether two IV drugs can run in the same line

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22. Question 22 · Medium · Select all that apply

    A nurse is asked to care for a client on an IV insulin infusion but has never been trained on the protocol. Which actions are appropriate?

    1. ALearn the protocol from the pump manual during care
    2. BAsk assistive personnel to watch the pump
    3. CAsk for a trained nurse to take the client or supervise the care
    4. DTell the charge nurse about the lack of training
    5. ELeave the unit until the assignment is changed

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23. Question 23 · Medium · Select all that apply

    A nurse is preparing morning medications on a busy unit. Which strategies reduce interruptions and medication errors?

    1. APrepare drugs for one client at a time
    2. BTake phone calls while drawing up insulin
    3. CAsk coworkers to hold non-urgent questions until later
    4. DPrepare medications in a designated no-interruption area
    5. EPour all clients' drugs at the start of the round

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24. Question 24 · Medium · Matrix

    For each documentation action in the electronic record, indicate whether it is acceptable.

    For each row, choose: Acceptable / Not acceptable

    1. Charting a 1600 drug at 1400 because the evening will be busy
    2. Deleting a wrong entry so that it can no longer be seen
    3. Adding a missed entry marked as a late entry with the current time
    4. Documenting a refused dose and that the provider was told
    5. Writing an addendum that clarifies an earlier note

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25. Question 25 · Medium · Matrix

    A nurse is preparing a bedside handoff report. For each item, indicate whether it belongs in the handoff.

    For each row, choose: Include / Leave out

    1. A change in condition and the response to a PRN drug
    2. The client's code status
    3. The nurse's opinion of the family's lifestyle
    4. A complaint that a coworker arrived late
    5. Blood culture results still pending

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