Prioritization Delegation & Assignment Practice Exercises for NCLEX 4th Ed.
Actual Exam 2026/2027 – Complete Test Bank with Detailed Rationales | 100%
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Section A: Guidelines for Prioritization, Delegation, and Assignment
Decisions (8 Questions)
Q1: The nurse is caring for four patients on a medical-surgical unit. Which patient
should the nurse assess first?
A. A patient with chronic osteoarthritis requesting pain medication
B. A patient 2 days post-appendectomy ambulating in the hallway
C. A patient with pneumonia whose oxygen saturation dropped from 94% to 88% on
room air
D. A patient with stable heart failure who needs discharge teaching
Correct Answer: C
Rationale: Using the ABC framework, a dropping oxygen saturation indicates a breathing
problem that requires immediate assessment and intervention. The other patients are
stable or have non-urgent needs.
Q2: Which task is appropriate for the nurse to delegate to an unlicensed assistive
personnel (UAP)?
A. Assessing a postoperative patient's pain level
B. Measuring and recording intake and output for a patient with heart failure
C. Teaching a newly diagnosed diabetic patient about foot care
D. Evaluating the effectiveness of a patient's antihypertensive medication
,Correct Answer: B
Rationale: Measurement and recording of I&O is within the UAP scope of practice.
Assessment, teaching, and evaluation are nursing responsibilities that cannot be
delegated to UAPs per the Five Rights of Delegation.
Q3: A nurse is receiving report on four patients using SBAR communication. Which
patient situation requires the nurse to seek clarification from the off-going nurse?
A. A patient with stable vital signs awaiting discharge
B. A patient with new-onset confusion and a sodium level of 118 mEq/L
C. A patient who received pain medication 30 minutes ago and rates pain as 3/10
D. A patient whose wound dressing was changed and shows no signs of infection
Correct Answer: B
Rationale: New-onset confusion with severe hyponatremia (118 mEq/L) indicates a
potentially life-threatening condition requiring the "Assessment" and "Recommendation"
components of SBAR to determine immediate interventions.
Q4: The charge nurse is making assignments for the shift. Which task is most
appropriate to assign to a licensed practical nurse (LPN)?
A. Developing a plan of care for a patient newly admitted with COPD exacerbation
B. Administering an oral antibiotic to a stable patient with pneumonia
C. Performing the initial assessment on a patient admitted from the emergency
department
D. Analyzing blood gas results and adjusting the ventilator settings
Correct Answer: B
Rationale: Administering oral medications to stable patients is within LPN scope of
practice. Initial assessment, care planning, and complex clinical analysis requiring RN
judgment are RN responsibilities.
Q5: A nurse is prioritizing care for four patients. Using Maslow's Hierarchy of Needs,
which patient need should be addressed first?
,A. A patient who is anxious about an upcoming cardiac catheterization
B. A patient with a potassium level of 6.8 mEq/L and peaked T-waves on ECG
C. A patient requesting help contacting family members
D. A patient who wants information about community support groups
Correct Answer: B
Rationale: Physiologic needs take priority in Maslow's hierarchy. Hyperkalemia with ECG
changes is a life-threatening physiologic problem requiring immediate intervention.
Anxiety, social contact, and self-actualization needs are higher-level priorities.
Q6: Which actions demonstrate proper supervision of delegated tasks? (Select all that
apply.)
A. The RN observes the UAP correctly using a transfer belt when ambulating a patient
B. The RN asks the UAP to report back after completing a blood glucose check
C. The RN assumes the UAP performed perineal care because the patient appears clean
D. The RN provides immediate feedback when noticing improper hand hygiene
technique
E. The RN delegates a sterile dressing change and does not follow up until end of shift
Correct Answer: A, B, D
Rationale: Proper supervision includes direct observation, clear communication with
follow-up, and immediate corrective feedback. Assuming tasks were completed without
verification and failing to follow up on delegated tasks are examples of improper
supervision.
Q7: The nurse manager observes a staff nurse delegating vital sign measurement to a
UAP for a patient who just returned from cardiac catheterization. What is the manager's
best response?
A. Commend the nurse for effective time management
B. Remind the nurse that vital signs require RN-level assessment in an unstable patient
C. Suggest the nurse delegate the task to an LPN instead
D. Document the incident as a medication error
Correct Answer: B
, Rationale: A patient immediately post-cardiac catheterization requires close monitoring
for complications such as bleeding or dysrhythmias. While UAPs can measure vital
signs, the RN must assess and interpret them in unstable patients.
Q8: Which scenario represents an example of under-delegation?
A. An RN delegates all patient care to a UAP while taking an extended break
B. An RN performs all bed baths and vital sign measurements despite having two UAPs
available
C. An RN delegates medication administration to an LPN without verifying the LPN's
competence
D. An RN asks a UAP to obtain a blood glucose on a patient with diabetes
Correct Answer: B
Rationale: Under-delegation occurs when a nurse fails to delegate appropriate tasks to
available team members, leading to inefficiency and potential delay in care. Performing
all tasks independently when appropriate delegation is available represents
under-delegation.
Chapter 1: Pain (8 Questions)
Q9: A patient reports pain rated 8/10 following total knee replacement surgery. The
nurse administers morphine 4 mg IV as ordered. When should the nurse reassess the
patient's pain?
A. Within 15 to 30 minutes
B. Within 1 to 2 hours
C. At the next scheduled assessment time
D. When the patient uses the call light
Correct Answer: A
Actual Exam 2026/2027 – Complete Test Bank with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
Section A: Guidelines for Prioritization, Delegation, and Assignment
Decisions (8 Questions)
Q1: The nurse is caring for four patients on a medical-surgical unit. Which patient
should the nurse assess first?
A. A patient with chronic osteoarthritis requesting pain medication
B. A patient 2 days post-appendectomy ambulating in the hallway
C. A patient with pneumonia whose oxygen saturation dropped from 94% to 88% on
room air
D. A patient with stable heart failure who needs discharge teaching
Correct Answer: C
Rationale: Using the ABC framework, a dropping oxygen saturation indicates a breathing
problem that requires immediate assessment and intervention. The other patients are
stable or have non-urgent needs.
Q2: Which task is appropriate for the nurse to delegate to an unlicensed assistive
personnel (UAP)?
A. Assessing a postoperative patient's pain level
B. Measuring and recording intake and output for a patient with heart failure
C. Teaching a newly diagnosed diabetic patient about foot care
D. Evaluating the effectiveness of a patient's antihypertensive medication
,Correct Answer: B
Rationale: Measurement and recording of I&O is within the UAP scope of practice.
Assessment, teaching, and evaluation are nursing responsibilities that cannot be
delegated to UAPs per the Five Rights of Delegation.
Q3: A nurse is receiving report on four patients using SBAR communication. Which
patient situation requires the nurse to seek clarification from the off-going nurse?
A. A patient with stable vital signs awaiting discharge
B. A patient with new-onset confusion and a sodium level of 118 mEq/L
C. A patient who received pain medication 30 minutes ago and rates pain as 3/10
D. A patient whose wound dressing was changed and shows no signs of infection
Correct Answer: B
Rationale: New-onset confusion with severe hyponatremia (118 mEq/L) indicates a
potentially life-threatening condition requiring the "Assessment" and "Recommendation"
components of SBAR to determine immediate interventions.
Q4: The charge nurse is making assignments for the shift. Which task is most
appropriate to assign to a licensed practical nurse (LPN)?
A. Developing a plan of care for a patient newly admitted with COPD exacerbation
B. Administering an oral antibiotic to a stable patient with pneumonia
C. Performing the initial assessment on a patient admitted from the emergency
department
D. Analyzing blood gas results and adjusting the ventilator settings
Correct Answer: B
Rationale: Administering oral medications to stable patients is within LPN scope of
practice. Initial assessment, care planning, and complex clinical analysis requiring RN
judgment are RN responsibilities.
Q5: A nurse is prioritizing care for four patients. Using Maslow's Hierarchy of Needs,
which patient need should be addressed first?
,A. A patient who is anxious about an upcoming cardiac catheterization
B. A patient with a potassium level of 6.8 mEq/L and peaked T-waves on ECG
C. A patient requesting help contacting family members
D. A patient who wants information about community support groups
Correct Answer: B
Rationale: Physiologic needs take priority in Maslow's hierarchy. Hyperkalemia with ECG
changes is a life-threatening physiologic problem requiring immediate intervention.
Anxiety, social contact, and self-actualization needs are higher-level priorities.
Q6: Which actions demonstrate proper supervision of delegated tasks? (Select all that
apply.)
A. The RN observes the UAP correctly using a transfer belt when ambulating a patient
B. The RN asks the UAP to report back after completing a blood glucose check
C. The RN assumes the UAP performed perineal care because the patient appears clean
D. The RN provides immediate feedback when noticing improper hand hygiene
technique
E. The RN delegates a sterile dressing change and does not follow up until end of shift
Correct Answer: A, B, D
Rationale: Proper supervision includes direct observation, clear communication with
follow-up, and immediate corrective feedback. Assuming tasks were completed without
verification and failing to follow up on delegated tasks are examples of improper
supervision.
Q7: The nurse manager observes a staff nurse delegating vital sign measurement to a
UAP for a patient who just returned from cardiac catheterization. What is the manager's
best response?
A. Commend the nurse for effective time management
B. Remind the nurse that vital signs require RN-level assessment in an unstable patient
C. Suggest the nurse delegate the task to an LPN instead
D. Document the incident as a medication error
Correct Answer: B
, Rationale: A patient immediately post-cardiac catheterization requires close monitoring
for complications such as bleeding or dysrhythmias. While UAPs can measure vital
signs, the RN must assess and interpret them in unstable patients.
Q8: Which scenario represents an example of under-delegation?
A. An RN delegates all patient care to a UAP while taking an extended break
B. An RN performs all bed baths and vital sign measurements despite having two UAPs
available
C. An RN delegates medication administration to an LPN without verifying the LPN's
competence
D. An RN asks a UAP to obtain a blood glucose on a patient with diabetes
Correct Answer: B
Rationale: Under-delegation occurs when a nurse fails to delegate appropriate tasks to
available team members, leading to inefficiency and potential delay in care. Performing
all tasks independently when appropriate delegation is available represents
under-delegation.
Chapter 1: Pain (8 Questions)
Q9: A patient reports pain rated 8/10 following total knee replacement surgery. The
nurse administers morphine 4 mg IV as ordered. When should the nurse reassess the
patient's pain?
A. Within 15 to 30 minutes
B. Within 1 to 2 hours
C. At the next scheduled assessment time
D. When the patient uses the call light
Correct Answer: A
