A.L.L.
coyura Academy
NCLEX-RN
PRIORITISATION
& DELEGATION
Study Guide + Practice Questions
Master every priority framework, delegation principle, triage system, and time-management
strategy tested on the NCLEX-RN — with 60 scenario-based practice questions.
— What's Inside: — — You Will Master: —
• ABCs, Maslow & ADPIE frameworks • Apply ABCs and Maslow to any scenario
• The 5 Rights of Delegation by role • Know exactly what RN, LPN, UAP can do
• Stable vs. unstable patient decisions • Distinguish urgent from routine findings
• Triage: START, SIEVE & emergency triage • Triage 4+ patients simultaneously
• Time management & shift organisation • Organise a full shift with competing needs
• Acute vs. expected finding decisions • Recognise the unexpected that always wins
• Multiple-patient priority scenarios • Choose which patient to see first — why
• Assignment & charge nurse responsibilities • Make safe charge nurse assignment decisions
Prioritisation and delegation are not separate topics — they are a single clinical mindset.
Priority Delegation Triage &
Frameworks By Role Assignments
Created by ALLcoyura Academy
,A.L.L.
coyura Academy
PRIORITY FRAMEWORKS — ABCs, MASLOW & DECISION RULES
Every NCLEX priority question uses one of these frameworks — know them cold and apply systematically.
THE ABCs — Airway, Breathing, Circulation
Priority Level Clinical Application & NCLEX Rule
Airway — Any actual or potential airway obstruction takes absolute priority. Stridor, angioedema, foreign body, epiglottitis, altered
ALWAYS FIRST consciousness with snoring = immediate action.
Breathing Once airway is secured, assess breathing. Apnoea, RR <8 or >30, O2 sat <90%, severe dyspnoea, Cheyne-Stokes = next
priority.
Circulation After airway and breathing are addressed. Pulselessness, BP <90 systolic, uncontrolled haemorrhage, shock signs = circulation
priority.
Exception to When circulation is CATASTROPHICALLY compromised and cannot wait (pulseless VF, massive haemorrhage), act on
ABCs circulation simultaneously with airway.
ABCs vs. Maslow If two patients both have physiological needs — use ABCs to differentiate. A patient with a blocked airway beats a patient with
low blood pressure.
MASLOW'S HIERARCHY — When ABCs Are Equal: DECISION RULES — The Universal NCLEX Priority Principles:
Maslow Level Priority Application Decision Rule How to Apply on NCLEX
Level 1 — Oxygen, food, water, elimination, warmth, sleep. Actual before potential An existing problem always takes priority
Physiological ALWAYS before psychosocial needs. O2 sat 88% over a risk for a problem. Active bleeding
before anxiety. before bleeding risk.
Level 2 — Physical safety, security, freedom from harm. Falls, Acute before chronic A new, sudden, or worsening problem in a
Safety restraints, environmental hazards. chronic condition takes priority over the
stable baseline.
Level 3 — Social relationships, family connections. Important
Love/Belonging but after physiological and safety needs. Unstable before stable Unstable vital signs, deteriorating
condition = priority over stable, expected
Level 4 — Self-worth, achievement, recognition. Address after findings.
Esteem lower needs are met.
Unexpected before A finding that is NOT expected for the
Level 5 — Reaching full potential, growth, creativity. The expected diagnosis/post-op state is more urgent
Self-Actualisation highest level — reached last. than an expected one.
NCLEX Physiological needs (Levels 1-2) ALWAYS come Assess before Always assess first (unless in an
Application before psychosocial (Levels 3-5). A client in pain intervene emergency requiring immediate action like
beats a client who is lonely. CPR or haemorrhage control).
Life-threatening first Any finding that threatens life immediately
(airway, breathing, circulation,
neurological) supersedes all other needs.
Objective before A measurable abnormal finding (low O2
subjective sat, low BP) is more urgent than a
reported complaint alone.
New symptoms win Sudden onset, new, or rapidly worsening
symptoms are always higher priority than
chronic, stable complaints.
Created by ALLcoyura Academy Page 2
,A.L.L.
coyura Academy
DELEGATION — SCOPE OF PRACTICE BY ROLE
Delegation is tested on every NCLEX. Know exactly what each role CAN and CANNOT do.
FIVE RIGHTS OF DELEGATION — The Foundation
Right Explanation & Clinical Application
Right Task The task must be within the delegatee's scope of practice and explicitly permitted by facility policy.
Right Circumstances The clinical setting, client condition, available resources, and supports are appropriate for delegation.
Right Person The specific individual delegatee has demonstrated competence to perform this specific task safely.
Right The RN gives clear, specific instructions: task, client, expected outcome, time frame, when to report.
Direction/Communication
Right Supervision The RN remains accountable: monitors, evaluates outcomes, is available for questions. Accountability NEVER transfers.
RN-ONLY TASKS (CANNOT BE DELEGATED): LPN/LVN SCOPE (STABLE CLIENTS):
RN-Only Task Why It Cannot Be Delegated LPN/LVN Task Scope & Conditions
Initial nursing The first comprehensive assessment of any new Medication Oral, subcutaneous, IM medications for stable
assessment client or any acute change in condition — RN administration clients. May collect medication-related data.
only.
Wound care & Routine wound care, dressing changes, wound
Care plan Nursing diagnosis, planning, and evaluation of dressing changes assessment on stable wounds.
development outcomes — requires professional judgment.
Foley catheter Urinary catheterisation in stable clients — within
Client education All teaching requiring assessment of learning insertion LPN scope in most states.
readiness, individualised instruction, and
evaluation of understanding. IV maintenance Monitoring and maintaining existing IV infusions
in many states (not initiation in all states).
Discharge Coordinating services, teaching, referrals —
planning requires RN assessment and professional Data collection Collecting objective data (vital signs, I&O,
judgment. wound appearance) and reporting to the RN.
IV push All IV push medications — requires immediate Reinforcing Can reinforce and remind — but cannot
medications assessment of response. (Exception: some teaching INITIATE or DEVELOP the teaching plan.
states allow LPN IV access maintenance.)
Stable chronic Managing clients with established, predictable,
Interpreting data Drawing clinical conclusions from assessment clients stable conditions with expected outcomes.
data — RN professional responsibility.
Cannot do Initial assessments, care planning, IV push
Unstable clients Any client with unpredictable, changing, or meds, unstable client assessment, interpreting
deteriorating condition. Acute symptoms, new complex data.
diagnosis, immediate post-op.
Blood Initiating blood products — RN only. (LPN may
transfusions monitor stable transfusion in some states.)
UAP/CNA/PATIENT CARE TECHNICIAN SCOPE
UAP Task Scope & Conditions
Activities of Daily Bathing, grooming, dressing, oral care, hair care, nail care (not diabetic nail care), toileting.
Living
Vital signs — stable Temperature, pulse, respirations,Created
blood pressure, O2 sat Academy
by ALLcoyura on stable clients with predictable conditions. Page 3
clients
I&O measurement Measuring and recording fluid intake and output — reporting findings to RN.
, A.L.L.
coyura Academy
TRIAGE SYSTEMS — ED, MASS CASUALTY & DISASTER TRIAGE
Triage principles and systems appear on the NCLEX — know standard ED triage and mass casualty (START).
EMERGENCY DEPARTMENT TRIAGE — ESI (Emergency Severity Index)
ESI Level Description, Examples & Wait Time
ESI Level 1 — Immediately life-threatening. Examples: cardiac arrest, unresponsive, severe respiratory failure. Seen IMMEDIATELY.
Resuscitation
ESI Level 2 — High risk situation or acute deterioration. Severe pain, altered mental status, high-risk chief complaint. Seen within minutes.
Emergent
ESI Level 3 — Stable but requires multiple resources (labs, imaging, IV). Examples: abdominal pain, chest pain (stable), fracture. Wait up to
Urgent 30-60 min.
ESI Level 4 — One resource needed. Mild pain, simple laceration, UTI symptoms, non-emergency prescription refill.
Less Urgent
ESI Level 5 — No resources needed. Simple complaint, routine follow-up, prescription renewal only. Can wait the longest.
Non-Urgent
START TRIAGE — Mass Casualty Incident (MCI): SIEVE TRIAGE (UK/Disaster) & Key Principles:
START Step/Category Decision Rule & Examples SIEVE/Principle Description & NCLEX Application
Step 1 — Walk Can the victim walk? YES = GREEN (Minor). SIEVE — Life-threatening, treatable: airway problem, RR
Move them to safe area and treat last. Immediate (P1) <10 or >29, HR >120, altered consciousness.
Step 2 — Not walking. Is the victim breathing? NO = SIEVE — Urgent Serious injury, stable: serious wounds,
Breathing Reposition airway. If breathing resumes = RED. (P2) fractures, burns without airway compromise.
Still no breathing = BLACK.
SIEVE — Delayed Minor injuries, walking wounded: lacerations,
Step 3 — Breathing. RR >30/min = RED (Immediate). RR (P3) minor burns, anxiety reactions.
Respirations <30/min = go to step 4.
SIEVE — Unsurvivable or requiring resources
Step 4 — Radial pulse present? NO or capillary refill >2 Expectant (P4) disproportionate to benefit in mass casualty.
Perfusion sec = RED. YES = go to step 5.
Key MCI Principle The goal of mass casualty triage is to do the
Step 5 — Mental Can follow commands? NO = RED. YES = GREATEST GOOD for the GREATEST
status YELLOW (Delayed). NUMBER — not to save any one individual at
any cost.
GREEN — Minor Walking wounded. Can wait for care. Treated
last. Examples: lacerations, sprains, minor Reversed from In MCI, the most severely injured may be LAST
fractures. normal (Black/Expectant) — the opposite of normal
clinical priority.
YELLOW — Serious but not immediately life-threatening.
Delayed Stable. Can wait for care after Red clients are Do NOT stop for In mass casualty situations, CPR is generally
treated. CPR NOT performed on pulseless victims —
resources go to survivable injuries.
RED — Immediate Life-threatening but SURVIVABLE with
immediate intervention. Highest priority for care. Re-triage Triage status can change. A Yellow client can
continuously deteriorate to Red. Reassess continuously.
BLACK — Dead or unsurvivable injuries given available
Expectant resources. No respirations after airway
repositioning. Palliate only.
Created by ALLcoyura Academy Page 4
coyura Academy
NCLEX-RN
PRIORITISATION
& DELEGATION
Study Guide + Practice Questions
Master every priority framework, delegation principle, triage system, and time-management
strategy tested on the NCLEX-RN — with 60 scenario-based practice questions.
— What's Inside: — — You Will Master: —
• ABCs, Maslow & ADPIE frameworks • Apply ABCs and Maslow to any scenario
• The 5 Rights of Delegation by role • Know exactly what RN, LPN, UAP can do
• Stable vs. unstable patient decisions • Distinguish urgent from routine findings
• Triage: START, SIEVE & emergency triage • Triage 4+ patients simultaneously
• Time management & shift organisation • Organise a full shift with competing needs
• Acute vs. expected finding decisions • Recognise the unexpected that always wins
• Multiple-patient priority scenarios • Choose which patient to see first — why
• Assignment & charge nurse responsibilities • Make safe charge nurse assignment decisions
Prioritisation and delegation are not separate topics — they are a single clinical mindset.
Priority Delegation Triage &
Frameworks By Role Assignments
Created by ALLcoyura Academy
,A.L.L.
coyura Academy
PRIORITY FRAMEWORKS — ABCs, MASLOW & DECISION RULES
Every NCLEX priority question uses one of these frameworks — know them cold and apply systematically.
THE ABCs — Airway, Breathing, Circulation
Priority Level Clinical Application & NCLEX Rule
Airway — Any actual or potential airway obstruction takes absolute priority. Stridor, angioedema, foreign body, epiglottitis, altered
ALWAYS FIRST consciousness with snoring = immediate action.
Breathing Once airway is secured, assess breathing. Apnoea, RR <8 or >30, O2 sat <90%, severe dyspnoea, Cheyne-Stokes = next
priority.
Circulation After airway and breathing are addressed. Pulselessness, BP <90 systolic, uncontrolled haemorrhage, shock signs = circulation
priority.
Exception to When circulation is CATASTROPHICALLY compromised and cannot wait (pulseless VF, massive haemorrhage), act on
ABCs circulation simultaneously with airway.
ABCs vs. Maslow If two patients both have physiological needs — use ABCs to differentiate. A patient with a blocked airway beats a patient with
low blood pressure.
MASLOW'S HIERARCHY — When ABCs Are Equal: DECISION RULES — The Universal NCLEX Priority Principles:
Maslow Level Priority Application Decision Rule How to Apply on NCLEX
Level 1 — Oxygen, food, water, elimination, warmth, sleep. Actual before potential An existing problem always takes priority
Physiological ALWAYS before psychosocial needs. O2 sat 88% over a risk for a problem. Active bleeding
before anxiety. before bleeding risk.
Level 2 — Physical safety, security, freedom from harm. Falls, Acute before chronic A new, sudden, or worsening problem in a
Safety restraints, environmental hazards. chronic condition takes priority over the
stable baseline.
Level 3 — Social relationships, family connections. Important
Love/Belonging but after physiological and safety needs. Unstable before stable Unstable vital signs, deteriorating
condition = priority over stable, expected
Level 4 — Self-worth, achievement, recognition. Address after findings.
Esteem lower needs are met.
Unexpected before A finding that is NOT expected for the
Level 5 — Reaching full potential, growth, creativity. The expected diagnosis/post-op state is more urgent
Self-Actualisation highest level — reached last. than an expected one.
NCLEX Physiological needs (Levels 1-2) ALWAYS come Assess before Always assess first (unless in an
Application before psychosocial (Levels 3-5). A client in pain intervene emergency requiring immediate action like
beats a client who is lonely. CPR or haemorrhage control).
Life-threatening first Any finding that threatens life immediately
(airway, breathing, circulation,
neurological) supersedes all other needs.
Objective before A measurable abnormal finding (low O2
subjective sat, low BP) is more urgent than a
reported complaint alone.
New symptoms win Sudden onset, new, or rapidly worsening
symptoms are always higher priority than
chronic, stable complaints.
Created by ALLcoyura Academy Page 2
,A.L.L.
coyura Academy
DELEGATION — SCOPE OF PRACTICE BY ROLE
Delegation is tested on every NCLEX. Know exactly what each role CAN and CANNOT do.
FIVE RIGHTS OF DELEGATION — The Foundation
Right Explanation & Clinical Application
Right Task The task must be within the delegatee's scope of practice and explicitly permitted by facility policy.
Right Circumstances The clinical setting, client condition, available resources, and supports are appropriate for delegation.
Right Person The specific individual delegatee has demonstrated competence to perform this specific task safely.
Right The RN gives clear, specific instructions: task, client, expected outcome, time frame, when to report.
Direction/Communication
Right Supervision The RN remains accountable: monitors, evaluates outcomes, is available for questions. Accountability NEVER transfers.
RN-ONLY TASKS (CANNOT BE DELEGATED): LPN/LVN SCOPE (STABLE CLIENTS):
RN-Only Task Why It Cannot Be Delegated LPN/LVN Task Scope & Conditions
Initial nursing The first comprehensive assessment of any new Medication Oral, subcutaneous, IM medications for stable
assessment client or any acute change in condition — RN administration clients. May collect medication-related data.
only.
Wound care & Routine wound care, dressing changes, wound
Care plan Nursing diagnosis, planning, and evaluation of dressing changes assessment on stable wounds.
development outcomes — requires professional judgment.
Foley catheter Urinary catheterisation in stable clients — within
Client education All teaching requiring assessment of learning insertion LPN scope in most states.
readiness, individualised instruction, and
evaluation of understanding. IV maintenance Monitoring and maintaining existing IV infusions
in many states (not initiation in all states).
Discharge Coordinating services, teaching, referrals —
planning requires RN assessment and professional Data collection Collecting objective data (vital signs, I&O,
judgment. wound appearance) and reporting to the RN.
IV push All IV push medications — requires immediate Reinforcing Can reinforce and remind — but cannot
medications assessment of response. (Exception: some teaching INITIATE or DEVELOP the teaching plan.
states allow LPN IV access maintenance.)
Stable chronic Managing clients with established, predictable,
Interpreting data Drawing clinical conclusions from assessment clients stable conditions with expected outcomes.
data — RN professional responsibility.
Cannot do Initial assessments, care planning, IV push
Unstable clients Any client with unpredictable, changing, or meds, unstable client assessment, interpreting
deteriorating condition. Acute symptoms, new complex data.
diagnosis, immediate post-op.
Blood Initiating blood products — RN only. (LPN may
transfusions monitor stable transfusion in some states.)
UAP/CNA/PATIENT CARE TECHNICIAN SCOPE
UAP Task Scope & Conditions
Activities of Daily Bathing, grooming, dressing, oral care, hair care, nail care (not diabetic nail care), toileting.
Living
Vital signs — stable Temperature, pulse, respirations,Created
blood pressure, O2 sat Academy
by ALLcoyura on stable clients with predictable conditions. Page 3
clients
I&O measurement Measuring and recording fluid intake and output — reporting findings to RN.
, A.L.L.
coyura Academy
TRIAGE SYSTEMS — ED, MASS CASUALTY & DISASTER TRIAGE
Triage principles and systems appear on the NCLEX — know standard ED triage and mass casualty (START).
EMERGENCY DEPARTMENT TRIAGE — ESI (Emergency Severity Index)
ESI Level Description, Examples & Wait Time
ESI Level 1 — Immediately life-threatening. Examples: cardiac arrest, unresponsive, severe respiratory failure. Seen IMMEDIATELY.
Resuscitation
ESI Level 2 — High risk situation or acute deterioration. Severe pain, altered mental status, high-risk chief complaint. Seen within minutes.
Emergent
ESI Level 3 — Stable but requires multiple resources (labs, imaging, IV). Examples: abdominal pain, chest pain (stable), fracture. Wait up to
Urgent 30-60 min.
ESI Level 4 — One resource needed. Mild pain, simple laceration, UTI symptoms, non-emergency prescription refill.
Less Urgent
ESI Level 5 — No resources needed. Simple complaint, routine follow-up, prescription renewal only. Can wait the longest.
Non-Urgent
START TRIAGE — Mass Casualty Incident (MCI): SIEVE TRIAGE (UK/Disaster) & Key Principles:
START Step/Category Decision Rule & Examples SIEVE/Principle Description & NCLEX Application
Step 1 — Walk Can the victim walk? YES = GREEN (Minor). SIEVE — Life-threatening, treatable: airway problem, RR
Move them to safe area and treat last. Immediate (P1) <10 or >29, HR >120, altered consciousness.
Step 2 — Not walking. Is the victim breathing? NO = SIEVE — Urgent Serious injury, stable: serious wounds,
Breathing Reposition airway. If breathing resumes = RED. (P2) fractures, burns without airway compromise.
Still no breathing = BLACK.
SIEVE — Delayed Minor injuries, walking wounded: lacerations,
Step 3 — Breathing. RR >30/min = RED (Immediate). RR (P3) minor burns, anxiety reactions.
Respirations <30/min = go to step 4.
SIEVE — Unsurvivable or requiring resources
Step 4 — Radial pulse present? NO or capillary refill >2 Expectant (P4) disproportionate to benefit in mass casualty.
Perfusion sec = RED. YES = go to step 5.
Key MCI Principle The goal of mass casualty triage is to do the
Step 5 — Mental Can follow commands? NO = RED. YES = GREATEST GOOD for the GREATEST
status YELLOW (Delayed). NUMBER — not to save any one individual at
any cost.
GREEN — Minor Walking wounded. Can wait for care. Treated
last. Examples: lacerations, sprains, minor Reversed from In MCI, the most severely injured may be LAST
fractures. normal (Black/Expectant) — the opposite of normal
clinical priority.
YELLOW — Serious but not immediately life-threatening.
Delayed Stable. Can wait for care after Red clients are Do NOT stop for In mass casualty situations, CPR is generally
treated. CPR NOT performed on pulseless victims —
resources go to survivable injuries.
RED — Immediate Life-threatening but SURVIVABLE with
immediate intervention. Highest priority for care. Re-triage Triage status can change. A Yellow client can
continuously deteriorate to Red. Reassess continuously.
BLACK — Dead or unsurvivable injuries given available
Expectant resources. No respirations after airway
repositioning. Palliate only.
Created by ALLcoyura Academy Page 4
