NCLEX-RN Leadership, Delegation & Prioritization 2026 — Practice Questions & Rationales

NCLEX-RN Leadership, Delega on & Priori za on 2026

1. The nurse receives report on four clients. Which client should the nurse assess first?

A. A client with COPD whose oxygen saturation is 91% on prescribed oxygen
B. A postoperative client reporting pain of 8/10
C. A client with diabetes who is diaphoretic and confused
D. A client awaiting discharge instructions

Answer: C
Rationale: Diaphoresis and confusion may indicate severe hypoglycemia, an immediate threat
requiring rapid assessment and intervention.



2. Which client should the nurse see first?

A. A client with a temperature of 38.1°C (100.6°F)
B. A client reporting sudden difficulty breathing
C. A client requesting a sleeping medication
D. A client needing assistance to the bathroom

Answer: B
Rationale: Acute breathing difficulty represents an immediate airway or breathing priority.



3. The nurse should prioritize assessment of which postoperative client?

A. A client reporting incisional pain of 6/10
B. A client with a blood pressure of 142/88 mm Hg
C. A client with new-onset restlessness and confusion
D. A client asking when family members may visit

Answer: C
Rationale: Acute changes in mental status may indicate hypoxia, bleeding, infection, or another
serious complication.



4. Which finding requires immediate intervention?

,A. Potassium level of 3.4 mEq/L
B. Blood glucose of 65 mg/dL with shakiness
C. Respiratory rate of 8/min after opioid administration
D. Temperature of 38°C (100.4°F)

Answer: C
Rationale: Respiratory depression following opioid administration can rapidly become life-
threatening.



5. A nurse has four tasks. Which should be completed first?

A. Administer a scheduled stool softener
B. Reassess a client reporting chest pressure
C. Complete routine documentation
D. Change a clean dressing

Answer: B
Rationale: Chest pressure may indicate myocardial ischemia and requires immediate
assessment.



6. Which client is the highest priority?

A. A stable client requesting pain medication
B. A client with asthma who has audible wheezing and increasing work of breathing
C. A client scheduled for discharge
D. A client requesting assistance with hygiene

Answer: B
Rationale: Increasing respiratory distress may progress to respiratory failure.



7. The nurse should assess which client first?

A. A client with pneumonia and a temperature of 38.5°C (101.3°F)
B. A client with heart failure who has new crackles and severe dyspnea
C. A postoperative client requesting pain medication
D. A client with diabetes waiting for breakfast

Answer: B
Rationale: Severe dyspnea and new crackles may indicate acute pulmonary edema and impaired
gas exchange.

,8. Which task is most appropriate to complete first?

A. Administer an antibiotic scheduled for 1000
B. Respond to a client whose IV pump is alarming “occlusion”
C. Refill the linen cart
D. Call dietary services about a meal preference

Answer: B
Rationale: An IV occlusion may interrupt critical therapy and requires prompt assessment.



9. Which client requires immediate assessment?

A. A client with chronic arthritis pain
B. A client who reports a sudden severe headache
C. A client requesting discharge paperwork
D. A client who needs a routine dressing change

Answer: B
Rationale: A sudden severe headache may indicate a neurological emergency.



10. A nurse is prioritizing four clients. Which client should be assessed first?

A. A client with a new cast reporting increasing numbness
B. A client requesting a blanket
C. A client waiting for transport
D. A client asking about medication side effects

Answer: A
Rationale: Increasing numbness after casting may indicate neurovascular compromise.



11. Which client should the nurse assess first?

A. A client receiving chemotherapy who reports mild nausea
B. A client receiving a blood transfusion who develops chills and dyspnea
C. A client with hypertension and a headache
D. A client requesting assistance with ambulation

, Answer: B
Rationale: Chills and dyspnea during a transfusion may indicate a serious transfusion reaction.



12. Which finding is the greatest priority?

A. A heart rate of 108/min after walking
B. A blood pressure of 150/90 mm Hg
C. Stridor after extubation
D. Pain rated 7/10

Answer: C
Rationale: Stridor may indicate upper airway obstruction and requires immediate intervention.



13. Which client should the nurse assess first?

A. A client with diarrhea requesting fluids
B. A client with a tracheostomy whose oxygen saturation suddenly drops
C. A client needing wound care
D. A client requesting a PRN analgesic

Answer: B
Rationale: A sudden oxygen desaturation indicates possible airway or breathing compromise.



14. The nurse receives four laboratory results. Which result should be reported immediately?

A. Hemoglobin 11.2 g/dL
B. Sodium 134 mEq/L
C. Potassium 6.2 mEq/L
D. Calcium 8.7 mg/dL

Answer: C
Rationale: Severe hyperkalemia can cause life-threatening cardiac dysrhythmias.



15. Which client is the priority?

A. A client with a pressure injury needing a dressing change
B. A client who is newly confused and attempting to climb out of bed