NCLEX Questions Update || Complete Test Bank (The Latest Edition) with 2
Versions: 500+ Questions & Approved Answers With Explained Rationales ||
A+ PASS || GUARANTEED || BRANDNEW!!!!!!!!!!!
Which task would NOT be appropriate for the RN to delegate to an LPN or UAP?
A. Reinforcing teaching done by the RN
B. Taking and reporting vital signs
C. Assessing response to IV pain medication
D. Removing a postoperative dressing
Correct Answer: C. Assessing response to IV pain medication
Rationale:
Assessment, evaluation, and interpretation of patient response are RN responsibilities only.
While LPNs and UAPs can perform delegated tasks such as routine care or reinforcement of
teaching, they cannot perform independent clinical evaluation. Evaluating pain medication
effectiveness requires nursing judgment, clinical reasoning, and the ability to adjust care
plans, which is outside LPN/UAP scope.
• A is appropriate for LPN
• B is appropriate for UAP
• D may be delegated to LPN depending on policy
• C requires RN-level critical thinking and assessment
If substance abuse is suspected in a nurse after narcotic discrepancy, the MOST
appropriate next step is:
A. Confront the nurse and suspend immediately
B. Report to police immediately
C. Complete an incident report and notify pharmacy and nursing administration
D. Ignore until confirmed by coworkers
Correct Answer: C. Complete an incident report and notify pharmacy and nursing
administration
Rationale:
Suspected controlled substance diversion must be handled through formal institutional and
regulatory channels. The nurse manager or charge nurse documents the discrepancy via
incident report and escalates to pharmacy and nursing administration for investigation. This
ensures chain-of-custody accountability and protects both patients and staff rights.
, • A is punitive and bypasses due process
• B is premature unless criminal evidence exists
• D is unsafe and violates reporting standards
Best indicator that nurses have accepted an electronic medical record (EMR) system is:
A. Nurses say they like it
B. Nurses occasionally use it
C. Nurses document consistently using the EMR in daily practice
D. Nurses still handwrite notes but prefer EMR
Correct Answer: C. Nurses document consistently using the EMR in daily practice
Rationale:
Acceptance of a system is demonstrated by consistent integration into routine workflow,
not opinions or occasional use. True adoption means the EMR is the standard method of
documentation, indicating both behavioral change and system integration.
• A is attitude, not behavior
• B is partial adoption
• D shows resistance to change
Best initial activity for nursing staff in a quality improvement project is:
A. Track supply usage
B. Document time spent on care
C. Administer client and family satisfaction surveys
D. Assess client acuity daily
Correct Answer: C. Administer client and family satisfaction surveys
Rationale:
Quality improvement begins with understanding patient-centered outcomes, especially
satisfaction and perceived quality of care. Surveys provide baseline data on care
effectiveness and service perception before operational metrics are analyzed.
• A is resource tracking
• B is productivity tracking
• D is advanced clinical measurement, not initial step
,Correct priority order for RN rounds:
Correct Answer: 3 → 1 → 5 → 4 → 2
Rationale:
Prioritization is based on stability, risk of deterioration, and immediacy of need.
• 3 (PACU arrival) = highest priority, immediate post-anesthesia risk
• 1 (post-cardiac cath) = risk of bleeding/complications
• 5 (pneumonia, O2 93%) = borderline respiratory status
• 4 (discharge waiting transport) = stable, non-urgent
• 2 (diabetes teaching) = lowest priority, education-only
This reflects ABCs (airway, breathing, circulation) and instability hierarchy.
Which task should be delegated to the charge nurse in respiratory distress situation?
A. Head-to-toe assessment
B. Insert second IV
C. Apply oxygen
D. Call respiratory therapist
Correct Answer: D. Call respiratory therapist
Rationale:
The charge nurse should delegate or initiate coordination of rapid interdisciplinary support.
Calling RT ensures immediate specialized respiratory intervention while other staff manage
direct stabilization (oxygen, IV, assessment). In severe distress, time-critical coordination is
priority.
• A is RN assessment role
• B is skilled procedure but not first action
• C is immediate bedside intervention (RN/UAP task)
• D ensures system-wide response
Best FIRST action when juggling patient feeding and another patient requesting pain
medication is:
A. Finish feeding first
B. Stop feeding and give pain medication immediately
, C. Ask charge nurse to give pain medication
D. Ask charge nurse to feed patient
Correct Answer: B. Stop feeding and give pain medication immediately
Rationale:
Pain management is a priority intervention because uncontrolled pain is an immediate
physiological and ethical concern. Feeding is non-urgent and can be safely interrupted.
Analgesia delays can worsen patient distress and outcomes.
• A delays pain treatment
• C unnecessary delegation of RN responsibility
• D inappropriate task redistribution when RN is available
CONTINUATION — NEW MCQs (SET BEGINS)
A nurse documents a medication administration that was not actually given. This action is
considered:
A. Negligence
B. Malpractice
C. Falsification of records
D. Delegation error
Correct Answer: C. Falsification of records
Rationale:
Documenting care that was not performed is intentional misrepresentation and violates
legal and ethical standards. This is not simple negligence—it is an act of falsifying
documentation, which can lead to license suspension or criminal liability.
Which element is required for malpractice to be proven?
A. Intent to harm
B. Financial loss
C. Nurse-patient relationship
D. Verbal warning
Correct Answer: C. Nurse-patient relationship
Versions: 500+ Questions & Approved Answers With Explained Rationales ||
A+ PASS || GUARANTEED || BRANDNEW!!!!!!!!!!!
Which task would NOT be appropriate for the RN to delegate to an LPN or UAP?
A. Reinforcing teaching done by the RN
B. Taking and reporting vital signs
C. Assessing response to IV pain medication
D. Removing a postoperative dressing
Correct Answer: C. Assessing response to IV pain medication
Rationale:
Assessment, evaluation, and interpretation of patient response are RN responsibilities only.
While LPNs and UAPs can perform delegated tasks such as routine care or reinforcement of
teaching, they cannot perform independent clinical evaluation. Evaluating pain medication
effectiveness requires nursing judgment, clinical reasoning, and the ability to adjust care
plans, which is outside LPN/UAP scope.
• A is appropriate for LPN
• B is appropriate for UAP
• D may be delegated to LPN depending on policy
• C requires RN-level critical thinking and assessment
If substance abuse is suspected in a nurse after narcotic discrepancy, the MOST
appropriate next step is:
A. Confront the nurse and suspend immediately
B. Report to police immediately
C. Complete an incident report and notify pharmacy and nursing administration
D. Ignore until confirmed by coworkers
Correct Answer: C. Complete an incident report and notify pharmacy and nursing
administration
Rationale:
Suspected controlled substance diversion must be handled through formal institutional and
regulatory channels. The nurse manager or charge nurse documents the discrepancy via
incident report and escalates to pharmacy and nursing administration for investigation. This
ensures chain-of-custody accountability and protects both patients and staff rights.
, • A is punitive and bypasses due process
• B is premature unless criminal evidence exists
• D is unsafe and violates reporting standards
Best indicator that nurses have accepted an electronic medical record (EMR) system is:
A. Nurses say they like it
B. Nurses occasionally use it
C. Nurses document consistently using the EMR in daily practice
D. Nurses still handwrite notes but prefer EMR
Correct Answer: C. Nurses document consistently using the EMR in daily practice
Rationale:
Acceptance of a system is demonstrated by consistent integration into routine workflow,
not opinions or occasional use. True adoption means the EMR is the standard method of
documentation, indicating both behavioral change and system integration.
• A is attitude, not behavior
• B is partial adoption
• D shows resistance to change
Best initial activity for nursing staff in a quality improvement project is:
A. Track supply usage
B. Document time spent on care
C. Administer client and family satisfaction surveys
D. Assess client acuity daily
Correct Answer: C. Administer client and family satisfaction surveys
Rationale:
Quality improvement begins with understanding patient-centered outcomes, especially
satisfaction and perceived quality of care. Surveys provide baseline data on care
effectiveness and service perception before operational metrics are analyzed.
• A is resource tracking
• B is productivity tracking
• D is advanced clinical measurement, not initial step
,Correct priority order for RN rounds:
Correct Answer: 3 → 1 → 5 → 4 → 2
Rationale:
Prioritization is based on stability, risk of deterioration, and immediacy of need.
• 3 (PACU arrival) = highest priority, immediate post-anesthesia risk
• 1 (post-cardiac cath) = risk of bleeding/complications
• 5 (pneumonia, O2 93%) = borderline respiratory status
• 4 (discharge waiting transport) = stable, non-urgent
• 2 (diabetes teaching) = lowest priority, education-only
This reflects ABCs (airway, breathing, circulation) and instability hierarchy.
Which task should be delegated to the charge nurse in respiratory distress situation?
A. Head-to-toe assessment
B. Insert second IV
C. Apply oxygen
D. Call respiratory therapist
Correct Answer: D. Call respiratory therapist
Rationale:
The charge nurse should delegate or initiate coordination of rapid interdisciplinary support.
Calling RT ensures immediate specialized respiratory intervention while other staff manage
direct stabilization (oxygen, IV, assessment). In severe distress, time-critical coordination is
priority.
• A is RN assessment role
• B is skilled procedure but not first action
• C is immediate bedside intervention (RN/UAP task)
• D ensures system-wide response
Best FIRST action when juggling patient feeding and another patient requesting pain
medication is:
A. Finish feeding first
B. Stop feeding and give pain medication immediately
, C. Ask charge nurse to give pain medication
D. Ask charge nurse to feed patient
Correct Answer: B. Stop feeding and give pain medication immediately
Rationale:
Pain management is a priority intervention because uncontrolled pain is an immediate
physiological and ethical concern. Feeding is non-urgent and can be safely interrupted.
Analgesia delays can worsen patient distress and outcomes.
• A delays pain treatment
• C unnecessary delegation of RN responsibility
• D inappropriate task redistribution when RN is available
CONTINUATION — NEW MCQs (SET BEGINS)
A nurse documents a medication administration that was not actually given. This action is
considered:
A. Negligence
B. Malpractice
C. Falsification of records
D. Delegation error
Correct Answer: C. Falsification of records
Rationale:
Documenting care that was not performed is intentional misrepresentation and violates
legal and ethical standards. This is not simple negligence—it is an act of falsifying
documentation, which can lead to license suspension or criminal liability.
Which element is required for malpractice to be proven?
A. Intent to harm
B. Financial loss
C. Nurse-patient relationship
D. Verbal warning
Correct Answer: C. Nurse-patient relationship
