NCLEX prioritization and delegation practice questions
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- 10 questions
- test-plan category
- Safe and effective care environment test-plan category
- last updated
- August 2026 last updated
These items rarely test a fact — they test whether you can rank four true things. Ten questions on which client the nurse assesses first, what can go to a UAP or an LPN, how assignments are made, and the parts of the nursing process that stay with the registered nurse no matter how busy the unit is.
Written and reviewed by Dana Whitfield, RN, MSN · Updated August 2026
Safe and effective care environment
The prioritization and delegation set, all 10 free
Answer, check, and read why each of the four options wins or loses.
Prioritization and delegation
Question 1 of 10
After receiving change-of-shift report on a medical unit, which client should the nurse assess first?
Not quite — the answer is C
Why each option is right or wrong
A. A client 2 days postoperative with a temperature of 38.1 C (100.6 F)
A temperature of 38.1 C on postoperative day two is common, warrants assessment, but is not an immediate threat to life.
B. A client with a fractured hip who rates pain 7 on a 0 to 10 scale
Pain rated 7 deserves prompt treatment, yet pain is not immediately life threatening and can be addressed after the airway problem.
C. A client with COPD whose respiratory rate is 30/min, who is using accessory muscles and speaking in two-word sentences
Accessory muscle use with two-word dyspnea and a rate of 30/min signals impending respiratory failure, the priority under the ABCs.
D. A client scheduled for discharge who needs teaching about warfarin
Warfarin discharge teaching matters but can be scheduled once unstable clients have been assessed and stabilized.
Key takeaway
Accessory muscle use with two-word dyspnea signals impending respiratory failure, which takes priority under the ABCs. Pain and a low-grade postoperative fever are important but neither is immediately life threatening, and discharge teaching can be scheduled after unstable clients are stabilized.
The charge nurse is assigning tasks on a busy surgical unit. Which task is appropriate to delegate to unlicensed assistive personnel (UAP)?
Not quite — the answer is A
Why each option is right or wrong
A. Assisting a stable postoperative client to ambulate in the hallway with a walker
Ambulating a stable postoperative client with an established walker plan is a standardized, predictable task within the UAP scope.
B. Reinforcing discharge teaching about a low-sodium diet
Reinforcing dietary teaching still requires nursing judgment about the client's understanding and cannot be delegated to unlicensed personnel.
C. Assessing a client's surgical incision for drainage and approximation
Assessing an incision for drainage and approximation is an assessment step reserved for the licensed nurse.
D. Administering an oral pain medication to a client who is due
Administering oral pain medication requires licensure, so UAP may not give it regardless of how stable the client is.
Key takeaway
Ambulating a stable client with an established plan is a standardized, predictable task within the UAP scope. Assessment, teaching, and medication administration require nursing judgment or licensure and cannot be delegated to UAP under the five rights of delegation.
A charge nurse is making assignments for a licensed practical nurse (LPN/LVN) on a medical-surgical unit. Which assignment is within the LPN's scope of practice?
Not quite — the answer is B
Why each option is right or wrong
A. Developing the individualized plan of care for a newly admitted client
Developing the individualized plan of care requires the RN's independent judgment and synthesis of admission assessment data.
B. Administering oral and subcutaneous medications and monitoring a stable client who has a nasogastric tube to suction
LPNs may give oral and subcutaneous medications and monitor stable clients with established plans, including one with nasogastric suction.
C. Performing the initial admission assessment on a client arriving from the emergency department
The initial admission assessment must be performed by the RN, who establishes the baseline and builds the plan of care.
D. Titrating an intravenous heparin infusion based on aPTT results
Titrating a high-alert heparin infusion against aPTT results requires RN judgment and cannot be assigned to an LPN.
Key takeaway
LPNs may administer most routine medications and monitor stable clients with established plans of care. Initial assessment, care planning, and titration of high-alert IV infusions require the RN's independent judgment and cannot be delegated.
The unlicensed assistive personnel reports the following to the nurse. Which report requires the nurse's immediate attention?
Not quite — the answer is D
Why each option is right or wrong
A. A client whose blood pressure is 148/86 mm Hg
A blood pressure of 148/86 mm Hg is mildly elevated and needs follow-up, but poses no immediate threat next to falling oxygenation.
B. A client who has not voided in the 4 hours since returning from surgery
Not voiding four hours after surgery requires bladder assessment soon, yet retention is less urgent than developing hypoxia.
C. A client who is requesting a snack before an early-morning laboratory draw
A snack request before fasting laboratory work is a scheduling matter easily handled after urgent clinical problems.
D. A client who is restless and whose oxygen saturation dropped from 95% to 88% on 2 L/min nasal cannula
A saturation drop to 88% with new restlessness is early hypoxia, the highest priority under the ABCs, and demands immediate assessment.
Key takeaway
A falling saturation with new restlessness is an early sign of hypoxia and is the highest priority by the ABCs. Postoperative urinary retention at 4 hours needs assessment soon, and the elevated blood pressure and the snack request are important but not immediately life threatening.
During triage after a multivehicle crash, which client should the nurse treat first?
Not quite — the answer is A
Why each option is right or wrong
A. An adult with an open chest wound that bubbles with respiration and asymmetric chest rise
An open pneumothorax with asymmetric chest rise is an immediately correctable breathing threat, making this the highest-priority emergent client.
B. An adult with an open femur fracture and a palpable pedal pulse
An open femur fracture with a palpable pedal pulse is urgent but delayed category, since distal circulation remains intact.
C. An adult with a 4-cm forehead laceration and a Glasgow Coma Scale score of 15
A forehead laceration with a Glasgow Coma Scale of 15 is a minor injury that can safely wait for treatment.
D. An adult with full-thickness burns over 60% of the body surface and no spontaneous respirations
Full-thickness burns over 60% with no spontaneous respirations is triaged expectant in mass casualty events, where resources go to salvageable clients.
Key takeaway
An open pneumothorax with asymmetric chest rise is an immediately correctable airway and breathing threat, making this client the highest-priority emergent case. The apneic client with 60% full-thickness burns is triaged as expectant in a mass casualty event, and the fracture and laceration are delayed or minor categories.
The RN is working with an experienced LPN/LVN. Which task must the RN perform rather than delegate?
Not quite — the answer is C
Why each option is right or wrong
A. Suctioning an established tracheostomy
Suctioning an established tracheostomy is a technical skill within the LPN's scope when the client is stable.
B. Inserting an indwelling urinary catheter
Inserting an indwelling urinary catheter is a sterile technical procedure LPNs are trained and licensed to perform.
C. Evaluating a client's response to the newly implemented plan of care
Evaluating the client's response to a newly implemented plan of care is a nursing process step reserved for the RN.
D. Changing a sterile dressing on a chronic wound
Changing a sterile dressing on a chronic wound falls within LPN scope when the client is stable and the plan is established.
Key takeaway
Evaluation, like assessment and care planning, is a nursing process step reserved for the RN and cannot be delegated. Tracheostomy suctioning, catheter insertion, and sterile dressing changes are technical skills within the LPN's scope when the client is stable.
A nurse from the postpartum unit is floated to a medical-surgical unit. Which client should the charge nurse assign to this nurse?
Not quite — the answer is D
Why each option is right or wrong
A. A client receiving a packed red blood cell transfusion for an upper gastrointestinal bleed
Monitoring a transfusion during an upper GI bleed requires recognition of reaction and hemorrhage patterns outside routine postpartum practice.
B. A client 1 hour after cardiac catheterization with a femoral sheath site
A femoral sheath one hour after cardiac catheterization demands specialized site, bleeding, and pulse assessment this nurse may lack.
C. A client on a continuous insulin infusion for diabetic ketoacidosis
Titrating a continuous insulin infusion for diabetic ketoacidosis requires critical care knowledge unfamiliar to a postpartum nurse.
D. A client with stable cellulitis of the lower leg receiving intravenous antibiotics
Stable cellulitis treated with routine IV antibiotics is a predictable assignment using skills common to all practice settings.
Key takeaway
Floated nurses should receive the most stable clients with predictable outcomes and skills common to all practice settings, such as routine IV antibiotics. Transfusion reactions, post-catheterization bleeding, and insulin titration in DKA all demand specialty knowledge that a postpartum nurse may not have, creating a safety risk.
The nurse has just received report on four clients. Which client should the nurse assess first?
Not quite — the answer is B
Why each option is right or wrong
A. A client with type 2 diabetes whose morning glucose is 210 mg/dL
A morning glucose of 210 mg/dL needs treatment but is not an emergency compared with a threatened artificial airway.
B. A client with a new tracheostomy who has thick secretions and audible gurgling with each breath
Audible gurgling with thick secretions through a new tracheostomy indicates partial airway obstruction requiring immediate suctioning.
C. A client with cirrhosis who has 2+ pitting edema of the lower extremities
Two-plus pitting edema in cirrhosis is a chronic expected finding that does not threaten airway, breathing, or circulation right now.
D. A client 1 day postoperative who reports nausea after breakfast
Postoperative nausea is uncomfortable and warrants an antiemetic, but it ranks well below an obstructed artificial airway.
Key takeaway
Audible gurgling with thick secretions indicates a partially obstructed artificial airway, the highest priority under the ABCs, and requires immediate suctioning. Hyperglycemia, chronic edema, and postoperative nausea all need attention but none threatens airway patency.
The nurse is supervising unlicensed assistive personnel on a medical unit. Which observed action requires the nurse to intervene?
Not quite — the answer is A
Why each option is right or wrong
A. The UAP places a blood pressure cuff on the arm containing an arteriovenous fistula
Cuff pressure on the fistula extremity can thrombose the access the client depends on for dialysis, so the nurse must intervene.
B. The UAP raises the bed to waist height before giving a bed bath
Raising the bed to waist height before a bed bath is correct body mechanics and needs no correction.
C. The UAP records the client's intake and output at the end of the shift
Recording intake and output at shift end is a routine measurement task appropriately within the UAP scope.
D. The UAP assists a client with denture care before a meal
Assisting a client with denture care before a meal is basic hygiene support entirely appropriate for the UAP.
Key takeaway
Blood pressure measurement, venipuncture, and IV access are prohibited in an extremity with an AV fistula because pressure can thrombose the access the client depends on for dialysis. The other three actions are safe, appropriate UAP tasks that support body mechanics, monitoring, and hygiene.
A clinic nurse is returning telephone messages. Which client should the nurse call back first?
Not quite — the answer is C
Why each option is right or wrong
A. A client taking levothyroxine who reports mild constipation
Mild constipation on levothyroxine may suggest underreplacement and merits a callback, but it carries no immediate danger.
B. A client 3 days postoperative who reports itching around the incision
Itching around a three-day-old incision is a normal sign of healing and can be addressed after urgent calls.
C. A client who started lisinopril yesterday and reports swelling of the lips and tongue since this morning
Lip and tongue swelling the day after starting lisinopril suggests angioedema, a potentially fatal airway emergency needing immediate action.
D. A client with osteoarthritis asking when to take ibuprofen in relation to meals
A question about taking ibuprofen with meals is routine teaching with no time pressure attached.
Key takeaway
Lip and tongue swelling after starting an ACE inhibitor suggests angioedema, a potentially fatal airway emergency requiring immediate action. Incisional itching is a normal sign of healing, and the constipation and medication timing questions are non-urgent and can be addressed later.
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