Prioritization and delegation.
The two skills that decide more NCLEX® questions than any single body system. Here are the frameworks that tell you who to see first and what you can hand off, plus the reasoning that makes them stick.
Who do you see first? Work the hierarchy.
- 01
Airway, Breathing, Circulation (ABC)
When two clients are both unstable, the one with the airway or breathing problem comes first. A client with an oxygen saturation of 84% outranks a client with chest pain. Circulation problems (active bleeding, no pulse) come next.
- 02
Maslow's hierarchy
Physiological needs before psychological ones. Oxygen, fluids, and elimination outrank safety, and safety outranks self-esteem. Use Maslow when the ABCs do not separate the options, for example a client in pain versus a client who is anxious.
- 03
Acute before chronic
A new, sudden change outranks a stable long-standing condition. New confusion in a post-op client beats a chronic diabetic's expected morning glucose. The word new is a cue to look closer.
- 04
Unstable before stable
Assess the client whose status could deteriorate. Abnormal vital signs, new symptoms, and post-op or post-procedure clients rank above those with expected findings. A predicted finding is rarely the priority.
- 05
Least restrictive, safety first
When the question is about intervention, pick the option that keeps the client safe with the least restriction. Try de-escalation before restraints, and the airway before the paperwork.
What can you delegate, and to whom?
The rule of thumb: the more stable and predictable the task, the further you can delegate. The nursing process (assessment, teaching, evaluation) and any unstable client stay with the RN.
Registered Nurse (RN)
Keeps assessment, teaching, evaluation, and any unstable or unpredictable client. The RN cannot delegate the nursing process itself. Anything requiring nursing judgment stays with the RN.
Licensed Practical/Vocational Nurse (LPN/LVN)
Can perform stable, predictable tasks: routine medications (often not IV push in many states), dressing changes, tube feedings, and monitoring stable clients. Reinforces teaching the RN started but does not do initial teaching.
Unlicensed Assistive Personnel (UAP)
Handles activities of daily living and standardized tasks: vital signs on stable clients, bathing, feeding, ambulating, intake and output, and positioning. No assessment, no teaching, no evaluation, no unstable clients.
Prioritization and delegation, answered
- How do I answer NCLEX® prioritization questions?
- Work through a hierarchy. Start with ABCs: the client with an airway or breathing threat comes first. If the ABCs do not separate the options, use Maslow (physiological before psychological), then acute before chronic and unstable before stable. The priority client is the one who will deteriorate fastest without you.
- What can an RN delegate to an LPN or UAP?
- Delegate stable, predictable, standardized tasks. A UAP can take vital signs on stable clients, help with bathing, feeding, and ambulation, and record intake and output. An LPN can give many routine medications, change dressings, and monitor stable clients. The RN keeps assessment, teaching, evaluation, and any unstable client.
- What are the five rights of delegation?
- Right task, right circumstance, right person, right direction and communication, and right supervision. Before delegating, the RN confirms the task is appropriate for that client and that team member, gives clear instructions, and stays responsible for the outcome.
- Why do prioritization questions feel so hard?
- Because every option is usually a real nursing action, so you cannot rule answers out as wrong. You are choosing which correct action comes first. Practicing with rationales that explain why the runner-up is second, not wrong, trains the ranking judgment the exam is testing.
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