Prioritization & Delegation Practice Test #3: Assignment and Staffing

Answer: B. A client with pneumonia on day 3 of IV antibiotics who is afebrile, stable, and walking in the hall

Rationale: A float nurse should receive clients who are stable, have a predictable course, and need care that matches skills the nurse already uses. A pediatric nurse manages pneumonia and IV antibiotics routinely, and this client is stable. A new atrial fibrillation on a titrated diltiazem infusion is unstable and needs a nurse experienced with adult cardiac drips. A fresh hip replacement with an epidural needs specialized adult postoperative and neurovascular monitoring. A paracentesis client needs procedure-specific assessment and initial teaching, which is better given to a nurse familiar with the unit and the procedure.

Answer: D. A client receiving chemotherapy whose absolute neutrophil count is 400/mm³

Rationale: A client with severe neutropenia is at high risk for infection and needs a private room (protective precautions) to limit exposure to other clients and visitors. An absolute neutrophil count below about 500/mm³ is generally treated as severe neutropenia, though the exact threshold for protective measures follows facility policy. The clients with a urinary tract infection, heart failure, and nondraining cellulitis can safely share a room using standard precautions.

Answer: A. Two clients who both have Clostridioides difficile diarrhea and are on contact precautions

Rationale: When private rooms are not available, clients infected with the same organism can be cohorted in the same room, following infection prevention policy. Two clients with C. difficile on contact precautions may share a room. A draining MRSA wound puts a client with a fresh surgical incision at risk of wound infection. A neutropenic client should not share a room with a client who has an infection. A client with influenza needs droplet precautions and should not room with a client with COPD, who is at high risk for severe complications of influenza.

Answer: C. Accept the assignment, tell the charge nurse the specific concerns right away, and document the objection using the facility's process

Rationale: The RN should raise specific safety concerns with the charge nurse at once and, if the assignment still stands, accept it while documenting the objection through the facility's process (often an assignment despite objection or staffing concern form) and using the chain of command. Leaving after accepting report can be considered client abandonment. Accepting silently gives up the chance to get help and leaves no record. Reporting to the board of nursing is not the first step and does not keep clients safe during this shift. Exact procedures vary by facility and state.

Answer: D. A client with an upper GI bleed whose hemoglobin has dropped since morning and who is receiving a blood transfusion

Rationale: The most experienced nurse should care for the client who is least stable and whose condition is changing. A client with an active GI bleed, a falling hemoglobin, and a transfusion in progress can deteriorate quickly and needs expert assessment and fast decisions. The client awaiting discharge, the client with chronic stable pain, and the client recovering from an uncomplicated surgery all have predictable courses and can go to less experienced staff.

Answer: A. Match clients to each nurse's competence, balance the total acuity, and keep each nurse's clients close together on the unit when possible

Rationale: Safe assignments match client needs to each nurse's skills, balance acuity (not just numbers), and group clients geographically so the nurse can respond quickly. Equal numbers can still leave one nurse with several unstable clients. New nurses should build skill with support, not be given the most complex clients alone. Continuity of care, keeping the same nurse with the same clients when possible, improves safety and assessment of change, so rotating clients every shift without a reason works against it.

Answer: C. A client 2 days after a lobectomy whose chest tube is to water seal, vital signs are stable, and pain is controlled with oral medication

Rationale: The client who is most stable and needs the least intensive monitoring is the best choice for transfer. Two days after a lobectomy with stable vital signs, a chest tube on water seal, and oral pain control, this client can be safely monitored on a step-down unit. Ongoing chest pain after a myocardial infarction signals continuing ischemia. A client on a ventilator for ARDS needs ICU care. A client with DKA on an insulin infusion with hourly glucose checks still needs close titration and electrolyte monitoring, which in many facilities happens in the ICU.

Answer: B. A client with cervical cancer who has a sealed radioactive implant in place

Rationale: A client with a sealed radioactive implant emits radiation, and staff who are pregnant should not be assigned to these clients because of the risk to the fetus. Facility radiation safety policy decides the exact limits. Caring for clients with heart failure or a fractured femur poses no special risk. Standard and droplet precautions protect the nurse from a client with pneumonia; specific infections such as cytomegalovirus or rubella may call for extra caution under facility policy, which is not the case here.

Answer: A. A client with a closed hip fracture who is waiting for surgery

Rationale: Herpes zoster is caused by the varicella-zoster virus, so a nonimmune nurse could get chickenpox from contact with shingles lesions or from airborne spread in disseminated zoster or chickenpox. Nonimmune staff should not care for clients with chickenpox, disseminated zoster, or localized zoster when immune staff are available. The client with a hip fracture poses no varicella risk. Facility occupational health policy guides staff restrictions.

Answer: D. Assign the admission to the RN whose current clients are most stable, and ask the AP to obtain vital signs and weight on arrival

Rationale: The initial admission assessment and plan of care belong to the RN, so the admission should go to the RN whose current clients are stable enough to allow the time. The AP can help by taking vital signs and weight, which are routine tasks. A light assignment does not change the LPN's scope; the LPN can collect data and contribute but does not complete the initial comprehensive assessment. An AP cannot perform assessment, and a cosignature does not make an assessment the RN did not do valid. Exact LPN scope varies by state.