Prioritization, Delegation, and Exam Questions
& Answers for the NCLEX ® Examination
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. - 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 necessary. 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). Prioritization,
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?" - 2.
,Ans: 3 Beliefs, attitudes, and familial influence are part of the sociocultural 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). Prioritization,
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) - 3.
Ans: 1 Gabapentin is an antiepileptic drug, but it is also used to treat diabetic
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). Prioritization,
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 - 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). Prioritization,
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.
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. - 5.
Ans: 4 In supervision of the new RN, good performance should be reinforced 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). Prioritization,
Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p. 3). 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 - 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). Prioritization,
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?
& Answers for the NCLEX ® Examination
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. - 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 necessary. 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). Prioritization,
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?" - 2.
,Ans: 3 Beliefs, attitudes, and familial influence are part of the sociocultural 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). Prioritization,
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) - 3.
Ans: 1 Gabapentin is an antiepileptic drug, but it is also used to treat diabetic
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). Prioritization,
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 - 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). Prioritization,
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.
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. - 5.
Ans: 4 In supervision of the new RN, good performance should be reinforced 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). Prioritization,
Delegation, and Assignment: Practice Excercises for the NCLEX Exam (p. 3). 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 - 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). Prioritization,
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?
