NCLEX safe and effective care practice questions
- questions
- 184 questions
- of the exam
- 17–23% of the exam
- test-plan category
- Safe and effective care environment test-plan category
- last updated
- August 2026 last updated
Management of care plus safety and infection control together make the largest block on the test plan. These items rarely test a fact — they test whether you can rank four true things. The 184 questions below are heavy on delegation and prioritization for that reason. Five are free below.
Written and reviewed by Dana Whitfield, RN, MSN · Updated August 2026
Safe and effective care environment
5 free safe and effective care questions
Playable here, no account. Rationales expand in place.
Safe and effective care · free set
1 of 5A nurse on a medical unit receives report on four clients. Which client should the nurse assess first?
Rationale
Prioritization items are airway, breathing, circulation, in that order — the ranking survives every rewording. Audible gurgling around a fresh tracheostomy is a partially obstructed airway and it is the only option that can kill the client in the next few minutes. Fever, post-op pain, and a glucose of 232 are all real problems that need the nurse, just not first.
Answer: C
Which tasks may the registered nurse delegate to unlicensed assistive personnel (UAP)? Select all that apply.
Rationale
Delegate tasks, never the nursing process. Vital signs on a stable client, ambulation of a stable client, and recording intake and output are standardized, predictable, and have a known outcome — all delegable. Teaching and assessment belong to the RN, and the word that gives it away is 'newly': a new inhaler and a new admission both require judgement the UAP is not licensed to make.
Answer: A, C, E
A client with chronic obstructive pulmonary disease has an oxygen saturation of 88% on 2 L/min via nasal cannula and is alert with no distress. What should the nurse do first?
Rationale
In COPD a saturation of 88–92% is the therapeutic target, not an emergency, and this client is alert with no distress. The first action is the independent nursing intervention that is least invasive and most likely to help: sit them up and reassess. Turning the oxygen up to 6 L/min risks blunting the hypoxic drive, and calling rapid response or drawing an ABG escalates ahead of an assessment you have not finished.
Answer: B
Four hours after a cardiac catheterization via the right femoral artery, the nurse notes the client's right dorsalis pedis pulse is now faint and the foot is cool and pale. What is the nurse's priority action?
Rationale
A pulse that was present and is now faint, with a cool, pale extremity distal to the puncture site, is arterial occlusion until proven otherwise — a limb-threatening complication that needs the provider now. Documenting and rechecking wastes the window, warming treats the symptom and masks the change, and asking the client to move the ankle neither restores flow nor gives you new information.
Answer: C
A client admitted with major depressive disorder tells the nurse, "Everyone would be better off without me." Which response is most appropriate?
Rationale
Ask directly. Asking about suicide does not plant the idea, and a veiled statement like this one has to be converted into an assessable answer before anything else happens — including exploring feelings. Reassurance dismisses the statement, deferring to group delays a safety assessment, and 'what made you feel this way' is a therapeutic question in the wrong order: safety first, then exploration.
Answer: B
Breakdown
What is tested in safe and effective care
How the questions in this set are distributed, so you can see what you are buying before you buy it.
| Subtopic | Questions |
|---|---|
| Delegation and supervision | 44 |
| Prioritization | 40 |
| Infection control | 38 |
| Client rights and advocacy | 32 |
| Accident and injury prevention | 30 |
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