Prioritization, Delegation, and Assignment Practice Exercises for the
NCLEXÿExamination
1. 1. Ans: 4 As charge nurse, you must assess the performance and attitude of the
staff in relation to this client. After data are gathered from the nurses, additional
information can be obtained from the records and the client as nec- essary. The
educator may be of assistance if a knowledge deficit or need for performance
improvement is the problem. Focus: Supervision, prioritization
LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Prioriti-
zation, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p. 3).
Elsevier Health Sciences. Kindle Edition.: 1. You are the charge nurse. A client with
chronic pain reports to you that the nurses have not been responding to requests for pain
medication. What is your initial action?
1. Check the medication administration records (MARs) for the past several days.
2. Ask the nurse educator to provide in-service training about pain management.
3. Perform a complete pain assessment on the client and take a pain history.
4. Have a conference with the nurses responsible for the care of this client.
2. 2. Ans: 3 Beliefs, attitudes, and familial influence are part of the sociocul- tural
dimension of pain. Location and radiation of pain address the sensory dimension.
Describing pain and its effects addresses the affective dimension. Activity level and
function address the behavioral dimension. Asking about knowledge addresses the
cognitive dimension. Focus: Prioritization 3.
LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Pri-
oritization, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p.
3). Elsevier Health Sciences. Kindle Edition.: 2. Family members are encouraging your
client to "tough out the pain" rather than risk drug addiction
to narcotics. The client is stoically abiding. You recognize that the sociocultural dimension
of pain is the current priority for the client. Which question will you ask?
1. " Where is the pain located, and does it radiate to other parts of your body?"
2. " How would you describe the pain, and how is it affecting you?"
3. " What do you believe about pain medication and drug addiction?"
4. " How is the pain affecting your activity level and your ability to function?"
5. " What information do you need about pain, healing, and addiction?"
3. 3. Ans: 1 Gabapentin is an antiepileptic drug, but it is also used to treat di- abetic
neuropathy. Corticosteroids are for pain associated with inflammation.
Hydromorphone is a stronger opioid, and it is not the first choice for chronic pain
that can be managed with other drugs. Lorazepam is an anxiolytic that may be
ordered as an adjuvant nedication. Focus: Prioritization
LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Pri-
, Prioritization, Delegation, and Assignment Practice Exercises for the
NCLEXÿExamination
oritization, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p
3). Elsevier Health Sciences. Kindle Edition.: 3. A client with diabetic neuropathy reports
a burning, electrical-type pain in the lower extremities that is worse at night and not
responding to nonsteroidal anti-inflammatory drugs. Which medication will you advocate
for first?
1. Gabapentin (Neurontin)
2. Corticosteroids
3. Hydromorphone (Dilaudid)
4. Lorazepam (Ativan)
4. 4. Ans: 3 Cancer pain generally worsens with disease progression, and the use of
opioids is more generous. Fibromyalgia is more likely to be treated with nonopioid
and adjuvant medications. Trigeminal neuralgia is treated with antiseizure
medications such as carbamazepine (Tegretol). Phantom limb pain usually subsides
after ambulation begins. Focus: Prioritization
LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Prioriti-
zation, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p. 3).
Elsevier Health Sciences. Kindle Edition.: 4. Which client is most likely to receive
opioids for extended periods of time?
1. A client with fibromyalgia
2. A client with phantom limb pain in the leg
3. A client with progressive pancreatic cancer
4. A client with trigeminal neuralgia
5. 5. Ans: 4 In supervision of the new RN, good performance should be re- inforced
first and then areas of improvement can be addressed. Asking the nurse about
knowledge of pain management is also an option; however, it would be a more
indirect and time-consuming approach. Making a note and watching do not help the
nurse to correct the immediate problem. In-service training might be considered if
the problem persists. Focus: Supervision, delegation
LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Pri-
oritization, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p
3). Elsevier Health Sciences. Kindle Edition.: 5. As the charge nurse, you are reviewing
the charts of clients who were assigned to the care of a newly graduated RN. The RN has
correctly charted dose and time of medication, but there is no documentation regarding
nonpharmaceutical measures. What action should you take first?
1. Make a note in the nurse's file and continue to observe clinical performance.
, Prioritization, Delegation, and Assignment Practice Exercises for the
NCLEXÿExamination
2. Refer the new nurse to the in-service education department.
3. Quiz the nurse about knowledge of pain management and pharmacology.
4. Give praise for correctly charting the dose and time and discuss the deficits in
charting.
6. 1. Ans: 1 Oral hygiene is within the scope of duties of the UAP. It is the
responsibility of the nurse to observe response to treatments and to help the patient
deal with loss or anxiety. The UAP can be directed to weigh the patient but should not
be expected to know when to initiate that measurement. Focus: Delegation
LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Prioriti-
zation, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p.
168). Elsevier Health Sciences. Kindle Edition.: 1. You are caring for a patient with
esophageal cancer. Which task could be delegated to a UAP?
1. Assisting the patient with oral hygiene
2. Observing the patient's response to feedings
3. Facilitating expression of grief or anxiety
4. Initiating daily weighings
7. 2. Ans: 4 The patient's physical condition is currently stable, but emotional needs
are affecting his or her ability to receive the information required
to make an informed decision. The other diagnoses are relevant, but if the patient
leaves the clinic the interventions may be delayed or ignored. Focus: Prioritization
LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Pri-
oritization, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p
168). Elsevier Health Sciences. Kindle Edition.: 2. A 56-year-old patient comes to the
walk-in clinic reporting scant rectal bleeding and intermittent diarrhea and constipation for
the past several months. There is a history of polyps and a family history of colorectal
cancer. While you are trying to teach about colonoscopy, the patient becomes angry and
threatens to leave. What is the priority diagnosis?
1. Diarrhea/ Constipation related to altered bowel patterns 2. Deficient Knowledge related
to the disease process and diagnostic procedure
3. Risk for Deficient Fluid Volume related to rectal bleeding and diarrhea
4. Anxiety related to unknown outcomes and perceived threats to body integrity
8. 3. Ans: 1 Pancreatic cancer is more common in African-Americans, males, and
smokers. Other associated factors include alcohol use, diabetes, obesity, history of
pancreatitis, exposure to organic chemicals, consumption of a high-fat diet, and
previous abdominal irradiation. Focus: Prioritization
, Prioritization, Delegation, and Assignment Practice Exercises for the
NCLEXÿExamination
LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Prioriti-
zation, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p.
168). Elsevier Health Sciences. Kindle Edition.: 3. Which patient is at greatest risk for
pancreatic cancer? 1. An elderly African-American man who smokes
2. A young white obese woman with gallbladder disease 3. A young African-Ameri- can
man with type 1 diabetes
4. An elderly white woman who has pancreatitis
9. 4. Ans: 2, 3, 5, 6, 7 Mouthwash should not include alcohol, because it has a drying
action that leaves mucous membranes more vulnerable. Insertion of suppositories,
probes, or tampons into the rectal or vaginal cavity is not recommended. All other
options are appropriate. Focus: Prioritization, knowl- edge
LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Pri-
oritization, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p
168). Elsevier Health Sciences. Kindle Edition.: 4. Patients receiving chemotherapy are a
risk for thrombocytopenia related to chemotherapy or disease processes. Which actions are
needed for patients who must be placed on bleeding precautions? (Select all that apply.)
1. Provide mouthwash with alcohol for oral rinsing.
2. Use paper tape on fragile skin.
3. Provide a soft toothbrush or oral sponge.
4. Gently insert rectal suppositories.
5. Avoid aspirin or aspirin-containing products.
6. Avoid overinflation of blood pressure cuffs.
7. Pad sharp corners of furniture.
10. 5. Ans: 2 Administering enemas and antibiotics is within the scope of prac- tice of
LPNs/ LVNs. Although some states an facilities may allow the LPN/ LVN to administer
blood, in general, administering blood, providing preoperative teaching, and assisting
with central line insertion are the responsibilities of the RN. Focus: Assignment
LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara (2013-11-22). Prioriti-
zation, Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p. 168)
Elsevier Health Sciences. Kindle Edition.: 5. When care assignments are being made for
patients with alterations related to gastrointestinal (GI) cancer, which patient would be the
most appropriate to assign to an LPN/ LVN under the supervision of a team leader RN? 1.
A patient with severe anemia secondary to GI
