NCLEX-PN Coordinated Care Practice Questions

The PN role in delivering coordinated, supervised care — scope, delegation to UAP, advocacy, documentation, and reporting. It sits under Safe and Effective Care Environment on the NCLEX-PN test plan and carries an approximate weight of 21% of the exam.

Below are 10 practice questions for this domain — 6 multiple-choice and 4 select-all-that-apply. Every item gives a rationale for each option, not just the correct one: on the NCLEX-PN the distractors are usually plausible actions that are simply lower priority, so knowing why an answer is wrong is worth as much as knowing why one is right.

How to use this page. Read the vignette, commit to an answer, and only then open “Show the answer and rationales”. Reading the worked answer first feels productive and teaches almost nothing — the recall attempt is what makes it stick.

Select-all-that-apply items are graded all-or-nothing: partial credit does not exist, so a single missed option loses the whole question.

Easy Select all that apply

1. Protecting client information — SATA

A nurse on a busy medical unit is reviewing ways to protect client health information during the shift.

Which actions by the nurse maintain client confidentiality? Select all that apply.

  1. Log off the computer workstation before walking away from it.
  2. Give the oncoming nurse a report on the client's condition at shift change.
  3. Shred the paper worksheet containing client information at the end of the shift.
  4. Confirm the client's diagnosis for a caller who states they are the client's cousin.
  5. Discuss the client's test results with a coworker from another unit while riding the elevator.
  6. Post about a memorable client encounter on social media without using the client's name.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . An unattended, logged-in workstation exposes electronic health records to anyone passing by. Logging off protects electronic protected health information, which HIPAA covers along with written and spoken forms.
  • B. Correct . Sharing information with caregivers who need it to provide care is an appropriate, permitted disclosure. Handoff to the nurse assuming care is the definition of need to know.
  • C. Correct . Report sheets and worksheets contain protected health information and must be destroyed — never carried home or thrown in regular trash — when no longer needed.
  • D. Incorrect . The nurse cannot verify a caller's identity or relationship, and the client has not authorized the disclosure. Health information is shared with family only with the client's permission.
  • E. Incorrect . This breaches confidentiality twice — the coworker is not involved in the client's care, and an elevator is a public place where visitors can overhear.
  • F. Incorrect . Omitting the name does not de-identify a client — dates, locations, and clinical details can still identify them. NCSBN guidance is clear that client information never belongs on social media.

Reference: HHS HIPAA Privacy Rule; NCSBN A Nurse's Guide to the Use of Social Media

Easy Multiple choice

2. Stroke discharge planning — which referral

A nurse is contributing to discharge planning for a client recovering from a stroke. The nurse observes that the client coughs frequently while drinking thin liquids, and the family plans to manage all meals at home.

Which referral should the nurse suggest to the RN?

  1. A speech-language pathologist.
  2. An occupational therapist.
  3. A physical therapist.
  4. A social worker.
Show the answer and rationales

Correct answer: A

  • A. Correct . Coughing while drinking thin liquids after a stroke suggests dysphagia and a risk of aspiration. The speech-language pathologist is the team member who evaluates and treats swallowing disorders, and the PN initiates the referral through the RN.
  • B. Incorrect . Occupational therapy helps with activities of daily living such as dressing and adaptive feeding equipment, but the swallowing evaluation itself belongs to the speech-language pathologist.
  • C. Incorrect . Physical therapy addresses strength, balance, and mobility after a stroke — important needs, but not the swallowing problem the nurse observed.
  • D. Incorrect . A social worker coordinates community resources and support services for discharge, but cannot evaluate or treat a swallowing disorder.

Reference: ASHA Adult Dysphagia Practice Portal; MedlinePlus (swallowing disorders)

Medium Multiple choice

3. Admission assessment — assignment outside PN scope

The medical unit is short-staffed, and the charge nurse asks an LPN to complete the initial admission assessment and develop the plan of care for a client who has just arrived from the emergency department.

Which action should the nurse take?

  1. Tell the charge nurse that the initial admission assessment and care plan must be completed by an RN, and offer to collect routine data instead.
  2. Complete the admission assessment and ask an RN to cosign the documentation afterward.
  3. Complete the assessment because the charge nurse made the assignment and is therefore accountable for it.
  4. Ask the assistive personnel to obtain the admission vital signs while the LPN writes the plan of care.
Show the answer and rationales

Correct answer: A

  • A. Correct . The initial comprehensive assessment and development of the plan of care are RN functions under the nurse practice act. The PN collects and reports data and contributes to the plan, so declining the out-of-scope portion while offering in-scope help protects both the client and the license.
  • B. Incorrect . A cosignature does not make an out-of-scope task legal. The nurse who performs a task is accountable for it, and performing an initial assessment exceeds PN scope regardless of who signs later.
  • C. Incorrect . Accountability for one's own practice cannot be transferred. Accepting and performing a task outside the legal scope of practice places the accountability — and the license — on the nurse who does the work.
  • D. Incorrect . Vital signs can be delegated, but this does not fix the core problem — developing the plan of care is nursing judgment that remains outside PN scope.

Reference: NCSBN NCLEX-PN Test Plan; NCSBN National Guidelines for Nursing Delegation (2019)

Medium Select all that apply

4. Change-of-shift handoff — what to include

A nurse is preparing to give a change-of-shift handoff report, using the SBAR format, for a client admitted with pneumonia.

Which information should the nurse include in the handoff report? Select all that apply.

  1. The client's most recent vital signs and oxygen saturation.
  2. An increase in the client's work of breathing observed during the shift.
  3. Blood cultures that were drawn and are still pending.
  4. The nurse's opinion that the client's family asks too many questions.
  5. A detailed account of every routine task already completed and charted during the shift.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . Current objective data anchor the Assessment portion of SBAR and let the oncoming nurse recognize a change in condition during the next shift.
  • B. Correct . Any change in condition is among the most important content in a handoff — it tells the oncoming nurse what to watch and what may need escalation to the RN or provider.
  • C. Correct . Pending labs and procedures belong in the Recommendation portion of SBAR so the oncoming nurse knows to follow up on the results and report them.
  • D. Incorrect . Personal opinions and judgmental comments about clients or families are unprofessional and clinically irrelevant. Handoff content should be objective and pertinent to care.
  • E. Incorrect . Routine completed care lives in the medical record. Repeating it all verbally buries the critical information — handoff focuses on current status, changes, and what comes next.

Reference: Institute for Healthcare Improvement SBAR communication tool; Joint Commission guidance on handoff communication

Medium Select all that apply

5. Delegating to assistive personnel — SATA

A nurse on a long-term care unit is working with an experienced assistive personnel (AP) and is deciding which tasks to delegate.

Which tasks are appropriate for the nurse to delegate to the assistive personnel? Select all that apply.

  1. Obtain routine vital signs on a stable resident.
  2. Assist a stable resident who ambulates daily to walk in the hallway.
  3. Measure and record the oral intake and urine output of assigned residents.
  4. Reinforce teaching about a fluid restriction with a resident who has heart failure.
  5. Determine whether a resident's pressure injury has improved since last week.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . Routine vital signs on a stable client are a right task for the AP — predictable, low risk, and within the AP role. The nurse remains accountable for reviewing the results and following up.
  • B. Correct . Assisting with ambulation for a stable client with an established routine is an appropriate delegated task. A first ambulation after surgery or a change in condition would not be.
  • C. Correct . Measuring and recording intake and output is routine data gathering the AP may perform. Interpreting those numbers and acting on them remains the nurse's responsibility.
  • D. Incorrect . Teaching — including reinforcement of teaching — requires nursing knowledge and judgment and cannot be delegated to assistive personnel. Reinforcing teaching initiated by the RN is the PN's role.
  • E. Incorrect . Deciding whether a wound is improving is evaluation, which is a nursing function that is never delegated. The AP may report what they see, but may not judge the finding.

Reference: NCSBN National Guidelines for Nursing Delegation (2019); ANA and NCSBN joint statement on delegation

Medium Multiple choice

6. Preoperative consent — client does not understand

A nurse is completing the preoperative checklist for a client scheduled for a laparoscopic cholecystectomy. A signed consent form is in the chart. When the nurse asks about the procedure, the client says they are not sure why the gallbladder has to come out and wishes someone would explain it again.

Which action should the nurse take?

  1. Notify the RN that the client cannot explain the procedure so the provider can return to clarify it before surgery.
  2. Explain the risks, benefits, and alternatives of the surgery to the client.
  3. Send the client to the operating room as scheduled because the consent form is already signed.
  4. Reassure the client that the surgical team will answer all questions after the procedure.
Show the answer and rationales

Correct answer: A

  • A. Correct . A signature without understanding is not informed consent. The provider is responsible for explaining the procedure and verifying understanding, so the nurse advocates for the client by stopping the process and escalating through the RN before the client goes to the operating room.
  • B. Incorrect . Explaining the risks, benefits, and alternatives is the legal responsibility of the provider who obtains consent, not the nurse. The nurse may reinforce information the provider has already given, but cannot supply the missing informed-consent discussion.
  • C. Incorrect . Consent must be informed and voluntary, not just signed. Proceeding when the client clearly does not understand the procedure violates the client's rights and exposes the team to liability.
  • D. Incorrect . This dismisses the client's concern and defeats the purpose of informed consent — questions about why a procedure is being done must be answered before it occurs.

Reference: AORN guidance on informed consent; NCSBN NCLEX-PN Test Plan

Medium Select all that apply

7. Unwitnessed fall — appropriate actions

A nurse answers a call light and finds a client lying on the floor beside the bed. No one saw what happened. The client is awake and says their knee hurts.

Which actions should the nurse take? Select all that apply.

  1. Check the client for injuries before helping them move.
  2. Notify the RN about the fall.
  3. Complete an incident report according to facility policy.
  4. Document objective findings in the medical record, such as the position the client was found in and the data collected.
  5. Record in the medical record that an incident report was completed.
  6. Chart that the client climbed over the side rails and fell out of bed.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Collecting data first prevents a possible fracture or head injury from being made worse by movement. The client is moved only after injuries have been checked.
  • B. Correct . The PN reports up the chain of command — the RN completes a full assessment and escalates to the provider as needed. A fall always requires notification, even if the client appears uninjured.
  • C. Correct . A fall is an incident, and a factual, non-blaming incident report is required. Incident reports are internal quality-improvement tools used to find and fix system problems.
  • D. Correct . The chart should contain the objective clinical facts — where the client was found, the data collected, who was notified, and the care provided.
  • E. Incorrect . The incident report is an internal document and is never referenced in the chart — mentioning it can make the report discoverable in litigation. Chart only the clinical facts.
  • F. Incorrect . No one witnessed the event, so this is speculation. Documentation must state only what was observed — for example, that the client was found lying on the floor beside the bed.

Reference: AHRQ PSNet patient safety primers (incident reporting and falls); standard nursing documentation principles

Hard Multiple choice

8. Client wants to stop dialysis — advocacy

A client with end-stage kidney disease who is alert and oriented tells a nurse privately that they want to stop hemodialysis, but they have stayed quiet because their son insists that treatment continue.

Which action by the nurse best demonstrates client advocacy?

  1. Communicate the client's wishes to the RN so the care team can discuss the options with the client.
  2. Remind the client that stopping dialysis will shorten their life and encourage them to continue treatment.
  3. Arrange a meeting with the son to explain what the client has decided.
  4. Document the conversation and take no further action because the decision belongs to the client.
Show the answer and rationales

Correct answer: A

  • A. Correct . Advocacy means acting on the client's expressed wishes, and the PN advocates up the chain of command — to the RN first — so the team and provider can explore the decision with the client. A competent adult has the right to refuse treatment, even life-sustaining treatment.
  • B. Incorrect . Pressuring the client toward the option the nurse or family prefers undermines autonomy. Advocacy supports the client's own informed choice, not the choice others want.
  • C. Incorrect . Sharing what the client said in confidence without permission breaches confidentiality and bypasses the client. The client decides whether and how the family is involved.
  • D. Incorrect . Documentation alone leaves the client unheard — the wish never reaches the team that can act on it. Advocacy requires escalating the client's concern, not just recording it.

Reference: ANA Code of Ethics for Nurses (advocacy and client autonomy); NCSBN NCLEX-PN Test Plan

Hard Multiple choice

9. Morning data collection — finding to report immediately

A nurse is collecting data on four assigned clients at the beginning of the day shift.

Which finding should the nurse report to the RN immediately?

  1. A client receiving morphine through a patient-controlled analgesia pump who is difficult to arouse and has a respiratory rate of 9 breaths per minute.
  2. A client 1 day after a total hip arthroplasty with an oral temperature of 37.8 C (100.0 F).
  3. A client with type 2 diabetes whose fasting blood glucose is 138 mg/dL.
  4. A client with chronic heart failure who has trace edema of both ankles, unchanged from the previous shift.
Show the answer and rationales

Correct answer: A

  • A. Correct . Increasing sedation is an early warning sign of opioid-induced respiratory depression, and a respiratory rate below 10 per minute confirms it. This is a life-threatening airway and breathing problem that the RN and provider must act on immediately — possibly with naloxone.
  • B. Incorrect . A low-grade temperature in the first 24 to 48 hours after surgery is a common, expected response to cytokines released by surgical tissue trauma. It warrants monitoring and routine reporting, not immediate escalation.
  • C. Incorrect . This value is only slightly above the usual fasting target of 80 to 130 mg/dL for adults with diabetes. It belongs in routine reporting and documentation, not an urgent call.
  • D. Incorrect . Trace peripheral edema that is chronic and unchanged is an expected finding in heart failure. New or worsening edema with weight gain would be a different story.

Reference: Anesthesia Patient Safety Foundation guidance on opioid-induced respiratory depression; American Diabetes Association Standards of Care (glycemic targets)

Hard Multiple choice

10. Postoperative unit — which client to see first

A nurse on a surgical unit receives a change-of-shift handoff for four assigned clients.

Which client should the nurse see first?

  1. A client 5 hours after a thyroidectomy who has new swelling of the neck and reports a feeling of tightness in the throat.
  2. A client with COPD whose oxygen saturation is 91 percent on 2 L of oxygen by nasal cannula.
  3. A client 2 days after abdominal surgery who rates incisional pain at 6 on a scale of 0 to 10.
  4. A client scheduled for discharge who is waiting for the nurse to reinforce wound care teaching.
Show the answer and rationales

Correct answer: A

  • A. Correct . Most post-thyroidectomy bleeds occur within the first 6 to 24 hours, and an expanding neck hematoma can rapidly obstruct the airway. Neck swelling and a sensation of tightness are early warning signs that appear before stridor, so this airway threat outranks every other client. The nurse collects data and notifies the RN immediately.
  • B. Incorrect . The recommended oxygen saturation target for clients with COPD is 88 to 92 percent, so 91 percent on low-flow oxygen is an expected finding that requires routine monitoring, not urgent action.
  • C. Incorrect . Pain deserves timely treatment, but a hemodynamically stable client with incisional pain does not take priority over a potential airway obstruction. Airway always comes before comfort needs.
  • D. Incorrect . Reinforcing teaching for a stable client awaiting discharge is the lowest priority — it is a planned, expected activity with no physiologic urgency.

Reference: Difficult Airway Society and BAETS 2022 consensus guidelines on post-thyroidectomy haematoma; British Thoracic Society emergency oxygen guideline (COPD target 88-92 percent)

Keep practising

These same questions are mixed into the interactive quizzes for this domain, where they are graded and feed your spaced-repetition schedule. The timed mock exam draws from every domain at its real test-plan weight.

Study sets in this domain

Not sure which domain to work on first? Take the NCLEX-PN diagnostic → It samples every domain by its exam weight and hands you a study-first list.