NCLEX › Practice questions › Prioritization and Delegation
Prioritization and Delegation NCLEX practice questions
Priority and delegation questions sit in Management of Care, the largest content area on the NCLEX-RN test plan (15 to 21% of the exam). Work through each one, then read the rationale for every option: the reasoning is what transfers to new questions.
Question 1 · Pharmacological and Parenteral Therapies
The nurse assesses a client receiving a blood transfusion and finds new hives, wheezing, and a blood pressure of 82/50 mmHg. What is the priority nursing action?
Show answer and rationale
Answer: C. New hives, wheezing, and hypotension during a transfusion indicate a possible transfusion reaction or anaphylaxis, which is a life-threatening event requiring the nurse to stop the transfusion immediately and keep the IV line open with normal saline to maintain access while treatment is initiated. Slowing the rate or continuing the transfusion in any form risks worsening the reaction and further compromising the client. Acetaminophen may be used for a febrile non-hemolytic reaction but is not the priority action when signs of a severe allergic or hemolytic reaction such as wheezing and hypotension are present. Documentation is important but must happen after the transfusion is stopped and the client is stabilized.
Checked against: OpenStax Clinical Nursing Skills, 13.4
Question 2 · Physiological Adaptation
The nurse suspects a client is developing sepsis. Which actions should the nurse anticipate completing within the first hour, per the sepsis bundle? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, B, C, F. The time-sensitive sepsis bundle includes obtaining blood cultures before giving antibiotics, measuring serum lactate, starting IV fluid resuscitation, and administering broad-spectrum antibiotics, all within the first hour of recognition. Scheduling a follow-up appointment in a week and giving an oral antipyretic with a 24-hour reassessment are far too delayed for a client with suspected sepsis, which requires rapid, aggressive intervention to prevent progression to septic shock.
Checked against: OpenStax Medical-Surgical Nursing, 23.3
Question 3 · Physiological Adaptation
The nurse enters a client's room and finds the client unresponsive, cyanotic and apneic, with a carotid pulse present. After calling for help, what should the nurse do first?
Show answer and rationale
Answer: D. An unresponsive client who is not breathing but still has a pulse is in respiratory arrest, so once help is called the nurse starts bag-valve-mask ventilation right away. For an adult with a pulse, current basic life support guidance is 1 breath about every 6 seconds with a pulse check about every 2 minutes; chest compressions are not needed while the pulse is present, but CPR begins with compressions if the pulse is lost. The client is already known to be apneic, so measuring the respiratory rate and oxygen saturation only delays treatment. A chest x-ray does not treat the emergent breathing problem. Notifying the provider is important, but it happens during or after ventilation, not before it.
Checked against: OpenStax Maternal-Newborn Nursing, 22.1
Question 4 · Pharmacological and Parenteral Therapies
A client is taking digoxin for heart failure. Which findings should the nurse recognize as manifestations of digoxin toxicity? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, B, D, E. Digoxin toxicity classically presents with GI symptoms (nausea, anorexia), visual disturbances (yellow-green halos, blurred vision), and cardiac dysrhythmias such as bradycardia. Hypertension is not a typical toxicity finding; digoxin toxicity is more associated with arrhythmias than elevated blood pressure. Tachypnea is not a hallmark sign of digoxin toxicity. Each option must be judged individually as true or false rather than trying to match a 'usual number' of correct answers.
Checked against: OpenStax Pharmacology for Nurses, 19.6; OpenStax Pharmacology for Nurses, 17.6
Question 5 · Management of Care
The RN has four tasks to delegate. Which task is most appropriate to delegate to the UAP?
Show answer and rationale
Answer: A. Positioning a stable client on bedrest is a routine, predictable task appropriate for UAP delegation. Assessing new dyspnea requires nursing judgment and cannot be delegated. Feeding a client with an unstable, pending swallow evaluation carries aspiration risk and needs licensed staff involvement until the client's status is clarified. Teaching a new skill such as insulin pen use is an RN or LPN-level task, not a UAP task.
Checked against: OpenStax Clinical Nursing Skills, 7.3
Question 6 · Physiological Adaptation
A nurse is caring for a client on postoperative day 1 following abdominal surgery. Which finding requires the nurse to notify the health care provider?
Show answer and rationale
Answer: A. A sudden gush of bright red blood is unexpected and suggests active hemorrhage, requiring immediate provider notification and intervention. Small serosanguineous drainage, a mild temperature elevation, and moderate incisional pain are all expected findings in the early postoperative period and do not require notification, only continued monitoring and routine comfort measures. Recognizing what is normal for the client's condition versus what is truly abnormal prevents unnecessary escalation.
Checked against: OpenStax Medical-Surgical Nursing, 27.3
Question 7 · Psychosocial Integrity
A client scheduled for surgery tomorrow states, "I'm scared I won't wake up from the anesthesia." Which response by the nurse is most therapeutic?
Show answer and rationale
Answer: D. Reflecting the client's feeling and inviting further expression validates the client's emotional experience and opens the door to therapeutic communication, which is the priority response. Providing statistics about anesthesia safety or a pamphlet moves straight to facts before the feeling has been addressed, and telling the client not to worry offers false reassurance that dismisses the emotion. In therapeutic communication, addressing feelings comes before providing information or reassurance.
Checked against: OpenStax Fundamentals of Nursing, 31.2; OpenStax Clinical Nursing Skills, 1.3
Question 8 · Management of Care
The RN is making rounds. Which client should be seen first?
Show answer and rationale
Answer: A. A sudden change in mental status on post-op day 3, when the client was previously baseline, is a new and unexpected finding that suggests a developing complication such as hypoxia, infection, or delirium, so it must be investigated first. Expected incisional pain on day 1 is a predictable finding that can be managed after the acute change is addressed. Discharge teaching is not time-critical and can be delayed. The chronic pressure injury dressing is a long-standing issue that does not represent an acute change.
Checked against: OpenStax Clinical Nursing Skills, 18.4
Question 9 · Physiological Adaptation
A nurse enters a client's room and finds the client short of breath, using accessory muscles to breathe, with an oxygen saturation of 84% on room air. What is the nurse's priority action?
Show answer and rationale
Answer: A. The stem has already provided a completed assessment — accessory muscle use and a saturation of 84% — so the nurse's job now is to act, not to reassess. Applying oxygen and positioning the client upright are independent nursing actions that directly address hypoxemia and can be done immediately without waiting for an order. Auscultating lungs and gathering more vitals delays urgently needed treatment when the danger is already clear. Notifying the provider is appropriate but only after the nurse has taken immediate life-saving action; documenting and waiting 15 minutes is unsafe with a saturation this low.
Checked against: OpenStax Medical-Surgical Nursing, 27.1
Question 10 · Management of Care
Which client assignment is most appropriate for the LPN/LVN working under RN supervision?
Show answer and rationale
Answer: B. The LPN/LVN can safely care for stable, predictable clients, including administering scheduled medications and providing routine chronic care such as ostomy management. Initial assessment of a new admission, initial teaching of a new diagnosis, and management of an unstable client experiencing anaphylaxis all require RN-level judgment and should not be assigned to the LPN. The RN must retain any assignment involving something new, unstable, or requiring evaluation or initial teaching.
Checked against: OpenStax Fundamentals of Nursing, 15.4; OpenStax Psychiatric-Mental Health Nursing, 13.5
Question 11 · Basic Care and Comfort
A nurse is teaching a new graduate about safe positioning for a client with dysphagia during meals. Which statement by the new nurse indicates a need for further teaching?
Show answer and rationale
Answer: D. Fully reclining a client with dysphagia during feeding increases the risk of aspiration, so this statement is incorrect and requires further teaching. The word 'always' is also a red flag — absolute statements are almost never correct in nursing practice because care must be individualized. High-Fowler's positioning, remaining upright after meals, and checking for pocketed food are all correct, evidence-based dysphagia precautions and would not need correction.
Checked against: OpenStax Medical-Surgical Nursing, 11.7; OpenStax Clinical Nursing Skills, 22.4
Question 12 · Management of Care
Which tasks are appropriate for the RN to assign to an LPN/LVN caring for a stable, chronically ill client in a state where IV push medications are outside LPN/LVN scope? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: B, D, E. The LPN/LVN can appropriately administer scheduled oral medications, perform focused data collection on a stable client, and reinforce teaching that was already provided by the RN, since these tasks involve stable, predictable situations. Developing the initial plan of care and completing the initial admission assessment require RN-level judgment, and IV push medications are outside the LPN/LVN's scope in this state; LPN/LVN scope for IV therapy varies by state. The RN must retain responsibility for anything involving initial assessment, initial teaching, or complex judgment. This distinction is central to safe delegation.
Checked against: OpenStax Fundamentals of Nursing, 15.4; OpenStax Psychiatric-Mental Health Nursing, 13.5
Want more priority and delegation questions?
NurseLingo has 600+ NCLEX-style questions across 35+ topics with a rationale on every answer, and brings back the ones you miss.
Practice more in NurseLingoOn Android, the free NurseLingo app has 750+ study cards, NCLEX question decks and a home-screen widget. The full practice-question bank with rationales is on iPhone and iPad for now; get new questions by email below.
Frequently asked questions
How do I answer NCLEX prioritization questions?
Look for the client whose problem is unexpected, unstable or threatens airway, breathing or circulation right now. Expected findings for a condition, chronic problems and stable clients usually come later. The rationale under each question shows that reasoning step by step.
What can an RN delegate to a UAP?
Routine, predictable tasks for stable clients, such as hygiene, ambulation, vital signs on a stable client and intake and output. Assessment, teaching, evaluation and care of unstable clients stay with the RN.
About these questions
Every question on this page was approved by a licensed RN, and its answer was checked against open nursing references (mostly OpenStax nursing textbooks) before publishing. They are NCLEX-style practice, not real NCLEX items. NurseLingo is not affiliated with NCSBN. Spot a problem? Tell us.