NCLEX-RN: Management practice questions questions 1-25

Answer: D. Administer an oral opioid to the client diagnosed with pyelonephritis.

Topic: Scope of Practice and Delegation

Administering routine oral medications, including opioids, to stable clients falls safely within the licensed practical nurse's scope of practice. The registered nurse must retain tasks involving complex clinical judgment, specialized administration, and primary client teaching.

Why the others are wrong

• A – Initial client education and discharge teaching require registered nurse assessment and clinical judgment.
• B – Administering antineoplastic or chemotherapy medications requires specialized certification reserved for registered nurses.
• C – Interpreting diagnostic laboratory values requires registered nurse-level clinical analysis and judgment.

Remember: RNs do EAT: evaluate, assess, and teach; LPNs give meds.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: C. Transformative

Topic: Shared Governance Leadership Style

Shared governance is a collaborative organizational model that empowers clinical nurses to participate in decision-making. This aligns with transformative leadership, which focuses on empowerment, collaboration, shared vision, and staff development to improve outcomes.

Why the others are wrong

• A – Laissez-faire leadership is hands-off and lacks the structured collaboration and support of shared governance.
• B – Autocratic leadership centralizes all decision-making power in a single leader, excluding staff input.
• D – Bureaucratic leadership relies strictly on fixed rules, hierarchy, and established policies rather than empowerment.

Remember: Shared governance transforms staff by giving them a voice.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: C. Potassium 3.2 mmol/L

Topic: Post‑operative Cardiac Care

Post‑CABG patients are at high risk for arrhythmias; a potassium of 3.2 mmol/L is below the safe threshold (<3.5) and needs prompt correction to prevent life‑threatening dysrhythmias.

Why the others are wrong

• A – Borderline low pressure; usually tolerated, treat if symptomatic.
• B – Mild anemia; typical post‑op value, no urgent action.
• D – Low output but not immediately life‑threatening; assess volume status.

Remember: Hypokalemia first: fix K⁺ to stop post‑CABG arrhythmias.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. Urinary output of 10mL/hr

Topic: Postoperative Fluid Management

Postoperative urine output of 10 mL/hr is critically low, indicating inadequate renal perfusion and possible hypovolemia, which can quickly progress to acute kidney injury; it requires immediate assessment and intervention.

Why the others are wrong

• A – BP 94/56 mmHg is low but not as critical as inadequate urine output.
• C – HR 93 bpm is within normal postoperative range, not immediately alarming.
• D – 10 mL serosanguinous JP output is typical early postoperative and not alarming.

Remember: Low urine output = red flag for hypovolemia after surgery.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: D. Physiological needs

Topic: Maslow Hierarchy of Needs

Physiological needs are the most basic survival requirements—air, water, food, sleep, and elimination—so they must be met before higher‑order needs can be addressed according to Maslow’s hierarchy.

Why the others are wrong

• A – Belongingness is a social need, which follows basic physiological and safety needs.
• B – Esteem needs rank above physiological needs, so they are not addressed first.
• C – Self‑actualization is the highest level, addressed only after all lower needs are satisfied.

Remember: First meet food, air, water—then climb Maslow’s ladder.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: D. Notify the surgeon and anesthesia provider

Topic: Preoperative Electrolyte Management

A potassium of 6.2 mEq/L indicates significant hyperkalemia; the nurse must promptly notify the surgeon and anesthesia provider so corrective measures can be taken before anesthesia induction.

Why the others are wrong

• A – Charting does not address the immediate danger of hyperkalemia.
• B – Increasing IV rate does not lower potassium and may worsen status.
• C – Only informing the OR nurse delays critical provider intervention.

Remember: Hyperkalemia? Alert surgeon and anesthesia before the knife.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. The LPN instructs the client how to properly use the incentive spirometer.

Topic: Scope of Practice Delegation

Initial client teaching and instruction are within the scope of practice of the registered nurse and cannot be delegated to a licensed practical nurse. The licensed practical nurse can only reinforce previously taught skills.

Why the others are wrong

• A – Encouraging coughing after spirometry is a safe, standard intervention within the LPN's scope.
• C – Reminding the client to perform the procedure frequently is appropriate reinforcement of the plan.
• D – Assisting a client to sit upright is a basic care task appropriate for an LPN.

Remember: RNs teach, LPNs reinforce.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: C. ISBARR

Topic: Structured Hand‑off Communication

ISBARR (Identify, Situation, Background, Assessment, Recommendation, Read-back) standardizes brief, structured handoffs, ensuring critical information is shared accurately among team members, reducing errors and improving patient safety.

Why the others are wrong

• A – "CUS" is a therapeutic communication model, not a structured handoff tool.
• B – "I'm Safe" is a patient safety checklist, not a team communication tool.
• D – "DESC" is a conflict‑resolution technique, not for routine handoffs.

Remember: ISBARR: the six‑step script for safe handoffs.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. Ensure good handwashing

Topic: Neutropenia Patient Teaching

Hand hygiene is the most effective way to prevent infection in patients with leukopenia; it reduces microbial transmission from staff, visitors, and the environment, making it the priority teaching point.

Why the others are wrong

• A – Aspirin affects platelets, not neutrophil count; it isn’t a primary infection precaution.
• C – Dietary fruits are healthy but do not directly reduce infection risk in neutropenia.
• D – Razors increase skin injury risk, but hand hygiene prevents broader infection exposure.

Remember: Clean hands, safe blood: handwashing beats all.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: C. Qualitative study

Topic: Primary Versus Secondary Sources

A qualitative study is a primary source because it represents original, empirical research where investigators directly collect and analyze first-hand data from participants. In contrast, syntheses and reviews analyze existing, previously published studies.

Why the others are wrong

• A – Literature reviews are secondary sources that summarize and synthesize existing published research.
• B – Systematic reviews are secondary sources because they analyze and pool data from multiple primary studies.
• D – Quality improvement projects focus on local clinical processes rather than generating generalizable primary research.

Remember: Primary sources collect original data; secondary sources review existing data.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: D. Advocacy

Topic: Magnet Recognition Program

Magnet-recognized organizations value nursing advocacy as a core component of exemplary professional practice. Nurses are empowered to advocate for patients, themselves, and the profession, which directly improves clinical outcomes and job satisfaction.

Why the others are wrong

• A – While financial stability is necessary, funding itself is not a core Magnet component.
• B – Magnet programs promote flat, shared governance structures rather than rigid organizational hierarchies.
• C – Magnet status is based on nursing excellence, not the specific patient population served.

Remember: Magnet attracts excellence through advocacy and shared governance.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: C. Right Assignment

Topic: Five Rights of Delegation

The five rights of delegation are Right task, Right circumstance, Right person, Right communication, and Right supervision; 'Right Assignment' is not a recognized component in current nursing practice.

Why the others are wrong

• A – Right Person is one of the five rights, so it is included.
• B – Right Circumstances is listed among the five rights, thus not excluded.
• D – Right Task is a core component of the five rights of delegation.

Remember: Remember: task, person, circumstance, communication, supervision—no 'assignment'.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: D. Outcome

Topic: PICO Components

Patient satisfaction scores represent the result measured to determine the effect of the nurse navigator, thus they correspond to the Outcome component of PICO in the study.

Why the others are wrong

• A – Population defines the group studied, not the measured result.
• B – Intervention is the nurse navigator itself, not the satisfaction score.
• C – Comparison Intervention would be an alternative care model, not the outcome.

Remember: Outcomes are what you measure, like satisfaction scores.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: D. A patient who is receiving an IV fluid bolus for low urinary output

Topic: Prioritization of Client Care

The nurse must prioritize the client receiving an active intervention for an acute issue. An IV fluid bolus for low urinary output requires immediate, close assessment to monitor for fluid overload and evaluate renal response.

Why the others are wrong

• A – Wound care is a routine, scheduled task that does not take priority over acute interventions.
• B – Discharge planning is important but involves a stable client who is safe to wait.
• C – This client is stable and a routine diagnostic test can be managed later.

Remember: Assess active interventions and unstable conditions first.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. ductus venosus

Topic: Fetal Circulation Shunts

The ductus venosus is a fetal shunt that connects the umbilical vein to the inferior vena cava, allowing oxygen-rich blood from the placenta to bypass the liver and flow directly to the heart.

Why the others are wrong

• A – Shunts blood from the pulmonary artery to the aorta, bypassing the fetal lungs.
• C – Carries deoxygenated blood and waste products from the fetus back to the placenta.
• D – Carries deoxygenated, nutrient-rich blood from the GI tract to the liver, not bypassing it.

Remember: Ductus Venosus bypasses the liVer; Ductus Arteriosus bypasses the Alveoli (lungs).

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: A. A patient with increased nasopharyngeal secretions who requires suctioning

Topic: Prioritization of Patient Care

Airway and breathing always take priority over other needs. A patient with increased nasopharyngeal secretions requires immediate suctioning to maintain airway patency and prevent aspiration, making this the most urgent clinical need.

Why the others are wrong

• B – Pericare is important for skin integrity but is not an immediate life-threatening priority.
• C – Severe pain is a high priority but ranks below airway compromise on the ABC scale.
• D – Dressing changes are scheduled, non-urgent tasks that can be safely delayed.

Remember: ABCs always come first: airway clearance trumps pain and hygiene.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: A. fetal pulmonary artery to the aorta

Topic: Fetal Circulation Shunts

The ductus arteriosus is a normal fetal blood vessel connecting the pulmonary artery to the descending aorta. This shunt allows blood to bypass the non-functional fetal lungs and flow directly into systemic circulation.

Why the others are wrong

• B – The ductus venosus connects the umbilical vein to the inferior vena cava, not left ventricle.
• C – No fetal shunt connects the descending aorta to the right atrium.
• D – No normal fetal shunt connects the carotid artery to the inferior vena cava.

Remember: Ductus Arteriosus connects Artery (pulmonary) to Aorta.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. right atrium

Topic: Fetal Circulation Pathway

Highly oxygenated blood travels from the placenta through the umbilical vein and inferior vena cava, entering the right atrium first. From there, it is shunted to the left atrium through the foramen ovale to bypass the nonfunctional lungs.

Why the others are wrong

• A – Blood reaches the left ventricle from the left atrium, not directly from the placenta.
• C – Blood only enters the left atrium after passing through the right atrium and foramen ovale.
• D – Most oxygenated blood bypasses the right ventricle, shunting directly from right to left atrium.

Remember: Oxygenated fetal blood always enters the right atrium first.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: D. Informatics

Topic: QSEN Competencies

Informatics involves using information and technology to communicate, manage knowledge, mitigate error, and support clinical decision-making. This QSEN competency leverages electronic health records, clinical decision support tools, and data systems to enhance patient care and safe practice.

Why the others are wrong

• A – Safety focuses on minimizing risk of harm through system effectiveness and individual performance.
• B – Patient-centered care focuses on recognizing the patient as the partner and source of control.
• C – Quality improvement focuses on using data and improvement methods to monitor and enhance care processes.

Remember: Informatics uses information and technology to guide clinical decisions and prevent errors.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: A. Quantitative

Topic: Quantitative Research Methods

Quantitative research collects measurable, numerical data and uses statistical analysis to link numeric values with specific outcomes, providing objective evidence. This approach enables researchers to test hypotheses and determine cause‑effect relationships.

Why the others are wrong

• B – Content analysis codes text for themes; it is not primarily numeric.
• C – Literature review summarizes existing studies; it does not collect original numeric data.
• D – Qualitative research explores experiences through words, not numeric measurement.

Remember: Numbers = quantitative; stories = qualitative.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: D. Monitor the patient's respiratory status

Topic: Patient-Controlled Analgesia Safety

Morphine is an opioid agonist that can cause life-threatening respiratory depression. When managing a patient-controlled analgesia pump, monitoring the patient's respiratory status (rate, depth, and oxygen saturation) is the highest priority to ensure safety.

Why the others are wrong

• A – Discharge teaching is premature for a patient newly transferred from PACU on a PCA.
• B – Monitoring temperature detects infection or hypothermia but is not the immediate priority over respiration.
• C – Monitoring urine output is important post-op but secondary to immediate airway and breathing safety.

Remember: ABCs first: Opioids depress breathing, so monitor respirations first.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. DESC

Topic: Conflict Resolution Tools

The DESC script is a structured TeamSTEPPS communication framework specifically designed for resolving interpersonal conflict. It guides healthcare team members to Describe the situation, Express concerns, Specify alternative solutions, and identify the resulting positive Consequences.

Why the others are wrong

• A – I-PASS is a standardized tool used primarily for clinical handoffs and transitions of care.
• C – I'M SAFE is a self-assessment checklist used to evaluate an individual's personal fitness for duty.
• D – ISBARR is a structured handoff tool used to communicate critical patient information, not resolve conflict.

Remember: DESC defuses drama and drives conflict resolution.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: A. STEP

Topic: Situation Awareness Tool

STEP (Situation, Task, Environment, People) provides a quick framework to assess the current state of the patient, team dynamics, and surroundings, supporting ongoing situation awareness.

Why the others are wrong

• B – I'm Safe is a safety culture survey, not a real‑time monitoring tool.
• C – DESC is a communication technique for assertive feedback, not situation monitoring.
• D – ISBARR structures handoff reports; it does not continuously monitor the environment.

Remember: STEP: Scan Situation, Tasks, Environment, People.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: C. A patient with a pulse oximetry reading of 87% on room air

Topic: Prioritization of Vital Signs

An oxygen saturation of 87% on room air indicates severe hypoxemia, which poses an immediate threat to tissue perfusion and organ function. This patient requires urgent assessment and oxygen administration to prevent rapid clinical deterioration.

Why the others are wrong

• A – Mild hypotension is concerning but less immediately life-threatening than severe hypoxemia.
• B – Bradypnea is concerning, but the patient with documented severe hypoxemia requires more immediate intervention.
• D – Tachycardia requires evaluation but is a lower priority than active respiratory compromise.

Remember: Oxygenation takes priority; prioritize severe hypoxemia first.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: A. I'm Safe

Topic: Patient Safety Assessment

The ‘I’m Safe’ tool is a structured self‑assessment checklist that prompts individuals and teams to evaluate personal and collective safety practices, identifying gaps that could compromise patient care.

Why the others are wrong

• B – TeamSTEPPS focuses on teamwork skills, not personal safety status assessment.
• C – IPASS is a handoff protocol, not a self‑assessment safety tool.
• D – ISBARR is a communication framework, not a safety self‑assessment tool.

Remember: ‘I’m Safe’ = self‑check for personal and team safety.

Question adapted from Nursing Management and Professional Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.