Management of care

NCLEX Prioritization Questions: Who to See First and What to Delegate

To answer a prioritization question, pick the problem that could harm the client soonest: airway, breathing and circulation, then anything new or unexpected, then urgent needs, then routine care. To answer a delegation question, give a routine task on a stable client to the role that covers it, and keep assessment, teaching, evaluation and the unstable client with the RN.

Method

The order to think in

The same five checks sort most prioritization questions, whatever the clinical topic.

01Find the threatIs anything affecting airway, breathing or circulation? That client or problem comes first.
02Look for what is newA change that does not fit the client's condition outranks one that does.
03Separate unstable from stableUnstable clients and uncontrolled symptoms come before stable clients and planned care.
04Place what is leftUrgent needs come before scheduled routine care, and comfort extras come last.
05Check the question wordFirst, next, initial and best ask for different things. Answer the one on the screen.

The trap to avoid

The client who is calling out loudest, or the task that is next on the schedule, is rarely the answer. Rank on the client’s condition, not on the clock or the call light.

Frameworks

Prioritization frameworks nurses use

Each framework is a quick rule for ranking. When two of them disagree, the one closer to a threat to life wins.

Prioritization frameworks, the rule for each and when to use it
Framework	The rule	Use it when
ABCs	Airway, then breathing, then circulation, before anything else.	A client with a threat to any of the three, such as new noisy breathing or a fall in blood pressure.
CAB	In adult cardiac arrest the order changes: a lone health care professional starts chest compressions before ventilation.	A client with no pulse. Use ABC for a client who has one.
Maslow	Physiological needs (oxygen, fluids, nutrition, elimination) come before safety, and safety before belonging, esteem and self-actualization.	Two needs that are both real, such as thirst and fear of falling.
CURE	Critical (act now) before urgent (discomfort or a safety risk) before routine (scheduled medicines, assessments) before extras (comfort measures that are not essential).	A mixed list of tasks with no obvious emergency.
Acute before chronic	A new problem usually comes before one the body has adapted to.	A new cough against a long-standing one.
Actual before potential	A problem that is happening now usually comes before a risk, although a serious risk can outrank a mild actual problem.	A wound that is draining against a client at risk of a fall.
Unexpected before expected	A finding that does not fit the condition needs action before one that is anticipated.	Pain at the incision after surgery against sudden chest pain after surgery.
Unstable before stable	Clients with unstable vital signs, oxygen therapy, high-risk infusions or uncontrolled pain are seen before stable clients.	Choosing which client to see first at the start of a shift.

Sources: Open RN, Tools for Prioritizing for the frameworks and American Heart Association, Adult Basic Life Support for compressions first in cardiac arrest.

Try it

Practice: who do you see first?

Decide before you open the answer.

You are the RN on a medical-surgical unit at the start of a shift. Four clients need you. Client A is 71 and had a hip replacement yesterday; she is newly short of breath, with an oxygen saturation of 88% and a respiratory rate of 26. Client B has pneumonia, is improving and is due for a scheduled oral antibiotic. Client C has chronic back pain that is unchanged from every other day, and asks for a heating pad. Client D is going home tomorrow and is due for wound care teaching. Who do you see first?

Show the answer and the reasoning

Client A. Her shortness of breath is new, it is unexpected for a client recovering from surgery, and it affects breathing, the second of the ABCs. She needs assessment and oxygen now, and then the provider. If her saturation stays under 90% despite supplemental oxygen, she meets one of the typical rapid response calling criteria that AHRQ lists, and the team is called.

The other three are routine or comfort needs: a scheduled medicine, a pain that has not changed and planned teaching. They wait until Client A is safe. A different question could put these three in an order, and the stem would then have to give the facts that decide it.

Delegation

The five rights of delegation

Delegation means letting someone else do a specific nursing activity. The nurse keeps accountability for the client, and the delegatee is responsible for doing the task correctly.

The five rights of delegation and the test for each
Right	The test
Right task	The task is in the delegatee's job description or agency policy, and the state Nurse Practice Act allows it.
Right circumstance	The client is stable and the outcome is predictable. If the client changes, the delegatee tells the nurse and the nurse reassesses whether to keep delegating.
Right person	The delegatee has the skill and knowledge and has shown competence.
Right directions and communication	Clear, specific, two-way instructions: what to do, what to collect, when to report back and what to report. The delegatee accepts the task and does not change it without checking.
Right supervision and evaluation	The nurse stays available, follows up when the task is done, evaluates the outcome and makes sure it is documented.

Assignment and delegation are not the same. An assignment is routine care within a person’s usual role, such as helping a stable client wash. Delegation hands over a specific activity that is outside that role after the person has the training and has shown competence. A delegatee cannot pass the task on to someone else, and a delegatee who cannot finish it tells the nurse at once.

Sources: NCSBN and ANA, National Guidelines for Nursing Delegation (2019) and Open RN, Delegation.

Scope

What can an RN delegate, and what stays with the RN?

The tasks below are the ones questions use most. Scope varies by state, so the state Nurse Practice Act and agency policy decide, and policy may be stricter than law but not looser.

Common tasks and the role that usually takes them
Task	Usually done by	Why
Measure vital signs on a stable client	Assistive personnel (AP, formerly called UAP)	A routine task on a stable client. The AP reports any change to the nurse. On an unstable client the RN does it.
Help a stable client eat a meal	AP	Routine care. A client with trouble swallowing is different: the RN, or an AP with specific training, feeds that client.
Give a routine oral medicine that is not high-risk to a stable client	LPN/VN	Typical scope, but the state Nurse Practice Act and agency policy decide.
Do the admission assessment	RN	An initial assessment needs nursing judgment.
Teach a client a new skill for the first time	RN	LPNs and APs may reinforce teaching the RN has already given, not give it.
Start the first dose of an IV medicine or give heparin or chemotherapy	RN	High-risk and IV work that starts a treatment stays with the RN.
Look after a client whose condition is changing	RN	Delegation needs a stable client with a predictable course.

A short way to remember it: assessment, teaching, evaluation and the unstable client stay with the RN. An AP can collect data such as vital signs, intake and output and weights on stable clients, and report what changes. A change in a client’s status goes to the nurse without delay, not at the end of the shift, and the nurse then reassesses.

Sources: Open RN, Assignment, Open RN, Delegation and NCSBN and ANA, National Guidelines for Nursing Delegation (2019).

Try it

Practice: which task goes to whom?

Apply the five rights before you open the answer.

The RN has one LPN/VN and one assistive person (AP). Client E is two days after surgery, stable, and needs a morning weight. Client F came in an hour ago and has not had a nursing assessment. Which task can go to the AP?

Show the answer and the reasoning

The morning weight for Client E. It is routine, needs no judgment, and the client is stable (right task, right circumstance). The AP is told when to report and what to report, and the RN checks the result. The admission assessment for Client F needs nursing judgment and stays with the RN.

Practice sets

Prioritization and safety questions in every format

Each NCLEX question type has a set of prioritization and safety questions, so you can practice ranking and delegating in the format you will meet on the exam.

Multiple Choice

Prioritization and safety set

Select All That Apply

Prioritization and safety set

Select N

Prioritization and safety set

Multiple Response Grouping

Prioritization and safety set

Matrix Multiple Choice

Prioritization and safety set

Matrix Multiple Response

Prioritization and safety set

Drop-Down Cloze

Prioritization and safety set

Drop-Down Rationale

Prioritization and safety set

Drop-Down Table

Prioritization and safety set

Drag-and-Drop Cloze

Prioritization and safety set

Drag-and-Drop Rationale

Prioritization and safety set

Highlight

Prioritization and safety set

Bow-Tie

Prioritization and safety set

Trend

Prioritization and safety set

Ordered Response

Prioritization and safety set

Dosage Calculation

Prioritization and safety set

All NCLEX question types

FAQ

Prioritization and delegation: FAQ

How do you answer NCLEX prioritization questions?

Find the problem that could harm the client soonest. Airway, breathing and circulation come first, then a new or unexpected change, then an unstable client, then urgent needs, then routine care and comfort measures. Read what the question asks for (first, next or best) and choose the action that fits that word.

What are the five rights of delegation?

Right task, right circumstance, right person, right directions and communication, and right supervision and evaluation. The task must fit the delegatee's role and state law, the client must be stable, the delegatee must be able to do it, the instructions must be clear and accepted, and the nurse must follow up and evaluate the outcome.

What tasks can an RN not delegate?

Nursing judgment, clinical reasoning and any activity that needs them. In the usual teaching this means initial or admission assessments, new client teaching and creating or evaluating the care plan, along with the care of an unstable client. Those stay with a registered nurse.

Can you give an example of delegation in nursing?

An RN asks an assistive person to take vital signs on a stable client, says which readings to report and when, confirms that the person accepts the task, and later checks the results and the client. If the client becomes unstable, the RN takes over the vital signs.

What can an RN delegate to an LPN?

Routine, basic care with predictable outcomes for stable clients, such as collecting data, carrying out the care plan, reinforcing teaching and giving medications that are not high-risk. The state Nurse Practice Act and agency policy decide the details. The RN keeps assessment, initial teaching, evaluation of the care plan, high-risk drugs and unstable clients.

Sources: NCSBN and ANA, National Guidelines for Nursing Delegation (2019); Open RN, Tools for Prioritizing; Open RN, Assignment; Open RN, Delegation; AHRQ PSNet, Rapid Response Systems; American Heart Association, Adult Basic Life Support. Last reviewed October 14, 2026.

NCLEX-RN practice exams