Introduction
Delegation is one of those skills that seems so simple on paper but suddenly becomes complex when you're in the middle of a busy shift. Knowing what to hand off, who can safely take it, and when you must step back in is something every nurse learns through a mix of judgment, experience, and solid foundational knowledge. These NCLEX-style delegation scenario questions are designed to reflect real situations that nurses face every day-the moments when teamwork, safety, and quick thinking matter most.
1. A charge nurse on a med-surg unit receives a report on four clients: a postoperative client with a PCA pump, a client with new-onset atrial fibrillation on telemetry, a stable diabetic client requiring insulin, and a client with a wound vac. Which tasks can the RN safely delegate to an LPN? (SATA)
A. Monitor the PCA pump infusion rate hourly.
B. Assess the atrial fibrillation rhythm strip.
C. Administer the scheduled insulin per sliding scale.
D. Empty and measure the wound vac drainage.
E. Teach the diabetic client about foot care.
Answer :
C. Administer the scheduled insulin per sliding scale.
D. Empty and measure the wound vac drainage.
2. An RN is delegating care for a client with chronic heart failure admitted for exacerbation. The client is stable on diuretics and requires daily weights. Which action by the UAP requires immediate intervention by the RN?
A. The UAP obtains the weight after the client voids.
B. The UAP documents the weight without notifying the RN of a 3-lb gain.
C. The UAP reminds the client to elevate feet during the shift.
D. The UAP assists with ADLs as assigned.
Answer :B. The UAP documents the weight without notifying the RN of a 3-lb gain.
3. In a pediatric unit, an RN delegates vital signs and oral care to a UAP for a 6-year-old post-appendectomy client. During rounds, the RN finds the client febrile at 101°F. The UAP had not reported the temperature. What is the RN's priority follow-up?
A. Re-delegate vital signs to another UAP.
B. Assess the client for infection signs and notify the provider.
C. Document the oversight in the UAP's performance log.
D. Counsel the UAP on reporting protocols after the shift.
Answer : B. Assess the client for infection signs and notify the provider.
4. A nurse manager observes an LPN accepting a delegation to initiate a blood transfusion for a client with anemia. The RN who delegated this task is unavailable. The manager's immediate action is:
A. Allow the LPN to proceed under supervision.
B. Instruct the LPN to hold and locate the RN for oversight.
C. Delegate the transfusion to a UAP instead.
D. Document the incident for performance review.
Answer :B. Instruct the LPN to hold and locate the RN for oversight.
5. During a code stroke activation, an RN delegates obtaining a 12-lead ECG to an LPN while assessing neuro status. The LPN questions the delegation due to unfamiliarity with the machine. The RN's best response is:
A, "Proceed; it's within your scope.
B. Re-delegate to a UAP familiar with ECGs.
C. Perform the ECG while the LPN assists with assessment
D. Delay the ECG until the stroke team arrives.
Answer :C. Perform the ECG while the LPN assists with assessment.
6. An RN delegates colostomy care to an LPN for a client post-colectomy. The LPN reports the stoma is pale and protruding. Select all tasks the RN must now assume: (SATA)
A. Irrigate the colostomy to relieve obstruction.
B. Reassess the stoma and surrounding skin integrity.
C. Notify the surgeon of the changes.
D. Teach the client self-care techniques.
E. Document the LPN's findings verbatim.
Answer :
B. Reassess the stoma and surrounding skin integrity.
C. Notify the surgeon of the changes.
D. Teach the client self-care techniques.7. In a long-term care facility, an RN delegates bathing and feeding to a UAP for a client with Alzheimer's. The UAP later reports the client refused food. The RN's delegation evaluation includes:
A. Accepting the refusal without further assessment.
B. Delegating NG tube insertion to the UAP.
C. Assessing for dysphagia and nutritional risks.
D. Re-delegating feeding to an LPN.
Answer :C. Assessing for dysphagia and nutritional risks.
8. A perioperative nurse delegates pre-op teaching to an LPN for a client undergoing cholecystectomy. The client has uncontrolled anxiety and hypertension. Which delegation principle is violated?
A. Task predictability.
B. Client stability for teaching
C. LPN scope for assessment-integrated education.
D. All of the above.
Answer :D. All of the above.
9. An RN in the ICU delegates turning and repositioning to a UAP for a ventilated client. The UAP performs the task but forgets to suction secretions. The client develops hypoxia. The RN's legal concern is:
A. Vicarious liability for UAP actions.
B. Breach in delegation supervision.
C. UAP scope violation only.
D. No concern if documented.
Answer :B. Breach in delegation supervision.
10. For a maternity unit, an RN delegates fundal checks post-delivery to an LPN. The LPN notes boggy uterus but delegates massage to a UAP. Select all inappropriate actions: (SATA)
A. LPN delegating to UAP.
B. RN not verifying LPN competence.
C. UAP performing uterine massage.
D. Documenting without RN review.
E. Immediate provider notification by LPN.
Answer : A. LPN delegating to UAP.
C. UAP performing uterine massage.
D. Documenting without RN review. |
11. A community health RN delegates blood glucose monitoring to an LPN for homebound diabetic clients. One client reports hypoglycemia symptoms post-monitoring. The LPN's appropriate response is:
A. Administer glucagon per standing order.
B. Contact the RN for further instructions.
C. Delegate glucose recheck to family.
D. Document and continue visit.
Answer :B. Contact the RN for further instructions.
12. In an oncology unit, an RN delegates chemotherapy side effect monitoring to an LPN. The LPN observes grade 3 neutropenia but waits for RN rounds to report. The RN's corrective measure is:
A. Praise timely documentation.
B. Educate on immediate reporting thresholds.
C. Re-delegate to UAP for vital signs only.
D. Ignore as low acuity.
Answer :B. Educate on immediate reporting thresholds.
13. An ER RN delegates triage documentation to an LPN during a mass casualty drill. The LPN assigns a yellow-tagged client to green without reassessment. The priority intervention is:
A. Recategorize based on RN reassessment.
B. Delegate triage to UAP next time.
C. Document LPN error for HR.
D. Proceed with green resources.
Answer : A. Recategorize based on RN reassessment.
14. A psych nurse delegates group therapy facilitation to an LPN for clients with bipolar disorder. A client exhibits manic escalation during the session. Which factor made this delegation unsafe?
A. Unpredictable client behavior.
B. LPN lack of crisis intervention training.
C. Group size exceeding 10.
D. A and B.
Answer :D. A and B.
15. In a rehab facility, an RN delegates gait training with walker to a UAP for a stroke client. The client falls, sustaining a hip fracture. The root cause is likely:
A. UAP improper body mechanics teaching.
B. Delegation of unstable mobility task.
C. Lack of RN supervision during activity.
D. All of the above.
Answer :D. All of the above.
16. Select all delegation-appropriate tasks for a UAP on a telemetry unit with stable clients: (SATA)
A. Emptying Foley bags and reporting output.
B. Interpreting rhythm strips for PVCs.
C. Assisting with ADLs for low-fall-risk clients.
D. Reinforcing discharge instructions.
E. Notifying RN of telemetry alarm changes.
Answer :A. Emptying Foley bags and reporting output.
- Assisting with ADLs for low-fall-risk clients.
- Notifying RN of telemetry alarm changes.
17. An RN delegates IV fluid rate adjustments to an LPN for a client with sepsis. The LPN increases rate without recent vitals. The RN's follow-up includes:
A. Allowing continuation per protocol.
B. Retrieving the task and reassessing fluid status.
C. Delegating vitals to UAP retroactively
D. Charting LPN independence.
Answer :B. Retrieving the task and reassessing fluid status.
18. During night shift, an RN delegates medication reconciliation to an LPN for a new admission with polypharmacy. The LPN identifies a potential interaction but doesn't flag it. The best prevention strategy is:
A. RN pre-review of high-risk meds.
B. LPN-only reconciliation for efficiency
C. UAP assistance in data entry.
D. Post-admission audit only.
Answer :A. RN pre-review of high-risk meds.
19. A school nurse delegates lice screening to an LPN for a classroom outbreak. The LPN treats a case without parental consent. This violates:
A. Delegation of assessment-only task.
B. Informed consent for minors.
C. LPN scope for treatment initiation.
D. B and C.
Answer :D. B and C.
20. In hospice care, an RN delegates pain assessment to an LPN for a terminal client. The LPN scores 8/10 but delegates PRN morphine to UAP. Select all errors: (SATA)
A. Pain assessment delegation to LPN.
B. UAP morphine administration.
C. No RN verification of score.
D. Failure to reassess post-dose.
E. Documentation by UAP.
Answer :B. UAP morphine administration.
C. No RN verification of score
E. Documentation by UAP.
21. An RN in dialysis delegates access site monitoring to an LPN mid-treatment. The LPN notes thrill absence but continues without alerting. The RN's priority is:
A. Terminate delegation permanently.
B. Stop treatment and assess for clot.
C. Switch to UAP monitoring.
D. Review LPN training logs later.
Answer :B. Stop treatment and assess for clot.
22. For a burn unit, an RN delegates dressing changes to an LPN for partial-thickness wounds. The client develops infection signs. Which delegation flaw contributed?
A. Wound complexity beyond stable care.
B. LPN sterile technique lapse.
C. No RN oversight of changes.
D. A and C.
Answer : D. A and C.
23. A float RN unfamiliar with unit protocols delegates NG tube feeding to a UAP. Aspiration occurs. The legal issue is:
A. Float RN scope overreach.
B. UAP task acceptance beyond training.
C. Inadequate right circumstance evaluation.
D. All of the above.
Answer :D. All of the above.
25. Select all tasks an LPN can be delegated for a client post-TIA with stable neuro: (SATA)
A. Administering oral antihypertensives.
B. Performing Glasgow Coma Scale.
C. Monitoring for recurrent symptoms.
D. Suctioning oral secretions.
E. Educating on TIA prevention.
Answer :A. Administering oral antihypertensives.
C. Monitoring for recurrent symptoms.
D. Suctioning oral secretions.
25. In an ortho clinic, an RN delegates cast care instructions to an LPN for a client with new fracture. The client reports neurovascular compromise. The LPN's response should be:
A. Apply ice per standing orders.
B. Elevate and notify RN immediately.
C. Re-delegate checks to UAP.
D. Document and follow up tomorrow.
Answer :B. Elevate and notify RN immediately.
26. An RN delegates specimen collection to a UAP for a client with C. diff. The UAP handles without PPE. The RN's intervention is:
A. Delegate PPE training post-incident.
B. Retrain on isolation protocols before next task.
C. Allow continuation if no symptoms.
D. Report to infection control only.
Answer :B. Retrain on isolation protocols before next task.
27. During flu season, an RN delegates vaccine administration to an LPN in a drive-thru clinic. A client reports egg allergy history. The LPN proceeds. This breaches:
A. Client-specific delegation safety.
B. LPN vaccine contraindication knowledge.
C. RN verification of allergies.
D. A and C.
Answer : D. A and C.
Conclusion
Delegation isn't just about sharing tasks; it's about protecting clients, supporting your team, and practicing with confidence. Working through these kinds of scenarios trains you to think ahead, recognize red flags, and understand the limits and responsibilities of each role on the healthcare team. Strong delegation truly makes nursing safer, more efficient, and ultimately more rewarding. A good training is all you need to clear the exam in the first attempt. Join now at the best NCLEX-RN training centre in Kerala now!
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