In most situations, correct choices are so vital in the nursing profession. This 20-item NCLEX practice exam is for students and practicing nurses who want to sharpen their skills in prioritizing, assigning, and delegating.
Believe you can and you’re halfway there.
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Nursing Prioritization, Delegation and Assignment: Emergencies and Disasters
Practice Mode: This is an interactive version of the Text Mode. All questions are given in a single page and correct answers, rationales or explanations (if any) are immediately shown after you have selected an answer. No time limit for this exam.
Nursing Prioritization, Delegation and Assignment: Emergencies and Disasters
Text Mode: All questions and answers are given on a single page for reading and answering at your own pace. Be sure to grab a pen and paper to write down your answers.
1. After exposure to hot weather and sun, clients with signs and symptoms of heat-related ailment rush to the Emergency Department (ED). Sort clients into those who need critical attention and those with less serious condition.
1. An abandoned person who is a teacher; has altered mental state, weak muscle movement, hot, dry, pale skin; and whose duration of heat exposure is unknown.
2. An elderly traffic enforcer who complains of dizziness and syncope after standing under the heat of the sun for several hours to perform his job.
3. A comparatively healthy housewife who states that the air conditioner has been down for 5 days and who exhibits hypotension, tachypnea, profuse diaphoresis, and fatigue.
4. A sportsman who complains of severe leg cramps and nausea, and displays paleness, tachycardia, weakness, and diaphoresis.
A. 4, 3, 2, 1
B. 1, 2, 4, 3
C. 1, 4, 2, 3
D. 4, 1, 3, 2
2. The ambulance has transported a man with severe chest pain. As the man is being transferred to the emergency stretcher, the nurse note unresponsiveness, cessation of breathing, and absence of palpable pulse. Which of the following tasks is proper to assign to the nursing assistant?
A. Aiding with oral intubation
B. Performing chest compressions
C. Placing the defibrillator pads
D. Starting bag valve mask ventilation
3. A high school student comes in the triage area alert and ambulatory, and his uniform is soaked with blood. He and his classmates are sounding, “We were running around outside the school and he got hit in the abdomen with a stick!” Which statement should be a priority?
A. “The stick was absolutely filthy and muddy.”
B. “He has a family history of diabetes, so he requires attention right now.”
C. “He pulled the stick out because it was too painful for him.”
D. “There was plenty of blood so we used three gauzes.”
4. A mother is so worried that her son took an unknown amount of children’s chewable vitamins at an unknown time. While in the ED, the child is alert and asymptomatic. What information should be directly stated to the physician?
A. The child was nauseated and vomited before arriving in the ED.
B. The child has been managed multiple times for unexpected injuries.
C. The child has been treated many times for ingestion of toxic substances.
D. The ingested children’s chewable vitamins contain iron.
5. Several clients arrive in the ED with the same complaint of abdominal pain. Designate them for care in order of the severity of their condition.
1. A 12-year-old girl with a low-grade fever, anorexia, nausea, and right lower quadrant tenderness for the past 2 days
2. A 25-year-old woman complaining of dizziness and severe left lower quadrant pain who states she is probably pregnant
3. A 38-year-old man complaining of severe occasional cramps with three episodes of watery diarrhea hours after meal
4. A 42-year-old woman with moderate right upper quadrant pain who has vomited little amounts of yellow bile and whose symptoms have worsened over the past week
5. A 53-year-old man who experiences discomforting mid-epigastric pain that is worse between meals and during the night
6. A 68-year-old man with a pulsating abdominal mass and sudden onset of “tearing” pain in the abdomen and flank within the past hour
A. 2, 6, 4, 1, 5, 3
B. 6, 2, 4, 1, 3, 5
C. 2, 6, 1, 4, 5, 3
D. 6, 2, 1, 4, 3, 5
6. The newly hired nurse is in his first week on the job in the ED. He used to be a traveling nurse for 5 years. Which area in his present job is the most appropriate assignment for him?
A. Fast-track clinic
B. Pediatric medicine team
C. Trauma team
7. A client with multiple injuries is rushed to the ED after a head-on car collision. Which assessment finding takes priority?
A. Irregular apical pulse
B. Ecchymosis in the flank area
C. A deviated trachea
D. Unequal pupils
8. Several people were killed and injured in a recent industrial explosion. The victims are being interviewed and assessed by the nurses for possible psychiatric crises. Which client has the greatest risk for posttraumatic distress disorder?
A. An individual who was injured and trapped for 8 hours before rescue
B. A person who saw the death of a co-worker during the blast
C. An individual who recently discovered that her daughter was killed in the incident
D. A person who repeatedly watched television coverage of the event
9. When several areas of a daycare center collapsed due to an earthquake, children especially injured ones are brought to the ED. As a competent nurse, you know that children will be more predisposed to which of the following? (Select all that apply.)
A. 2, 3, and 8
B. 2, 5, and 6
C. 3, 4, 5, and 7
D. 1, 2, 3, 4, 5, and 8
E. 1, 2, 3, 4, 5, 6, 7, and 8
10. What is regarded as one of the priority actions that must be accomplished when a primary assessment of a trauma client is conveyed?
A. Taking a full set of vital sign measurements
B. Completing a brief neurologic assessment
C. Monitoring pulse oximetry reading
D. Palpating and auscultating the abdomen
11. Prior to oral defense, a 21-year-old nursing student goes straight to the clinic due to tingling sensations, palpitations, and chest tightness. Deep, rapid breathing and carpal spasms are also observed. What is the nursing priority action for this situation?
12. The nurse is assigned to a small rural community hospital. Six clients have arrived at the ED because the local church is caught on deadly fire. More affected residents are expected to arrive soon and it is the only hospital in the nearby area. Arrange the following six clients in the order in which they should obtain medical attention utilizing disaster triage principles.
1. A 5-year-old child with respiratory distress and burns over more than 70% of the anterior body.
2. An 11-year-old boy wheezing and heavily labored breathing unrelieved by an asthma inhaler
3. A 19-year-old anxious girl with a crushed leg that is very swollen and has tachycardia
4. A firefighter who is exhibiting combative behavior and has respiratory stridor
5. A 50-year-old man in full cardiac arrest who has been receiving CPR continuously for the past 30 minutes
6. A 62-year-old grandmother with full-thickness burns to the hands and forearms
A. 2, 4, 3, 6, 1, 5
B. 5, 1, 2, 4, 3, 6
C. 4, 2, 3, 6, 1, 5
D. 1, 5, 2, 4, 3, 6
13. Identify the five most important elements in conducting disaster triage for multiple victims.
1. Assess level of consciousness
2. Check airway, breathing, and circulation
3. Monitor vital signs, including pulse and respirations
4. Inquire about last tetanus shot
5. Determine a history of allergies to food or medicine
6. Know the list of current medications
7. Identify past medical and surgical history
8. Note color, presence of moisture and temperature of the skin
9. Visually examine for gross deformities, bleeding, and obvious injuries
A. 1, 2, 3, 8, and 9
B. 4, 5, 6, and 7
C. 1, 2, 3, and 4
D. 1, 2, and 3
14. A group of passengers enters the ED with complaints of cough, tightness in the throat, and extreme periorbital swelling. There is a strong odor exuding from their clothes. They report exposure to a “gas bomb” that was placed in the bus terminal. What is the priority action?
A. Readily transfer clients and visitors from the area
B. Check vital signs and auscultate lung sounds
C. Assist clients in the decontamination area
D. Direct clients to the cold or clean zone for immediate treatment
15. A drunk driver has been in the police station for 48 hours. During the first hours, he had tremors and was feeling anxious and sweaty. Currently, he is experiencing disorientation, hallucination, and hyperactivity. It was noted that the client has a history of alcohol abuse. What is the priority nursing diagnosis?
A. Risk for Nutritional Deficit related to chronic alcohol abuse
B. Risk for Injury related to seizures
C. Risk for Situational Low Self-Esteem related to police custody
D. Risk for Other-Directed Violence related to hallucinations
16. During a class discussion, the 50-year-old professor suddenly feels left-sided chest pain, dizziness, and diaphoresis. What is the priority action when he arrives in the ED triage area?
A. Supply oxygen via nasal cannula
B. Place intravenous (IV) access
C. Notify the ED physician
D. Set the client on continuous electrocardiographic monitoring
17. A child with fever has been admitted to the ED for several hours. Cooling measures are ordered by the physician in order for the client’s temperature to come down. Which task would be appropriate to delegate to the nursing assistant?
A. Prepare and administer a tepid bath
B. Assist the child in removing outer garments
C. Educate the need for giving cool fluids
D. Tell the parent to use acetaminophen (Tylenol) instead of aspirin
18. A traveler’s feet suddenly become pale, turn red, and feels very cold. In just 30 minutes, the affected part became prickly and numb. Place the following interventions in the correct order for a client with frostbite.
1. Administer pain medication
2. Apply loose, sterile, bulky dressing
3. Monitor for compartment syndrome
4. Remove the client from the cold environment
5. Immerse the feet in warm water of 105°F to 115°F (40.6°C to 46.1°C)
A. 4, 1, 5, 3, 2
B. 1, 5, 3, 4, 2
C. 1, 4, 5, 2, 3
D. 1, 5, 4, 3, 2
E. 4, 1, 5, 2, 3
19. An elderly maintenance staff is lying on the floor and the ED nurse responds to a call for help. List the order in which the nurse must carry out the following actions.
1. Establish unresponsiveness
2. Call for help and activate the code team
3. Perform the chin lift or jaw thrust maneuver
4. Instruct the nurse assistant to get the crash cart
5. Initiate cardiopulmonary resuscitation (CPR)
A. 1, 2, 3, 4, 5
B. 1, 2, 3, 5, 4
C. 2, 1, 3, 4, 5
D. 2, 1, 3, 5, 4
E. 4, 1, 2, 3, 5
20. Which task is most appropriate to assign to the nursing assistant when an instantaneous death transpires in the ED? (Select all that apply.)
1. Assisting with postmortem care
2. Escorting the family to a place of privacy
3. Going with the organ donor specialist to talk to the family
4. Helping the family to collect belongings
B. 1 and 2
C. 2, 3, and 4
D. 1, 2, 3, and 4
Answers and Rationale
1. Answer: B. 1, 2, 4, 3
- Option B: Prioritization. (1) The abandoned person has symptoms of heat stroke, a medical emergency, which heightens the risk of brain damage. (2) The elderly traffic enforcer is at risk for heat syncope and should be instructed to relax in a cool environment and withdraw from approaching related circumstances. (4) The sportsman is experiencing heat cramps, which can be treated with rest and fluids. (3) The homemaker is having heat exhaustion and management includes IV or oral fluids and settle in a cool area.
2. Answer: B. Performing chest compressions
- Option B: Delegation. Basic cardiac life support is learned by nursing assistants so they can perform chest compressions.
- Option A: The nurse or the respiratory therapist should provide assistance as needed during intubation.
- Option C: The defibrillator pads are accurately labeled; nevertheless, the responsibility of placing them should be done by the RN or physician because of the potential for skin damage and electrical arcing.
- Option D: The use of the bag valve mask demands practice, and normally, a respiratory therapist will implement this measure.
3. Answer: C. “He pulled the stick out because it was too painful for him.”
- Option C: Prioritization. An impaled object may be giving a tamponade effect, and removal can result in abrupt hemodynamic decompensation.
- Options A and B: Information such as the dirt on the stick or history of diabetes, is significant in the overall treatment plan but can be addressed next.
- Option D: Additional history including a more precise extent of blood loss, depth of penetration, and medical history should be collected.
4. Answer: D. The ingested children’s chewable vitamins contain iron.
- Option D: Prioritization. Iron is a toxic substance that can lead to severe bleeding, shock, hepatic failure, and coma. The antidote that can be used for severe cases of iron poisoning is deferoxamine.
- Options A, B, and C: The other data required further evaluation but will not change the immediate diagnostic testing or treatment plan.
5. Answer: D. 6, 2, 1, 4, 3, 5
- Option D: Prioritization. (6) The 68-year-old man with pulsating mass is experiencing abdominal aneurysm that may rupture, and he may abruptly deteriorate. (2) The 25-year-old woman with lower left quadrant pain is at risk for ectopic pregnancy, which is a life-threatening condition. (1) The 12-year-old girl needs evaluation to rule out appendicitis. (4) The 42-year-old woman with vomiting needs evaluation for gallbladder problem, which seems to be worsening. (3) The 38-year-old man has food poisoning, which is usually self-limiting. (5) The 53-year-old man with mid-epigastric pain may have ulcer, but followup diagnostic testing and educating lifestyle modification can be scheduled with the primary health care provider.
6. Answer: A. Fast-track clinic
- Option A: Assignment. The ambulatory or fast-track clinic deals with relatively stable clients.
- Options B, C, and D: The pediatric medicine, trauma, and triage areas should be staffed with trained and experienced nurses who are familiar with the hospital routines and policies and can quickly locate equipment.
7. Answer: C. A deviated trachea
- Option C: Prioritization. A deviated trachea is a symptom of tension pneumothorax, which will result in respiratory arrest if not managed.
- Options A, B, and D: The remaining options are of lower priority but still need to be addressed.
8. Answer: A. An individual who was injured and trapped for 8 hours before rescue
- Option A: Prioritization. Any of these victims may need or require psychiatric counseling. There will be changes in previous coping skills and support groups; nevertheless, the individual who encountered threat to his or her own life is at the greatest chance of having psychiatric difficulties following a disaster incident.
9. Answer: C. 3, 4, 5, and 7
- Option C: Prioritization. Children will be more prone to head trauma, hypothermia, hypoxemia, and liver and spleen injuries. They have proportionately larger heads that predispose them to head injuries or trauma. Hypothermia is more likely due to their thinner skin and proportionately larger body surface area. Hypoxemia is more likely because of their higher oxygen demand. Liver and spleen injuries are more likely due to the thoracic cage of children gives less protection.
- Options A, B, D, and E: Children have strong hearts; hence pulse rate will increase to compensate, but other arrhythmias are less likely to occur. They have almost flexible bones compared with those adults. Injury to the cervical area is the most likely spinal injury in children.
10. Answer: B. Completing a brief neurological assessment
- Option B: Prioritization. A brief neurologic assessment to ascertain level of consciousness and pupil reaction is part of the primary survey.
- Options A, C, and D: Vital sign measurements, monitoring pulse oximetry readings, and assessment of abdomen are basically part of the secondary survey.
11. Answer: B. Allow the student to breathe into a paper bag
- Option B: Prioritization. The student is hyperventilating secondary to anxiety, and breathing into paper bag will provide rebreathing of carbon dioxide. Encouraging slow breathing will also help.
- Options A and D: Other options such as oxygen and drug administration may be needed if other causes are known.
12. Answer: A. 2, 4, 3, 6, 1, 5
- Option A: Prioritization. First, initiate an albuterol treatment for the 11-year-old with asthma. This action is quick to perform, and the child or significant other can be instructed to hold the apparatus while the nurse attends to other clients. The firefighter is in greater respiratory distress that the 11-year-old; nevertheless, maintaining a strong combative client is demanding and time-consuming. The 11-year-old may die if the nurse consumes too much time attempting to control the firefighter. Next, attend the 19-year-old with a crush injury. Anxiety and tachycardia may be due to the pain or stress; yet, the swelling hints hemorrhage. Take care of the grandmother with burns on the forearms next by providing dressings and pain management. Then, give comfort measures to the child with burns over more than 70% of the anterior body; however, prognosis is very poor. The prognosis of the client in cardiac arrest is also very poor, and the CPR attempts have been held.
13. Answer: A. 1, 2, 3, 8, and 9
- Option A: Prioritization. The following would be appropriate for disaster triage. The other options would be discussed when the staff has time and means to collect additional data. It would be appropriate to include all items during nondisaster circumstances.
14. Answer: C. Assist clients in the decontamination area
- Option C: Prioritization. Decontamination in a specified area is the priority.
- Options A and B: Doing assessments and transferring others delay decontamination and do not protect the total environment. Donning personal protective equipment and measures is vital before assisting with decontamination or assessing the clients.
- Option D: The clients must undergo decontamination before entering cold or clean zones.
15. Answer: B. Risk for Injury related to seizures
- Option B: Prioritization. Client safety is the priority because the driver exhibits neurologic hyperactivity and is on the verge of a seizure. Medications such as chlordiazepoxide (Librium) is needed to decrease neurologic irritability and phenytoin (Dilantin) for seizures. Thiamine and haloperidol (Haldol) may also be ordered to treat other problems.
- Options A, C, and D: The other diagnoses are related but less necessary.
16. Answer: A. Supply oxygen via nasal cannula
- Option A: Prioritization. Increasing myocardial oxygenation is the priority goal.
- Options B, C, and D: The other actions are also appropriate and should be done immediately.
17. Answer: B. Assist the child in removing outer garments
- Option B: Delegation. The nursing assistant can assist with the elimination of outer garments, which enables the heat to dissipate from the child’s skin.
- Option A: Tepid baths are not usually given because of the potential for rebound and shivering.
- Options C and D: Advising and educating are teaching functions that are the responsibility of the RN.
18. Answer: E. 4, 1, 5, 2, 3
- Option E: Prioritization. Initially, the client should be removed from the cold environment. Pain medication should be given before immersing the feet in warm water to lessen the discomfort. The client should be monitored for compartment syndrome every hour after initial treatment.
19. Answer: B. 1, 2, 3, 5, 4
- Option B: Prioritization. First, establish unresponsiveness. Get help and activate the code team if client is unresponsive. To open the airway, perform chin lift or jaw thrust maneuver. Then start CPR. CPR should not be interrupted until the client recovers or it is determined that all heroic efforts have been exhausted. A crash cart should be present at the site when the code team arrives; however, basic CPR can be definitely performed until the team is present.
20. Answer: A. 1
- Option A: Delegation. Postmortem care demands some turning, cleaning, lifting, and so on, and the nursing assistant is equipped and authorized to assist with these responsibilities. The RN should be responsible for the other duties mentioned to help the family begin the grieving process. In case of uncertain death, belongings may be preserved for evidence, so the chain of custody would have to be maintained.
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