Question 1

The charge nurse is assigning staff for the day. The staff consists of an RN, an LPN, and two certified nursing assistants. Which client assignment should be given to the nursing assistants?

Accepted Answer

Answer reason: Stable, predictable needs (e.g., basic hygiene, turning) can be delegated to CNAs with appropriate RN supervision.

Question 2

Which client will be assigned to the nurse on a care team consisting of a nurse, an LPN/LVN, and unlicensed assistive personnel (UAP)?

Accepted Answer

Answer reason: The RN should care for the client with toxic shock syndrome because this condition is potentially life-threatening and requires ongoing assessment, evaluation, and nursing judgment, which cannot be delegated to an LPN/LVN or UAP.

Question 3

The RN is making assignments for clients hospitalized on a neurological unit. Which client should be assigned to the LPN?

Accepted Answer

Answer reason: Assign the most stable client with predictable outcomes to the LPN. The hemiplegic client with a UTI is stable and requires routine care and medications. The others are higher acuity and require RN assessment and close monitoring: cervical spine injury with traction, MS exacerbation, and recent laminectomy.

Question 4

Which nurse should be assigned to care for the postpartum client with preeclampsia?

Accepted Answer

Answer reason: A labor and delivery nurse has specific experience with obstetric complications such as preeclampsia, making this the safest and most appropriate assignment based on competency.

Question 5

The registered nurse is assigning staff for four clients on the 3–11 shift. Which client should be assigned to the LPN?

Accepted Answer

Answer reason: LPNs should be assigned stable clients with predictable outcomes. A pneumonia patient awaiting discharge is stable, whereas a recent ICU transfer with ARDS, an immediate post-op colon resection, and active bleeding from varices require RN care.

Question 6

The registered nurse is making shift assignments. Which client should be assigned to the licensed practical nurse (LPN)?

Accepted Answer

Answer reason: LPNs care for stable clients with predictable outcomes. A diabetic with a foot ulcer is stable and within LPN scope for routine care and dressing changes. The other clients involve higher-acuity needs: IV heparin titration (RN), airway weaning from tracheostomy (RN), and early post-op care with a T-tube (RN).

Question 7

The RN is making assignments on a 12-bed unit. Staff consists of one RN and two certified nursing assistants. Which client should be self-assigned?

Accepted Answer

Answer reason: New-onset hemoptysis after chest trauma indicates potential life-threatening bleeding/airway compromise and requires immediate RN assessment and interventions; CNAs cannot manage this level of acuity.

Question 8

Which of the following assignments by the RN would be appropriate for an LPN/LVN?

Accepted Answer

Answer reason: LPNs are assigned stable clients with predictable outcomes. A patient in traction with a fractured femur is stable and involves routine, ongoing care. The other options involve initial or discharge teaching or potentially unstable/new conditions, which require an RN.

Question 9

Which client should the charge nurse assign to a nurse with postpartum care experience who is reassigned to a medical-surgical care area?

Accepted Answer

Answer reason: Float/postpartum nurse should receive the most stable client. Trauma with facial injury, heatstroke, and systemic latex reaction can be emergent/unstable. Scleroderma with Raynaud phenomenon is a chronic, stable condition appropriate for reassignment.

Question 10

Which client should the charge nurse assign to the nurse with postpartum care experience who is reassigned to a medical-surgical care area?

Accepted Answer

Answer reason: Assign the reassigned postpartum nurse a stable, chronic condition. Facial trauma, heatstroke, and systemic latex reaction are acute emergencies requiring experienced med-surg care. Progressive systemic sclerosis with Raynaud phenomenon is more stable and appropriate.

Question 11

A nurse with postpartum care experience is reassigned to a medical-surgical unit; which client should the charge nurse assign to this nurse?

Accepted Answer

Answer reason: The safest assignment for a nurse floated from postpartum is a stable client with a chronic condition. The other options involve emergencies or potential airway/critical instability (trauma, heatstroke, systemic latex reaction).

Question 12

The nurse is making assignments for the day. The staff consists of an RN, a novice RN, an LPN, and a nursing assistant. Which client should be assigned to the RN?

Accepted Answer

Answer reason: Clients with an esophageal tamponade (e.g., Sengstaken–Blakemore tube) are unstable and at high risk for airway obstruction and hemorrhage, requiring continuous assessment and advanced nursing judgment. This assignment is most appropriate for the experienced RN.

Question 13

The RN is making assignments for the morning staff. Which client should be cared for by the RN?

Accepted Answer

Answer reason: Hemoptysis indicates active airway bleeding and potential respiratory compromise, requiring immediate RN assessment and intervention. The other conditions are not as acutely life-threatening for delegation decisions.

Question 14

The following clients are to be assigned for daily care. The newly licensed nurse should not be assigned to provide primary care for the client with?

Accepted Answer

Answer reason: ARDS involves severe respiratory compromise, risk of rapid deterioration, need for advanced assessment skills, and complex interventions such as ventilator management. This level of acuity is inappropriate for a newly licensed nurse.

Question 15

The charge nurse is making assignments for clients on a cardiac unit. Which client should the charge nurse assign to a new graduate nurse?

Accepted Answer

Answer reason: A new graduate should be assigned the most stable client with predictable care needs. A scheduled cardiac catheterization patient is stable and routine, whereas MI, unstable angina, and current chest pain require experienced assessment and rapid intervention.

Question 16

The charge nurse on the cardiac unit has to float a nurse to the emergency department for the shift. Which nurse should be floated to the emergency department?

Accepted Answer

Answer reason: Float the nurse whose competencies best match the receiving unit. A nurse with recent critical care experience has the acute care skills required for the ED, making them the safest choice over cardiac-only, less-experienced, or OR-focused nurses.

Question 17

The charge nurse is making client assignments in the cardiac critical care unit. Which client should be assigned to the most experienced nurse?

Accepted Answer

Answer reason: Multifocal PVCs indicate significant ventricular irritability with risk of deterioration to VT/VF, requiring close monitoring and rapid intervention by the most experienced nurse. The other clients are stable or routine (near-normal ABGs, planned procedure, or bed-rest noncompliance).

Question 18

Which client should be assigned to the nursing assistant?

Accepted Answer

Answer reason: Delegate stable clients with predictable outcomes to UAPs. A cervical spine fracture, an infant with meningitis, or a recent thoracotomy require RN assessment/monitoring. A thyroidectomy client on postoperative day 4 is the most stable for basic care by a nursing assistant.

Question 19

The nurse is making assignments for the day. Which client should be assigned to the pregnant nurse?

Accepted Answer

Answer reason: External-beam radiation via a linear accelerator does not make the client radioactive, so it is safe for a pregnant nurse. Clients with radium implants, soluble radioisotopes, or iridium seeds emit radiation and should not be assigned to a pregnant nurse.

Question 20

The nurse is planning room assignments for the day. Which client should be assigned to a private room if only one is available?

Accepted Answer

Answer reason: Cushing’s disease causes immunosuppression (often worsened by steroid therapy), increasing infection risk; these clients should have a private room. Diabetes, acromegaly, and myxedema do not require private rooms for infection control.

Question 21

Due to a high census, it has been necessary for a number of clients to be transferred to other units within the hospital. Which client should be transferred to the postpartum unit?

Accepted Answer

Answer reason: Postpartum nurses care for women’s health and gynecologic postoperative patients; a hysterectomy patient is appropriate overflow. The other options include males (not appropriate for a postpartum unit) or an infectious GI illness that would risk mothers/newborns.

Question 22

Which client can best be assigned to the newly licensed nurse?

Accepted Answer

Answer reason: Newly licensed nurses should be assigned stable, predictable clients. Clients receiving chemotherapy, post–coronary bypass, or post-TURP require specialized skills and close monitoring. A client with diverticulitis is typically a stable medical patient appropriate for a new RN.

Question 23

The emergency room is flooded with clients injured in a tornado. Which clients can be assigned to share a room in the emergency department during the disaster?

Accepted Answer

Answer reason: During disaster crowding, clients who are stable and pose minimal safety risk may share a room. A pregnant client with abdominal pain and a client with facial lacerations/broken arm are likely stable and noninfectious. The hallucinating psychiatric client could be unpredictable and unsafe for a roommate (A). Fixed, dilated pupils indicate critical neurologic compromise; plus including parents is inappropriate (C). Abdominal puncture wound and chest pain are potentially unstable and require close monitoring/resuscitation, not room sharing (D).

Question 24

The nurse is working with another nurse and a patient care assistant. Which of the following clients should be assigned to the registered nurse?

Accepted Answer

Answer reason: Thoracotomy patients are high-risk for respiratory complications and require full RN assessment.

Question 25

The registered nurse is making assignments for the day. Which client should not be assigned to the pregnant nurse?

Accepted Answer

Answer reason: Internal radium implants emit radiation and must not be cared for by pregnant staff.

Question 26

The charge nurse on the medical-surgical unit makes assignments for the team consisting of one RN, an LPN and a nursing assistant. Which one of the following clients should be assigned to the RN?

Accepted Answer

Answer reason: Discharge teaching and final assessments require an RN; LPN/NA can care for stable, predictable clients like chronic COPD or routine post-op recovery.

Question 27

The charge nurse on a surgical unit is making assignments for the day. There are two RNs, one LPN, and two unlicensed assistive personnel (UAPs). Which one of the following tasks could be assigned to the LPN?

Accepted Answer

Answer reason: LPNs can perform sterile/complex wound care such as irrigation and dressing changes. Ambulation and occult blood testing can be delegated to UAPs, while admitting a patient requires an RN for initial assessment.

Question 28

A nurse from the maternity unit is floated to the critical care unit because of staff shortage. Which one of the following patients would be appropriate to assign to this nurse?

Accepted Answer

Answer reason: Float nurses must be given stable patients within their competency level. A post-MI patient who is stable and asymptomatic is the safest option. The other clients require advanced critical-care skills.

Question 29

The nursing team consists of one RN, two LPNs/LVNs, and three nursing assistants. The RN should care for which of the following patients?

Accepted Answer

Answer reason: The client refusing treatment requires RN assessment, teaching, and therapeutic communication to address refusal and informed decision-making. The other clients can be assigned to LPNs/LVNs or nursing assistants (stable chest tube monitoring, colostomy irrigation assistance, and bathing assistance).

Question 30

A medical-surgical unit is short-staffed. The charge nurse must assign clients to an incoming float nurse who has strong med-surg experience but has never worked on this unit. Which client is MOST appropriate for the charge nurse to assign to the float nurse?

Accepted Answer

Answer reason: Float nurses should receive clients whose conditions are predictable and do not require unit-specific skills or advanced hemodynamic management. A stable post-op client fits this profile. Clients requiring titrated infusions, vasopressors, or rapid deterioration monitoring must remain with core staff.

Question 31

The charge nurse must assign clients during a high-acuity shift. Which client should be assigned to the newly licensed RN?

Accepted Answer

Answer reason: Newly licensed RNs are appropriate for caring for stable clients with predictable needs and straightforward teaching. Education requiring device mastery (insulin pump), clients at high fall risk, or clients with active complications (vomiting with tube feeds) should be assigned to more experienced nurses.

Question 32

A charge nurse is organizing assignments for the next shift. A staffing mix includes one experienced RN, one RN orienting with a preceptor, and one LPN. Which client is MOST appropriate to assign to the LPN?

Accepted Answer

Answer reason: LPNs can safely manage stable clients with predictable outcomes and can administer most oral medications and routine treatments. New admissions, clients needing comprehensive discharge education, or those requiring IV push medications must remain with an RN.

Question 33

The charge nurse is making assignments for the shift. Which client is MOST appropriate for the LPN?

Accepted Answer

Answer reason: LPNs can safely manage stable clients with predictable needs, including routine glucose monitoring and oral medications. New admissions, complex teaching, and fresh postoperative assessments require RN-level care.

Question 34

A nurse who has been on the unit for only 3 weeks is requesting a lighter assignment. Which client should the charge nurse assign to this nurse?

Accepted Answer

Answer reason: A novice nurse should be assigned predictable, lower-acuity clients. Clients needing titration, ICU transfer, or PCA management exceed the skill comfort for a new nurse.

Question 35

The charge nurse must assign a postoperative client arriving from PACU. Which client on the unit is MOST appropriate to reassign to the floating RN with no surgical experience?

Accepted Answer

Answer reason: A stable client with predictable needs is appropriate for a float nurse unfamiliar with surgical nuances. Recent postoperative clients or those requiring specialized assessments must stay with core surgical-trained staff.

Question 36

The charge nurse is preparing assignments for the shift. One nurse is returning to work after a prolonged medical leave and requests a lower-acuity assignment. Which client is MOST appropriate for this nurse?

Accepted Answer

Answer reason: A nurse returning after time away should be assigned a stable client with predictable care needs. Controlled hypertension managed with oral medications does not require rapid assessment, complex teaching, or high-acuity decision-making.

Question 37

The charge nurse must assign a client to an RN who is competent but unfamiliar with this unit’s specialty equipment. Which client is MOST appropriate for assignment to this nurse?

Accepted Answer

Answer reason: Nurses unfamiliar with unit-specific equipment should be assigned clients whose care does not depend on specialized protocols or frequent titration. Routine IV fluid management for a stable chronic condition is appropriate.

Question 38

A charge nurse is balancing assignments for a busy evening shift. Which client is MOST appropriate to assign to the most experienced RN on the unit?

Accepted Answer

Answer reason: The most experienced RN should manage clients with signs of potential deterioration. Worsening respiratory status requires advanced assessment, rapid intervention, and clinical judgment.

Question 39

The unit is short one RN, and a float nurse arrives from another medical-surgical floor. Which assignment is MOST appropriate for the charge nurse to make?

Accepted Answer

Answer reason: Float nurses should be assigned stable clients with predictable care needs and minimal risk for rapid deterioration. This client’s condition is improving and does not require complex assessments or titrated therapies.

Question 40

A newly licensed RN is beginning an evening shift on a busy unit. The charge nurse is reviewing assignments. Which client should be assigned to the MOST experienced RN?

Accepted Answer

Answer reason: Clients showing signs of clinical deterioration require advanced assessment, prioritization, and rapid intervention. These responsibilities are best managed by the most experienced RN on the unit.

Question 41

Staffing includes one RN, one LPN, and one assistive personnel. Which client is MOST appropriate for assignment to the LPN?

Accepted Answer

Answer reason: LPNs may care for stable clients with predictable outcomes and routine medication needs. New admissions, unstable conditions, and complex teaching require RN-level assessment and judgment.

Question 42

Which task must the charge nurse reassign because it cannot be safely completed by assistive personnel?

Accepted Answer

Answer reason: Any assessment related to a change in condition requires RN-level judgment. Assistive personnel may collect routine data but cannot assess or interpret new clinical findings.

Question 43

An RN who is competent but unfamiliar with this unit’s routines is floated in for the shift. Which assignment best supports safe care?

Accepted Answer

Answer reason: Float nurses should be assigned clients with predictable needs and minimal risk for rapid deterioration. New admissions and invasive therapies require unit-specific familiarity.

Question 44

A charge nurse is adjusting assignments midway through the shift. Which situation MOST strongly indicates the need for reassignment to a more experienced RN?

Accepted Answer

Answer reason: Worsening oxygenation signals potential respiratory compromise and requires advanced assessment and intervention. This level of acuity should be managed by an experienced RN.

Question 45

Which task should the charge nurse assign to assistive personnel on a busy medical-surgical unit?

Accepted Answer

Answer reason: Assistive personnel may collect routine, non-interpretive data for stable clients. Assessment, interpretation, and teaching remain RN responsibilities.

Question 46

A float RN arrives from another unit and has not used this unit’s specialty infusion pumps. Which assignment best supports safety?

Accepted Answer

Answer reason: Float nurses unfamiliar with unit-specific equipment should be assigned predictable, low-risk care. New admissions, specialty infusions, and frequent assessments require unit familiarity.

Question 47

Mid-shift, which change most strongly indicates the need to reassign care to the most experienced RN?

Accepted Answer

Answer reason: Progressive hypotension despite intervention signals potential instability and requires advanced assessment and rapid decision-making by an experienced RN.

Question 48

Which assignment decision by the charge nurse BEST demonstrates appropriate use of a newly hired RN who is still in orientation?

Accepted Answer

Answer reason: A nurse in orientation should care for clients with predictable, low-acuity needs. Complex therapies, unstable conditions, and advanced device management require greater independence and experience.

Question 49

Midway through the shift, which task should the charge nurse reassign to an RN because it exceeds the role of assistive personnel?

Accepted Answer

Answer reason: Any evaluation of a change in condition requires RN-level assessment and clinical judgment. Assistive personnel may collect routine data but cannot assess or interpret acute changes.

Question 50

The nursing team includes two RNs, one LPN/LVN, and one nursing assistant. The nurse should consider the assignment of which client as assigned to care for?

Accepted Answer

Answer reason: Tasks appropriate for a nursing assistant include assistance with activities of daily living such as feeding, when the client is stable and does not require nursing assessment or judgment. Alzheimer’s disease with a need for feeding help is an ADL-focused assignment that can be safely delegated with appropriate supervision. The other options suggest needs requiring nursing assessment/intervention (possible UTI symptoms, management/monitoring of tube feeding, and abnormal breathing pattern consistent with potential deterioration/end-of-life changes) and are more appropriate for licensed nursing staff.

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