Delegation & Prioritization: 2026 Clinical Decision Making
Examination Questions
1. A Registered Nurse (RN) is planning the care workload for a medical-surgical unit. Which statement
best defines the concept of delegation in nursing practice?
A. The transfer of authority, responsibility, and accountability for a task to another peer.
B. The transfer of the performance of an activity from one individual to another, while the delegating RN
retains accountability for the outcome.
C. The division of labor among staff members where everyone is responsible for their own patients.
D. Giving a task to a colleague of equal licensing status who takes full accountability.
Correct Answer: B. The transfer of the performance of an activity from one individual to another, while the
delegating RN retains accountability for the outcome.
Rationale: Delegation involves transferring the responsibility of performing a specific task to a competent
individual (such as an LPN or UAP), but the delegating RN retains ultimate accountability for the patient
assessment and the clinical outcome of the task. Accountability cannot be delegated.
2. During shift transition, a nurse manager is discussing legal boundaries. What is the primary source
of legal authority that governs what a nurse can delegate in any specific state?
A. The hospital's policies and procedures manual.
B. The State's Nurse Practice Act (NPA) and administrative rules.
C. The American Nurses Association (ANA) guidelines.
D. The physician's written order.
Correct Answer: B. The State's Nurse Practice Act (NPA) and administrative rules.
Rationale: Each state's Nurse Practice Act is the law that defines the legal scope of nursing practice, including
delegation regulations. While hospital policies can restrict delegation further, they cannot expand it beyond the
limits set by the state's NPA.
3. An RN delegates the task of obtaining post-operative vital signs to a Unlicensed Assistive Personnel
(UAP). The UAP records a blood pressure of 82/48 mmHg but does not notify the RN. The patient
subsequently deteriorates. Who is legally accountable for the failure to identify the patient's
deterioration?
A. The UAP only, because they failed to report the abnormal vitals.
B. The RN, because they retained accountability for interpreting the vital signs and evaluating the patient's
clinical status.
C. The physician, for not writing parameters for vital signs.
D. Nobody, as this is a known risk of delegation.
,Correct Answer: B. The RN, because they retained accountability for interpreting the vital signs and
evaluating the patient's clinical status.
Rationale: Although the UAP is responsible for performing the task correctly, the RN remains accountable for the
patient. The RN must supervise the delegatee, review the results, and interpret the clinical significance of the data.
The RN's failure to follow up on the delegated task represents a breach of duty.
4. An RN is reviewing the "Five Rights of Delegation." Which of the following examples illustrates a
violation of the "Right Circumstance"?
A. Delegating the administration of oral medications to a LPN.
B. Delegating the feeding of an unstable patient with a newly diagnosed stroke and severe dysphagia to a UAP.
C. Asking a UAP to obtain a urine specimen from a stable patient.
D. Having an LPN perform a sterile wound dressing change on a stable patient.
Correct Answer: B. Delegating the feeding of an unstable patient with a newly diagnosed stroke and severe
dysphagia to a UAP.
Rationale: The "Right Circumstance" requires that the patient's clinical condition is stable and predictable. An
acute stroke patient with severe dysphagia is at high risk for aspiration and is unstable, requiring continuous RN
assessment during feeding. Delegating this to a UAP is unsafe.
5. A nurse delegates a complex task to a new LPN without verifying if the LPN has ever performed the
task before. Which right of delegation has the nurse violated?
A. Right Task
B. Right Person
C. Right Direction/Communication
D. Right Supervision/Evaluation
Correct Answer: B. Right Person
Rationale: The "Right Person" requires the delegator to verify that the delegatee has the necessary knowledge,
training, and verified competency to perform the task safely on the specific patient. Delegating a task without
confirming competency violates this principle.
6. An RN asks a UAP to check on a patient who has been reporting nausea. Which instruction best
illustrates the "Right Direction and Communication"?
A. "Go check on the patient in room 202 and let me know if they need anything."
B. "Please check on Mr. Jones in room 202. Measure his heart rate and blood pressure, and report the values
directly to me within 15 minutes, especially if the systolic BP is less than 90."
C. "Can you tell the patient in room 202 that the doctor is coming soon?"
D. "Assess the patient in room 202 and give him some water."
,Correct Answer: B. "Please check on Mr. Jones in room 202. Measure his heart rate and blood pressure,
and report the values directly to me within 15 minutes, especially if the systolic BP is less than 90."
Rationale: "Right Direction and Communication" requires the nurse to provide clear, concise, specific, and
complete instructions, including the task details, timeframes, and specific parameters for when to report back.
Option B outlines the exact parameters and expectations. "Assess" is an RN role and cannot be delegated.
7. Which of the following tasks is most appropriate for the RN to delegate to a Unlicensed Assistive
Personnel (UAP) on a medical-surgical unit?
A. Performing an admission assessment on a client with heart failure.
B. Educating a patient on how to administer their home insulin injections.
C. Assisting a stable patient, who is 3 days post-op hip replacement, to ambulate to the bathroom.
D. Monitoring the chest tube drainage volume of a patient with a new pneumothorax.
Correct Answer: C. Assisting a stable patient, who is 3 days post-op hip replacement, to ambulate to the
bathroom.
Rationale: UAP scope of practice covers routine, non-invasive tasks and activities of daily living (ADLs) on stable
clients. Helping a stable, recovering post-op patient ambulate falls within this scope. Assessments (A), education
(B), and clinical monitoring of unstable chest tubes (D) require RN judgment and cannot be delegated.
8. A nurse is planning to delegate care tasks on a pediatric unit. Which task must the RN perform and
NEVER delegate to an LPN or UAP?
A. Administering an oral antibiotic to a 5-year-old child.
B. Suctioning a stable tracheostomy site.
C. Performing the initial assessment of a child admitted with severe asthma exacerbation.
D. Performing a blood glucose check on an infant.
Correct Answer: C. Performing the initial assessment of a child admitted with severe asthma exacerbation.
Rationale: According to the "E-A-T" rule, Registered Nurses cannot delegate Evaluation, Assessment, or
Teaching. The initial admission assessment of a patient, especially an unstable one (acute asthma), requires
advanced clinical judgment, diagnostic reasoning, and evaluation, which is the sole responsibility of the RN.
9. An RN delegates a sterile wound dressing change to an LPN. During the procedure, the RN notices
the LPN accidentally touches the sterile field with a non-sterile hand. What is the RN's immediate
action to fulfill the "Right Supervision"?
A. Wait until the LPN completes the dressing, then tell them they made a mistake.
B. Stop the LPN immediately, point out the contamination, provide a new sterile dressing kit, and ensure the
sterile technique is corrected.
C. Report the LPN to the nursing supervisor immediately.
D. Step in and complete the dressing change himself without explaining why.
, Correct Answer: B. Stop the LPN immediately, point out the contamination, provide a new sterile dressing
kit, and ensure the sterile technique is corrected.
Rationale: The "Right Supervision" includes monitoring the delegatee's performance, intervening if necessary to
ensure patient safety, and providing feedback. The RN must act immediately to prevent contamination of the
patient's wound, using it as an educational opportunity.
10. An RN is preparing the daily schedule. Which of the following assignments is the most appropriate
for a Licensed Practical Nurse (LPN) under the supervision of the RN?
A. A patient who is newly admitted with diabetic ketoacidosis (DKA) and requires continuous insulin infusion.
B. A patient who is 1 day post-operative bowel resection and has sudden, severe abdominal pain and a rigid
abdomen.
C. A stable patient with chronic obstructive pulmonary disease (COPD) who requires administration of
scheduled oral medications and reinforcing spacer education.
D. A patient with a head injury whose Glasgow Coma Scale score has dropped from 14 to 11.
Correct Answer: C. A stable patient with chronic obstructive pulmonary disease (COPD) who requires
administration of scheduled oral medications and reinforcing spacer education.
Rationale: LPNs care for stable, predictable patients. Giving scheduled oral meds and reinforcing education (not
initial teaching) to a stable COPD patient is appropriate. Patients with acute DKA (A), suspected peritonitis/rigid
abdomen (B), or deteriorating neurological status (D) are highly unstable and require immediate, continuous RN
assessment and intervention.
11. A nurse is delegating vital signs to a UAP. For which of the following patients is it inappropriate to
delegate vital sign collection to a UAP?
A. A patient who is 4 days post-op knee arthroplasty, preparing for discharge.
B. A patient with chronic hypertension who has been stable for 2 days.
C. A patient who is receiving a blood transfusion and has just started shaking, reporting chills and chest
tightness.
D. A patient with a stable gastric ulcer.
Correct Answer: C. A patient who is receiving a blood transfusion and has just started shaking, reporting
chills and chest tightness.
Rationale: The patient receiving a blood transfusion who develops shaking, chills, and chest tightness is exhibiting
signs of an acute hemolytic or allergic transfusion reaction. This patient is unstable. The RN must immediately
stop the transfusion, assess the patient, and obtain vitals himself. Stable post-op, chronic hypertensive, and gastric
ulcer patients are appropriate for UAP vitals.
12. A nurse is assigning tasks to a UAP. Which of the following tasks involves clinical judgment and is
therefore NOT delegable to a UAP?
A. Recording the amount of fluid left in a patient's water pitcher.
Examination Questions
1. A Registered Nurse (RN) is planning the care workload for a medical-surgical unit. Which statement
best defines the concept of delegation in nursing practice?
A. The transfer of authority, responsibility, and accountability for a task to another peer.
B. The transfer of the performance of an activity from one individual to another, while the delegating RN
retains accountability for the outcome.
C. The division of labor among staff members where everyone is responsible for their own patients.
D. Giving a task to a colleague of equal licensing status who takes full accountability.
Correct Answer: B. The transfer of the performance of an activity from one individual to another, while the
delegating RN retains accountability for the outcome.
Rationale: Delegation involves transferring the responsibility of performing a specific task to a competent
individual (such as an LPN or UAP), but the delegating RN retains ultimate accountability for the patient
assessment and the clinical outcome of the task. Accountability cannot be delegated.
2. During shift transition, a nurse manager is discussing legal boundaries. What is the primary source
of legal authority that governs what a nurse can delegate in any specific state?
A. The hospital's policies and procedures manual.
B. The State's Nurse Practice Act (NPA) and administrative rules.
C. The American Nurses Association (ANA) guidelines.
D. The physician's written order.
Correct Answer: B. The State's Nurse Practice Act (NPA) and administrative rules.
Rationale: Each state's Nurse Practice Act is the law that defines the legal scope of nursing practice, including
delegation regulations. While hospital policies can restrict delegation further, they cannot expand it beyond the
limits set by the state's NPA.
3. An RN delegates the task of obtaining post-operative vital signs to a Unlicensed Assistive Personnel
(UAP). The UAP records a blood pressure of 82/48 mmHg but does not notify the RN. The patient
subsequently deteriorates. Who is legally accountable for the failure to identify the patient's
deterioration?
A. The UAP only, because they failed to report the abnormal vitals.
B. The RN, because they retained accountability for interpreting the vital signs and evaluating the patient's
clinical status.
C. The physician, for not writing parameters for vital signs.
D. Nobody, as this is a known risk of delegation.
,Correct Answer: B. The RN, because they retained accountability for interpreting the vital signs and
evaluating the patient's clinical status.
Rationale: Although the UAP is responsible for performing the task correctly, the RN remains accountable for the
patient. The RN must supervise the delegatee, review the results, and interpret the clinical significance of the data.
The RN's failure to follow up on the delegated task represents a breach of duty.
4. An RN is reviewing the "Five Rights of Delegation." Which of the following examples illustrates a
violation of the "Right Circumstance"?
A. Delegating the administration of oral medications to a LPN.
B. Delegating the feeding of an unstable patient with a newly diagnosed stroke and severe dysphagia to a UAP.
C. Asking a UAP to obtain a urine specimen from a stable patient.
D. Having an LPN perform a sterile wound dressing change on a stable patient.
Correct Answer: B. Delegating the feeding of an unstable patient with a newly diagnosed stroke and severe
dysphagia to a UAP.
Rationale: The "Right Circumstance" requires that the patient's clinical condition is stable and predictable. An
acute stroke patient with severe dysphagia is at high risk for aspiration and is unstable, requiring continuous RN
assessment during feeding. Delegating this to a UAP is unsafe.
5. A nurse delegates a complex task to a new LPN without verifying if the LPN has ever performed the
task before. Which right of delegation has the nurse violated?
A. Right Task
B. Right Person
C. Right Direction/Communication
D. Right Supervision/Evaluation
Correct Answer: B. Right Person
Rationale: The "Right Person" requires the delegator to verify that the delegatee has the necessary knowledge,
training, and verified competency to perform the task safely on the specific patient. Delegating a task without
confirming competency violates this principle.
6. An RN asks a UAP to check on a patient who has been reporting nausea. Which instruction best
illustrates the "Right Direction and Communication"?
A. "Go check on the patient in room 202 and let me know if they need anything."
B. "Please check on Mr. Jones in room 202. Measure his heart rate and blood pressure, and report the values
directly to me within 15 minutes, especially if the systolic BP is less than 90."
C. "Can you tell the patient in room 202 that the doctor is coming soon?"
D. "Assess the patient in room 202 and give him some water."
,Correct Answer: B. "Please check on Mr. Jones in room 202. Measure his heart rate and blood pressure,
and report the values directly to me within 15 minutes, especially if the systolic BP is less than 90."
Rationale: "Right Direction and Communication" requires the nurse to provide clear, concise, specific, and
complete instructions, including the task details, timeframes, and specific parameters for when to report back.
Option B outlines the exact parameters and expectations. "Assess" is an RN role and cannot be delegated.
7. Which of the following tasks is most appropriate for the RN to delegate to a Unlicensed Assistive
Personnel (UAP) on a medical-surgical unit?
A. Performing an admission assessment on a client with heart failure.
B. Educating a patient on how to administer their home insulin injections.
C. Assisting a stable patient, who is 3 days post-op hip replacement, to ambulate to the bathroom.
D. Monitoring the chest tube drainage volume of a patient with a new pneumothorax.
Correct Answer: C. Assisting a stable patient, who is 3 days post-op hip replacement, to ambulate to the
bathroom.
Rationale: UAP scope of practice covers routine, non-invasive tasks and activities of daily living (ADLs) on stable
clients. Helping a stable, recovering post-op patient ambulate falls within this scope. Assessments (A), education
(B), and clinical monitoring of unstable chest tubes (D) require RN judgment and cannot be delegated.
8. A nurse is planning to delegate care tasks on a pediatric unit. Which task must the RN perform and
NEVER delegate to an LPN or UAP?
A. Administering an oral antibiotic to a 5-year-old child.
B. Suctioning a stable tracheostomy site.
C. Performing the initial assessment of a child admitted with severe asthma exacerbation.
D. Performing a blood glucose check on an infant.
Correct Answer: C. Performing the initial assessment of a child admitted with severe asthma exacerbation.
Rationale: According to the "E-A-T" rule, Registered Nurses cannot delegate Evaluation, Assessment, or
Teaching. The initial admission assessment of a patient, especially an unstable one (acute asthma), requires
advanced clinical judgment, diagnostic reasoning, and evaluation, which is the sole responsibility of the RN.
9. An RN delegates a sterile wound dressing change to an LPN. During the procedure, the RN notices
the LPN accidentally touches the sterile field with a non-sterile hand. What is the RN's immediate
action to fulfill the "Right Supervision"?
A. Wait until the LPN completes the dressing, then tell them they made a mistake.
B. Stop the LPN immediately, point out the contamination, provide a new sterile dressing kit, and ensure the
sterile technique is corrected.
C. Report the LPN to the nursing supervisor immediately.
D. Step in and complete the dressing change himself without explaining why.
, Correct Answer: B. Stop the LPN immediately, point out the contamination, provide a new sterile dressing
kit, and ensure the sterile technique is corrected.
Rationale: The "Right Supervision" includes monitoring the delegatee's performance, intervening if necessary to
ensure patient safety, and providing feedback. The RN must act immediately to prevent contamination of the
patient's wound, using it as an educational opportunity.
10. An RN is preparing the daily schedule. Which of the following assignments is the most appropriate
for a Licensed Practical Nurse (LPN) under the supervision of the RN?
A. A patient who is newly admitted with diabetic ketoacidosis (DKA) and requires continuous insulin infusion.
B. A patient who is 1 day post-operative bowel resection and has sudden, severe abdominal pain and a rigid
abdomen.
C. A stable patient with chronic obstructive pulmonary disease (COPD) who requires administration of
scheduled oral medications and reinforcing spacer education.
D. A patient with a head injury whose Glasgow Coma Scale score has dropped from 14 to 11.
Correct Answer: C. A stable patient with chronic obstructive pulmonary disease (COPD) who requires
administration of scheduled oral medications and reinforcing spacer education.
Rationale: LPNs care for stable, predictable patients. Giving scheduled oral meds and reinforcing education (not
initial teaching) to a stable COPD patient is appropriate. Patients with acute DKA (A), suspected peritonitis/rigid
abdomen (B), or deteriorating neurological status (D) are highly unstable and require immediate, continuous RN
assessment and intervention.
11. A nurse is delegating vital signs to a UAP. For which of the following patients is it inappropriate to
delegate vital sign collection to a UAP?
A. A patient who is 4 days post-op knee arthroplasty, preparing for discharge.
B. A patient with chronic hypertension who has been stable for 2 days.
C. A patient who is receiving a blood transfusion and has just started shaking, reporting chills and chest
tightness.
D. A patient with a stable gastric ulcer.
Correct Answer: C. A patient who is receiving a blood transfusion and has just started shaking, reporting
chills and chest tightness.
Rationale: The patient receiving a blood transfusion who develops shaking, chills, and chest tightness is exhibiting
signs of an acute hemolytic or allergic transfusion reaction. This patient is unstable. The RN must immediately
stop the transfusion, assess the patient, and obtain vitals himself. Stable post-op, chronic hypertensive, and gastric
ulcer patients are appropriate for UAP vitals.
12. A nurse is assigning tasks to a UAP. Which of the following tasks involves clinical judgment and is
therefore NOT delegable to a UAP?
A. Recording the amount of fluid left in a patient's water pitcher.
