NCLEX-RN EXAM PREP | PRIORITIZATION & DELEGATION
NCLEX-RN Prioritization & Delegation
High-Yield Study Guide with 25 Exam-Style Questions and Full Rationales (aligned with current
NCLEX-RN test plan)
How to use this guide: read the framework sections first (pages 1-4), work through the 25 questions without
peeking at the answers, then use the 60-second summary table on the final page for last-minute review.
Every question is written in the style of the current NCLEX-RN test plan, including prioritization, delegation,
and safety scenarios.
1. Why Prioritization and Delegation Matter
Prioritization and delegation questions appear across every section of the NCLEX-RN and are a core
component of the clinical judgment model. The exam does not ask you to recite facts; it asks you to
decide which patient to see first, which task to delegate, and which finding to report. This guide
condenses the decision rules into one repeatable system.
The Six Core Rules
• Rule 1 - ABCs first. Airway, then breathing, then circulation. When two patients compete for
attention, the one with an airway, oxygenation, or perfusion problem wins.
• Rule 2 - Maslow before comfort. Physiologic needs (oxygen, fluids, elimination, pain from tissue
damage) outrank safety, love, esteem, and psychosocial requests.
• Rule 3 - Acute before chronic. A new or worsening symptom beats a stable, long-standing
problem. A patient who is "the same as always" is rarely the priority.
• Rule 4 - Unstable before stable. Watch trends: a drop in blood pressure, falling oxygen saturation,
rising heart rate, or new confusion signals a patient whose condition is changing.
• Rule 5 - Safety and least restrictive. Patient and nurse safety come before convenience. Use the
least restrictive intervention first, and reserve restraints for last.
• Rule 6 - Delegate tasks, not judgment. You may transfer a task, but you never transfer
accountability, assessment, or teaching. If a task requires nursing judgment, you keep it.
Page 1
, 2. The Five-Step Prioritization Method
1. Scan all assigned patients. Pull the key data: vital signs, mental status, pain, diagnosis, and any
new symptoms or orders.
2. Apply ABCs and Maslow. Ask: is anyone's airway, breathing, or circulation threatened? Physiologic
emergencies outrank every comfort request.
3. Separate acute from chronic and unstable from stable. The patient whose numbers are trending in
a bad direction is your first stop.
4. Think about scope. Which tasks can a UAP or LPN complete safely? Only stable, routine,
predictable tasks. Assessment, teaching, and unstable patients stay with the RN.
5. Re-evaluate and reassign. After you handle the priority, return to the other patients. Priorities
change as conditions change; reassess after every intervention.
3. Delegation: Who Can Do What
Delegation questions test three scopes of practice. UAPs (nursing assistants, techs) can perform routine,
stable, predictable tasks. LPNs/LVNs can care for stable patients and administer many medications, but
cannot perform initial assessments, develop plans of care, or provide initial teaching. The RN retains
accountability for every delegated task.
Task or Situation UAP LPN / LVN RN
Vital signs, stable patient Yes Yes Yes
ADLs: bathing, feeding, toileting
Yes Yes Yes
(stable)
Intake & output, routine
Yes Yes Yes
measurements
Ambulating a stable patient Yes Yes Yes
Point-of-care glucose check Per policy Yes Yes
Oral medications, stable patient No Yes Yes
IV push medications No Usually no Yes
Uncomplicated wound care (stable) No Yes Yes
Nasogastric tube insertion No Varies Yes
Tracheostomy suctioning (stable) No Varies Yes
Blood transfusion / transfusion No No Yes
Page 2
NCLEX-RN Prioritization & Delegation
High-Yield Study Guide with 25 Exam-Style Questions and Full Rationales (aligned with current
NCLEX-RN test plan)
How to use this guide: read the framework sections first (pages 1-4), work through the 25 questions without
peeking at the answers, then use the 60-second summary table on the final page for last-minute review.
Every question is written in the style of the current NCLEX-RN test plan, including prioritization, delegation,
and safety scenarios.
1. Why Prioritization and Delegation Matter
Prioritization and delegation questions appear across every section of the NCLEX-RN and are a core
component of the clinical judgment model. The exam does not ask you to recite facts; it asks you to
decide which patient to see first, which task to delegate, and which finding to report. This guide
condenses the decision rules into one repeatable system.
The Six Core Rules
• Rule 1 - ABCs first. Airway, then breathing, then circulation. When two patients compete for
attention, the one with an airway, oxygenation, or perfusion problem wins.
• Rule 2 - Maslow before comfort. Physiologic needs (oxygen, fluids, elimination, pain from tissue
damage) outrank safety, love, esteem, and psychosocial requests.
• Rule 3 - Acute before chronic. A new or worsening symptom beats a stable, long-standing
problem. A patient who is "the same as always" is rarely the priority.
• Rule 4 - Unstable before stable. Watch trends: a drop in blood pressure, falling oxygen saturation,
rising heart rate, or new confusion signals a patient whose condition is changing.
• Rule 5 - Safety and least restrictive. Patient and nurse safety come before convenience. Use the
least restrictive intervention first, and reserve restraints for last.
• Rule 6 - Delegate tasks, not judgment. You may transfer a task, but you never transfer
accountability, assessment, or teaching. If a task requires nursing judgment, you keep it.
Page 1
, 2. The Five-Step Prioritization Method
1. Scan all assigned patients. Pull the key data: vital signs, mental status, pain, diagnosis, and any
new symptoms or orders.
2. Apply ABCs and Maslow. Ask: is anyone's airway, breathing, or circulation threatened? Physiologic
emergencies outrank every comfort request.
3. Separate acute from chronic and unstable from stable. The patient whose numbers are trending in
a bad direction is your first stop.
4. Think about scope. Which tasks can a UAP or LPN complete safely? Only stable, routine,
predictable tasks. Assessment, teaching, and unstable patients stay with the RN.
5. Re-evaluate and reassign. After you handle the priority, return to the other patients. Priorities
change as conditions change; reassess after every intervention.
3. Delegation: Who Can Do What
Delegation questions test three scopes of practice. UAPs (nursing assistants, techs) can perform routine,
stable, predictable tasks. LPNs/LVNs can care for stable patients and administer many medications, but
cannot perform initial assessments, develop plans of care, or provide initial teaching. The RN retains
accountability for every delegated task.
Task or Situation UAP LPN / LVN RN
Vital signs, stable patient Yes Yes Yes
ADLs: bathing, feeding, toileting
Yes Yes Yes
(stable)
Intake & output, routine
Yes Yes Yes
measurements
Ambulating a stable patient Yes Yes Yes
Point-of-care glucose check Per policy Yes Yes
Oral medications, stable patient No Yes Yes
IV push medications No Usually no Yes
Uncomplicated wound care (stable) No Yes Yes
Nasogastric tube insertion No Varies Yes
Tracheostomy suctioning (stable) No Varies Yes
Blood transfusion / transfusion No No Yes
Page 2
