NCLEX-RN: Priority Setting and Delegation

Priority setting and delegation sit at the center of NCLEX-RN clinical judgment. They are not “tricks” or memorized lists. They are structured ways to decide what matters most right now, what can safely wait, and what tasks can be assigned to others while the RN remains accountable for outcomes. On exam day and in practice, strong performance comes from combining safety principles (ABCs), patient needs (Maslow’s hierarchy), and legal boundaries (scope of practice).

What “priority” really means on the NCLEX-RN

On many questions, several answers seem reasonable. The NCLEX is often asking: Which action prevents the most harm in the shortest time? That usually means:

• Addressing immediate threats to life or limb
• Preventing rapid deterioration
• Identifying unstable versus stable patients
• Recognizing when you must assess first versus when you must act now

Priority setting is dynamic. A stable post-op patient with pain becomes a higher priority if they develop new shortness of breath. A patient waiting for discharge teaching becomes a lower priority if another patient has signs of shock.

The ABCs: your first safety filter

ABCs refers to Airway, Breathing, Circulation. It is a triage mindset: problems that interfere with oxygenation and perfusion rise to the top.

Airway

Airway problems include obstruction, inability to protect the airway, and swelling that may progress. Examples of airway red flags:

• Stridor, choking, inability to speak
• Drooling with difficulty swallowing
• Facial or neck swelling after an allergic exposure

Breathing

Breathing priorities include respiratory distress and impaired gas exchange. High-priority findings often include:

• Increased work of breathing, cyanosis
• Sudden drop in oxygen saturation with symptoms
• New onset confusion with hypoxia risk

Circulation

Circulation focuses on perfusion. Consider:

• Hypotension with symptoms, signs of shock
• Active, uncontrolled bleeding
• Chest pain with concerning features (especially if unstable)

Practical test-taking tip: If one option addresses airway or breathing compromise and others address comfort, education, or routine care, the airway/breathing option is usually correct.

Maslow’s hierarchy: organizing needs beyond the immediate crisis

Maslow’s hierarchy can help when multiple issues are present but none are an immediate ABC emergency. The classic ordering is:

1. Physiological needs (oxygen, fluids, nutrition, elimination, thermoregulation)
2. Safety and security (fall prevention, infection control, environmental safety)
3. Love and belonging
4. Self-esteem
5. Self-actualization

On the NCLEX, Maslow often separates “important” from “most important.” For example:

• A patient who is anxious about surgery (psychosocial) is not the priority over a patient with poor oxygenation (physiological).
• A patient requesting detailed discharge planning (higher-level needs) can typically wait if another patient is at high fall risk without assistance (safety).

Safety is a frequent “tie-breaker”

When two choices both seem physiological, the exam often rewards the one that best reduces harm. A confused patient trying to climb out of bed without help is a safety priority even if their vital signs are stable.

“Assess first” versus “intervene first”

Many questions are really about timing. As a general rule, assessment comes before intervention when:

• You do not have enough data to choose a safe action
• The situation is not immediately life-threatening
• The options include gathering key information (vital signs, focused assessment)

However, intervene first when:

• The patient is unstable
• There is a clear threat to airway, breathing, or circulation
• Delaying treatment would increase harm

A simple way to think about it: if you can justify that waiting to assess would be unsafe, act. If acting without assessment would be unsafe, assess.

Delegation: what the RN can assign and what must stay with the RN

Delegation questions test your understanding of scope of practice and the RN’s role. The RN may assign tasks, but remains responsible for supervision, evaluation, and judgment. The safest delegation decisions match the right task to the right person under the right circumstances.

Core principle: stable, routine, predictable tasks delegate best

Tasks are more appropriate to delegate when they are:

• Standard, repetitive, and have predictable outcomes
• Performed on stable patients
• Do not require interpretation, clinical judgment, or teaching

Tasks that typically must remain with the RN

While exact rules vary by jurisdiction and facility policy, NCLEX-style delegation commonly keeps these with the RN:

• Initial assessments and any assessment of an unstable patient
• Nursing diagnoses and care planning
• Patient teaching (especially initial education)
• Evaluation of response to interventions
• Complex clinical judgment, triage, and prioritization

Example: An RN can ask assistive personnel to obtain vital signs on a stable patient, but the RN must interpret the findings and decide what they mean.

Assignment decisions: matching patient needs to staff roles

Delegation and assignment often overlap. The exam expects you to recognize differences among team members and how patient acuity affects assignment.

Unlicensed assistive personnel (UAP)

UAP can often perform basic care that does not require nursing judgment, such as:

• Hygiene, ambulation, toileting assistance
• Feeding (when the patient is not at high aspiration risk and no new swallowing concerns exist)
• Measuring intake and output
• Obtaining routine vital signs (for stable patients)

Avoid assigning UAP tasks that involve:

• Assessment, interpretation, or decision-making
• New or worsening symptoms that require clinical judgment

Licensed practical/vocational nurse (LPN/LVN)

In many NCLEX frameworks, the LPN/LVN can provide care to stable patients with predictable outcomes, such as:

• Administering certain medications per policy
• Wound care and dressing changes for stable conditions
• Reinforcing teaching that the RN has initiated
• Monitoring and reporting changes (with the RN interpreting and acting)

Avoid assigning LPN/LVN primary responsibility for:

• Initial assessments
• Unstable patients or rapidly changing conditions
• Complex patient education and discharge planning that requires comprehensive teaching

Registered nurse (RN)

The RN is the appropriate assignment for:

• Unstable patients
• New admissions requiring comprehensive assessment
• Complex clinical decisions, care coordination, and education
• Patients with high risk for sudden deterioration

High-yield patterns the NCLEX uses

1) Unstable beats stable

If asked who to see first, prioritize the patient with acute changes, abnormal vital signs, or new symptoms.

2) Acute beats chronic

A sudden onset problem often takes precedence over a longstanding issue, even if the chronic condition is serious.

3) Actual problems beat potential problems

A patient who is actively short of breath usually outranks a patient at risk for shortness of breath, unless the “risk” is immediate and severe.

4) Time-sensitive treatments rise quickly

Any intervention that must happen promptly to prevent harm becomes a priority. Think in terms of deterioration risk and what cannot safely wait.

Putting it together: a practical decision sequence

When you face a priority setting or delegation question, move through a consistent mental checklist:

1. Is anyone crashing? Apply ABCs. If yes, act on airway/breathing/circulation first.
2. Who is unstable or changing? New symptoms, worsening status, or abnormal findings rise to the top.
3. What need level is this? Physiological and safety needs outrank psychosocial needs (Maslow).
4. Do I need more data? If not emergent, choose the option that assesses to clarify the situation.
5. Can I delegate this safely? Delegate stable, routine tasks. Keep assessment, teaching, and judgment with the RN.

Why this topic matters beyond the exam

Priority setting and delegation are not just test skills. They reflect how safe nursing care is delivered in real clinical environments where time, staffing, and acuity are constant constraints. The NCLEX-RN rewards choices that protect the patient first, use the team appropriately, and keep clinical judgment where it belongs. When you consistently apply ABCs, Maslow’s hierarchy, and scope of practice, the “best” answer becomes less about memorization and more about professional reasoning.