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NCLEX delegation practice questions

20 free NCLEX-style delegation questions: the Five Rights, what the RN can never hand off, and which tasks go to the LPN/LVN or to assistive personnel, each with the answer and rationale.

Tap an answer to check it, or open "Show the answer and rationale" under each question. Every client is fictional. For exam practice only, not medical advice.

Question 1 of 20

A newly hired nurse is unsure whether assistive personnel (AP) on the unit may remove peripheral IV catheters. Before delegating this to an AP, what should the nurse do?

  1. Ask the charge nurse whether other nurses on the unit usually delegate it
  2. Check the AP job description and the AP's documented competency for the task
  3. Delegate it, since removing an IV catheter is a simple, routine task
  4. Ask the AP whether the AP removed IV catheters at a previous job
Show the answer and rationale

Answer: B

The employer defines which tasks AP may perform through job descriptions and policy, and the delegating nurse must also confirm that the AP's competency for the task has been validated and documented. Asking the charge nurse is the runner-up, since the charge nurse is a good resource, but what other nurses usually do is custom, not policy, and it says nothing about this AP's validated competency. An AP's account of a previous job does not show competency here, and a task that seems simple can still be outside the AP's role.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 2 of 20

A nurse observes an assistive personnel (AP) measuring the blood pressure of a client with a large upper arm using a standard adult cuff that is too small. What should the nurse do?

  1. Accept the reading but note in the record that the cuff was too small
  2. Remeasure the blood pressure yourself with a correctly sized cuff, and review cuff sizing with the AP at the end of the shift
  3. Ask the AP to take a second reading with the same standard cuff and record the average of the two readings
  4. Ask the AP to remeasure with a correctly sized cuff and explain why
Show the answer and rationale

Answer: D

A cuff that is too small produces a falsely high reading, so the nurse corrects the technique right away by having the AP repeat the measurement with the right size and explaining why, which is the supervision and evaluation part of delegation. The runner-up is remeasuring it yourself and reviewing cuff sizing with the AP at the end of the shift, because the value would be accurate, but the AP could repeat the same error on other clients all shift before being corrected, and the nurse never verifies the AP's own technique. Accepting the reading with a note about the cuff leaves a value known to be inaccurate in the record for others to act on. Averaging two readings from the same undersized cuff just repeats the same error twice.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 3 of 20

At 1845, a nurse is finishing a 12-hour day shift on a medical unit when the charge nurse asks her to stay until 0300 because a night nurse called in sick. The nurse slept poorly the night before and feels exhausted. Which response by the nurse is most appropriate?

  1. 'I'm too tired to work safely, so I can't stay, but I'll give a full report first.'
  2. 'I can stay until 2300, since 4 extra hours is safer than leaving the unit short.'
  3. 'I'll stay, because saying no now would count as abandoning my clients.'
  4. 'I'll leave a written report at the desk for whoever covers my clients.'
Show the answer and rationale

Answer: A

ANA's fatigue position statement says nurses should be able to decline extra shifts or overtime and supports limiting work to 12 hours in 24, and a nurse who knows she is too tired to practice safely has a duty to say so. Declining extra hours for that reason is not abandonment as long as she hands off her clients before she leaves. Staying until 2300 is the strongest distractor because it sounds like a fair compromise, but it still puts an exhausted nurse at 16 hours of work. Abandonment means leaving accepted clients without a handoff, which is why a written note left at the desk, with no nurse accepting the clients, is unsafe.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 4 of 20

At 1100 on a medical unit, a client develops sepsis and now needs vital signs every 15 minutes, two IV antibiotics, and a fluid bolus while awaiting an ICU bed in about 2 hours. The client's RN has four other clients, all stable. Which action by the charge nurse is best?

  1. Take over the septic client's care until the ICU bed is ready
  2. Reassign two of the RN's remaining clients to nurses with lighter loads
  3. Have the AP take the septic client's vital signs every 15 minutes
  4. Tell the RN to call the rapid response team and keep her full assignment
Show the answer and rationale

Answer: B

When one client's acuity rises sharply, the charge nurse rebalances the workload so the nurse who already knows the client can give the intensive care sepsis demands, and moving some of her stable clients to colleagues does that without breaking continuity. Taking over the septic client is the strongest distractor, but it hands the sickest client to a nurse who does not know him and pulls the charge nurse away from coordinating the unit. Vital signs on a client this unstable need the RN's ongoing interpretation, and a full assignment leaves the nurse unable to give either the septic client or the others safe care.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 5 of 20

At 0700, an assistive personnel (AP) began a 24-hour urine collection for creatinine clearance on a client whose condition is stable. At 1400, the nurse asks the AP how the collection is going. Which statement by the AP requires follow-up?

  1. 'He voided at 0700 when we started, and I threw that urine away.'
  2. 'He flushed the 1300 urine by mistake, so I made a note and kept collecting.'
  3. 'I'm keeping the container on ice and pouring each void into it.'
  4. 'At 0700 tomorrow I'll have him void and add that urine to the container.'
Show the answer and rationale

Answer: B

A 24-hour collection must contain all the urine made during the period, so a flushed void makes the result invalid; the nurse tells the lab, since the collection usually has to be restarted, and reminds the AP to report a missed void right away. Discarding the 0700 urine is the strongest distractor because throwing urine away sounds wrong, but the first void is discarded because it was made before the start time. Keeping the container cold, on ice or refrigerated as the lab directs, protects the sample, and the final void at the end time belongs in the container.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 6 of 20 ยท Select all that apply

An agency RN with 5 years of medical-surgical experience reports for her first shift on a medical unit. Which actions by the charge nurse are appropriate? Select all that apply.

  1. Skip the unit orientation, since the agency has already verified her license and skills
  2. Confirm she has been checked off on the unit's infusion pumps before she uses them
  3. Show her where the emergency equipment is and how to call a rapid response
  4. Give her the most complex clients, since agency nurses are hired for their experience
  5. Pair her with an experienced unit RN she can go to with questions
  6. Have her chart under another nurse's login until her own access is set up
Show the answer and rationale

Answer: B, C, E

A contracted nurse brings general skills but not this hospital's equipment, policies or emergency procedures, so the charge nurse orients her to the emergency equipment and rapid response process, confirms she is validated on equipment such as the unit's pumps, and gives her a resource nurse for questions. The agency's checks of license and skills do not replace the hospital's own orientation and competency assessment. Experience earns a fair assignment, not the unit's most complex clients on a first shift in unfamiliar surroundings, and charting under another nurse's login falsifies the record and breaches security.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 7 of 20

A client with suspected pulmonary tuberculosis is admitted to an airborne infection isolation room on a medical unit. Which RN should the charge nurse avoid assigning to this client?

  1. An RN who was fit-tested for the unit's N95 respirator 8 months ago
  2. An RN whose last N95 fit test was 14 months ago and whose retest is scheduled for next week
  3. An agency RN on her first shift whose fit test on the unit's N95 model was confirmed at orientation
  4. The newly licensed RN, fit-tested last week
Show the answer and rationale

Answer: B

A respirator protects only if it seals to the wearer's face, so OSHA requires a fit test on the model a worker will wear before first use, at least once a year, and whenever the size, style, model, or make changes. A test 14 months ago has lapsed, so this nurse should not enter the airborne infection isolation room until she has passed a fit test. The agency nurse is the strongest distractor because a first shift seems like a reason to pick someone else, but her fit test on the model the unit stocks has been confirmed. A test 8 months ago is still within the yearly cycle, and the newly licensed RN was tested last week.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 8 of 20

A nurse on a postpartum unit is working with an assistive personnel (AP). Which task can the nurse delegate to the AP?

  1. Walking a client to the bathroom for the first time 2 hours after a vaginal birth with an epidural
  2. Bringing a fresh perineal ice pack to a client 6 hours after an uncomplicated vaginal birth
  3. Massaging the fundus of a client whose uterus feels soft and boggy
  4. Showing a first-time mother how to help her newborn latch on to the breast
Show the answer and rationale

Answer: B

A perineal ice pack in the first 24 hours after birth is a routine comfort measure with a predictable outcome, so the AP can bring it. Walking a client to the bathroom is the strongest distractor, because ambulation is usually an AP task, but the first time out of bed after birth, especially after an epidural, carries a high fall risk from leftover numbness or weakness and orthostatic hypotension, so the nurse checks leg strength, sensation, and bleeding and helps with that first walk. Massaging a boggy uterus is an assessment-based intervention for possible hemorrhage, and helping a mother learn to breastfeed is teaching.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 9 of 20

At 0630, the charge nurse on a 30-bed medical unit learns that two of the six RNs scheduled for day shift have called in sick. The unit is full, and three clients need frequent monitoring. What should the charge nurse do first?

  1. Give each remaining RN two extra clients, assigned by room number
  2. Assign the three clients who need frequent monitoring to the LPN
  3. Ask two night-shift RNs to stay until the shortage is resolved
  4. Notify the house supervisor of the shortage and request replacement staff
Show the answer and rationale

Answer: D

The charge nurse's first step is to report the shortage to the house supervisor or staffing office, which controls resources the unit does not have, such as float pool, on-call and agency staff. Asking night nurses to stay is the strongest distractor and may be needed briefly while help is found, but it stretches their hours with no end point when fatigue is already a safety risk, and it does not replace asking for staff. Dividing clients by room number ignores acuity, and clients unstable enough to need frequent monitoring belong with RNs, not the LPN.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 10 of 20

A nurse is caring for a client with heart failure whose condition is stable. Which task should the nurse delegate to the assistive personnel (AP)?

  1. Weighing the client on the standing scale before breakfast
  2. Checking the ankles for pitting edema during morning care
  3. Comparing today's weight with yesterday's and calling the provider about a gain
  4. Showing the client how to keep a daily weight log at home
Show the answer and rationale

Answer: A

Obtaining a daily weight on a standard scale is a routine, predictable measurement that the AP can perform and report, while the nurse remains responsible for interpreting it. Checking the ankles for pitting edema sounds like something the AP could do during morning care, and the AP should report swelling it notices, but judging edema is an assessment that requires nursing judgment. Comparing weights to decide whether to call the provider is evaluation, and showing the client how to keep a home weight log is teaching; each stays with the nurse.

๐Ÿ“š Learn it: The Five Rights of Delegation

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Question 11 of 20

An assistive personnel (AP) tells the nurse, 'Mrs. Lopez's IV pump kept beeping, so I restarted it and turned it up from 50 to 125 mL/hr because the bag was behind.' The client is 84 years old, has heart failure, and is receiving 0.9% sodium chloride. What should the nurse do first?

  1. Tell the AP that changing an IV pump setting is outside the AP's role
  2. Notify the provider that the client received extra IV fluid
  3. Complete an incident report describing the change in the infusion rate
  4. Go to the client, reset the prescribed rate, and assess her breathing
Show the answer and rationale

Answer: D

An older client with heart failure who has been receiving more than twice the prescribed rate is at risk for fluid overload, so the nurse first stops the harm and looks for its effects by restoring the prescribed rate and assessing breathing, lung sounds, and oxygen saturation. Telling the AP that pump settings are outside the AP's role is the runner-up; the nurse must address it, but after the client is safe. The provider needs to know, and the call is more useful once the nurse has assessment findings to report, and the incident report comes after the client has been cared for.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 12 of 20

An RN is supervising a licensed practical nurse (LPN) on a medical unit. Which action by the LPN requires the RN to intervene?

  1. Reinforcing the RN's teaching about how to use an incentive spirometer and documenting the client's return demonstration
  2. Completing the admission assessment for a newly arrived client
  3. Giving scheduled oral medications to a client with stable pneumonia and checking the client's response an hour later
  4. Collecting admission data, including vital signs and a health history, for a newly arrived client
Show the answer and rationale

Answer: B

The initial, or admission, assessment of a client is an RN responsibility, so the RN must step in and complete it. The runner-up is collecting admission data for a newly arrived client, because it sounds like the same task, but gathering vital signs and a health history is data collection within the LPN's scope; the RN then interprets that data to complete the assessment. Reinforcing teaching the RN has already provided, including documenting a return demonstration of the incentive spirometer, is also within scope. Giving scheduled oral medications to a stable client and checking the response afterward is routine LPN work on a medical unit.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 13 of 20

A newly licensed RN is busy with a client who is vomiting. An experienced nurse on the team says, 'I mixed your other client's 1000 dose of IV pantoprazole and left the labeled syringe on your cart.' What should the newly licensed RN do?

  1. Check the label against the MAR, then give the dose
  2. Give the dose, since an experienced nurse labeled it
  3. Have the charge nurse watch her give that dose
  4. Prepare a new dose herself before giving the medication
Show the answer and rationale

Answer: D

The nurse who gives a medication is accountable for knowing exactly what is in the syringe, and a label shows only what someone else intended, so nurses do not give medications another clinician prepared, apart from doses the pharmacy dispenses ready to give. Checking the label against the MAR is the strongest distractor because it is part of every safe administration, but it cannot confirm the drug, dose or diluent in a syringe she did not fill. Another nurse's experience does not transfer accountability, and a witness at the bedside sees the injection, not the preparation.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 14 of 20 ยท Select all that apply

A nurse on a medical unit observes the assistive personnel (AP) during the morning. Which actions by the AP require the nurse to intervene? Select all that apply.

  1. Washing hands with soap and water after leaving the room of a client with C. difficile
  2. Trimming the toenails of a client with diabetes during the bath
  3. Lowering the head of the bed flat to change the sheets while a client's continuous tube feeding runs
  4. Counting a client's respirations while still appearing to count the pulse
  5. Reporting that the urine in a client's drainage bag has turned dark and cloudy
  6. Telling a client with heart failure that a 3-lb (1.4-kg) overnight weight gain is 'just water, nothing to worry about'
Show the answer and rationale

Answer: B, C, F

Calling a 3-lb overnight gain in heart failure nothing to worry about is interpreting a finding and teaching, and a gain that size goes to the nurse. Lying a client flat while a tube feeding runs raises the risk of aspiration; the head of the bed stays at 30 degrees or higher, and the nurse decides whether to pause the feeding. AP should not trim the toenails of a client with diabetes, since a small cut can become a serious infection, so the nurse arranges podiatry care. Soap and water after C. difficile care is correct because alcohol rub does not kill the spores, counting respirations without announcing it keeps the client from changing the breathing pattern, and reporting dark, cloudy urine is what the nurse wants.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 15 of 20

A nurse who is precepting a newly licensed nurse discusses delegation to assistive personnel (AP). Which statement by the newly licensed nurse requires follow-up?

  1. 'An AP who isn't trained to do a task has the right to refuse it.'
  2. 'I can delegate taking vital signs on a stable client but not interpreting them.'
  3. 'If the AP gets too busy, the AP can pass the task to another AP.'
  4. 'The AP is responsible for doing the task right, but I'm still accountable.'
Show the answer and rationale

Answer: C

A delegatee may not pass a delegated task to someone else; an AP who cannot complete it informs the nurse right away, and the nurse decides how the work will get done. The statement that an untrained AP may refuse a task sounds like insubordination, but it is correct, because a delegatee accepts only tasks the delegatee is competent to perform. The AP is responsible for doing the task well while the nurse who delegates remains accountable for the client and the outcome, and the nurse keeps the interpretation of vital signs, because assessment cannot be delegated.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 16 of 20

A nurse who has worked only on an adult medical-surgical unit is told to float to the neonatal intensive care unit (NICU) for the shift. What should the nurse do?

  1. Accept the full NICU assignment and look up unfamiliar procedures as they come up
  2. Report to the NICU, observe the experienced nurses for the shift, and help with nonclinical tasks as needed
  3. Decline the NICU assignment but agree to stay and cover the medical-surgical unit so a more experienced nurse can float instead
  4. Tell the supervisor about the lack of NICU experience and ask for suitable tasks
Show the answer and rationale

Answer: D

A floated nurse should accept only care the nurse is competent to give, so the nurse tells the supervisor about the lack of neonatal experience and asks to work alongside a NICU nurse on tasks within the nurse's skills, or to be placed elsewhere. The runner-up is reporting to the NICU and helping with observation and nonclinical tasks, because it avoids unsafe care, but the nurse never discloses the lack of experience to the supervisor, so no suitable assignment is formally arranged. Declining the float, even while offering to cover the home unit, is still refusing an assignment. Accepting a full NICU assignment and looking procedures up as they arise endangers the infants.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 17 of 20

A client 3 days after a laparoscopic colectomy has a discharge order, and the nurse has completed the discharge teaching. Which task can the nurse delegate to the assistive personnel (AP)?

  1. Going over the printed discharge instructions with the client and answering questions
  2. Asking the client to describe the signs of wound infection to report
  3. Helping the client dress and taking the client by wheelchair to the car
  4. Deciding whether the client's pain is controlled well enough for the ride home
Show the answer and rationale

Answer: C

Helping the client dress, gathering belongings, and taking the client to the car are routine tasks with predictable outcomes that the AP can do. Going over the printed instructions is the strongest distractor, because it looks like handing out paperwork, but answering a client's questions about care at home is teaching, which stays with the nurse. Asking the client to describe the signs of infection evaluates whether the teaching worked, and judging whether pain is controlled well enough for discharge is assessment; both require the nurse.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 18 of 20

A nurse working with an assistive personnel (AP) receives four requests at the same time. Which request should the nurse respond to personally?

  1. A client with C. difficile who needs help to the bedside commode
  2. A client on a fluid restriction who asks for ice chips because of a dry mouth
  3. A client with COPD who uses pursed-lip breathing and asks to sit up
  4. A client who says, 'All of a sudden I feel like I can't get enough air.'
Show the answer and rationale

Answer: D

Sudden shortness of breath is a new, unexplained change that calls for the nurse's assessment, and assessment cannot be delegated. The client with COPD is the runner-up because pursed-lip breathing sounds like distress, but it is a technique clients with COPD are taught and use routinely to ease breathing, and helping the client sit up is positioning the AP can do. Helping a client with C. difficile to the commode is routine care the AP gives under contact precautions, and the AP can give ice chips within a fluid restriction and count them as intake. The nurse keeps the client whose situation requires judgment and delegates the predictable comfort and mobility needs.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 19 of 20

A nurse asks an assistive personnel (AP) to obtain vital signs on a client who had a total knee arthroplasty yesterday and is stable. Which instruction by the nurse is most appropriate?

  1. 'Take his vital signs at 1000, and tell me right away if his systolic BP is under 100.'
  2. 'Take his vital signs at 1000, and record them in the chart before your lunch break.'
  3. 'Take his vital signs at 1000, and tell me before noon if his systolic BP drops below 110.'
  4. 'Take his vital signs at 1000, and if his systolic BP is under 100, recheck it in 15 minutes before you come get me.'
Show the answer and rationale

Answer: A

Clear direction tells the AP what to do, when to do it, and exactly which results to report and how quickly, so the nurse can act on an abnormal value. The runner-up gives the same systolic threshold of 100, but asking the AP to recheck it in 15 minutes before reporting delays the nurse's own assessment of a possibly bleeding postoperative client. Reporting any drop below 110 sometime before noon sets a threshold but leaves a long, vague window before the nurse hears about it. Recording the values in the chart before a lunch break gives a time and a place, but no values to report and no instruction to report at all.

๐Ÿ“š Learn it: The Five Rights of Delegation

Question 20 of 20

A nurse from the labor and delivery unit is floated to a medical-surgical unit for the shift. Which client should the charge nurse assign to the float nurse?

  1. A client with an upper GI bleed receiving a second unit of red cells
  2. A stable client 1 day after a stroke who needs hourly neurologic checks
  3. A stable client 2 days after a bowel resection with a nasogastric tube to suction
  4. A client 1 day after an abdominal hysterectomy whose condition is stable
Show the answer and rationale

Answer: D

A float nurse should receive stable clients whose care resembles the nurse's usual practice, and recovery from abdominal gynecologic surgery is close to the postoperative care a labor and delivery nurse gives after a cesarean birth. The client after a bowel resection is also stable and postoperative, but nasogastric suction and bowel surgery call for gastrointestinal care the float nurse does not give routinely. Hourly neurologic checks after a stroke call for specialized skills the float nurse may not have, and a client with a GI bleed who needs a second unit of blood could become unstable and belongs with an experienced nurse from the unit.

๐Ÿ“š Learn it: The Five Rights of Delegation

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