How to Answer Priority and Delegation Questions on Nursing Exams: The Ultimate Guide

Struggling with NCLEX priority and delegation questions? This ultimate guide breaks down the proven frameworks (ABCs, Maslow, Nursing Process) and provides 10 practice questions with rationales to help you think like a nurse. Master these critical skills and pass your exams!

If there’s one type of question that makes every nursing student pause, it’s the “priority” or “delegation” question. You know the ones: “Which client should the nurse see first?” or “Which task is appropriate to delegate to the unlicensed assistive personnel (UAP)?”

These questions are the cornerstone of the NCLEX and your nursing school exams because they don’t just test your knowledge—they test your clinical judgment. They assess your ability to think like a nurse, make safe decisions under pressure, and manage care effectively.

Feeling overwhelmed by these questions while also trying to keep up with essays, care plans, and other coursework? You’re not alone. At NursingResearchHelp.com, we specialize in supporting nursing students by providing expert assistance with assignments, research papers, and understanding complex topics, so you can focus on mastering critical thinking skills like these.

This comprehensive guide will demystify priority and delegation questions. We’ll provide you with simple, memorable frameworks, walk you through numerous examples, and give you the confidence to tackle these questions head-on.

Part 1: Conquering Priority Questions (“Who Do You See First?”)

The goal of a priority question is to identify the patient who is at the greatest risk for harm if not seen immediately. It’s not about who is the sickest in the long term, but who has the most urgent, unstable, or life-threatening need right now.

The Essential Frameworks for Setting Priorities

To answer these questions consistently, you need a mental checklist. Use these frameworks in the following order of importance:

1. The ABCs: Airway, Breathing, Circulation

This is your number one rule. Any problem with a patient’s airway or breathing is almost always the top priority.

• Airway: Is the airway patent? Is there a risk of obstruction (e.g., choking, swelling, secretions)?

• Breathing: Is the patient effectively breathing? Look for signs of respiratory distress (e.g., low O2 saturation, increased work of breathing, abnormal breath sounds).

• Circulation: Is there adequate blood flow? Look for problems with cardiac output (e.g., decreased level of consciousness, low blood pressure, weak pulse, active bleeding).

Tip: If one option involves an airway issue and the others do not, the airway problem is likely the correct answer.

2. Maslow’s Hierarchy of Needs

This psychological theory is perfectly applicable to nursing. Physiological needs must be met before higher-level needs. The hierarchy, from most to least urgent, is:

• Physiological Needs: Oxygen, fluid, nutrition, temperature, elimination. These are the basics for survival.

• Safety and Security: Protection from injury, both physical and psychological.

• Love and Belonging: Support systems, family.

• Self-Esteem: Feelings of accomplishment.

• Self-Actualization: Achieving one’s full potential.

A physiological need (e.g., difficulty breathing) will always trump a safety need (e.g., a concern about falling), which will always trump a psychological need (e.g., anxiety).

3. The Nursing Process (ADPIE)

Use this process to sequence your actions. You cannot implement a plan before you assess the patient.

• Assessment > Diagnosis > Planning > Implementation > Evaluation

• Therefore, an answer that involves assessing a patient or a situation is often higher priority than one that involves implementing a routine intervention.

4. Acute vs. Chronic, Unstable vs. Stable

An acute problem (sudden onset) is typically more urgent than a chronic one (long-standing). An unstable patient requires immediate attention over a stable one.

• Example: A patient with chronic stable angina complaining of chest pain is important. But a patient with new, crushing chest pain is acute and unstable, making them a higher priority.

5. Least Invasive vs. Most Invasive

If all other factors seem equal, the least invasive action is often correct. Check the patient before calling the doctor. Assess before intervening.

Practice Priority Questions with Detailed Rationales

Let’s apply these frameworks. Read each question, choose your answer, and then study the rationale.

Question 1:
The nurse is caring for four clients. Which client should the nurse assess first?

• A. A client with diabetes mellitus whose blood glucose is 180 mg/dL.

• B. A client with heart failure who has 2+ pitting edema in the ankles.

• C. A client with pneumonia who is diaphoretic and has a respiratory rate of 32 breaths/minute.

• D. A client one-day post-op who reports pain rated 6/10.

Correct Answer: C

Rationale:

• Framework Used: ABCs (Breathing).

• Analysis: Option A (BG 180) is elevated but not immediately life-threatening. Option B (edema) is an expected finding in heart failure and relates to circulation, but the patient is not described as unstable. Option D (pain 6/10) is a comfort issue but not an ABC threat. Option C, however, presents with tachypnea (RR 32) and diaphoresis, which are classic signs of respiratory distress. This indicates a potential problem with Breathing, making this client the top priority.

Question 2:
A client tells the nurse, “I feel like something is really wrong. I can’t catch my breath.” The nurse obtains the following vital signs: BP 148/90 mmHg, HR 130 bpm, RR 28, SpO2 88% on room air. What is the nurse’s first action?

• A. Notify the healthcare provider.

• B. Administer supplemental oxygen.

• C. Assess lung sounds.

• D. Help the client into a High-Fowler’s position.

Correct Answer: B

Rationale:

• Framework Used: ABCs (Breathing) + Least Invasive.

• Analysis: All actions are relevant, but we must prioritize based on ABCs. The patient is hypoxic (SpO2 88%). While assessing lung sounds (C) is important, you must first address the immediate life threat of low oxygen. The least invasive way to immediately correct hypoxia is to administer oxygen (B). After the oxygen is on, you can then assess further (C), position the client (D), and notify the provider (A).

Part 2: Mastering Delegation and Assignment Questions

Delegation questions test your understanding of the roles and responsibilities of each member of the healthcare team and your ability to assign tasks appropriately to ensure patient safety.

The Five Rights of Delegation

Always run through this checklist when considering delegation:

1. Right Task: Is the task one that can be delegated for this specific client?

2. Right Circumstance: Is the client stable, and is the outcome predictable?

3. Right Person: Is the staff member (RN, LPN/LVN, UAP) competent and legally permitted to perform the task?

4. Right Direction/Communication: Did you give a clear, concise explanation of the task, including limits and what to report?

5. Right Supervision/Evaluation: Will you, as the RN, provide oversight and evaluate the outcome?

Understanding the Healthcare Team’s Scope

• Registered Nurse (RN): Responsible for assessment, nursing diagnosis, planning, evaluation, and teaching. Cannot delegate these functions. Manages complex, unstable patients.

• Licensed Practical/Vocational Nurse (LPN/LVN): Provides basic care under the supervision of an RN. Can administer most medications (often excluding IV push in some states), perform routine procedures, and reinforce teaching. Cannot perform initial assessments or develop care plans for unstable patients.

• Unlicensed Assistive Personnel (UAP/Nurse Aide): Assists with activities of daily living (ADLs): bathing, feeding, ambulating, vital signs on stable patients, and specimen collection. Cannot assess, educate, or perform sterile or invasive procedures.

Simple Rule of Thumb for Delegation

“ADLs to the UAP, stable to the LPN, unstable to the RN.”

• UAP: Tasks involving Activities of Daily Living (ADLs) for stable patients (e.g., bathing, feeding, ambulating, making beds).

• LPN/LVN: Tasks for stable patients with predictable outcomes (e.g., administering oral medications, dressing a stable wound, monitoring a defined output).

• RN: Unstable patients, assessment, teaching, evaluation, and IV medications/push medications (depending on state law).

Practice Delegation Questions with Detailed Rationales

Question 1:
An RN is leading a team including an LPN and a UAP. Which client is most appropriate to assign to the LPN?

• A. A client who was just admitted from the emergency department with new-onset atrial fibrillation.

• B. A client who is one-day post-op and requires teaching about wound care at home.

• C. A client with stable congestive heart failure who needs morning medications administered.

• D. A client awaiting discharge who needs assistance with packing belongings.

Correct Answer: C

Rationale:

• Framework Used: “Stable to the LPN.”

• Analysis: Option A (“just admitted,” “new-onset”) describes an unstable patient requiring RN-level assessment and planning. Option B (“teaching”) is an RN responsibility. Option D (packing belongings) is a non-skilled task appropriate for a UAP. Option C involves a stable client with a predictable outcome (administering scheduled medications), which is within the scope of an LPN.

Question 2:
The RN must delegate tasks to the UAP. Which task is appropriate for the UAP to perform?

• A. Reinforce teaching about crutch-walking.

• B. Check a client’s blood sugar before breakfast.

• C. Assess a client’s pain level after administering an analgesic.

• D. Perform a Foley catheter insertion.

Correct Answer: B

Rationale:

• Framework Used: “ADLs to the UAP.”

• Analysis: Obtaining a blood sugar via fingerstick is a skill that UAPs are typically trained to perform, especially for a stable client. It is a data collection task. Option A (“reinforce teaching”) is outside their scope (teaching is an RN/LPN function). Option C (“assess pain”) is an assessment, which is an RN function. Option D (Foley insertion) is a sterile, invasive procedure that cannot be delegated to a UAP.

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Part 3: Advanced Scenarios – Putting It All Together

The most challenging questions combine prioritization and delegation. You must first prioritize the patients, then decide on the appropriate staff action.

Practice Combined Questions

Question 1:
The nurse receives report on the following four clients. Which action should the nurse take first?

• Client 1: A post-op thyroidectomy client who reports “a lot of tightness” in their neck.

• Client 2: A client with Crohn’s disease who needs assistance ambulating to the bathroom.

• Client 3: A client with hypertension who requests a refill of their water pitcher.

• Client 4: A client scheduled for a colonoscopy who has questions about the procedure.

• A. Delegate ambulation assistance to the UAP for Client 2.

• B. Assess Client 1 for signs of respiratory distress or bleeding.

• C. Refill the water pitcher for Client 3.

• D. Explain the colonoscopy procedure to Client 4.

Correct Answer: B

Rationale:

• Framework Used: ABCs + Prioritization before Delegation.

• Analysis: You must first identify the highest-priority patient. Client 1, after a thyroidectomy, complaining of “tightness” is a red flag for potential hemorrhage or airway obstruction due to swelling. This is an ABC (Airway) emergency and requires immediate assessment by the RN. The other tasks can be delegated or delayed. The nurse’s first action is not to delegate another task but to personally assess the most critical patient.

Question 2:
An LPN reports to the RN that a client’s blood pressure has dropped from 130/80 to 90/50 over the past hour. What is the RN’s priority action?

• A. Tell the LPN to continue monitoring the client every 15 minutes.

• B. Delegate the UAP to take a full set of vital signs.

• C. Assess the client personally.

• D. Call the healthcare provider immediately.

Correct Answer: C

Rationale:

• Framework Used: Nursing Process (Assess First) + Unstable to the RN.

• Analysis: A significant drop in blood pressure indicates an unstable client. The LPN has appropriately reported the finding. The RN’s responsibility is to now perform their own assessment (C) to gather more data (e.g., check skin condition, level of consciousness, heart rate). You cannot effectively implement (A, D) or delegate (B) without first assessing. Calling the provider (D) is necessary, but you need your own assessment findings to report.

Your Next Steps for Mastery

1. Practice, Practice, Practice: The only way to get better is to apply these frameworks repeatedly. Use NCLEX review books and question banks.

2. Always Read the Rationale: Whether you get the question right or wrong, read the explanation. This reinforces the “why” behind the decision.

3. Talk It Out: Study with a partner and explain your reasoning for each answer. Verbalizing your thought process solidifies the frameworks.

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Conclusion: You Can Do This

Priority and delegation questions are challenging but conquerable. By consistently applying the ABCs, Maslow’s Hierarchy, and the Five Rights of Delegation, you will develop a systematic approach that leads to the correct answer. Remember, you are learning to think like a nurse—a skill that is invaluable both on the NCLEX and at the bedside.

Trust the frameworks, practice diligently, and don’t hesitate to seek support. You are on your way to becoming an exceptional nurse.