Question 1

A client with heart failure is being discharged home from a telemetry unit with a new medication regimen and dietary restrictions. Which health care provider would be the most appropriate for the charge nurse to assign to provide discharge teaching for this client?

Accepted Answer

Answer reason: An RN familiar with telemetry/heart-failure care is best positioned to teach red-flag symptoms, daily weights, fluid/sodium limits, and medication adherence while tailoring education to the client’s status. An LPN may reinforce teaching but typically cannot perform the full scope of initial discharge education and evaluation required for complex conditions. A floated RN from orthopedics may have strong general skills, but the telemetry-experienced RN is more appropriate due to unit-specific expertise and higher likelihood of accurately addressing heart-failure discharge priorities.

Question 2

The medical-surgical charge nurse is assigning clients to a telemetry nurse who is floating to their unit. Which of the following clients would be the most appropriate to assign to this float nurse?

Accepted Answer

Answer reason: This client has mild hyperglycemia with no urine ketones/glucose reported and no acute symptoms, indicating a relatively stable condition with routine monitoring needs. In contrast, shortness of breath in a lupus patient raises concern for potentially rapid deterioration (e.g., pulmonary embolism, pleuritis, pericarditis) requiring complex assessment and intervention. Seizures with meningitis and IV antibiotics also represents high acuity with significant neurologic risk and need for frequent assessments, making it inappropriate for a float assignment.

Question 3

Ms. Gail is making shift assignments. Which client should be assigned to the most experienced RN?

Accepted Answer

Answer reason: A falling SpO2 despite supplemental oxygen signals worsening respiratory failure and requires rapid assessment and escalation (ABCs, airway/ventilation support, possible advanced oxygen delivery or intubation). This is an unstable, high-risk change in condition where subtle assessment findings and timely interventions are critical, making it appropriate for the most experienced RN. The pneumonia client with 96% saturation is currently oxygenating adequately and is more stable. Post-op tonsillectomy pain and purulent drainage after a sinus procedure typically need routine pain/infection assessment and prescribed interventions, but they are less immediately life-threatening than deteriorating oxygenation.

Question 4

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

Accepted Answer

Answer reason: An RN with focused obstetric experience is best prepared to recognize early deterioration and respond rapidly to complications such as eclampsia, pulmonary edema, or HELLP syndrome. A new postpartum nurse may not yet have the clinical judgment for rapid escalation in a potentially unstable patient. Experience in surgery or NICU is valuable but is less directly applicable to managing maternal hypertensive emergencies and obstetric-specific monitoring.

Question 5

The nursing team on the medical/surgical unit consists of an RN, two LPNs, and a nursing assistant. Which of the following clients should be assigned to the nursing assistant?

Accepted Answer

Answer reason: A postoperative day-2 client who simply needs help to the bathroom is typically stable and the task has predictable outcomes. The RN should still ensure safety measures (e.g., fall precautions, assist with first ambulation if needed), but the actual toileting assistance is appropriate to delegate. By contrast, new seizure disorder and electrolyte-imbalance recovery carry higher risk for acute change and require closer assessment, and client questions about recovery involve teaching that must be done by an RN (or within LPN scope per policy).

Question 6

The nursing team includes two RNs, one LPN, a nursing assistant, and a nurse reassigned from the postpartum unit. The nurse should consider the assignments appropriate if the reassigned nurse cares for which of the following patients?

Accepted Answer

Answer reason: This client’s primary need is basic assistance with feeding, which is routine and low risk compared with managing evolving cardiopulmonary or neurologic instability. A Glasgow coma scale of 5 indicates severe neurologic compromise requiring expert neuro assessment and airway protection. Cheyne-Stokes respirations and myocardial infarction with new urinary symptoms both signal potentially unstable conditions needing focused assessment and rapid clinical judgment more appropriate for experienced acute-care RNs.

Question 7

Which client should the charge nurse on the pediatric unit assign to the most experienced nurse?

Accepted Answer

Answer reason: The core delegation/assignment principle is that the most experienced nurse should manage clients with the greatest need for complex assessment, education, and coordination of care. A new diagnosis of a chronic inflammatory disease requires extensive family teaching (medication regimen, symptom monitoring, activity pacing, follow-up), psychosocial support, and early recognition of complications during initial treatment planning. In contrast, factor VIII administration for known hemophilia is a more protocol-driven therapy when the client is stable, and a scheduled CT scan is generally routine preparation/monitoring. A child recovering from a sickle cell crisis is improving and typically needs ongoing standard supportive care rather than intensive new-diagnosis education.

Question 8

The charge nurse is making assignments in the intensive care unit (ICU) and is making client assignments for a nurse floated from the medical-surgical (med-surg) unit. Which client would be appropriate to assign to the nurse floated from med-surg?

Accepted Answer

Answer reason: Assignment should match the nurse’s competency and current ICU experience, with floated med-surg nurses receiving the most stable, predictable patients and avoiding high-acuity, rapidly changing conditions. Receiving scheduled IV antibiotics and nebulizer treatments is a relatively routine med-surg skill set and typically does not require continuous invasive monitoring or complex titration. By contrast, suspected shock and vasopressor titration require advanced hemodynamic assessment and rapid intervention skills typical of experienced ICU nurses. Targeted temperature management post–cardiac arrest is a highly specialized ICU protocol with significant risk for instability and complications requiring expert critical care management.

Question 9

A nurse is making assignments to the staff on the cardiology unit. Which assignment/delegation is most appropriate?

Accepted Answer

Answer reason: A dressing change is a predictable, skill-based intervention that an LPN is typically permitted to perform per facility policy, with RN oversight as needed. Assigning an RN to obtain routine vitals on a stable patient is an inefficient use of RN-level assessment skills and is more appropriate for UAP/LPN depending on policy. Patient education requires RN-level teaching and evaluation of learning, making it inappropriate to delegate to an LPN in most settings.

Question 10

Which patient is best for the coronary care charge nurse to assign to a float RN who has come for the day from the general medical-surgical unit?

Accepted Answer

Answer reason: A stable patient needing routine discharge education is predictable and appropriate for a med-surg float nurse. In contrast, immediate post-angioplasty care and a new unstable angina admission require frequent assessments, rapid recognition of complications (bleeding, re-occlusion, dysrhythmias), and tight protocol-based management. Managing acute LV failure with IV diuretics also carries higher risk due to potential hemodynamic instability and electrolyte shifts. Therefore, the lowest-acuity, most stable option is the safest assignment.

Question 11

A nurse is working with an LPN and unlicensed assistive personnels. Which of the following tasks should the nurse assign to the LPN?

Accepted Answer

Answer reason: LPNs can provide care to stable clients and collect focused data (e.g., observe a surgical incision and report findings) but do not perform initial or comprehensive RN assessments or initial teaching. A client who is postoperative day 2 after a knee replacement is typically more stable than immediate post-op, making focused incision monitoring an appropriate delegated LPN task. New diagnosis education requires RN-level teaching because it involves assessment of readiness to learn and creating/adjusting the teaching plan. Pain assessment on postoperative day 1 is an RN responsibility because it is a key part of ongoing assessment that guides clinical decisions and analgesic management.

Question 12

A newly licensed RN is assigned to the emergency department (ED). Which client would be the most appropriate assignment for this nurse?

Accepted Answer

Answer reason: An uncomplicated hand laceration needing sutures is a straightforward problem with clear protocols and typically stable vital signs. In contrast, chest pain with diaphoresis is possible acute coronary syndrome requiring rapid reassessment and escalation, and sudden dyspnea with an SpO2 of 84% indicates a potentially life-threatening respiratory emergency. Confusion with high fever awaiting IV antibiotics raises concern for sepsis and requires timely intervention and close monitoring, making it inappropriate for a novice ED assignment.

Question 13

The charge nurse is creating assignments for the night shift. There is an employee who requires a limited assignment due to lifting restrictions after a recent surgery. Which patient would be most appropriate to assign this nurse?

Accepted Answer

Answer reason: A post-ERCP patient typically requires focused monitoring for complications (e.g., pancreatitis, bleeding, sedation effects) and pain/nausea management rather than frequent turning, transfers, or heavy repositioning. In contrast, a hip fracture with a cervical spine injury and an older adult with a pressure injury on BiPAP commonly require extensive mobility assistance, repositioning, and higher physical workload. A post-op hysterectomy with a PCA also often needs more assistance with ambulation, toileting, and repositioning than the ERCP patient, making it less appropriate for a nurse who cannot lift.

Question 14

Which client should the charge nurse assign to a new graduate RN who is orientating to the neurologic unit?

Accepted Answer

Answer reason: A post-stroke client 3 days out with unilateral weakness is typically medically stable and has predictable care needs (neuro checks, fall precautions, mobility assistance, and routine rehab-focused care), making the workload appropriate for a new graduate RN. In contrast, a newly admitted spinal cord injury client may have rapidly changing respiratory/hemodynamic status and complex acute assessment needs, which are higher risk. Dementia with transfer planning emphasizes complex discharge coordination, and Parkinson-related bathing is suitable for assistive personnel rather than the best learning assignment for an orienting RN.

Question 15

The nurse is preparing to admit a client with a seizure disorder. Which action can be assigned to an LPN/LVN?

Accepted Answer

Answer reason: Seizure precautions such as preparing the environment to reduce injury risk are standard, noninvasive safety measures that can be delegated. The RN must complete the admission assessment because it requires comprehensive data collection and interpretation. A common pitfall is preparing a tongue blade, which is unsafe and not recommended during seizures due to risk of oral trauma and airway obstruction.

Question 16

Which client should the charge nurse assign to the traveling nurse, new to neurologic nursing care, who has been on the neurologic unit for 1 week?

Accepted Answer

Answer reason: A client with chronic ALS is typically more predictable and medically stable, with established care routines, making this the most appropriate assignment for a nurse who is new to neuro nursing. In contrast, GBS with respiratory distress represents an unstable, rapidly evolving airway/ventilation risk that requires highly experienced assessment and urgent intervention. A new C4 spinal cord injury is also high-risk for respiratory compromise and autonomic instability, and newly diagnosed MS may require extensive teaching and nuanced assessment that is better handled by more experienced unit staff.

Question 17

A nurse manager is assigning care responsibilities for the upcoming shift. A client is awaiting transfer back to the unit from the PACU following hip arthroplasty. To which staff member should the nurse assign to this client?

Accepted Answer

Answer reason: Immediate post-op transfer from PACU requires comprehensive assessment, clinical judgment, and rapid recognition of complications (airway/respiratory depression, bleeding, neurovascular compromise, pain control, and hemodynamic instability). An RN is licensed to perform the initial head-to-toe and focused post-operative assessment, interpret findings, and initiate/adjust the plan of care and provider notifications. An LPN may provide care for stable clients with predictable outcomes but is not the best assignment for a fresh post-op return requiring higher-level assessment and decision-making. Assistive personnel can obtain vital signs or assist with mobility only after an RN has assessed stability and established priorities of care.

Question 18

When making assignments in the obstetrical unit, the charge nurse should assign the most experienced staff nurse to which client?

Accepted Answer

Answer reason: This situation requires prompt, skilled assessment of fetal status (continuous fetal heart rate monitoring), evaluation for complications (eg, cord compression), and rapid coordination with the obstetric and neonatal team. It also carries higher acuity and potential for rapid deterioration compared with normal labor findings. By contrast, pink-tinged “bloody show,” active labor at 7 cm without other warning signs, and mild ankle edema are commonly expected findings that are typically more stable and appropriate for less experienced staff with routine oversight.

Question 19

The nurse completes client assignments for the day. The nurse assigns the LPN/LVN to which client?

Accepted Answer

Answer reason: LPN/LVNs are appropriate for stable clients with predictable outcomes and can provide routine, non-complex care such as basic mobility assistance and reinforcement of teaching. A post–total hip replacement client who needs help ambulating is typically stable and the task is within LPN scope when the RN has established the plan of care and safety parameters. In contrast, new or worsening findings suggesting potential complications (e.g., marked bilateral 4+ edema in a type 1 diabetic) require RN assessment and clinical judgment. Clients receiving IV opioids or in the early postoperative period after procedures may require closer monitoring for complications and higher-level assessment/intervention best handled by the RN.

Question 20

The nurse from a maternity unit has been assigned to the emergency department (ED) to assist with clients injured in an external disaster. It would be most appropriate to assign the maternity nurse to the?

Accepted Answer

Answer reason: Dressing a partial-thickness burn is a straightforward, non–high-acuity intervention that a maternity nurse can safely perform with standard wound-care principles and minimal specialized ED/critical-care experience. In contrast, monitoring a transfusion requires competence in recognizing and managing acute transfusion reactions, and thoracic contusions with pleuritic chest pain raise concern for rib fracture, pneumothorax, or pulmonary contusion requiring advanced assessment and rapid escalation. An open tibia fracture may involve neurovascular compromise, bleeding, and complex pain/trauma management that is less appropriate for redeployed staff.

Question 21

The nurse with postpartum care experience gets reassigned to a medical-surgical care area. Which client will the charge nurse assign to the postpartum care nurse?

Accepted Answer

Answer reason: Assignment should match the nurse’s competency and the client’s acuity, reserving high-risk therapies and unstable conditions for nurses with current med-surg/critical-care skills. A stable postoperative client primarily needs routine assessments, pain control, neurovascular checks, and basic post-op monitoring, which are broadly transferable skills for a postpartum-experienced RN. In contrast, administering thrombolytics carries immediate life-threatening bleeding and neurologic risks requiring intensive monitoring and rapid response. Sickle cell crisis management and immediate post-pacemaker care can involve complex hemodynamic/respiratory monitoring and procedure-specific complications that are less appropriate for reassignment without current specialty experience.

Question 22

The nurse employed in a long-term care facility is planning the client assignments for the shift. Which client should the nurse assign to the unlicensed assistive personnel (UAP)?

Accepted Answer

Answer reason: Collecting urine over 24 hours is a standard, predictable procedure that can be delegated with clear instructions and RN oversight for accuracy and labeling. Dressing changes typically require sterile technique and wound assessment, which are nursing responsibilities. Insulin administration and dietary reinforcement involve medication administration and teaching, and rectal suppositories/enemas are invasive procedures requiring nursing judgment and are not appropriate for UAP in this context.

Question 23

A nurse from a medical unit is asked to work on an orthopedic unit. The medical nurse has no orthopedic experience. Which of the following clients should be assigned to the medical nurse?

Accepted Answer

Answer reason: A stable post-op day 3 hip arthroplasty client typically has established orders, routine neurovascular checks, pain management, mobilization with PT/OT, and standard hip precautions that a competent medical-surgical nurse can safely follow. In contrast, balanced skeletal traction requires specialized setup/maintenance and complication surveillance, and a new cast for a femur fracture has higher risk for acute neurovascular compromise/compartment syndrome early after casting. A 24-hour above-knee amputation is immediate post-op with higher risk for hemorrhage, shock, airway/respiratory issues, and intensive wound/closure monitoring, making it less appropriate for an inexperienced orthopedic nurse.

Question 24

Which client should Ms. Teresa assign to the most experienced RN on the unit?

Accepted Answer

Answer reason: Pink, frothy sputum is a classic sign of acute pulmonary edema from decompensated heart failure, indicating impaired gas exchange and risk for rapid respiratory failure. This patient may deteriorate quickly and requires immediate high-level assessment and interventions (e.g., oxygen/ventilatory support, rapid diuresis/vasodilators per orders, continuous monitoring). Assigning this case to the most experienced RN supports rapid recognition of worsening hypoxia and timely escalation of care. By comparison, a first dose of dabigatran and occasional PVCs after MI can be monitored with routine precautions when the patient is otherwise stable, and mitral valve prolapse with mild dyspnea is less immediately life-threatening than frank pulmonary edema.

Question 25

A nurse is planning the client assignments for the day and has a licensed practical nurse (LPN) and a nursing assistant on the nursing team. Which client would the nurse most appropriately assign to the LPN?

Accepted Answer

Answer reason: A stable heart failure client with early dementia typically needs scheduled meds, basic assessments (as permitted), reinforcement of teaching, and monitoring for routine changes, which fits LPN scope with RN oversight. The client needing bathing assistance is most appropriate for a nursing assistant because it is basic hygiene care without licensed nursing judgment. The emphysema client becoming dyspneic with exertion suggests potential instability and need for RN-level assessment and clinical decision-making, making it less appropriate for LPN assignment.

Question 26

Which patient is an appropriate assignment for the LPN/LVN?

Accepted Answer

Answer reason: LPN/LVNs are typically assigned stable clients with predictable outcomes and can perform routine treatments such as uncomplicated dressing changes using an established plan of care. A venous stasis ulcer dressing change is a standard, non-assessment, non-triage task if the wound is not newly deteriorating or requiring complex evaluation. By contrast, a patient being transferred to hospice involves significant teaching, coordination, and psychosocial support that requires RN-level planning. Pain complaints in cancer or new functional needs after fracture can require comprehensive assessment and medication titration decisions, which are RN responsibilities.

Question 27

Which client should you, as charge nurse, assign to a new RN graduate who is on orientation to the neurologic unit?

Accepted Answer

Answer reason: Needing help with hygiene is a basic, routine task where safety focus is primarily fall prevention and assistance with mobility, making it appropriate for a novice under supervision. In contrast, a newly admitted spinal cord injury patient is high acuity and can have evolving airway, hemodynamic, and neuro complications requiring experienced assessment and rapid intervention. A recent stroke patient may have changing neurologic status and aspiration risk, and a same-day transfer involves complex discharge coordination that is better handled by a more experienced nurse.

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