NCLEX-RN 2026 Prioritization & Delegation Practice
Questions | SATA, NGN & Rationales | INSTANT PDF
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NCLEX-RN 2026 practice exam on prioritization, delegation, and clinical judgment. This resource contains
200 questions covering who to see first, stable vs unstable patients, RN vs LPN vs UAP task delegation, ABCs,
Maslow’s hierarchy, safety, emergency decisions, and Next Generation NCLEX (NGN) style scenarios. Each
question includes the correct answer and rationale. Use this exam to master priority nursing actions and
delegation for the NCLEX.
Key Topics Covered
• Prioritization Frameworks – ABCs (Airway, Breathing, Circulation), Maslow’s hierarchy of needs, safety,
acute vs chronic, stable vs unstable, urgent vs non-urgent
• Delegation & Assignment – RN, LPN (licensed practical nurse), and UAP (unlicensed assistive personnel)
roles and scope of practice; tasks appropriate for each; supervision requirements
• Clinical Judgment – Recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions,
taking action, evaluating outcomes
• Emergency & Disaster Nursing – Triage (START), rapid assessment, first actions in codes (respiratory
arrest, cardiac arrest, anaphylaxis, hemorrhage)
• Legal & Ethical Considerations – Informed consent, refusal of treatment, advance directives, scope of
practice, patient rights
Questions 1–200
1. The nurse is caring for four clients. Which client should the nurse assess first?
A) Client with COPD and SpO2 89% on 2 L/min oxygen
B) Client post-op day 1 with a temperature of 38.1°C (100.6°F)
C) Client with a fractured femur reporting pain 7/10
D) Client with diabetes and blood glucose 250 mg/dL
Answer A: Client with COPD and SpO2 89% on 2 L/min oxygen
Rationale: SpO2 <90% indicates hypoxemia, an immediate threat to oxygenation (ABCs). Pain and fever are
lower priority.
2. Which task is appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP)?
,A) Assess the client’s lung sounds
B) Obtain a clean-catch urine specimen
C) Administer a tube feeding
D) Evaluate a client’s fall risk
Answer B: Obtain a clean-catch urine specimen
Rationale: Collecting a clean-catch urine specimen is a standard, non-invasive task within UAP scope.
Assessment and tube feeding require RN/LPN.
3. The nurse receives report on four clients. Which client should be seen first?
A) Client with chest pain radiating to the jaw
B) Client requesting pain medication for headache
C) Client with a new order for a diet
D) Client who needs help ambulating to the bathroom
Answer A: Client with chest pain radiating to the jaw
Rationale: Jaw radiation suggests cardiac ischemia; immediate assessment is needed. This is a potential life-
threatening emergency (ABC/circulation).
4. A client with a tracheostomy has thick, tenacious secretions and is coughing weakly. Which action
should the nurse take first?
A) Suction the tracheostomy
B) Assess breath sounds
C) Increase oxygen flow rate
D) Notify the respiratory therapist
Answer A: Suction the tracheostomy
Rationale: Thick secretions with weak cough indicate airway compromise; suctioning is the priority to clear
the airway (ABC – Airway).
5. The charge nurse is assigning staff. Which client is most appropriate to assign to an LPN?
A) Client newly admitted with unstable angina
B) Client with a urinary tract infection receiving IV antibiotics
C) Client with a chest tube requiring assessment every 2 hours
D) Client with a new tracheostomy needing initial teaching
Answer B: Client with a urinary tract infection receiving IV antibiotics
,Rationale: LPNs can administer IV antibiotics to stable clients and monitor for side effects. Initial unstable or
teaching needs require RN.
6. A client is found on the floor after a fall. Which action should the nurse take first?
A) Check for injuries
B) Assess level of consciousness and vital signs
C) Notify the provider
D) Complete an incident report
Answer B: Assess level of consciousness and vital signs
Rationale: Primary survey (LOC, vitals) determines immediate life threats. Injury assessment follows.
Reporting is later.
7. Which client should the nurse assess first after receiving change-of-shift report?
A) Client with heart failure and crackles in bilateral lung bases
B) Client with a new diagnosis of pulmonary embolism and SpO2 88%
C) Client with diabetes and blood glucose 180 mg/dL
D) Client with a hip fracture requesting pain medication
Answer B: Client with a new diagnosis of pulmonary embolism and SpO2 88%
Rationale: Hypoxemia (SpO2 <90%) from PE is an immediate threat to oxygenation; treat before crackles
(stable) or pain.
8. A client reports dizziness and lightheadedness after standing up. The nurse notes the client’s blood
pressure dropped from 120/80 to 90/60. What is the priority action?
A) Raise the head of the bed
B) Assist the client to a lying position
C) Administer IV fluids
D) Check blood glucose
Answer B: Assist the client to a lying position
Rationale: Orthostatic hypotension with syncope risk requires immediate lying down to prevent fall. Then
assess and treat cause.
, 9. The nurse is delegating tasks to a UAP. Which statement by the UAP indicates a need for further
teaching?
A) “I can measure intake and output for a client.”
B) “I can assess a client’s pain level and give pain medication.”
C) “I can help a client with bathing and oral care.”
D) “I can record vital signs on stable clients.”
Answer B: “I can assess a client’s pain level and give pain medication.”
Rationale: Pain assessment and medication administration are beyond UAP scope; these require RN or LPN.
10. A client with anaphylaxis has stridor and is becoming lethargic. After calling for help, what is the
nurse’s priority action?
A) Start an IV line
B) Administer epinephrine IM
C) Apply oxygen via non-rebreather
D) Elevate the head of the bed
Answer B: Administer epinephrine IM
Rationale: Epinephrine is first-line for anaphylaxis to reverse airway edema and hypotension. Oxygen and
IV are secondary.
11. The nurse is caring for a client with a nasogastric tube to low intermittent suction. The client
reports nausea and the abdomen is distended. Which action should the nurse take first?
A) Irrigate the NG tube
B) Verify tube placement by aspirating gastric contents
C) Notify the provider
D) Increase the suction level
Answer B: Verify tube placement by aspirating gastric contents
Rationale: Nausea and distention suggest tube displacement; first confirm placement before irrigating or
notifying.
12. A client with a history of seizures is having a generalized tonic-clonic seizure. Which action
should the nurse take first?
A) Restrain the client’s arms
B) Move furniture away from the client
Questions | SATA, NGN & Rationales | INSTANT PDF
DOWNLOAD
NCLEX-RN 2026 practice exam on prioritization, delegation, and clinical judgment. This resource contains
200 questions covering who to see first, stable vs unstable patients, RN vs LPN vs UAP task delegation, ABCs,
Maslow’s hierarchy, safety, emergency decisions, and Next Generation NCLEX (NGN) style scenarios. Each
question includes the correct answer and rationale. Use this exam to master priority nursing actions and
delegation for the NCLEX.
Key Topics Covered
• Prioritization Frameworks – ABCs (Airway, Breathing, Circulation), Maslow’s hierarchy of needs, safety,
acute vs chronic, stable vs unstable, urgent vs non-urgent
• Delegation & Assignment – RN, LPN (licensed practical nurse), and UAP (unlicensed assistive personnel)
roles and scope of practice; tasks appropriate for each; supervision requirements
• Clinical Judgment – Recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions,
taking action, evaluating outcomes
• Emergency & Disaster Nursing – Triage (START), rapid assessment, first actions in codes (respiratory
arrest, cardiac arrest, anaphylaxis, hemorrhage)
• Legal & Ethical Considerations – Informed consent, refusal of treatment, advance directives, scope of
practice, patient rights
Questions 1–200
1. The nurse is caring for four clients. Which client should the nurse assess first?
A) Client with COPD and SpO2 89% on 2 L/min oxygen
B) Client post-op day 1 with a temperature of 38.1°C (100.6°F)
C) Client with a fractured femur reporting pain 7/10
D) Client with diabetes and blood glucose 250 mg/dL
Answer A: Client with COPD and SpO2 89% on 2 L/min oxygen
Rationale: SpO2 <90% indicates hypoxemia, an immediate threat to oxygenation (ABCs). Pain and fever are
lower priority.
2. Which task is appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP)?
,A) Assess the client’s lung sounds
B) Obtain a clean-catch urine specimen
C) Administer a tube feeding
D) Evaluate a client’s fall risk
Answer B: Obtain a clean-catch urine specimen
Rationale: Collecting a clean-catch urine specimen is a standard, non-invasive task within UAP scope.
Assessment and tube feeding require RN/LPN.
3. The nurse receives report on four clients. Which client should be seen first?
A) Client with chest pain radiating to the jaw
B) Client requesting pain medication for headache
C) Client with a new order for a diet
D) Client who needs help ambulating to the bathroom
Answer A: Client with chest pain radiating to the jaw
Rationale: Jaw radiation suggests cardiac ischemia; immediate assessment is needed. This is a potential life-
threatening emergency (ABC/circulation).
4. A client with a tracheostomy has thick, tenacious secretions and is coughing weakly. Which action
should the nurse take first?
A) Suction the tracheostomy
B) Assess breath sounds
C) Increase oxygen flow rate
D) Notify the respiratory therapist
Answer A: Suction the tracheostomy
Rationale: Thick secretions with weak cough indicate airway compromise; suctioning is the priority to clear
the airway (ABC – Airway).
5. The charge nurse is assigning staff. Which client is most appropriate to assign to an LPN?
A) Client newly admitted with unstable angina
B) Client with a urinary tract infection receiving IV antibiotics
C) Client with a chest tube requiring assessment every 2 hours
D) Client with a new tracheostomy needing initial teaching
Answer B: Client with a urinary tract infection receiving IV antibiotics
,Rationale: LPNs can administer IV antibiotics to stable clients and monitor for side effects. Initial unstable or
teaching needs require RN.
6. A client is found on the floor after a fall. Which action should the nurse take first?
A) Check for injuries
B) Assess level of consciousness and vital signs
C) Notify the provider
D) Complete an incident report
Answer B: Assess level of consciousness and vital signs
Rationale: Primary survey (LOC, vitals) determines immediate life threats. Injury assessment follows.
Reporting is later.
7. Which client should the nurse assess first after receiving change-of-shift report?
A) Client with heart failure and crackles in bilateral lung bases
B) Client with a new diagnosis of pulmonary embolism and SpO2 88%
C) Client with diabetes and blood glucose 180 mg/dL
D) Client with a hip fracture requesting pain medication
Answer B: Client with a new diagnosis of pulmonary embolism and SpO2 88%
Rationale: Hypoxemia (SpO2 <90%) from PE is an immediate threat to oxygenation; treat before crackles
(stable) or pain.
8. A client reports dizziness and lightheadedness after standing up. The nurse notes the client’s blood
pressure dropped from 120/80 to 90/60. What is the priority action?
A) Raise the head of the bed
B) Assist the client to a lying position
C) Administer IV fluids
D) Check blood glucose
Answer B: Assist the client to a lying position
Rationale: Orthostatic hypotension with syncope risk requires immediate lying down to prevent fall. Then
assess and treat cause.
, 9. The nurse is delegating tasks to a UAP. Which statement by the UAP indicates a need for further
teaching?
A) “I can measure intake and output for a client.”
B) “I can assess a client’s pain level and give pain medication.”
C) “I can help a client with bathing and oral care.”
D) “I can record vital signs on stable clients.”
Answer B: “I can assess a client’s pain level and give pain medication.”
Rationale: Pain assessment and medication administration are beyond UAP scope; these require RN or LPN.
10. A client with anaphylaxis has stridor and is becoming lethargic. After calling for help, what is the
nurse’s priority action?
A) Start an IV line
B) Administer epinephrine IM
C) Apply oxygen via non-rebreather
D) Elevate the head of the bed
Answer B: Administer epinephrine IM
Rationale: Epinephrine is first-line for anaphylaxis to reverse airway edema and hypotension. Oxygen and
IV are secondary.
11. The nurse is caring for a client with a nasogastric tube to low intermittent suction. The client
reports nausea and the abdomen is distended. Which action should the nurse take first?
A) Irrigate the NG tube
B) Verify tube placement by aspirating gastric contents
C) Notify the provider
D) Increase the suction level
Answer B: Verify tube placement by aspirating gastric contents
Rationale: Nausea and distention suggest tube displacement; first confirm placement before irrigating or
notifying.
12. A client with a history of seizures is having a generalized tonic-clonic seizure. Which action
should the nurse take first?
A) Restrain the client’s arms
B) Move furniture away from the client
