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NCLEX management of care practice questions

20 free NCLEX-style management of care questions: informed consent, advance directives, confidentiality, client rights, medication errors, ethics and discharge planning, each with the answer and a full 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 client enrolled in a clinical trial of a new chemotherapy regimen tells the clinic nurse, 'I want to quit the study, but I'm afraid my oncologist won't treat me anymore.' Which response by the nurse is accurate?

  1. 'You agreed to finish the whole study when you signed the consent form.'
  2. 'You can leave the study at any time without losing your regular care.'
  3. 'You can leave once the research team agrees it's medically safe to stop.'
  4. 'You can leave after you finish the treatment cycle you're in now.'
Show the answer and rationale

Answer: B

Research participation is voluntary, and federal rules require that a participant may withdraw at any time without penalty or loss of the care and benefits the client is otherwise entitled to; the nurse supports the decision and lets the research team know. Waiting for the team to agree it is safe is the strongest distractor, because the team should explain any steps for stopping safely, but the right to leave does not depend on anyone's approval. Requiring the current cycle to end first, or saying the consent form obligates the client to finish, misstates the client's rights and pressures the client to stay.

๐Ÿ“š Learn it: Whose Job Is Informed Consent? (Not Yours)

Question 2 of 20

A nurse faxes a client's discharge summary and medication list to the skilled nursing facility that is admitting the client. A few minutes later, the nurse realizes that one digit of the fax number was wrong and the documents went to an unknown number. What should the nurse do?

  1. Call the client and explain that the records were sent to the wrong place
  2. Wait to see whether whoever received the fax calls the hospital about it
  3. Report the misdirected fax to the privacy officer or supervisor right away
  4. Resend the documents to the correct number and note the error in the client's record
Show the answer and rationale

Answer: C

A fax sent to the wrong number may be a breach of protected health information, so the nurse reports it at once through the facility's process, usually to the privacy officer, who works to have the documents returned or destroyed and decides whether the client must be notified. Resending to the correct number is the strongest distractor, since the facility still needs the documents, but doing only that leaves the breach unreported, and incident details do not belong in the client's record. Calling the client skips the facility's breach review, and waiting does nothing to limit the harm.

๐Ÿ“š Learn it: HIPAA in the Elevator, the Hallway and the Group Chat

Question 3 of 20

A 74-year-old client admitted with pneumonia gives the nurse a copy of her living will, which refuses CPR if she is terminally ill or permanently unconscious. The admission orders list her as full code. She is alert and oriented. What should the nurse do?

  1. Change her code status in the record to DNR to match the living will
  2. File the living will, since it applies only if she becomes terminally ill
  3. File the living will and ask the provider to talk with her about code status
  4. Place a DNR wristband on her, since her living will refuses CPR
Show the answer and rationale

Answer: C

A living will records wishes but is not a medical order, and if she arrests without a DNR order, resuscitation will be attempted, so the nurse files the document in her record and asks the provider to talk with her, while she can decide, about whether she wants CPR during this stay. Filing it without further action is the tempting choice because her pneumonia is not a terminal illness, but that leaves her current wishes unknown. A nurse cannot change code status or apply a DNR band without a provider's order.

๐Ÿ“š Learn it: Living Wills, Proxies and the DNR That Is Not 'Do Not Treat'

Question 4 of 20

A client 2 days after abdominal surgery rates his pain 8 on a 0-to-10 scale and asks for medication every 3 hours. The provider tells the nurse, 'I think he's drug seeking. Give him 1 mL of normal saline IV, tell him it's for pain, and we'll see if it works.' What should the nurse do?

  1. Give the saline, then tell the client afterward that it was a test
  2. Give the saline and tell the client it is a medicine that may ease his pain
  3. Give the saline as prescribed and carefully document the client's response
  4. Decline to give the saline, and ask the provider to reassess the pain plan
Show the answer and rationale

Answer: D

Giving saline while telling the client it is pain medicine is deception that violates veracity and the client's autonomy, and nursing organizations hold that placebos should not be used to judge whether pain is real or to treat it, even when a provider prescribes them. The nurse declines, advocates for reassessment of the pain plan, and uses the chain of command if needed. Giving the saline and documenting the response is the strongest distractor, since it looks like carrying out an order carefully, but the order itself is the problem. Explaining afterward that it was a test does not undo the deception.

๐Ÿ“š Learn it: Six Ethical Principles the Exam Names by Name

Question 5 of 20

A competent client decides to leave the hospital against medical advice. After hearing the risks from the provider, the client refuses to sign the against-medical-advice form and walks out. What should the nurse do?

  1. Document the refusal to sign and the time the client left in the record, and ask security to escort the client from the unit
  2. Chart a brief note with the time the client left the unit, the provider who was notified, and the unsigned form placed in the record
  3. Complete an incident report describing the risks explained and the refusal to sign, and leave the entry in the client's record to the provider
  4. Document the refusal to sign, the risks explained, and who was notified
Show the answer and rationale

Answer: D

A competent adult may leave and cannot be forced to sign, so the nurse documents objectively that the client refused to sign, which risks were explained and by whom, and who was notified, protecting both the client and the staff. The runner-up is the brief chart note with the time of departure, the provider notified, and the unsigned form filed, because it covers the record well but omits the risks explained, so it does not show the client made an informed choice. Documenting the refusal and departure time and arranging an escort still leaves the risks and notifications out of the record. An incident report is an internal document that does not replace the nurse's own entry in the client's record.

๐Ÿ“š Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment

Question 6 of 20 ยท Select all that apply

A nurse educator is reviewing consent with newly hired emergency department nurses. In which situations may treatment begin under the emergency exception to informed consent? Select all that apply.

  1. An unresponsive adult in cardiac arrest with no DNR order, POLST, or family present
  2. An adult found alone and unresponsive with a respiratory rate of 4 breaths/min and pinpoint pupils
  3. An alert adult with decision-making capacity who is bleeding heavily and refuses a blood transfusion
  4. A confused client with a hip fracture whose health care agent can be reached by phone
  5. A 15-year-old in anaphylaxis at school whose parents cannot be reached
  6. A client who is drowsy from a sedative and is scheduled for an elective colonoscopy
Show the answer and rationale

Answer: A, B, E

The emergency exception applies when treatment is urgent, the client cannot take part in the decision, and no surrogate is available, as with an adult in cardiac arrest or one with life-threatening respiratory depression from a likely opioid overdose; for a minor in an emergency, consent is implied and treatment is never delayed to reach a parent. A capable adult's refusal stands even in an emergency. A health care agent who can be reached by phone can give consent, so the exception does not apply, and an elective procedure is not urgent, so it waits until the sedative wears off.

๐Ÿ“š Learn it: Whose Job Is Informed Consent? (Not Yours)

Question 7 of 20

During a scheduled video visit 1 week after discharge for pneumonia, a 71-year-old client who lives alone begins slurring her words, and the left side of her face droops. She says, 'I'm fine, just tired.' The nurse confirmed her home address at the start of the visit. Which action should the nurse take first?

  1. Have her chew an aspirin while the nurse calls her provider
  2. Book an in-person visit for later today and review stroke warning signs
  3. Call emergency services to her location and stay connected with her
  4. End the call and tell her to dial 911 right away
Show the answer and rationale

Answer: C

Slurred speech and a new facial droop are stroke warning signs, and the time to treatment decides how much brain can be saved, so the nurse sends emergency medical services to her confirmed address and keeps the video open to watch her, note when the symptoms began and help the crew get in. Ending the call so she can dial 911 is the runner-up: it is the right service, but a client with slurred speech who minimizes her symptoms may not call or be understood. Aspirin can worsen a hemorrhagic stroke and is not given before imaging, and a visit later today wastes the treatment window.

๐Ÿ“š Learn it: SBAR, Handoffs and When to Climb the Chain of Command

Question 8 of 20

At 0730 the day nurse finds that a client's IV bag, hung at 0400 by the night nurse, contains 5% dextrose in water instead of the prescribed 0.9% sodium chloride. After hanging the correct solution, assessing the client, and notifying the provider, who should complete the incident report?

  1. The charge nurse, who is responsible for the unit's staff
  2. The day nurse, who discovered the error
  3. The nurse manager, after interviewing both of the nurses
  4. The night nurse, when she returns for her shift tonight
Show the answer and rationale

Answer: B

The person who discovers or witnesses an event completes the incident report promptly, while the facts are fresh, so the day nurse files it. Waiting for the night nurse is the runner-up because she hung the bag, but the report would be delayed by many hours, and her account can be gathered during the follow-up review. The charge nurse and the manager review and act on reports; they do not write them in place of the nurse who found the problem.

๐Ÿ“š Learn it: Incident Reports, Root Causes and Who to Refer To

Question 9 of 20

A 34-year-old client with a severe intellectual disability who lives in a group home needs several teeth removed under general anesthesia. His mother, listed as next of kin, has signed his consent forms since he was a child. Last year a court appointed his sister as guardian of the person. Who should give consent for the procedure?

  1. The client himself, after the procedure is explained in words he can understand
  2. The group home manager, since the home is responsible for his daily care
  3. His mother, since she is his next of kin and has always made his health care decisions
  4. His sister, since a guardian of the person makes his health care decisions
Show the answer and rationale

Answer: D

Once a court appoints a guardian of the person for an adult it has found unable to make his own decisions, the guardian, not the next of kin, consents to health care, so the nurse confirms the scope in the letters of guardianship and the sister signs; the client should still hear about the procedure in words he can follow and be asked for his agreement. His mother is the strongest distractor because she is next of kin and has signed for years, but a parent's legal authority ends when a child reaches adulthood unless a court grants it, and the court chose the sister. The client's own signature is not valid consent once a court has placed the decision with a guardian, and group home staff have no legal authority to consent.

๐Ÿ“š Learn it: Whose Job Is Informed Consent? (Not Yours)

Question 10 of 20

A coworker tells the nurse, 'My password expired, and IT can't reset it for an hour. Can I use your login to chart my vital signs?' Which response by the nurse is best?

  1. 'Enter them under my login this time, and add a note that you took the vital signs.'
  2. 'Ask the charge nurse to log in for you, since supervisors can authorize access.'
  3. 'I can't share my login. Let's call the help desk and use downtime forms.'
  4. 'Use the unit's generic training login, which IT set up for situations like this.'
Show the answer and rationale

Answer: C

Login credentials are unique to each user, so any charting under another person's login falsifies the audit trail and violates security policy; the safe path is an urgent help desk reset plus downtime forms. The runner-up is charting under the nurse's login with a note explaining who took the vital signs, but a note does not fix documentation recorded under the wrong identity. A supervisor cannot authorize use of a personal login, and a generic training login is not approved for real clinical documentation.

๐Ÿ“š Learn it: HIPAA in the Elevator, the Hallway and the Group Chat

Practice 10 more Management of care questions free โ†’

A timed or tutor-mode set in the app, scored by area, with every miss saved for review. Free, no sign-up needed.

Question 11 of 20

A 79-year-old client is unresponsive after a large stroke. She has no health care agent, and her living will, written 2 years ago, states that if she cannot speak for herself she wants all life-sustaining treatment, including CPR and tube feeding. Her two sons tell the nurse, 'Mom would never want to live like this. Stop everything and just keep her comfortable.' Which response by the nurse is best?

  1. 'The ethics committee will decide whether her treatment should continue.'
  2. 'As her next of kin, the two of you can now decide to stop her treatment.'
  3. 'Living wills are used only to refuse treatment, so we can follow your wishes.'
  4. 'Her living will asks for these treatments. Let's talk with her provider.'
Show the answer and rationale

Answer: D

Family members who speak for a client must base decisions on her known wishes, and an advance directive can request treatment as well as refuse it, so the nurse points the sons to what their mother wrote and brings in the provider to talk with them. Saying that next of kin can now stop treatment is the tempting choice, because the sons are her surrogates, but a surrogate decides by her standard, not theirs. A living will is not limited to refusals, and an ethics committee advises the team and family when a conflict cannot be resolved; it does not make the decision.

๐Ÿ“š Learn it: Living Wills, Proxies and the DNR That Is Not 'Do Not Treat'

Question 12 of 20

A charge nurse has one open telemetry bed. A client in the emergency department has new atrial fibrillation with a heart rate of 142 beats/min and dizziness. A client already on the unit, a relative of a hospital board member, was admitted 6 hours ago for a planned procedure tomorrow, has stable vital signs, and has asked for a telemetry room 'for peace of mind.' Which action by the charge nurse best reflects the principle of justice?

  1. Keep the bed open for a possible post-surgical admission expected later this evening
  2. Give the bed to the client with atrial fibrillation, who needs monitoring
  3. Give the bed to the stable client, and check the ED client hourly until a bed opens
  4. Give the bed to the client who was admitted first, since that is the fairest
Show the answer and rationale

Answer: B

Justice allocates a scarce resource by clinical need, so the telemetry bed goes to the client with rapid atrial fibrillation and dizziness, who needs continuous monitoring now. The runner-up is giving it to the client admitted first; treating everyone by arrival order feels fair, but it ignores the difference in need. Holding the bed for a possible later admission puts a speculative need ahead of a present one, and hourly checks on a symptomatic client with a rate of 142 leave long unmonitored gaps.

๐Ÿ“š Learn it: Six Ethical Principles the Exam Names by Name

Question 13 of 20

A client with no health insurance arrives at the emergency department reporting chest pain. A staff member suggests sending the client to the county hospital across town. Which response by the nurse is accurate?

  1. 'We can send him if the county hospital agrees to accept him.'
  2. 'We have to screen him here and stabilize him if he has an emergency.'
  3. 'We can send him by ambulance so that he is monitored on the way there.'
  4. 'We need to verify his coverage first, then decide where he goes.'
Show the answer and rationale

Answer: B

Under the federal Emergency Medical Treatment and Labor Act (EMTALA), a hospital emergency department must give a medical screening examination to anyone who comes for care and must stabilize an emergency condition, or arrange an appropriate transfer, regardless of the client's ability to pay. The receiving hospital's acceptance is the strongest distractor, because it is one requirement for a lawful transfer, but it does not replace the screening that must come first. Sending him by ambulance before screening, or delaying screening to verify coverage, violates the law and endangers a client who may be having a myocardial infarction.

๐Ÿ“š Learn it: Negligence, Malpractice, Assault, Battery, False Imprisonment

Question 14 of 20 ยท Select all that apply

A nurse educator reviews social media guidance with a group of newly hired nurses. Which statements by the nurses indicate understanding of the guidance? Select all that apply.

  1. 'Deleting a post right away doesn't mean no one saw, shared, or saved it.'
  2. 'I can post about a rude client's behavior as long as I don't name the client or the hospital.'
  3. 'Blurring a client's face doesn't make it okay to post a photo I took at work.'
  4. 'Setting my account to private keeps my posts about work confidential.'
  5. 'If a client I'm caring for sends me a friend request, I'll decline it.'
  6. 'Once a client posts about her own surgery, I can add details about her care in the comments.'
Show the answer and rationale

Answer: A, C, E

NCSBN guidance says client images do not belong on social media, blurred or not, that deleted content may still be accessible, and that online contact with clients blurs professional boundaries even when the client starts it. Privacy settings are not enough to keep posts private, posts that disparage clients are unprofessional even when no one is named, and a client's choice to share her own story does not permit the nurse to add details about her care.

๐Ÿ“š Learn it: HIPAA in the Elevator, the Hallway and the Group Chat

Question 15 of 20

A nurse in a remote monitoring program for clients with heart failure notices that a 77-year-old client who sent a weight and blood pressure every morning for 6 weeks has sent no readings for the past 3 days. Which action should the nurse take first?

  1. Document nonadherence and tell the provider at the next weekly review
  2. Send a reminder through the app's messaging feature to transmit readings
  3. Call the client to ask how she is and why the readings stopped
  4. Ask the vendor to check her scale and cuff for a connection problem
Show the answer and rationale

Answer: C

A sudden stop in readings from a client who has transmitted faithfully is a change that needs assessment: she could be too ill, in the hospital, confused, or have a dead device. A phone call lets the nurse ask about weight gain, swelling and shortness of breath and find the cause, and if she cannot be reached, the nurse follows protocol, such as calling her emergency contact. The app reminder is the runner-up, but it cannot assess her and may go unread if she is ill. Checking the equipment assumes a technical cause, and labeling her nonadherent waits a week on a possible emergency.

๐Ÿ“š Learn it: SBAR, Handoffs and When to Climb the Chain of Command

Question 16 of 20

A 63-year-old client who started outpatient hemodialysis 6 weeks ago has a potassium of 6.1 mEq/L and a phosphorus of 7.4 mg/dL before today's treatment. He takes his phosphate binder with meals as prescribed and says, 'I eat a lot of frozen dinners and fast food, and I use a salt substitute because the doctor said to cut salt.' Which referral is most appropriate?

  1. A home health nurse, to supervise how he takes his medications at home
  2. The dialysis social worker, to address barriers to buying fresh food
  3. The renal dietitian, to plan meals and teach label reading for his dialysis diet
  4. The pharmacist, to review the dose and timing of his phosphate binder
Show the answer and rationale

Answer: C

Frozen dinners and fast food are processed foods high in sodium and phosphate additives, and most salt substitutes contain potassium, which explains both high values; the renal dietitian, a required member of the dialysis team, can teach label reading and plan meals within his limits. The pharmacist is the runner-up because a high phosphorus can call for a binder change, but he already takes it correctly, and no binder fixes the potassium from his salt substitute. The social worker addresses cost or access, which he has not described, and he does not need home medication supervision.

๐Ÿ“š Learn it: Incident Reports, Root Causes and Who to Refer To

Question 17 of 20

A 16-year-old client brings her 10-month-old son to an ear, nose, and throat clinic, and the provider recommends ear tubes under general anesthesia for repeated ear infections. The client lives with her own mother, who has no guardianship over the infant. Who should sign the consent for the infant's surgery?

  1. The infant's mother, as the infant's parent
  2. A guardian appointed by a court, since the infant's mother is a minor
  3. The infant's grandmother, because the infant's mother is a minor
  4. The infant's mother, after her own mother cosigns the form
Show the answer and rationale

Answer: A

Authority to consent for a child belongs to the child's parent, and most states (30 and the District of Columbia) explicitly allow a minor parent to consent to medical care for her own child, so the 16-year-old mother signs, following state law and facility policy. Having the grandmother cosign is the tempting choice because it feels safer, but without a guardianship order she has no legal authority over the infant, so her signature adds nothing. For the same reason she cannot sign in the mother's place, and no court guardian is needed when the parent can consent.

๐Ÿ“š Learn it: Whose Job Is Informed Consent? (Not Yours)

Question 18 of 20

A transport aide arrives to take a 58-year-old client to the MRI department. The client has well-controlled HIV infection, a wound infected with methicillin-resistant Staphylococcus aureus (MRSA) that requires contact precautions, and a high fall risk after two falls this week. Which information should the nurse give the transport aide?

  1. The client's diagnoses, including HIV, so the aide can protect himself
  2. Only the client's name and destination, since the rest is confidential
  3. The full history, including the MRSA and HIV, since the aide is on the care team
  4. The client needs contact precautions and is at high risk for falls
Show the answer and rationale

Answer: D

The minimum necessary standard limits each staff member's access to what the role requires, and the aide needs the precautions to use and the fall risk to move the client safely. Telling him about the HIV is the strongest distractor, since it sounds protective, but standard precautions with every client already guard against bloodborne infection, so the diagnosis adds nothing to his task. Giving only the name and destination leaves out safety information he needs, and being part of the care team does not open the whole record.

๐Ÿ“š Learn it: HIPAA in the Elevator, the Hallway and the Group Chat

Question 19 of 20

A client in the intensive care unit was intubated in the emergency department before his family arrived with his living will, which refuses mechanical ventilation if he is permanently unconscious. His providers now agree that he is permanently unconscious, and his health care agent asks that the ventilator be removed. A newly hired nurse says, 'Not starting it would have been fine, but taking him off is different.' Which response by the charge nurse is accurate?

  1. 'Once a ventilator has been started, a court has to approve its removal first.'
  2. 'It can be removed only after he has been declared brain dead.'
  3. 'Stopping a treatment he refused is ethically the same as never starting it.'
  4. 'It can be removed only if every member of his family agrees to removing it.'
Show the answer and rationale

Answer: C

Ethics guidance holds that there is no ethical difference between withholding and withdrawing a treatment, although stopping one can feel different emotionally, so removing a ventilator the client refused in his living will honors his wishes, with full comfort care. Requiring brain death is the tempting choice, but a client or agent may decline life support whatever the neurologic status. His named agent decides with the care team, so the family need not be unanimous, and this decision does not routinely go to a court.

๐Ÿ“š Learn it: Living Wills, Proxies and the DNR That Is Not 'Do Not Treat'

Question 20 of 20

At 0900 a nurse gives a client metoprolol tartrate 25 mg orally and then sees that another nurse already gave the scheduled dose at 0800. The nurse notifies the provider, who prescribes vital signs every hour. HR 66 beats/min, BP 118/72 mm Hg. The client asks, 'Did I just get an extra pill?' Which response by the nurse is best?

  1. 'Another nurse gave your dose before I came in, so this wasn't my mistake.'
  2. 'Yes, you got an extra dose by mistake. Your provider knows, and I'll check you often.'
  3. 'Your provider will come by this morning to talk with you about your medicines.'
  4. 'It was only a small dose, so there's really nothing for you to worry about.'
Show the answer and rationale

Answer: B

Veracity means telling the truth, and clients have a right to be informed about unanticipated outcomes of their care, so when asked directly the nurse acknowledges the extra dose, says the provider knows, and explains the monitoring. Saying the provider will come by is the strongest distractor, since providers often lead disclosure conversations, but deflecting a direct question is evasive and erodes trust. Calling the dose harmless is false reassurance while monitoring is under way, and blaming a coworker does not answer the client and undermines the team.

๐Ÿ“š Learn it: Six Ethical Principles the Exam Names by Name

Practice 10 more Management of care questions free โ†’

A timed or tutor-mode set in the app, scored by area, with every miss saved for review. Free, no sign-up needed.

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