Study guide

10+ PNLE Delegation and Supervision of Unlicensed Assistive Personnel (UAP) Review Questions Study Guide and Review Materials

NP6 — PALMR· 10+ questions

Cognitive level

Where these questions land on Bloom's taxonomy.

L1 Remembering

L2 Understanding

L3 Applying

50%

L4 Analyzing

L5 Evaluating

50%

L6 Creating

Topic distribution

Common themes across 10+ questions in this area.

Patient Safety

Delegation

Assessment

Leadership

Fundamentals of Nursing

Mental Health

Nursing Administration

Infection Control

Vital Signs

Pediatrics

Community Health

Introduction

This topic looks “common sense” until the PNLE turns it into a landmine. I’ve seen smart people miss easy points because they delegated the right task to the wrong person, or they delegated without the one thing the exam wants: accountability.

On the PNLE, delegation and supervision of UAP shows up as priority questions disguised as staffing questions. You’ll get short clinical scenarios, then a “Which task can the RN delegate?” or “Which client assignment is best for the nursing assistant?” and the options are all stuff you’ve seen on duty. The trick is that one option quietly involves assessment, teaching, clinical judgment, or an unstable patient, and that’s your hard stop.

What trips people up is mixing up “UAP can do this in real life” with “UAP can do this on the PNLE.” The exam is strict: predictable, routine, and no interpretation. Master the rules and you stop guessing, which is the whole point. Let’s make this one of your free points.

Key concepts

Five Rights of Delegation
What it is: A safety framework, right task, right circumstances, right person, right direction/communication, right supervision/evaluation.
Why PNLE cares: They test which task is safe to delegate given the patient’s stability and the setting, then who should do it.
Common trap: Picking a “simple” task but ignoring unstable circumstances, like a “routine” VS on a fresh postop with low BP.

RN vs UAP, Assessment, Teaching, Judgment
What it is: UAP can perform routine, noninvasive tasks, but the RN keeps assessment, nursing diagnosis, planning, teaching, evaluation, and clinical judgment.
Why PNLE cares: Many items are basically “Is this an assessment or interpretation?” disguised as a task list.
Common trap: Delegating “check pain level,” “evaluate breathing,” or “teach incentive spirometer,” because it sounds like “just asking questions.”

Stable vs Unstable, Predictable vs Unpredictable
What it is: Delegate to UAP when the patient is stable and the outcome is predictable, keep RN care for unstable or changing conditions.
Why PNLE cares: Client condition is the real answer key, not the task itself.
Common trap: Delegating to UAP for a chronic diagnosis that suddenly became unstable, like CKD patient who is now confused and hypotensive.

What UAP Can Commonly Do (and how PNLE phrases it)
What it is: ADLs, ambulation, feeding stable patients, routine VS, I&O, specimen collection, bed making, positioning, non-sterile basic care.
Why PNLE cares: Options often include one “legal” UAP task and three that sneak in assessment, teaching, or risk.
Common trap: Choosing feeding for a patient with dysphagia or neuro deficits, the task is “feeding” but aspiration risk makes it RN/closer supervision.

UAP Red Flags, Lines, Drains, High-Risk Devices
What it is: UAP usually should not manage tasks requiring sterile technique, invasive lines, titration, or interpretation (IV meds, central lines, chest tubes, traction care specifics).
Why PNLE cares: They love device-related scenarios, the safest choice is often basic care around the device, not the device itself.
Common trap: Delegating pin site assessment, traction adjustment, or troubleshooting alarms because “it’s just equipment.”

Clear Directions, Expected Findings, When to Report
What it is: RN must give specific instructions, what to do, what to measure, and exactly what findings require reporting immediately.
Why PNLE cares: “Right direction/communication” shows up as the best instruction or the best follow-up after delegating.
Common trap: Giving vague orders like “watch him closely” instead of “report RR < 12, SpO2 < 94%, new confusion, or SBP < 90.”

Supervision and Follow-up
What it is: Delegation is not dumping tasks, the RN evaluates outcomes and reassesses the patient as needed.
Why PNLE cares: A common question is “After delegating, what should the RN do?” and the answer is usually evaluate or reassess, not “document and move on.”
Common trap: Thinking supervision means “be nearby,” when it also means verifying completion and interpreting results.

Appropriate Assignment Patterns (Team workloads)
What it is: UAP assignment goes to stable, predictable care needs, while RN keeps unstable, new admits, fresh postop, complicated education, and complex assessments.
Why PNLE cares: Assignment questions are delegation questions with different packaging.
Common trap: Assigning the nursing assistant to the most time-consuming patient even if the patient is high risk, like neuro checks or aspiration precautions.

What to expect on the PNLE

Expect around 2 to 5 questions across NP6 leadership and management blocks that are directly delegation or supervision flavored, and several more that indirectly test it through assignment and safety scenarios.

Most items are clinical scenario application and priority style. You will rarely get pure definition questions, they’ll give you a patient with devices, neuro issues, or renal failure, then ask what can be delegated or who should do it.

Scenarios that keep showing up: fresh postop or unstable VS, neuro patients needing checks (SCI, stroke, head injury), traction or complex devices, and patients with aspiration risk (Parkinson’s, dysphagia).
Pattern that catches people: the option starts like a UAP task, then ends with an RN-only verb, “assess,” “evaluate,” “teach,” “interpret,” “determine,” “monitor for complications.” That last verb flips the whole option to RN-only.
What trap answers look like: technically within what a UAP might do, but not the priority because the patient is unstable or the task requires judgment. Another trap is delegating to “save time” instead of delegating for safety.

If you can quickly label each option as task-only vs judgment-required, you’ll answer faster and with way less stress.

Study tips

Use the “A-T-E-E” filter before you delegate: If the task involves Assessment, Teaching, Evaluation, or Emergency potential, it stays with the RN. This shortcut is not fancy, but it stops you from overthinking. Run every option through A-T-E-E and eliminate fast.
Make a two-column table tonight: Left column “UAP can do,” right column “RN must do.” Fill it with at least 15 items, include VS, I&O, ambulation, feeding, specimen collection, then contrast with neuro checks, pain assessment, discharge teaching, IV meds, wound assessment. Keep it beside you when you answer practice questions until it’s automatic.
Drill the “unstable patient” tells: Fresh postop, new admit, new fever, new confusion, new SOB, chest pain, active bleeding, changing LOC, hypotension, uncontrolled pain. Anytime the scenario says “new” or “sudden,” your delegation options shrink hard. Write these tells on one index card.
Practice giving instructions out loud: Take a basic task like I&O, then say, “Measure urine output every shift, report output < 30 mL/hr or dark tea-colored urine.” This trains you for questions asking the best direction/communication. It also forces you to think like an RN supervisor, not a task doer.
Do hard questions in sets, not random: Since most of the available items are hard, do 3 to 5 delegation questions in a row on tangerine. After each, write one sentence: “The dealbreaker was assessment/instability/teaching.” Patterns show up fast when you do them back-to-back.

Common mistakes to avoid

“But it’s just vital signs”: You read the question, you see a UAP taking BP and you think, “Perfect, routine.” Your gut picks the fresh postop patient because you want the RN free for meds. But the PNLE wants you to keep UAP on stable patients, because postop hypotension and bleeding are time-sensitive and need RN assessment if abnormal.
Delegating the measurement that actually needs interpretation: You see “monitor intake and output” and you delegate it, because UAP can measure. But the option quietly adds “and determine if the patient is dehydrated” or “decide if urine output is adequate.” That last part is evaluation, and the RN owns it.
Feeding the wrong patient: You see “assist with meals” and you pick it fast. The scenario includes Parkinson’s, stroke, dysphagia, or decreased LOC, and aspiration risk is screaming, even if the question doesn’t say “aspiration.” The PNLE wants RN assessment or at least tight RN-controlled planning for feeding and swallowing safety.
Forgetting that delegation includes follow-up: You delegate ambulation and then you choose “document completion” as the next step because it sounds responsible. The PNLE wants “evaluate response,” like checking orthostatic BP, gait safety, pain, or oxygenation after ambulation. Documentation matters, but it comes after you confirm the patient tolerated it.
Assigning based on who is “available”: You read staffing questions and you start matching tasks to whoever has time. The exam punishes that. It wants safe matching based on stability, predictability, and scope, even if it means the RN keeps the heavier patient load.

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A real Delegation and Supervision of Unlicensed Assistive Personnel (UAP) question from our bank. Give it a shot.

Medium

The main responsibility of the nurse when the physician obtains the informed consent is:

Explain the procedure, alternatives, prognosis and diagnosis

Listen to the physician’s explanation

Make sure that the client fully understood the instructions, the consent was given voluntarily, the signature is authentic and the client is competent when receiving the consent.

Make sure that the client fully understood the instructions, the consent was given voluntarily, the signature is authentic and the client is competent when giving the consent.

Rationale

The nurse’s primary responsibility during the process of obtaining informed consent is to act as a patient advocate and witness. This means ensuring that the client fully understands the information provided by the physician, that the consent is given voluntarily without coercion, that the signature is authentic, and that the client is competent at the time of signing the consent form.

Key Nursing Responsibilities in Informed Consent
Assess client understanding of the procedure and information provided
Confirm that the client is signing voluntarily, without pressure or undue influence
Verify the authenticity of the client’s signature
Ensure the client is legally and mentally competent when signing

Why D is Correct:

The nurse must ensure the client is competent and understands the procedure, risks, benefits, and alternatives at the time of giving consent. The nurse also verifies the signature and that consent is voluntary. This aligns with legal and ethical standards in nursing practice, emphasizing advocacy and protection of client rights.
The phrase "when giving the consent" is crucial. The nurse’s role is not just to check understanding at any time, but specifically at the moment the client is providing consent, ensuring all criteria are met.

Why the Other Options are Incorrect:

A. Explain the procedure, alternatives, prognosis and diagnosis:
- This is the physician’s responsibility, not the nurse’s. According to legal and ethical guidelines, only the healthcare provider performing the procedure should explain these aspects, as they are qualified to discuss risks, benefits, and alternatives in detail.
B. Listen to the physician’s explanation:
- While the nurse may be present, simply listening does not fulfill the nurse’s advocacy role. The nurse must actively assess the client’s understanding and voluntariness, not just observe the physician.
C. Make sure that the client fully understood the instructions, the consent was given voluntarily, the signature is authentic and the client is competent when receiving the consent:
- The phrase "when receiving the consent" is incorrect. The nurse must ensure these criteria are met at the time the client is actually giving (signing) consent, not just when the form is received by the healthcare team.

Underlying Concepts:

Informed consent is both a legal and ethical process. The nurse acts as a witness and advocate, not as the primary educator about the procedure. The nurse’s role is to ensure the client’s rights are protected, and that the consent is valid and legally defensible.
If the nurse suspects the client does not understand or is not competent, the nurse must notify the physician and withhold the signature until clarification is provided.

Clinical Pearl:

Remember: The nurse does NOT explain the procedure in detail, that is the physician’s role. The nurse ensures understanding, voluntariness, authenticity, and competence at the time of signing.

Udan's Comprehensive Nursing Lecture Review Book, Udan's Nursing Review Book (Green Book), Philippine Nursing Law (RA 9173), Potter & Perry's Fundamentals of Nursing

More Delegation and Supervision of Unlicensed Assistive Personnel (UAP) questions

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Question 2 Medium

Charge Nurse Sharmaine is planning patient assignments for the night shift staff. Which task can be safely delegated to a nursing assistant?

Assist client with a new colostomy in practicing his first colostomy irrigation

Obtain a stool specimen from a client with diarrhea

Evaluate the voiding pattern for a client who had a urinary retention catheter removed

Obtain a dietary history from a client with peptic ulcer disease

See answer and rationale

Question 3 Medium

A nurse is working on a medical-surgical floor and is managing the delegation of tasks for the evening shift. Which task should the nurse delegate to a nursing assistant?

Evaluate the voiding pattern for a client who had a urinary retention catheter removed

Conduct a dietary interview for a client with peptic ulcer disease

Guide a client with a new colostomy in performing their initial colostomy irrigation

Collect a stool specimen from a client experiencing diarrhea

See answer and rationale

Question 4 Hard

A registered nurse is organizing the care tasks for the shift and needs to delegate appropriately to unlicensed assistive personnel (UAP). Which task should the nurse delegate to ensure safe and effective care?

Assist with a complete bed bath for a 2-year-old who has sustained multiple injuries from a fall

Check the IV site of a preschooler receiving treatment for Kawasaki disease

Administer an oatmeal bath to an infant diagnosed with eczema

Monitor the intake and output of a comatose toddler patient who has salicylate poisoning

See answer and rationale

Practice questions

Q: An RN is caring for four clients on a medical ward. Which task is most appropriate to delegate to a UAP?

A. Teach a client newly diagnosed with diabetes how to use a glucometer / B. Obtain routine vital signs for a stable client with hypertension / C. Assess a client’s pain level 30 minutes after IV analgesic administration / D. Evaluate the effectiveness of oxygen therapy in a client with COPD

Answer: B. Routine vital signs for a stable client are predictable and do not require clinical judgment, making them appropriate for UAP. Choice C is tempting because it sounds like “just checking,” but post-medication pain reassessment is evaluation, which stays with the RN. View more questions

Q: A nurse is delegating tasks during a busy shift. Which instruction best demonstrates the right direction/communication when assigning urine output monitoring to a UAP?

A. “Monitor the urine output and let me know if it’s low.” / B. “Measure urine output every 4 hours and report if it is less than 30 mL/hour or if urine becomes tea-colored.” / C. “Encourage fluids and report if the client looks dehydrated.” / D. “Record the intake and output and decide if the client needs more IV fluids.”

Answer: B. Delegation requires clear parameters for what to do and exactly when to report, using objective thresholds. Choice A is vague and delays escalation, while D adds evaluation and treatment decisions that require RN judgment. View more questions

Q: The RN has a UAP available to assist with morning care. Which client is the best assignment for the UAP?

A. A 2-hour postoperative client after abdominal surgery with a BP of 88/56 mmHg / B. A client with new-onset confusion and a temperature of 38.8 C / C. A stable client with Parkinson’s disease who needs assistance with bathing and dressing / D. A client admitted 1 hour ago for shortness of breath requiring initial assessment

Answer: C. Stable clients with predictable needs like bathing and dressing are appropriate for UAP assignment. Choice C may make you worry about Parkinson’s, but basic ADLs are fine when the client is stable and the RN has assessed safety needs. The others involve instability or new assessment needs. View more questions

Q: A client with acute renal failure has a Foley catheter and strict I&O. Which task can the RN safely delegate to the UAP?

A. Interpret the urine output trend and determine if oliguria is present / B. Teach the client why fluid restriction is necessary / C. Empty the Foley bag and record urine output at the end of the shift / D. Assess the client for signs of fluid overload such as crackles and edema

Answer: C. Emptying the Foley bag and accurately recording output are measurable, routine tasks suitable for UAP. Choice D is tempting because it sounds like “just checking,” but lung sounds and edema assessment require nursing assessment skills and judgment. View more questions

Q: A nurse is caring for a client in halo traction. Which task is appropriate to delegate to a UAP?

A. Assess pin sites for redness and drainage / B. Tighten the halo vest straps as needed / C. Provide oral care and assist with feeding after the RN verifies swallowing is safe / D. Perform neurovascular checks every 2 hours

Answer: C. Basic hygiene and feeding assistance can be delegated if the RN has assessed safety, especially swallowing and aspiration risk. Choice A is tempting because it looks like “just looking,” but pin site assessment is assessment and early infection detection, which the RN should perform. View more questions

Q: A client with spinal cord injury is at risk for autonomic dysreflexia. Which task should the RN keep rather than delegate to a UAP?

A. Reposition the client every 2 hours / B. Measure and record routine vital signs for a stable client / C. Assess a sudden complaint of pounding headache and facial flushing / D. Assist with passive range-of-motion exercises as prescribed

Answer: C. A sudden headache and flushing in SCI can indicate autonomic dysreflexia, which is an emergency requiring rapid RN assessment and intervention. The other tasks are routine and predictable when the client is stable. The PNLE is checking if you recognize the unstable change, not whether you know ROM exercises. View more questions

Q: A nurse is delegating ambulation to a UAP for a client with Parkinson’s disease. Which action by the RN is the best example of right supervision/evaluation?

A. Ask the UAP to ambulate the client and report back “if anything happens” / B. Reassess the client’s gait stability and orthostatic blood pressure after the first ambulation session / C. Tell the family to assist with walking to promote independence / D. Document that ambulation was delegated to the UAP

Answer: B. The RN must evaluate outcomes and patient response, especially fall risk and orthostatic changes after ambulation. Choice D is tempting because it feels “legal,” but documentation does not replace checking how the patient tolerated the activity. View more questions

References and further reading

Joint Statement on Delegation by ANA and NCSBN (American Nurses Association & National Council of State Boards of Nursing) — 2019 organization
Authoritative joint position statement describing the 2019 National Guidelines for Nursing Delegation, including distinctions between delegation vs assignment and the RN’s responsibilities for supervision and evaluation.
New National Guidelines on Delegation | 2019 (NCSBN Year in Review story page) organization
Official NCSBN overview of the updated delegation model and rationale for standardizing delegation decisions across nursing licensure levels, useful for reinforcing PNLE-style concepts.
Position Statements & Decision Trees — Delegation to UAP (North Carolina Board of Nursing) government
Regulatory-board educational resource providing delegation decision trees and related position statements that can be used to build stepwise delegation/supervision algorithms for study guides.
Unlicensed Assistive Personnel (UAP) (North Carolina Department of Health and Human Services) government
Government resource defining UAP and linking to delegation decision support, helpful for clarifying scope and common UAP roles/titles in delegation questions.
Effective Delegation: Understanding Responsibility, Authority, and Accountability (Journal of Nursing Regulation) journal
Peer-reviewed article detailing the delegation process and the RN’s accountability, supporting exam rationales on what can/cannot be delegated and why supervision is required.
A scoping review of registered nurses' delegating care and support to unlicenced care and support workers (Journal of Clinical Nursing) — PubMed record journal
Recent evidence synthesis on delegation to unlicensed workers that can be used to add research-based context (risks, facilitators, gaps) to supervision/delegation study notes.
Accountability and delegation (Royal College of Nursing) organization
Professional nursing-organization guidance emphasizing accountability, delegation principles, and supervision expectations that map well to core PNLE management/leadership competencies.
DELEGATION AND SUPERVISION (Nursing Management and Professional Concepts) — NCBI Bookshelf textbook
Open educational textbook chapter summarizing delegation and supervision concepts (including the 'five rights of delegation') in a structured format suitable for exam review.

Introduction

Key concepts

What to expect on the PNLE

Study tips

Common mistakes to avoid

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References and further reading

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