NCLEX Priority and Delegation Questions: 8 Practice Questions
Priority and delegation questions are among the most common on the NCLEX — and the most frequently missed. They require applying a framework consistently: Airway-Breathing-Circulation first, then safety, then psychosocial. Use the same logic every time.
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Evidence-based · For exam prep, not medical advice
update Updated October 2026
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Built by surgery and anesthesiology residents·Written for the NCLEX-RN
High-Yield Topics Covered
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ABCs — Airway, Breathing, Circulation priority
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Maslow's hierarchy applied to clinical priority
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Actual vs potential problems (actual first)
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Delegation to UAP vs LPN vs RN
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Unstable vs stable patient assignment
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Abnormal vs expected findings
Question 1 of 8Score: 0 / 0
Q1Priority Framework
A nurse has four newly admitted patients. Which patient should the nurse assess FIRST?
Explanation: Airway and breathing are the top priorities. SpO2 88% with RR 28 = active respiratory compromise — immediate assessment and intervention required. The other patients have concerning findings but are not imminently life-threatening. New confusion with hypertension (choice 4) is also urgent but does not take priority over active respiratory failure.
Q2Delegation
A nurse can delegate which of the following tasks to an unlicensed assistive personnel (UAP)?
Explanation: UAPs can measure and record routine vital signs and intake/output for stable patients. They cannot: perform assessments (nursing judgment), administer medications, educate patients (requires professional nursing judgment), or perform complex procedures. The NCLEX tests whether you know what falls within the UAP scope of practice.
Q3Delegation
A charge nurse is assigning patients. Which patient is most appropriate to assign to an LPN?
Explanation: LPNs can care for stable patients with predictable outcomes, administer oral and some IV medications (per state practice act and facility policy), and perform routine nursing care. They should NOT be assigned: unstable patients, patients requiring complex assessment, initial admissions, or critically ill patients requiring RN-level judgment.
Q4Priority Framework
A patient calls the nurse saying 'something feels wrong.' Assessment reveals HR 118, BP 88/54, skin pale and diaphoretic, urine output 15 mL/hr over the past 2 hours. The priority nursing diagnosis is:
Explanation: This patient is in shock (hypotension, tachycardia, poor perfusion, oliguria). Fluid volume deficit with decreased cardiac output is the most immediate, life-threatening problem. Using Maslow's and ABCs: physiological needs (circulation and perfusion) take absolute priority over pain, anxiety, or elimination problems.
Q5Emergency Response Priority
A nurse just administered heparin 5,000 units SC. The patient develops sudden chest pain, dyspnea, and becomes diaphoretic. The first nursing action is:
Explanation: The patient is experiencing an acute event (likely pulmonary embolism or MI) — this is a life-threatening emergency. First action: stop the medication and call rapid response (or activate emergency response). Then follow rapid response team orders. Protamine sulfate reverses heparin but requires a provider order — it is not the first independent nursing action.
Q6Priority Framework
A nurse receives report on four patients. Which finding requires the nurse to intervene FIRST?
Explanation: aPTT 3× control in an anticoagulated patient indicates supratherapeutic anticoagulation with high bleeding risk — this requires immediate provider notification and possible dose hold. DVT signs and post-op pain are expected or manageable. Fever in pneumonia is expected. The anticoagulation finding is the most immediately dangerous and actionable.
Q7Medication Priority
A nurse is preparing to administer morning medications to multiple patients. Which medication should be administered FIRST?
Explanation: Insulin lispro is a rapid-acting insulin with onset 15 minutes — it must be given with meals (or immediately after the patient begins eating) to prevent hypoglycemia from mismatch between insulin peak and carbohydrate absorption. Time-critical medications — especially insulin, nitrates, and seizure medications — take priority over routine stable medications.
Q8Emergency Priority / Transfusion Reactions
A newly licensed nurse asks the charge nurse which patient to see first. The charge nurse should instruct the new nurse to assess which patient first?
Explanation: Chills and back pain within minutes of blood transfusion suggest an acute hemolytic transfusion reaction — a potentially fatal emergency. First action: stop the transfusion immediately, maintain IV access, notify provider, send blood samples to lab. This is the most time-critical situation. The other patients can be safely addressed afterward.
What is the best framework for answering NCLEX priority questions?
Apply in order: (1) ABCs — Airway, Breathing, Circulation. (2) Safety — are any patients at immediate risk? (3) Maslow's hierarchy — physiological needs before psychosocial. (4) Actual problems before potential problems. (5) Unstable or changing condition before stable. When two choices both seem urgent, ask: which one will kill the patient fastest if not addressed? That's your answer.
What can a UAP do vs what requires an RN?
UAP CAN: measure vital signs, record I&O, assist with ADLs, transport stable patients, collect specimens, apply non-sterile dressings. UAP CANNOT: perform initial or focused assessments, administer medications (except state-specific exceptions), educate patients, make clinical judgments, care for unstable patients, perform sterile procedures. RN retains accountability for all delegated tasks.
How do you answer 'which patient do you see first' questions?
Go through the ABCs: any patient with airway or breathing compromise is seen first. Then circulation (hypotension, active bleeding, chest pain). Then safety (fall risk, aspiration, acute allergic reaction). Then new or unexpected findings (a patient who 'was fine' but is now different). Stable, expected findings in post-op or chronic patients are seen last. The NCLEX rewards consistent application of this hierarchy.
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