Prioritization, Delegation, and Assignment in Nursing NCLEX Practice Questions

In this section are the practice questions to exercise your knowledge on nursing prioritization, delegation, and assignment. As with other quizzes, be sure to read and understand the question carefully. For prioritization, delegation, and assignment questions, read each choices carefully before deciding on your answer. Good luck and answer these questions at your own pace. You are here to learn.

Quizzes included in this guide are:

• Part 1: Nursing Prioritization, Delegation, Assignment for NCLEX (25 Items)
• Part 2: Nursing Prioritization, Delegation, Assignment for NCLEX (25 Items)
• Part 3: Nursing Prioritization, Delegation, Assignment for NCLEX (25 Items)
• Part 4: Nursing Prioritization, Delegation, Assignment for NCLEX (25 Items)

Guidelines

• Read and understand each question before choosing the best answer.
• Since this is a review, answers and rationales are shown after you click on the “Check” button.
• There is no time limit, answer the questions at your own pace.
• Once all questions are answered, you’ll be prompted to click the “Quiz Summary” button where you’ll be shown the questions you’ve answered or placed under “Review”. Click on the “Finish Quiz” button to show your rating.
• After the quiz, please make sure to read the questions and rationales again by click on the “View Questions” button.
• Comment us your thoughts, scores, ratings, and questions about the quiz in the comments section below!

This is your guide to help you answer NCLEX priority, delegation, and assignment style questions.

NCLEX Tips for Nursing Prioritization, Delegation, and Assignment questions:

Here are six tips and strategies to help you ace NCLEX questions about delegation, assignment, and prioritization.

1. Do not make decisions based on resolutions

Do not make decisions concerning management of care issues based on resolutions you may have witnessed during your clinical experience in the hospital or clinic setting. As a student nurse, you are constantly reminded that NCLEX questions are to be solved and responded in the context of “Ivory Tower Nursing.” That is, if you only had one patient at a time, loads of assistive personnel, countless supplies, and equipment. This is what people mean when they refer to “textbook nursing.” But when you’re in the real world without the time and resources, you adjust. Your clinical rotation in management may have been less than ideal but remember that in NCLEX, the answers to the questions are seen in nursing textbooks or journals. Always bear in mind, “Is this textbook nursing care?”

2. Never delegate the functions of assessment, evaluation and nursing judgment.

Throughout your nursing education, you learned that assessments, nursing diagnosis, establishing expected outcomes, evaluating care and any other tasks and aspects of care including but not limited to those that entail sterile technique, critical thinking, professional judgment, and professional knowledge are the responsibilities of the registered professional nurse. You cannot give these responsibilities to nonprofessional, unlicensed assistive nursing personnel, such as nursing assistants, patient care technicians, and personal care aides.

3. Identify tasks for delegation based on the client’s needs.

Delegate activities for stable patients because some of these needs are relatively predictable and more frequently encountered. These are somewhat routinized and without the need for high levels of professional judgment and skill. But if the patient is unstable, the needs are acute and become unpredictable, ever-changing, and rarely, encountered as based on the changing status of the patient. These needs should not be delegated.

4. Ensure the appropriate education, skills, and experience of personnel performing delegated tasks.

Delegate activities that involve standard, consistent, and unchanged systems and procedures. The care of a patient with chest tubes and chest drainage can be delegated to either another RN or a licensed practical nurse, therefore, the RN who is authorizing must ensure that the nurse is qualified, skilled, and competent to perform this intricate task, to observe the patient’s response to this treatment, and to ensure that the equipment is operating suitably and accurately.

The care of a stable chronically ill patient who is comparatively stable and more anticipated than a seriously ill and unstable acute patient can be assigned to the licensed practical nurse; and assistance with the activities of daily living and basic hygiene and comfort care can be assigned and delegated to an unlicensed assistive staff member like a nursing assistant or a patient care technician. Activities that frequently occur in daily patient care can be delegated. Bathing, feeding, dressing and transferring patients are examples.

Procedures that are complex or complicated should not be delegated especially if the patient is highly unstable.

5. Remember priorities!

Recall and understand Maslow’s Hierarchy of Needs, the ABC’s (Airway, Breathing, Circulation), and stable versus unstable. It is necessary to know and understand the priorities when deciding which patient the RN should attend to first. Remember that you can see only one patient or perform one activity when answering questions that require you to establish priorities.

Always keep in mind that improper and inappropriate assignments can lead to inadequate quality of care, unexpected outcomes of care, the jeopardization of client safety, and even legal consequences. Right assignment of care to others, including nursing assistants, licensed practical nurses, and other registered nurses, is certainly one of the most significant daily decisions that nurses make.

6. Additional Test Taking Tips and Strategies

1. Questions using keywords such as “best,” “essential,” “highest priority,” “primary,” “immediate,” “first,” or “initial response” are asking for your prioritizing skills.
2. Know the patient’s purpose of care, current clinical condition, and outcome of care in order to determine and plan priorities.
3. Identify the priority patient based on the following: patient’s age, day of admission/surgery, or the number of body systems involved.
4. Unlicensed assistive personnel (UAP) such as nurses’ aides, certified nursing assistants, attendants, health aides are not allowed to delegate. Only a registered nurse can delegate tasks.
5. In some states, Licensed Practical Nurses (LPN) may delegate to a UAP depending on the state nursing practice.
6. Ensure the appropriate knowledge, skills, and experience of personnel performing the delegated tasks.
7. Do not delegate teaching, assessment, planning, evaluating, and nursing judgment to an unlicensed nurse.
8. A client with an unstable and unpredictable condition cannot be delegated to a UAP’s or LPNs.
9. Delegate tasks that involve standard, simple procedures such as bathing, dressing, feeding, and transferring patients.
10. Student nurses, float nurses, personal assistants, and other personnel may require levels of guidance and supervision.

Nursing Prioritization

Prioritization is deciding which needs or problems require immediate action and which ones could be delayed until at a later time because they are not urgent. In the NCLEX, you will encounter questions that require you to use the skill of prioritizing nursing actions. These nursing prioritization questions are often presented using the multiple-choice format or via ordered-response format. For a review, in an ordered-response question format, you’ll be asked to use the computer mouse to drag and drop your nursing actions in order or priority. Based on the information presented, determine what you’ll do first, second, third, and so forth. Directions are provided with the question. To help you answer nursing prioritization questions, remember the three principles commonly used:

1. Remember ABC’s (airway, breathing, and circulation).

Patients with obvious respiratory problems or interventions to provide airway management are given priority.

2. Maslow’s Hierarchy of Needs

Use Maslow’s hierarchy of needs as a guide to prioritize by determining the order of priority by addressing the physiological needs first.

There are five different levels of Maslow’s hierarchy of needs:

• Physiological Needs. The basic physiological needs have the highest priority and must be met first. Some examples of physiological needs include oxygen, food, fluid, nutrition, shelter, sleep, clothing, and reproduction.
• Safety Needs. Safety can be divided into physical and physiological. These include health, property, employment, security of the environment, and resources.
• Social Needs. These include love, family, friendship, and intimacy.
• Esteem. These include confidence, self-esteem, respect, and achievement.
• Self-actualization. These include creativity, morality, and problem-solving.

3. Using the Nursing Process

The nursing process is a systematic approach to assess and give care to patients. Assessment should always be done first before planning or providing interventions.

Delegation in Nursing

Delegation is the transference of responsibility and authority for an activity to other health care members who are competent to do so. The “delegate” assumes responsibility for the actual performance of the task and procedure. The nurse (delegator) maintains accountability for the decision to delegate and for the appropriateness of nursing care rendered to the patient. The role of a registered nurse also includes delegating care, assigning tasks, organizing and managing care, supervising care delivered by other health care providers, while effectively managing time! The NCLEX includes questions related to this unique nursing role of delegation.

5 Rights of Delegation in Nursing

The following are the five rights of delegation in nursing:

• Right Person. The licensed nurse and the employer and the delegatee are responsible for ensuring that the delegatee possesses the appropriate skills and knowledge to perform the activity.
• Right Tasks. The activity falls within the delegatees’ job description or is included as part of the nursing practice settings established written policies and procedures. The facility needs to ensure the policies and procedures describe the expectations and limits of the activity and provide any necessary competency training.
• Right Direction and Communication.
  • Each delegation situation should be specific to the patient, the licensed nurse, and the delegatee.
  • The licensed nurse is expected to communicate specific instructions for the delegated activity to the delegatee; the delegatee should ask any clarifying questions as part of two-way communication. This communication includes any data that needs to be collected, the method for collecting the data, the time frame for reporting the results to the licensed nurse, and additional information pertinent to the situation.
  • The delegatee must understand the terms of the delegation and must agree to accept the delegated activity.
  • The licensed nurse should ensure that the delegatee understands that she or he cannot make any decisions or modifications in carrying out the activity without first consulting the licensed nurse.
• Right Circumstances. The health condition of the patient must be stable. If the patient’s condition changes, the delegatee must communicate this to the licensed nurse, and the licensed nurse must reassess the situation and the appropriateness of the delegation.
• Right Supervision and Evaluation.
  • The licensed nurse is responsible for monitoring the delegated activity, following up with the delegatee at the completion of the activity, and evaluating patient outcomes. The delegatee is responsible for communicating patient information to the licensed nurse during the delegation situation. The licensed nurse should be ready and available to intervene as necessary.
  • The licensed nurse should ensure appropriate documentation of the activity is completed.