Assignment & delegation NCLEX-RN Practice Questions

Assignment & Delegation NCLEX-RN Practice Questions are designed to sharpen your ability to prioritize care, assign safe workloads, and delegate tasks within the interprofessional team while maintaining accountability. In the Management of Care domain, you must know what RNs must do themselves (assessment, teaching, evaluation, nursing judgment), what LPN/LVNs can safely manage (care for stable clients with predictable outcomes, selected sterile procedures, selected medications), and what UAPs can perform (noninvasive, routine tasks). This topic-wise set of questions mirrors real NCLEX-RN scenarios you will face in hospitals, community settings, and specialty units. Use these 30 questions to practice applying the Five Rights of Delegation, match tasks to competencies, and supervise effectively to protect patient safety and outcomes.

Q1. The RN plans to delegate to an experienced UAP on a postoperative unit. Which task is most appropriate to delegate?

• Assist a stable patient 2 days after hip arthroplasty to ambulate with a walker after the RN has taught proper use
• Teach a patient how to use an incentive spirometer after abdominal surgery
• Monitor a patient receiving a blood transfusion during the first 15 minutes
• Evaluate a patient’s response to PRN analgesics

Correct Answer: Assist a stable patient 2 days after hip arthroplasty to ambulate with a walker after the RN has taught proper use

Q2. Which assignment is most appropriate for an experienced LPN/LVN under RN supervision?

• Care for a patient with new-onset chest pain awaiting serial troponins
• Administer IV push morphine to a patient in a sickle cell crisis
• Perform a sterile dressing change for a Stage III pressure injury in a hemodynamically stable patient
• Develop a comprehensive teaching plan for a newly diagnosed diabetic patient

Correct Answer: Perform a sterile dressing change for a Stage III pressure injury in a hemodynamically stable patient

Q3. Which example best demonstrates the Right Direction/Communication in delegation?

• “Take vitals on everyone and let me know if anything is wrong.”
• “Please obtain 0800 vitals on rooms 302–310. Report immediately if SBP < 90, HR > 120, T ≥ 38.0°C, or new chest pain.”
• “Do what you can; I trust your judgment.”
• “I’ll check later to see what you did.”

Correct Answer: “Please obtain 0800 vitals on rooms 302–310. Report immediately if SBP < 90, HR > 120, T ≥ 38.0°C, or new chest pain.”

Q4. A UAP reports a BP of 82/48 mm Hg on a post-op patient. What is the RN’s best immediate action?

• Ask the UAP to recheck the blood pressure in 30 minutes
• Personally assess the patient and recheck vital signs while directing the UAP to obtain needed equipment
• Tell the UAP it’s likely an equipment error and continue routine care
• Document the reading as the patient’s new baseline

Correct Answer: Personally assess the patient and recheck vital signs while directing the UAP to obtain needed equipment

Q5. The charge RN is assigning patients to an LPN. Which assignment is most appropriate?

• New admission with diabetic ketoacidosis requiring insulin infusion
• Patient with acute stroke requiring frequent neuro checks and dysphagia screening
• Stable patient with COPD on 2 L/min oxygen receiving scheduled nebulizers and routine assessments
• Patient with GI bleed requiring ongoing transfusions and hemodynamic monitoring

Correct Answer: Stable patient with COPD on 2 L/min oxygen receiving scheduled nebulizers and routine assessments

Q6. The RN plans to delegate blood glucose monitoring to a UAP. What must the RN verify first?

• That the UAP has documented competency for glucometer use per facility policy
• That the UAP can independently interpret glucose trends
• That the UAP can adjust insulin doses based on sliding scale
• That the UAP can provide dietary counseling for high readings

Correct Answer: That the UAP has documented competency for glucometer use per facility policy

Q7. A medical-surgical nurse is floated to the ICU. Which assignment is safest?

• Stable patient admitted to ICU for bed availability, requiring routine IV antibiotics and q4h vital signs
• Patient on norepinephrine infusion for septic shock
• Postoperative CABG patient on ventilator support
• Patient with active GI bleed requiring rapid transfusion and vasopressors

Correct Answer: Stable patient admitted to ICU for bed availability, requiring routine IV antibiotics and q4h vital signs

Q8. In home health, which task is appropriate to delegate to a home health aide?

• Teach a patient to draw up insulin for the first time
• Change a sterile dressing on a surgical wound
• Remind a patient to take medications from a pillbox prefilled by the RN
• Assess wound granulation and revise the care plan

Correct Answer: Remind a patient to take medications from a pillbox prefilled by the RN

Q9. Which specimen collection can the RN delegate to a UAP?

• Clean-catch midstream urine specimen from a cooperative adult after the RN provides instructions
• Sterile urine specimen from the sampling port of an indwelling catheter
• Induced sputum specimen for TB evaluation requiring detailed coaching and airborne precautions
• Arterial blood gas sampling from a radial artery

Correct Answer: Clean-catch midstream urine specimen from a cooperative adult after the RN provides instructions

Q10. Which task related to enteral nutrition is appropriate for delegation to an LPN/LVN?

• Insert a nasogastric tube for emergent gastric lavage in an actively bleeding patient
• Administer a bolus feeding via an established NG tube and monitor for tolerance
• Provide initial discharge teaching on home tube feeding management
• Evaluate resolution of aspiration risk after a coughing episode

Correct Answer: Administer a bolus feeding via an established NG tube and monitor for tolerance

Q11. The RN delegates vital signs to a UAP on a telemetry unit. What instruction is most critical to include?

• Report any systolic blood pressure less than 90 mm Hg or any new chest pain immediately
• Only report heart rates above 140 beats/min
• Document results at the end of the shift to avoid interruptions
• Reassure patients with dizziness that it is expected postoperatively

Correct Answer: Report any systolic blood pressure less than 90 mm Hg or any new chest pain immediately

Q12. Which task should the RN avoid delegating to a UAP?

• Performing range-of-motion exercises for a stable stroke patient
• Measuring and recording intake and output
• Obtaining routine post-op vital signs after the RN’s initial assessment
• Assessing a patient’s risk for aspiration

Correct Answer: Assessing a patient’s risk for aspiration

Q13. Which statement by an RN demonstrates correct understanding of accountability in delegation?

• “I remain accountable for the outcomes of tasks I delegate to UAPs.”
• “If the UAP makes an error, I am not responsible.”
• “Delegation transfers my nursing judgment to the delegatee.”
• “Experienced LPNs don’t require any supervision.”

Correct Answer: “I remain accountable for the outcomes of tasks I delegate to UAPs.”

Q14. Which activity related to a blood transfusion can be delegated to a UAP?

• Obtain baseline vital signs within 15 minutes prior to initiating the transfusion
• Verify patient identity and blood product with the RN before hanging
• Monitor for transfusion reactions during the first 15 minutes
• Initiate the blood transfusion

Correct Answer: Obtain baseline vital signs within 15 minutes prior to initiating the transfusion

Q15. Which medication administration is appropriate to assign to an LPN/LVN?

• IV push diltiazem for rapid atrial fibrillation
• First dose of IV antibiotic through a central line
• Subcutaneous heparin injection for DVT prophylaxis
• Titration of an insulin infusion based on hourly glucose

Correct Answer: Subcutaneous heparin injection for DVT prophylaxis

Q16. Which patient is the best assignment for a newly licensed RN on a medical-surgical unit?

• Patient 2 hours post-thyroidectomy with potential airway compromise
• Patient with DKA on insulin infusion protocol
• Patient with acute ischemic stroke requiring frequent neuro assessments
• Patient with cellulitis on oral antibiotics needing routine dressing changes

Correct Answer: Patient with cellulitis on oral antibiotics needing routine dressing changes

Q17. Which tracheostomy-related task can the RN safely delegate to an experienced LPN/LVN?

• Provide initial tracheostomy self-care teaching to the patient and family
• Change tracheostomy ties on a fresh tracheostomy less than 24 hours old
• Suction an established tracheostomy in a stable patient and report changes
• Evaluate the effectiveness of suctioning and modify the care plan

Correct Answer: Suction an established tracheostomy in a stable patient and report changes

Q18. On a medical unit, which postmortem care task is appropriate to delegate to a UAP after the RN completes the death assessment and necessary notifications?

• Pronounce death and complete the death certificate
• Remove invasive lines and tubes without an order
• Provide perineal care, align the body, and place dentures per RN direction
• Discuss autopsy consent with the family

Correct Answer: Provide perineal care, align the body, and place dentures per RN direction

Q19. A patient is using a PCA for postoperative pain. Which task is appropriate to delegate to a UAP?

• Assess sedation level and respiratory status every 2 hours
• Change PCA settings per the provider order
• Remind the patient to press the PCA button before ambulation with physical therapy
• Press the PCA button for the patient when they are asleep

Correct Answer: Remind the patient to press the PCA button before ambulation with physical therapy

Q20. In a school health screening, which task may the RN delegate to trained support staff/UAP?

• Perform standardized vision screening using an eye chart and record results
• Interpret abnormal findings and refer for ophthalmologic evaluation
• Develop individualized health plans for students with chronic conditions
• Provide initial education on asthma action plans

Correct Answer: Perform standardized vision screening using an eye chart and record results

Q21. Which assignment is appropriate for an LPN/LVN on a postpartum unit?

• Patient with severe preeclampsia on magnesium sulfate infusion
• Newborn with respiratory distress and oxygen requirement
• Patient 2 hours post-cesarean section with ongoing bleeding
• Stable postpartum day 2 patient requiring routine care and oral analgesics

Correct Answer: Stable postpartum day 2 patient requiring routine care and oral analgesics

Q22. Which feeding-related task is appropriate to delegate to a UAP?

• Feed a patient with a new stroke pending swallow evaluation
• Assist a stable patient with unilateral weakness cleared for a mechanical soft diet
• Initiate and manage continuous enteral feeding pump
• Teach aspiration precautions to a patient and family

Correct Answer: Assist a stable patient with unilateral weakness cleared for a mechanical soft diet

Q23. Which stool specimen task can be delegated to a UAP?

• Collect a stool specimen for occult blood per protocol
• Perform digital rectal examination for impaction
• Interpret stool characteristics and modify diet
• Insert a rectal tube to relieve severe flatulence

Correct Answer: Collect a stool specimen for occult blood per protocol

Q24. Which task is appropriate to assign to an LPN/LVN caring for a patient on warfarin therapy?

• Adjust warfarin dose based on today’s INR
• Provide initial comprehensive anticoagulation teaching
• Monitor for signs of bleeding and report epistaxis or easy bruising
• Interpret INR trend and update the plan of care

Correct Answer: Monitor for signs of bleeding and report epistaxis or easy bruising

Q25. Which scenario best illustrates the Right Circumstance in delegation?

• Delegating ambulation to a UAP for a patient with symptomatic orthostatic hypotension
• Delegating bathing to a UAP for a stable patient with no complex wounds
• Delegating medication reconciliation to a UAP at discharge
• Delegating initial post-op assessment to an LPN

Correct Answer: Delegating bathing to a UAP for a stable patient with no complex wounds

Q26. Regarding documentation of delegated tasks, which practice is best?

• The RN documents vital signs obtained by the UAP to ensure accuracy
• The UAP documents vital signs in the electronic flow sheet and promptly reports abnormalities to the RN
• The UAP writes a narrative note interpreting the trends in vital signs
• The UAP delays documentation until the end of the shift to avoid interruptions

Correct Answer: The UAP documents vital signs in the electronic flow sheet and promptly reports abnormalities to the RN

Q27. An LPN/LVN is floated to a general medical unit. Which medication-related task is appropriate?

• Initiate and titrate total parenteral nutrition
• Administer IV push opioids
• Hang and monitor blood products
• Administer oral medications to assigned stable patients

Correct Answer: Administer oral medications to assigned stable patients

Q28. The RN determines that restraints are necessary and obtains a provider order. Which task can be delegated to a UAP?

• Assess the patient’s circulation and determine restraint need
• Apply soft wrist restraints as directed and report skin redness or numbness
• Obtain the initial consent and complete the order
• Adjust restraint type without RN notification

Correct Answer: Apply soft wrist restraints as directed and report skin redness or numbness

Q29. During a new admission, which task must the RN perform personally?

• Obtain a height and weight
• Orient the patient to the call bell and room
• Inventory patient belongings
• Complete the initial comprehensive nursing assessment

Correct Answer: Complete the initial comprehensive nursing assessment

Q30. A patient on oxygen by nasal cannula keeps removing it. Which task is appropriate to delegate to a UAP?

• Assess for signs of hypoxia and adjust the oxygen flow to maintain SpO₂ ≥ 92%
• Reapply the nasal cannula and notify the RN if the patient continues to remove it
• Titrate oxygen during ambulation based on dyspnea
• Determine the need for humidification

Correct Answer: Reapply the nasal cannula and notify the RN if the patient continues to remove it

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