How to Answer NCLEX Priority and Delegation Questions

Priority and delegation questions are among the most challenging on the NCLEX because every answer choice can look correct. The exam is testing your clinical judgment — your ability to decide who needs care first and who can safely perform which tasks. Understanding a few core frameworks will help you consistently choose the best answer.

Think ABCs before anything else

The airway-breathing-circulation framework is your first decision tool. A patient with a compromised airway always takes priority over a patient with a circulation problem, and circulation takes priority over everything else. Apply ABCs before Maslow or any other framework.

The ABC Framework

When the NCLEX asks "which patient should the nurse see first," start with ABCs. A post-op patient reporting difficulty breathing is always the priority over a patient with elevated blood pressure or increased pain. If two patients both have airway issues, choose the one with the acute or unexpected change.

Maslow's Hierarchy of Needs

After ABCs, Maslow helps you prioritize. Physiological needs (oxygen, fluid, nutrition, elimination) come before safety needs, which come before psychosocial needs. A patient who is dehydrated takes priority over one who is anxious about a procedure.

Acute vs. Chronic

New-onset or unexpected findings almost always take priority over chronic, stable conditions. A diabetic patient with a blood glucose of 45 mg/dL is more urgent than a diabetic with a blood glucose of 210 mg/dL, even though both are abnormal. The acute change signals an immediate risk.

Know the scope of practice

Delegation questions hinge on understanding what each team member can legally and safely perform. RNs assess, plan, and evaluate. LPN/LVNs perform predictable, stable nursing tasks. UAPs handle routine ADLs. Never delegate assessment, teaching, or evaluation.

The Five Rights of Delegation

Use the five rights to evaluate every delegation option: right task, right circumstance, right person, right direction/communication, and right supervision/evaluation. If any of the five rights is violated by an answer choice, that choice is wrong.

What Can Be Delegated?

To a UAP (nursing assistant): vital signs on stable patients, bathing, ambulation, intake and output measurement, and feeding. To an LPN/LVN: medication administration (excluding IV push in most states), wound care on stable patients, and data collection. The RN always retains accountability for assessment, care planning, patient education, and evaluation of outcomes.

Common Traps to Avoid

The NCLEX will present unstable patients disguised as routine situations. Watch for clue words: "new onset," "unexpected," "change in," and "sudden." These signal that the patient needs an RN and cannot be delegated. Also watch for tasks being assigned to the wrong team member — an LPN should not receive a new admission, and a UAP should not perform a focused assessment.

If you are stuck between two answer choices, ask yourself: which patient is most likely to deteriorate if I do not intervene right now? That patient is your priority.
NCLEX Test Strategy

Frequently Asked Questions

Can an LPN administer IV medications?

In most states, LPNs can maintain IV infusions and administer IV medications that do not require calculation adjustments. They cannot administer IV push medications or titrate drips. Always check your state's nurse practice act.

Who should the nurse see first after receiving report?

Apply ABCs first, then acute over chronic, then unstable over stable. The patient with the most immediate physiological threat is your first priority.

Can assessment be delegated to a UAP?

No. Assessment is an RN responsibility and cannot be delegated. A UAP can collect data (like vital signs), but interpreting that data is the RN's role.

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