Medical-Surgical Nursing Priority, Delegation, and
Management of Care
75 Questions with Verified Answers & Complete
Rationales (2026/2027 NCLEX-RN Aligned)
INSTRUCTIONS
This practice exam focuses on three critical areas tested on the
NCLEX-RN:
1. Priority Setting & Clinical Judgment - Determining which
patient needs to be seen first, which intervention is most
important, and how to prioritize care using frameworks like
ABCs, Maslow's Hierarchy, and the nursing process.
2. Delegation & Supervision - Understanding which tasks can be
delegated to unlicensed assistive personnel (UAP), licensed
practical/vocational nurses (LPN/LVN), and other members of
the healthcare team.
3. Management of Care - Coordinating care, managing patient
assignments, and ensuring safe, effective care delivery.
,SECTION A: PRIORITY SETTING & CLINICAL JUDGMENT
(Questions 1-30)
1. The nurse is caring for four patients on a medical-
surgical unit. Which patient should the nurse assess first?
A. A patient with COPD who has a SpO2 of 88% on 2 L/min
oxygen
B. A patient with heart failure who has 2+ pitting edema and
crackles in the lung bases
C. A patient who had a hip replacement 2 days ago and is
requesting pain medication
D. A patient with a new onset of slurred speech and unilateral
facial drooping
Correct Answer: D
Rationale: The patient with new onset slurred speech and facial
drooping is showing signs of an acute cerebrovascular accident
(stroke). This is a time-sensitive emergency requiring immediate
assessment and intervention (ABCs first, then neurological
,assessment). The "new onset" makes this the highest priority.
The COPD patient's SpO2 of 88% is concerning but not as
immediately life-threatening as an evolving stroke. The heart
failure patient has expected findings. The hip replacement
patient's pain is a lower priority.
2. The nurse receives report on four patients. Which patient
should the nurse see first?
A. A patient with pneumonia who has a fever of 38.2°C (100.8°F)
and is diaphoretic
B. A patient with atrial fibrillation who has a heart rate of 110
beats/min
C. A patient with a new colostomy who has a pink, moist stoma
D. A patient with a chest tube who has continuous bubbling in
the water seal chamber
Correct Answer: D
Rationale: Continuous bubbling in the water seal chamber
indicates an air leak, which is a priority concern. The nurse
should assess the chest tube system for the source of the leak.
, Fever and tachycardia are concerning but expected. A pink,
moist stoma is a normal finding.
3. The nurse is caring for a patient who just returned from a
cardiac catheterization via the femoral artery. Which
assessment finding requires immediate action?
A. The patient reports mild discomfort at the insertion site
B. The patient's blood pressure is 130/80 mmHg
C. The patient's pedal pulse is absent on the affected extremity
D. The patient's heart rate is 72 beats/min
Correct Answer: C
Rationale: An absent pedal pulse on the affected extremity
indicates arterial occlusion or thrombosis, a serious
complication requiring immediate intervention. Mild discomfort
and vital signs within normal limits are expected findings.
Management of Care
75 Questions with Verified Answers & Complete
Rationales (2026/2027 NCLEX-RN Aligned)
INSTRUCTIONS
This practice exam focuses on three critical areas tested on the
NCLEX-RN:
1. Priority Setting & Clinical Judgment - Determining which
patient needs to be seen first, which intervention is most
important, and how to prioritize care using frameworks like
ABCs, Maslow's Hierarchy, and the nursing process.
2. Delegation & Supervision - Understanding which tasks can be
delegated to unlicensed assistive personnel (UAP), licensed
practical/vocational nurses (LPN/LVN), and other members of
the healthcare team.
3. Management of Care - Coordinating care, managing patient
assignments, and ensuring safe, effective care delivery.
,SECTION A: PRIORITY SETTING & CLINICAL JUDGMENT
(Questions 1-30)
1. The nurse is caring for four patients on a medical-
surgical unit. Which patient should the nurse assess first?
A. A patient with COPD who has a SpO2 of 88% on 2 L/min
oxygen
B. A patient with heart failure who has 2+ pitting edema and
crackles in the lung bases
C. A patient who had a hip replacement 2 days ago and is
requesting pain medication
D. A patient with a new onset of slurred speech and unilateral
facial drooping
Correct Answer: D
Rationale: The patient with new onset slurred speech and facial
drooping is showing signs of an acute cerebrovascular accident
(stroke). This is a time-sensitive emergency requiring immediate
assessment and intervention (ABCs first, then neurological
,assessment). The "new onset" makes this the highest priority.
The COPD patient's SpO2 of 88% is concerning but not as
immediately life-threatening as an evolving stroke. The heart
failure patient has expected findings. The hip replacement
patient's pain is a lower priority.
2. The nurse receives report on four patients. Which patient
should the nurse see first?
A. A patient with pneumonia who has a fever of 38.2°C (100.8°F)
and is diaphoretic
B. A patient with atrial fibrillation who has a heart rate of 110
beats/min
C. A patient with a new colostomy who has a pink, moist stoma
D. A patient with a chest tube who has continuous bubbling in
the water seal chamber
Correct Answer: D
Rationale: Continuous bubbling in the water seal chamber
indicates an air leak, which is a priority concern. The nurse
should assess the chest tube system for the source of the leak.
, Fever and tachycardia are concerning but expected. A pink,
moist stoma is a normal finding.
3. The nurse is caring for a patient who just returned from a
cardiac catheterization via the femoral artery. Which
assessment finding requires immediate action?
A. The patient reports mild discomfort at the insertion site
B. The patient's blood pressure is 130/80 mmHg
C. The patient's pedal pulse is absent on the affected extremity
D. The patient's heart rate is 72 beats/min
Correct Answer: C
Rationale: An absent pedal pulse on the affected extremity
indicates arterial occlusion or thrombosis, a serious
complication requiring immediate intervention. Mild discomfort
and vital signs within normal limits are expected findings.
