NCLEX Prioritization and Delegation: Master the Questions Everyone Gets Wrong

Prioritization and delegation questions are among the most challenging on the NCLEX—and for good reason. These questions test your ability to think like a practicing nurse, making critical decisions about patient care and team management. They require you to apply multiple concepts simultaneously: clinical knowledge, priority frameworks, scope of practice, and patient safety principles.

The good news? With the right frameworks and practice, you can master these questions.

Understanding Prioritization Questions

What They’re Really Asking

Prioritization questions ask you to determine:

• Which patient to see first
• Which intervention takes priority
• What should the nurse do initially/immediately
• The most important assessment or action

Key Prioritization Frameworks

1. ABCs (Airway, Breathing, Circulation)

The foundation of all prioritization. In order of priority:

1. Airway: Obstruction, inability to maintain airway, aspiration risk
2. Breathing: Respiratory distress, abnormal breath sounds, low oxygen
3. Circulation: Cardiac issues, hemorrhage, severe hypotension, shock

2. Maslow’s Hierarchy of Needs

Meet basic physiological needs before higher-level needs:

1. Physiological: Oxygen, water, food, elimination, pain
2. Safety: Physical safety, infection prevention, fall prevention
3. Love/Belonging: Family involvement, social support
4. Self-Esteem: Dignity, respect, autonomy
5. Self-Actualization: Personal goals, education

3. Nursing Process

Generally, follow this order:

1. Assessment: Gather data before acting
2. Diagnosis: Identify the problem
3. Planning: Develop the plan of care
4. Implementation: Take action
5. Evaluation: Assess outcomes

4. Actual vs. Potential Problems

• Actual problems take priority over potential problems
• A patient currently experiencing respiratory distress is priority over one at risk for it

5. Acute vs. Chronic

• New, acute changes typically take priority over chronic, stable conditions
• A new symptom in a stable patient may indicate deterioration

Priority-Setting Practice

Which patient should the nurse see first?

1. Patient with COPD and SpO2 of 89%
2. Patient post-op day 1 complaining of incisional pain rated 6/10
3. Patient with diabetes awaiting morning insulin
4. Patient who just returned from cardiac catheterization

Analysis:

• Option 1: Breathing issue – priority (though 89% may be normal for COPD, need more info)
• Option 2: Pain is important but expected post-op and stable
• Option 3: Insulin is scheduled – important but not emergent
• Option 4: Post-cardiac cath requires frequent assessment for complications (bleeding, hematoma)

Answer: 4 – The newly post-procedure patient requires immediate assessment to identify any potential life-threatening complications.

Understanding Delegation Questions

The Five Rights of Delegation

1. Right Task: Is this task appropriate to delegate?
2. Right Circumstance: Is the patient’s condition stable enough?
3. Right Person: Does this person have the competency?
4. Right Direction: Have I given clear instructions?
5. Right Supervision: Can I appropriately monitor the outcome?

Who Can Do What?

Registered Nurses (RN) ONLY:

• Initial assessment and nursing diagnosis
• Creating the plan of care
• Patient/family teaching for new information
• Evaluation of patient outcomes
• Receiving new physician orders
• Administering IV push medications
• Blood transfusion initiation
• Any task requiring nursing judgment

Licensed Practical Nurses (LPN/LVN) CAN:

• Reinforce teaching (not initial teaching)
• Collect data (not initial assessment)
• Administer oral and some IV medications (state-dependent)
• Perform dressing changes
• Maintain IV sites
• Care for stable, predictable patients

Unlicensed Assistive Personnel (UAP/CNA) CAN:

• Activities of daily living (bathing, feeding, dressing)
• Vital signs on stable patients
• Intake and output measurement
• Ambulation of stable patients
• Turning and positioning
• Transport

What CANNOT Be Delegated

• Tasks for unstable patients
• Initial assessment or evaluation
• Nursing judgment decisions
• New or complex patient teaching
• Care requiring sterile technique (usually)
• Tasks beyond the delegate’s scope or competency

Common Delegation Question Types

Type 1: “Which patient can be delegated to the LPN?”

Strategy: Look for stable, predictable patients with expected findings.

Type 2: “Which task can be delegated to the UAP?”

Strategy: Look for routine tasks that don’t require nursing judgment.

Type 3: “Which assignment is most appropriate?”

Strategy: Match patient complexity to staff competency.

Type 4: “What should the nurse do first after delegation?”

Strategy: Remember that the RN remains accountable and must supervise.

Practice Scenario

The RN has four patients. Which patient is most appropriate to assign to an LPN?

1. A patient who requires discharge teaching after hip replacement
2. A patient receiving a blood transfusion
3. A patient with stable type 2 diabetes receiving scheduled insulin
4. A patient newly diagnosed with heart failure

Analysis:

• Option 1: Initial teaching = RN only
• Option 2: Blood transfusion monitoring = RN only
• Option 3: Stable, predictable care = Appropriate for LPN ✓
• Option 4: New diagnosis requires RN assessment and teaching

Answer: 3

Key Tips for Success

1. Don’t overthink: Apply frameworks systematically
2. Consider patient stability: Unstable = RN only
3. Think safety: When in doubt, the safest choice is usually correct
4. Know scope of practice: Understand what each team member can do
5. The RN is always accountable: Even after delegation
6. Assessment and evaluation are RN functions: Never delegated

Practice Is Essential

Prioritization and delegation questions require practice. The more scenarios you work through, the more automatic your reasoning becomes. Focus on understanding the rationales, not just memorizing answers, and these question types will become much more manageable.