Priority and Delegation
Priority and delegation questions test your ability to determine which client to see first, which action to take first, or which task can be safely delegated to another member of the healthcare team. These questions require clinical judgment, knowledge of scope of practice, and the ability to triage based on patient acuity. They are among the most commonly tested question types on the NCLEX.
Strategy
Use the ABCs (Airway, Breathing, Circulation) and Maslow's hierarchy of needs as your primary frameworks. When asked which client to see first, identify the client with the most acute or life-threatening change in condition rather than the client who simply sounds the sickest at baseline. For delegation questions, remember that RNs cannot delegate assessment, teaching, evaluation, or care of unstable clients. LPNs can perform predictable, stable care tasks. Unlicensed assistive personnel (UAPs) can perform routine, non-invasive tasks like vital signs on stable clients, hygiene, ambulation, and intake/output measurement.
Key Tips
- ✓Apply ABCs first: airway problems take priority over breathing, and breathing over circulation
- ✓Distinguish between expected findings for a diagnosis and unexpected findings that signal a complication
- ✓For delegation, remember that RNs cannot delegate assessment, teaching, evaluation, or nursing judgment
- ✓LPNs can perform tasks for stable, predictable clients including medication administration and wound care for established plans
- ✓When all clients seem equally urgent, look for the one with an unexpected or new change in condition
- ✓Use Maslow's hierarchy when ABCs do not clearly differentiate: physiological needs before safety, safety before psychosocial
Example Question
A charge nurse is making assignments at the start of the shift. Which client should be assigned to the most experienced RN?
Rationale
The client who had a cardiac catheterization one hour ago and now has a developing hematoma at the femoral access site requires the most experienced RN. A hematoma at the catheterization site can indicate hemorrhage or pseudoaneurysm, which are acute, potentially life-threatening complications requiring immediate assessment and intervention. The post-appendectomy client (A) has a routine request. The blood glucose of 210 (B) is elevated but not critically so for a known diabetic. The low-grade fever (D) is expected with an active infection being treated.
Common Mistakes
- ✗Choosing the client with the most serious chronic diagnosis rather than the one with the most acute change in status
- ✗Delegating assessment or teaching tasks to LPNs or UAPs, which falls outside their scope of practice
- ✗Selecting 'notify the provider' as the first action when there is an independent nursing intervention to perform first
- ✗Confusing expected findings for a condition with signs of a new complication
Practice Priority and Delegation Questions
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Common questions about priority and delegation
When two clients both appear critical, apply ABCs strictly: airway issues take priority over breathing concerns, and breathing takes priority over circulation problems. If both are at the same ABC level, choose the client with the unexpected finding or change in condition over the one with expected symptoms of their diagnosis.
Unlicensed assistive personnel can perform routine, non-invasive tasks on stable clients. These include measuring vital signs, recording intake and output, assisting with hygiene and ambulation, performing simple dressing changes on intact skin, and feeding clients. UAPs cannot perform assessments, administer medications, provide client education, or care for unstable clients.