nursing prioritization delegation and assignment

Prioritization, Delegation, and Assignment in Nursing NCLEX Practice Questions (100 Items)

In this NCLEX guide , we’ll help you review and prepare for prioritization, delegation, and assignment in your nursing exams. For this nursing test bank , improve your prioritization, delegation , and patient assignment skills by exercising with these practice questions. We will also be teaching you test-taking tips and strategies so you can tackle these questions in the NCLEX with ease. The goal of these practice quizzes and reviewers is to help student nurses establish a foundation of knowledge and skills on prioritization, delegation, and assignment.

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Prioritization, Delegation, and Assignment Practice Quiz

This section contains 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 choice 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:

Nursing Prioritization, Delegation and Assignment Reviewer for Nurses

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 the 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 to 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 based on the patient’s changing status. 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 authorizing RN must ensure that the nurse is qualified, skilled, and competent to perform this intricate task, observe the patient’s response to this treatment, and 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 ABCs (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 care outcomes, 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 nurses make.

6. Additional Test Taking Tips and Strategies

• Questions using keywords such as “ best ,” “ essential ,” “ highest priority ,” “ primary ,” “ immediate ,” “ first ,” or “ initial response ” are asking for your prioritizing skills.
• Know the patient’s purpose of care, current clinical condition, and outcome of care in order to determine and plan priorities.
• Identify the priority patient based on the following: patient’s age, day of admission/ surgery , or the number of body systems involved.
• 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. 
• In some states, Licensed Practical Nurses ( LPN ) may delegate to a UAP depending on the state nursing practice .   
• Ensure the appropriate knowledge, skills, and experience of personnel performing the delegated tasks.
• Do not delegate teaching, assessment , planning , evaluating, and nursing judgment to an unlicensed nurse.
• A client with an unstable and unpredictable condition cannot be delegated to a UAP’s or LPNs.
• Delegate tasks that involve standard, simple procedures such as bathing , dressing , feeding , and transferring patients.
• 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 later 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.
• 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.
• 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.

Recommended Resources

Recommended books and resources for your NCLEX success:

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Saunders Comprehensive Review for the NCLEX-RN Saunders Comprehensive Review for the NCLEX-RN Examination is often referred to as the best nursing exam review book ever. More than 5,700 practice questions are available in the text. Detailed test-taking strategies are provided for each question, with hints for analyzing and uncovering the correct answer option.

Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items Next Generation NCLEX®-style practice questions of all types are illustrated through stand-alone case studies and unfolding case studies. NCSBN Clinical Judgment Measurement Model (NCJMM) is included throughout with case scenarios that integrate the six clinical judgment cognitive skills.

Saunders Q & A Review for the NCLEX-RN® Examination This edition contains over 6,000 practice questions with each question containing a test-taking strategy and justifications for correct and incorrect answers to enhance review. Questions are organized according to the most recent NCLEX-RN test blueprint Client Needs and Integrated Processes. Questions are written at higher cognitive levels (applying, analyzing, synthesizing, evaluating, and creating) than those on the test itself.

NCLEX-RN Prep Plus by Kaplan The NCLEX-RN Prep Plus from Kaplan employs expert critical thinking techniques and targeted sample questions. This edition identifies seven types of NGN questions and explains in detail how to approach and answer each type. In addition, it provides 10 critical thinking pathways for analyzing exam questions.

Illustrated Study Guide for the NCLEX-RN® Exam The 10th edition of the Illustrated Study Guide for the NCLEX-RN Exam, 10th Edition. This study guide gives you a robust, visual, less-intimidating way to remember key facts. 2,500 review questions are now included on the Evolve companion website. 25 additional illustrations and mnemonics make the book more appealing than ever.

NCLEX RN Examination Prep Flashcards (2023 Edition) NCLEX RN Exam Review FlashCards Study Guide with Practice Test Questions [Full-Color Cards] from Test Prep Books. These flashcards are ready for use, allowing you to begin studying immediately. Each flash card is color-coded for easy subject identification.

Recommended Links

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• Nursing Test Bank: Free Practice Questions UPDATED ! Our most comprehenisve and updated nursing test bank that includes over 3,500 practice questions covering a wide range of nursing topics that are absolutely free!
• NCLEX Questions Nursing Test Bank and Review UPDATED! Over 1,000+ comprehensive NCLEX practice questions covering different nursing topics. We’ve made a significant effort to provide you with the most challenging questions along with insightful rationales for each question to reinforce learning.

11 thoughts on “Prioritization, Delegation, and Assignment in Nursing NCLEX Practice Questions (100 Items)”

Very helpful. A LPN graduate who has taken the nclex four times. It gives me a quick overview. Thanks

Love it!!! These made me think. They up there with ReMar and uWorld.

Very helpful thanks

In which order will the nurse perform the following actions as she prepares to leave the room of a client with airborne precautions after performing oral suctioning?

please your order for this question is wrong

I have learned a lot from the NursesLabs. Love it!

Nurse Pietro receives an 11-month old child with a fracture of the left femur on the pediatric unit. Which action is important for the nurse to take FIRST? First- Speak with parents as to how injury occurred??? Yes, this is going to take place but this the first thing to do? Perhaps the wording needs to change as I have been “textbook” taught, treat first, then question in cases of suspected abuse.

good questions which test your analyzing and critical thinking skils

Thank you for making this free. It is my additional resources. This has been very helpful. I really appreciate that you are helping all future nurses to be at their best .

I’m really grateful for this excercise which aids in preparing for the NCLEX. Thanks

This has help me pass my nclex !! Thanks

I am interested to join nurseslab daily question

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Prioritization, Delegation, and Assignment, 5th Edition

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• NEW and UNIQUE! Updated question formats prepare you to succeed on the Next-Generation NCLEX-RN ® Examination (NGN) by including the latest item types and highlighting each with a distinctive icon.
• NEW and UNIQUE! Next-Generation NCLEX Questions chapter includes only NGN-style questions to help you focus your study time on these new question formats and optimize your chances for success on the NGN.
• NEW! Dozens of additional questions and answers provide more review and practice for the increasingly challenging NCLEX-RN Exam.
• NEW! Updated content throughout matches the latest evidence-based guidelines and treatment protocols.
• Management-of-care focus addresses the emphasis on prioritization, delegation, and patient assignment in the NCLEX-RN ® Examination.
• Three-part organization first establishes foundational knowledge and then provides exercises with scenarios of increasing difficulty to help you build confidence in your prioritization, delegation, and patient assignment skills.
• Part One: Introduction provides a concise foundation and practical guidelines for making prioritization, delegation, and patient assignment decisions.
• Part Two: Prioritization, Delegation, and Assignment in Common Health Scenarios provides practice in applying the principles you’ve learned to relatively straightforward health scenarios involving single patients or simple patient assignments.
• Part 3: Prioritization, Delegation, and Assignment in Complex Health Scenarios includes unfolding cases involving patients with progressively more complicated health problems or challenging assignment issues, demonstrating the progression of typical health scenarios and helping you learn to "think like a nurse."
• Answer keys follow each chapter and provide the correct answer plus a detailed rationale.
• Practice quizzes on the Evolve website include all of the book’s questions in an interactive format that allows you to create a virtually unlimited number of practice sessions or tests in Study Mode or Exam Mode.

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Prioritization, Delegation, and Assignment: Practice Exercises for the NCLEX Examination 3rd Edition

The only NCLEX review book on the market with a focus on prioritization, delegation, and patient assignment ? just like the current NCLEX Examination itself! Using a unique simple-to-complex approach, Prioritization, Delegation, and Assignment: Practice Exercises for the NCLEX® Examination, 3rd Editionestablishes your foundational knowledge in management of care, then provides exercises of increasing difficulty to help you build confidence in your prioritization, delegation, and patient assignment skills.

"..certainly a great resource for use in any healthcare setting." Reviewed by Anne Duell on behalf of Nursing Times, September 2015

• UNIQUE! Emphasis on the NCLEX Examination’s management-of-care focus addresses the heavy emphasis on prioritization, delegation, and patient assignment in the current NCLEX Examination (17–23% of the 2013 NCLEX-RN Exam).
• UNIQUE! Three-part organization establishes foundational knowledge and then provides exercises of increasing difficulty to help you build confidence in your prioritization, delegation, and patient assignment skills.
• Answer key at the back of the book offers a detailed rationale and an indication of the focus of the question to encourage formative assessment.
• Introduction chapter by delegation expert Ruth Hansten provides guidelines for prioritization, delegation, and patient assignment decisions as well as a concise, practical foundation on which Parts 2 and 3 build.
• Part 2: Prioritization, Delegation, and Assignment in Common Health Scenarios give you practice in applying the principles from Part 1 with straightforward NCLEX-style multiple-choice, multiple-select, ordering, and short-answer questions to help you develop and build confidence in prioritization, delegation, and patient assignment skills while working within the confines of relatively simple health scenarios.
• Part 3: Prioritization, Delegation, and Assignment in Complex Health Scenarios utilizes unfolding cases that build on the skills learned in Part 2 to equip you to make sound decisions in realistic, complex health scenarios involving complicated health problems and/or challenging patient assignment decisions and help you learn to "think like nurses" by developing what Benner (2010) calls "clinical imagination."
• NEW! Fully interactive question functionality features optional online answer submission with automated scoring.
• Introducing the QSEN initiative and QSEN competencies in Part I
• Including a new chapter focused primarily on safety and other "nursing fundamentals" issues
• Identifying corresponding QSEN competencies and Concepts for each question in the Answer Key in the Evolve Instructor Resources
• NEW! Faculty-only Unfolding Cases and Suggested Uses resource on Evolve facilitate classroom discussion, development of clinical reasoning skills, and learner evaluation, as well as tips for teaching with the book throughout the nursing curriculum.
• NEW! Safety and Infection Control chapter features an increased number of questions specific to the QSEN safety competency.
• NEW! Separate Diabetes Mellitus and Other Endocrine Problems chapters give greater emphasis to diabetes as requested in feedback on the previous edition.
• NEW! Pediatric Problems and Psychiatric–Mental Health Problems chapters expand on content formerly integrated into body systems chapters to provide you with a more thorough understanding of these key clinical areas.
• NEW! NCLEX chart-format questions include six patient "charts" in Case Study 6 (Home Health) to reflect the NCLEX Exam's chart-format questions.
• NEW! Design and navigation enhancements include page cross-references at the bottom of each page, quick-reference tabs on the answer key, and a new two- color design.
• NEW! Additional questions address the newborn, immunization, catheter-related infection, and ventilator-related infection.
• ISBN-10 0323113435
• ISBN-13 978-0323113434
• Edition 3rd
• Publisher Mosby
• Publication date December 16, 2013
• Language English
• Dimensions 8.25 x 0.5 x 10.5 inches
• Print length 256 pages
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"This book should be considered for reading in any nursing environment, incorporating hospital and community homes where an individual is cared for by a range of health care staff. It should be read by learning and development departments where they support nursing staff with clinical decision making." Reviewed by Anne Duell on behalf of Nursing Times, September 2015

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• Publisher ‏ : ‎ Mosby; 3rd edition (December 16, 2013)
• Language ‏ : ‎ English
• Paperback ‏ : ‎ 256 pages
• ISBN-10 ‏ : ‎ 0323113435
• ISBN-13 ‏ : ‎ 978-0323113434
• Item Weight ‏ : ‎ 1 pounds
• Dimensions ‏ : ‎ 8.25 x 0.5 x 10.5 inches
• #143 in Nursing Administration & Management
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Next-Gen NCLEX-RN: Identifying Prioritization, Delegation, and Scope of Practice Questions

This section of allnurses' Next-Gen NCLEX-RN Study Guide focuses on questions relating to prioritization, delegation, and scope of practice. Resources

• Next Gen Nclex
• Table of Contents:
• Prioritization Questions
• Delegation Questions
• Scope of Practice Questions

Prioritization , delegation , and scope of practice questions are some of the most difficult questions to answer for NCLEX candidates. These questions are plentiful on the exam and often challenge test-takers to make safe and sound decisions about the care they are providing. Since these questions ask candidates to make decisions, these are typically higher-level questions and require a great deal of concentration and understanding of the nursing concepts that guide nursing practice. To help you focus on what's most important, let's look at how each of these high-level nursing concepts requires a bit of strategy to stay focused on the bigger picture.

This article is part of a more extensive study guide for the Next-Gen NCLEX-RN:

• Best Free Online Next-Gen NCLEX-RN Study Guide
• The Nursing Process: Everything Next-Gen NCLEX-RN Test-Takers Need to Know
• Next-Gen NCLEX-RN Question Leveling: Recognition, Comprehension, Application, and Analysis
• Next-Gen NCLEX-RN Expert Test-Taking Strategies

Prioritization

When you see the words:

These indicate that the test question is focusing on the nursing concept of prioritization. This concept challenges candidates to understand the criteria requiring the nurse to shift priorities as they move through care delivery. To make it easier, the following principles will help set guidelines that should help make decisions and priorities.

Acute vs Chronic

The principle of acute versus chronic can be interpreted as all acute issues or problems always taking priority over chronic issues or problems. For example, a patient that is experiencing a sudden onset of shortness of breath will take priority over a patient that is short of breath due to a COPD exacerbation. The "sudden onset" is a key term that lets the test-taker know it is a new status change. If the question offers several acute issues as possible answer choices, then you must think about the issues separately and determine which one is more severe and requires immediate attention.

Actual vs Potential

The principle of actual versus potential can be interpreted as all actual issues or problems taking priority over potential issues or problems. For example, a patient that is complaining of pain will take priority over a patient that has right-sided weakness and is requesting to go to the commode. Of course, the candidate may consider the possibility of the patient with right-sided weakness falling if they attempt to get up to go to the commode on their own, but as it stands, it remains a potential problem and therefore does not take priority over the person in pain. It is important to always consider the fact that the test questions want the test-taker to focus on the immediate need that needs to be addressed at this moment. One of the biggest challenges for new grad nurses is thinking too deeply about the "what ifs," which can quickly get them to choose the incorrect answer.

Physical vs Psychosocial

The principle of physical versus psychosocial can be interpreted as all physical issues or problems taking priority over psychosocial issues or problems. For example, a patient that is complaining of chills takes priority over a patient that is complaining of pain. Both of these are actual problems; however, on the NCLEX, pain is considered a psychosocial issue. Chills could be related to infection and, therefore, the priority at this moment. Of all the physical needs that a patient may have, you can prioritize those by using Maslow's Hierarchy of Needs.

Physical needs include:

• Circulation
• Elimination
• Temperature

Psychosocial needs include:

• Emotional support

Unstable vs Stable

The principle of unstable versus stable is a little less cut and dry in regard to interpretation. The word unstable in itself is pretty vague and could involve many considerations and factors. To make it easier for candidates to determine if a patient is unstable or not, consider the following:

• Is there a sudden or new onset of a status change? If so, then the patient is unstable.
• Are there any actual issues that require the skill set of the nurse? If so, that patient is unstable.
• Is there a question about the outcome of the patient? If so, then the patient is unstable.
• Is the patient brand new or just returned from a procedure? If so, then the patient is unstable.
• Is the patient emotionally distraught, angry, or fearful? If so, the patient is unstable.
• Does the patient have abnormal vital signs that put them at risk for injury? If so, then the patient is unstable.
• Is the patient at risk of losing life or limb? If so, the patient is unstable.

Stable patients have predictable outcomes, have normal vital signs, are not demonstrating any actual issues or problems at the moment, and are within normal limits of the care plan .

Just remember that if a patient requires a great deal of nursing judgment and close assessment, then that patient can be considered unstable and requires the RN to tend to them first. When establishing priority, you can utilize all of the above principles to help you determine which answer choice best meets the criteria for the prioritization rules.

Nursing students often struggle with delegation simply because they do not get enough opportunities throughout their schooling to practice the art and science of safe and effective delegation. Despite having first-hand experience or not, if candidates understand the fundamental principles and guidelines of delegation, then they can correctly answer NCLEX questions surrounding this concept.

Rules of Delegation

Nursing delegation can begin anytime after the RN has assessed the patient, and after the patient's condition and needs have been considered. The RN will prioritize the patient's needs based on their condition and differentiate between nursing and non-nursing tasks.

Tasks such as obtaining a set of vital signs on a stable patient could be delegated to allow the RN to do other tasks that require the skill set of an RN.

The NCLEX is mainly concerned with the candidate's understanding of what the nurse should not delegate. The functions of the nurse that cannot be delegated include:

• Nursing Judgement

For RNs, this is limited to initial assessment, initial evaluation, and initial teaching. PNs are perfectly capable of doing ongoing assessments, reinforcing patient education, and evaluating the effectiveness of the care they are providing. However, they must follow the same principles as an RN and not delegate the functions of the nurse to a nursing assistant or unlicensed assistive personnel.

Another thing to consider when determining if it is safe to delegate is the person's ability to complete the task safely and whether or not the delegating nurse will be available to supervise and intervene if necessary. If the nurse is not available to assist in the event that there is a complication or unexpected outcome, then the nurse should not delegate the task as it would be considered to violate the rules of safe and effective delegation.

When In Doubt, Check It Out

Sometimes situations are difficult and require much discernment to determine if we are upholding the highest standards of patient safety and nursing practice. NCLEX questions can be very challenging and require candidates to carefully consider the best, safest, and most appropriate actions related to the situation provided. In many cases, this task is difficult because there may be a lot of questions or there isn't enough information to make a sound decision about what to do.

When nurses run into situations where they do not know what to do next, they rely on assessment to figure it out. So when test-takers are confused or uncertain of what to do next, they can rely on assessment to help guide them.

Let's take a look at how being unsure or not having enough information can guide a candidate into using assessment to select the correct answer:

A mother calls the clinic to report that her child has been nauseated and vomiting and that her child has type I diabetes. What should the nurse tell the mother?

• Give the child foods with simple sugars
• Give all medications as prescribed
• Check the blood glucose every three to four hours
• Give small, frequent meals

The correct answer is 3.

This question does not provide enough information for the candidate to make a safe and informed decision regarding the care of the patient. Several things could relate to nausea and vomiting that may or may not be related to diabetes. Therefore, the only answer that would help the nurse make a better, informed decision is to use assessment to obtain more data that can be analyzed.

Frequent blood sugar readings will help the nurse determine if the patient is stable enough to be treated at home or if they need to report to the nearest healthcare facility for treatment.

Assessment is always the first step in The Nursing Process and therefore becomes the default when nurses are unsure what to do next or if they require more information to make an informed decision.

Here is another example of how being unsure or not having enough information can guide a candidate into using assessment to select the correct answer:

The nurse responds to a Rapid Response. When the nurse arrives to assist in the rapid response, a nursing assistant tells the nurse that the patient started to complain of chest pain before they fell to the floor. Which of the following actions, if taken by the nurse, would be most appropriate?

• Help the nursing assistant move the patient from the floor to the bed
• Ask the nursing assistant what the patient was doing before the chest pain started
• Tell the nursing assistant to get supplies for supplemental oxygen therapy
• Ask the patient if they are okay

The correct answer is 4.

This question does not provide enough information for the candidate to make a safe and informed decision regarding the care of the patient. When nurses do not have enough information, they should always default to assessment. In this case, the nurse needs to assess the patient to determine what level of care they may need. Are they alert? Responsive? Do they look injured? Do they require emergent intervention? The nurse must first assess the patient before they can decide what to do next.

Scope of Practice

Nurses have a very special role within the healthcare team. Nurses spend the most time with their patients. They are with their patients during the most intimate of situations. Nurses are on the front lines of patient care delivery, patient satisfaction, patient safety, and patient outcomes.

The NCLEX challenges candidates to fully understand the scope of practice, including ability and limitations. Just as test-takers must be able to answer questions about The Nursing Process correctly, they must also be able to answer scope of practice questions successfully. RNs and PNs must be able to distinguish between the differences within their scope of practice.

Let's review the key differences between each scope and give examples of how the NCLEX may challenge this nursing concept.

Rules of Management (RNs)

RNs are considered to be "managers" of patient care. With this responsibility falling under the scope of practice for the RNs, candidates taking the NCLEX-RN must be well-versed in the rules that guide their practice. In addition to understanding concepts of nursing leadership, conflict resolution, customer service, and other administrative skills, the NCLEX wants RNs to understand the rules that help them make careful decisions about managing patient care.

Here are the rules of management for RN candidates:

• Always follow the rules of delegation (never delegate what you can E.A.T.). Remember that RNs must do all of the initial assessment, evaluation, and teaching.
• Nursing practice and decision-making must always stem from evidence-based practice and textbook nursing.
• Always follow the rules of Prioritization (ABCs, Maslow's, Actual vs. Potential, etc.)
• RNs are responsible for verifying, validating, and following up with all status changes, new patients, complaints, and unexpected outcomes.
• RNs must never leave their patients until they have been determined to be stable.

Here is an example of how the NCLEX could challenge the RN candidate to answer a question about the rules of management:

A 37-year-old patient is being admitted to the unit for a fracture of the right femur. Which of the following actions by the nurse is best?

• Tell the nursing assistant to obtain the vital signs while the RN obtains a health history from the patient
• Tell the PN to go obtain phone orders from the physician while the RN assesses the pedial pulses
• Tell the PN to stay with the client while the RN goes to get supplies to care for the patient
• Tell the nursing assistant to fill out the admission forms while the RN goes on a lunch break

The correct answer is 2.

This question challenges the candidate to be able to identify the correct action that falls within the scope of practice for the RN. Following the rules of management as a guide really helps test-takers make decisions about correct and incorrect answer choices. Answer choice 1 violates the rules of management of care because the RN is responsible for all initial assessments. Answer choice 3 violates the rules of management because the RN should never leave the patient until they are determined to be stable. Answer choice 4 violates the rules of management of care because the RN is responsible for documenting their findings during the admission assessment. Also, the RN should not leave the patient until they are determined to be stable.

Here is another example of how the NCLEX could challenge the RN candidate to answer a question about the rules of management:

A nurse is creating the unit assignment for the day. Which of the following clients would be appropriate to assign to an LPN?

• A 33-year-old patient who had an appendectomy yesterday and is scheduled to be discharged later today
• A 42-year-old patient who had a bowel resection two days ago and has a nasogastric tube inserted and set to intermittent suction
• A 68-year-old patient who has lower abdominal pain and is scheduled to have an exploratory endoscopy in the afternoon
• A 98-year-old patient who is on hospice and is demonstrating agonal breathing

This question challenges the candidate to identify the correct action that falls with-in the scope of practice for the RN—which, in this case, is appropriate delegation. Following the rules of management as a guide helps test-takers make decisions about correct and incorrect answer choices. Answer choice 1 violates the rules of management of care because the RN is responsible for all initial teaching. Discharge teaching is the responsibility of the RN. Answer choice 3 violates the rules of management of care because the RN is responsible for all initial teaching, assessment, and evaluation. Patients going for procedures should be managed by the RN for these reasons. Answer choice 4 violates the rules of management because the RN should keep patients with complex needs and/or who have unexpected outcomes. Although hospice patients demonstrating agonal breathing is expected in the stages of death and dying, each person's response to death can vary. These patients and their family members may require additional teaching, assessment, and evaluation to provide the best care possible.

Rules of Coordination (PNs)

PNs are considered to be the coordinators of patient care. With this responsibility falling under the scope of practice for the practical nurse, candidates taking the NCLEX-PN must be well-versed in the rules that guide their practice. In addition to understanding concepts of nursing leadership, conflict resolution, customer service, and other administrative skills, the NCLEX wants PNs to understand the rules that help them make careful decisions about coordinating patient care.

Here are the rules of management for PN candidates:

• Always follow the rules of delegation (never delegate what you can E.A.T.). This also applies to PNs, as they cannot delegate these functions to unlicensed assistive personnel. Remember that PNs can do ongoing assessments, evaluation, and teaching after the RN has completed the initial.
• Always follow the rules of prioritization (ABCs, Maslow's, Actual vs. Potential, etc.)
• PNs are responsible for reporting changes in status and unexpected outcomes to the RN so the RN can verify, validate, and follow up.
• PNs must never leave their patients until they have been determined to be stable or unless an RN comes in to take over.

Here is an example of how the NCLEX could challenge the PN candidate to answer a question about the rules of management:

The nurse is caring for a 22-year-old patient who has been admitted for a fracture of the right femur. The nursing assistant reports to the nurse that the patient is complaining of a headache. Which of the following actions by the nurse is best?

• Have the nursing assistant obtain vital signs while the nurse calls the physician
• The nurse obtains a full set of vital signs, assesses the patient, and reports the findings to the RN in charge
• The nurse tells the nursing assistant to stay with the patient while the nurse goes to get medication for the patient
• Have the nursing assistant go give a report to the RN in charge while the nurse goes on a lunch break.

This question challenges the candidate to identify the correct action that falls within the scope of practice for the PN. Following the rules of coordination as a guide helps test-takers make decisions about correct and incorrect answer choices. Answer choice 1 violates the rules of coordination of care because the PN is responsible for all initial assessments before reporting to the RN to validate their findings. Answer choice 3 violates the rules of coordination because the PN should never leave the patient until they are determined to be stable. Answer choice 4 violates the rules of coordination of care because the PN is responsible for reporting their findings to the RN so that the RN can assess the patient and be determined stable before the PN goes on a lunch break.

Here is another example of how the NCLEX could challenge the PN candidate to answer a question about the rules of management:

The nurse is caring for an 87-year-old patient admitted for failure to thrive. Which care tasks would be appropriate for the PN to delegate to an experienced nursing assistant?

• Have the nursing assistant ask the patient's family how much the patient has eaten in the past 24 hours.
• Ask the nursing assistant to look at the patient's skin for breakdown or open areas.
• Tell the nursing assistant to provide information to the patient and family regarding the use of the remote, call bell, and bed controls.
• Have the nursing assistant gather equipment that will be needed to care for the patient.

This question challenges the candidate to identify the correct action that falls within the scope of practice for the PN. Following the rules of coordination as a guide helps test-takers decide on correct and incorrect answer choices. Answer choice 1 violates the rules of coordination of care because the PN is responsible for all initial assessments before reporting to the RN to validate their findings. Answer choice 2 violates the rules of coordination because the PN cannot delegate the functions of assessment. Answer choice 3 violates the rules of coordination of care because the PN cannot delegate the function of teaching.

Therapeutic Communication

Both RNs and PNs are responsible for responding to others in a professional and therapeutic manner. Whether the nurse is speaking with patients, family members, visitors, colleagues, or other members of the healthcare team, they must follow the rules of therapeutic communication at all times. The NCLEX challenges candidates to understand these rules and often places distractors and traps in questions that challenge this nursing concept. To help candidates better understand how to answer therapeutic communication questions successfully, let's first list out the answer types that are always incorrect.

The following answer choice options are incorrect for therapeutic communication questions:

• Authoritative answers (telling the patient or others what to do because you know best)
• Asking "why?” (asking "why?” causes patients and others to become defensive)
• Focusing on self rather than the patient or other (it's not about the nurse, it's about the patient or other person)
• False reassurance (everything will be fine, you're going to be okay)
• Asking closed-ended questions (limits the opportunity for the patient or other to talk about what they want to)

None of the above answer types should even be considered as an option for the correct answer to therapeutic communication questions. These responses typically cause further emotional conflict and do not promote a positive outcome.

Documentation

All nursing students leave school understanding the importance of documentation. It serves a legal purpose, as well as serves as the primary method of communication for all members of the healthcare team. The NCLEX challenges candidates to understand this concept fully and often writes questions that ask test-takers to identify good or bad documentation samples.

Although this nursing concept is pretty straightforward, test anxiety or feelings of test fatigue can often be a barrier when candidates try to pull from their memory banks. To help, we've listed out the rules of "good" documentation to make it easier to recall when needed.

Here are the rules of "good" nursing documentation:

• Documentation must be objective
• Documentation must be specific
• Documentation must be descriptive
• Documentation must be measurable

Here is an example of how an NCLEX question can challenge the nurse regarding nursing documentation:

The nurse is caring for a 12-year-old patient brought to the emergency department by their parents with a fractured pelvic bone. When asked how the injury occurred, the parents state that the child fell down the stairs while chasing their family dog. Upon assessment, the nurse notes several large bruises and three large scratches on the child's inner thighs. How should the nurse document these findings?

• "Multiple marks on child's legs"
• "Three large purple-colored bruises and one large scratch noted on right inner thigh, and two large purple-colored bruises and two large scratches noted on left inner thigh"
• "Several large bruises and scratches caused by abuse"
• "Multiple bruises and scratches noted on bilateral inner thighs, caused by falling down the stairs"

This question challenges candidates to follow the rules of good documentation when choosing the correct answer. The only option that meets the criteria for the rules is answer choice 2 because it is objective, specific, descriptive, and measurable. That means that anyone else could read that documentation and validate these findings.

Answer choice 1 is not descriptive enough. Answer choice 3 is assuming that it was abuse, and nurses must remain objective. We do not know for sure whether it was caused by abuse or not, so one cannot document that in the chart. Answer choice 4 also assumes that the injuries were sustained from falling down the stairs, which the nurse cannot prove or disprove, so therefore, it should not be documented as a definitive reason.

Caring And Compassion

While providing safe and effective patient care, it is part of the nurse's role also to provide that care in a caring and compassionate manner. Although caring and compassion can come at varying degrees of personal investment, a fundamental rule must be followed at all times. On the NCLEX, this fundamental rule isn't so much about compassion as it is about caring. It is important that candidates understand that no matter how complex and overwhelming patient care can become with all the various care equipment, such as heart monitors, traction, wound vacs, IV pumps, chest tubes, central lines, surgical drains, etc.—always take care of the patient first.

Here is an example of how the NCLEX can take this fundamental rule and put it into a test question:

The nurse is caring for a 48-year-old patient in skeletal traction who sustained a fractured femur from a car accident. The patient reports to the nurse that they have terrible pain in the affected extremity. Which action by the nurse is best?

• Check that the weights are in line and hanging free
• Check that the traction sling is correctly positioned
• Ask the client to describe the location and characteristics of their pain
• Ask the nursing assistant to reposition the client to ease their pain

The principle of caring for the patient first can be related to the first step of The Nursing Process and the statement, "When in doubt, check it out." When a patient states that they are having pain, difficulty breathing, dizziness, or provides any other subjective symptom, it is the responsibility of the nurse to assess further so that they can address the patient's complaints and immediately begin working towards meeting the patient's needs. Answer 1 is incorrect because the equipment may or may not be causing the pain, so asking the patient is more important. Answer 2 is incorrect for the same reason as answer 1. Answer 4 is incorrect because the nurse has not yet determined if the patient is stable and therefore should not delegate tasks to unstable patients.

When thinking about caring for patients, always remember to "Put the needs of your patients second to the needs of your own, and in all other possible circumstances, take care of your patients first,” according to Damion Keith Jenkins, RN, MSN.

Teaching And Learning Considerations

Since much of what nurses do is teaching and counseling patients, families, communities, students, and staff, the NCLEX challenges candidates' understanding of teaching and learning principles. 

The first way to ensure that a nurse will teach effectively is to be confident in speaking to the content. Many of the NCLEX questions surrounding this nursing concept are written in a way that asks test-takers to identify correct or incorrect information regarding a particular topic. This type of question helps to determine if a candidate is competent in determining if teaching is effective or if further teaching is necessary.

Here is an example of how the NCLEX can write questions that challenge candidates to understand teaching and learning principles:

The nurse is caring for a patient admitted to the labor suite for premature contractions. The treatment was successful, and the patient is scheduled to be discharged later today. The nurse provides discharge teaching regarding a new prescription for terbutaline. The nurse understands that teaching was effective if the patient states which of the following?

• I can be certain that I will not have my baby prematurely while on this medication
• I will take this medication every day unless I am feeling really tired
• I will remain on bedrest so this medication can work
• I may feel mild muscle tremors while on this medication

This question challenges the candidate to know the correct information regarding the medication terbutaline. If the candidate is unfamiliar with this medication, then it is possible that they may answer this question incorrectly. The best way to approach these questions is to carefully look at each answer choice for clues. Answer choice 1 is incorrect because it includes the absolute term - "certain." We cannot be certain of anything in healthcare as each person responds differently to treatment. This is similar to giving false reassurance, which we cannot do. Answer choice 2 is incorrect because the medication should be taken all the time unless the doctor says otherwise. Answer choice 3 is incorrect because bedrest does not affect whether or not medication will be effective. Additionally, this patient is being discharged home, which rarely includes mandatory bed rest.

About Damion Jenkins, MSN, RN

Damion Jenkins has 14 years experience as a MSN, RN and specializes in NCLEX Prep Expert - 100% Pass Rate!.

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Prioritization, Delegation, and Assignment in LPN/LVN Nursing, 1st Edition

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VitalSource Bookshelf gives you access to content when, where, and how you want. When you read an eBook on VitalSource Bookshelf, enjoy such features as:

• Access online or offline, on mobile or desktop devices.
• Bookmarks, highlights and notes sync across all your devices.
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• Search and navigate content across your entire Bookshelf library.
• Interactive notebook and read-aloud functionality.
• Look up additional information online by highlighting a word or phrase.
• UNIQUE! Three-part organization first establishes foundational knowledge and then provides exercises with health scenarios of increasing difficulty to help you build confidence in your prioritization, delegation, and patient assignment skills.
• Evidence-based guidelines and treatment protocols reflect the latest research studies and best practices.
• Variety of question types and case studies prepare you for the Next-Generation NCLEX-PN ® exam’s new question formats and new focus on critical thinking.
• Practice quizzes on the Evolve website include all of the book’s questions and allow you to create a virtually unlimited number of practice sessions or tests in Study Mode or Exam Mode .
• Focus on coordinated care addresses the NCLEX-PN’s heavy emphasis on prioritization, delegation, and patient assignment.

PART ONE: INTRODUCTION

Guidelines for Prioritization, Delegation, and Assignment Decisions

PART TWO: PRIORITIZATION, DELEGATION, AND ASSIGNMENT IN COMMON HEALTH SCENARIOS

3. Immunologic Problems

4. Fluid, Electrolyte, and Acid-Base Balance Problems

5. Safety and Infection Control

6. Respiratory Problems

7. Cardiovascular Problems

8. Hematologic Problems

9. Neurologic Problems

10. Visual and Auditory Problems

11. Musculoskeletal Problems

12. Gastrointestinal and Nutritional Problems

13. Diabetes Mellitus

14. Other Endocrine Problems

15. Integumentary Problems

16. Renal and Urinary Problems

17. Reproductive Problems

18. Problems in Pregnancy and Childbearing

19. Pediatric Problems

20. Pharmacology

21. Emergencies and Disasters

22. Psychiatric-Mental Health Problems

PART THREE: PRIORITIZATION, DELEGATION, AND ASSIGNMENT IN COMPLEX HEALTH SCENARIOS

Case Study 1 - Chest Pressure, Indigestion, and Nausea

Case Study 2 - Dyspnea and Shortness of Breath

Case Study 3 - Multiple Clients on a Medical-Surgical Unit

Case Study 4 - Shortness of Breath, Edema, and Decreased Urine Output

Case Study 5 - Diabetic Ketoacidosis

Case Study 6 - Home Health

Case Study 7 - Spinal Cord Injury

Case Study 8 - Multiple Patients with Adrenal Gland Disorders

Case Study 9 - Multiple Clients with Gastrointestinal Problems

Case Study 10 - Multiple Patients with Pain

Case Study 11- Multiple Clients with Cancer

Case Study 12 - Gastrointestinal Bleeding

Case Study 13 - Head and Leg Trauma and Shock

Case Study 14 - Septic Shock

Case Study 15 - Heart Failure

Case Study 16 - Multiple Patients with Peripheral Vascular Disease

Case Study 17 - Respiratory Difficulty After Surgery

Case Study 18 - Long-Term Care

Case Study 19 - Pediatric Clients in Clinic and Acute Care Setting

Case Study 20 - Multiple Patients with Mental Health Disorders

Case Study 21 - Childbearing

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Prioritization, Delegation, and Assignment in LPN/LVN Nursing

Practice exercises for the nclex-pn® examination.

• 1st Edition - January 22, 2022
• Authors: Linda A. LaCharity, Candice K. Kumagai, Shirley M. Hosler
• Language: English
• Paperback ISBN: 9780323779166 9 7 8 - 0 - 3 2 3 - 7 7 9 1 6 - 6
• eBook ISBN: 9780323779173 9 7 8 - 0 - 3 2 3 - 7 7 9 1 7 - 3

Build the skills needed to apply prioritization, delegation, and assignment concepts to nursing practice! Providing a solid foundation in coordinated care, Prioritization, Deleg… Read more

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Build the skills needed to apply prioritization, delegation, and assignment concepts to nursing practice! Providing a solid foundation in coordinated care, Prioritization, Delegation, and Assignment in LPN/LVN Nursing uses practical exercises to prepare you for the Next-Generation NCLEX-PN® (NGN) examination and to boost your job readiness. It helps you develop clinical judgment skills by guiding you through patient care scenarios progressing from common to complex. NGN-style questions are included in the book, and the Evolve website allows you to answer all of the book’s questions in interactive Study or Exam mode. Written by a team of noted educators led by Linda A. LaCharity, this text helps LPNs and LVNs apply decision-making concepts in many different settings.

• Cover image
• Table of Contents
• Contributors and Reviewers
• Acknowledgments
• Part 1. Introduction
• Guidelines for Prioritization, Delegation, and Assignment Decisions
• Outcomes Focus
• Definition of Terms
• Assignment Process
• Delegation and Assignment: the Five Rights
• Practice Based on Research Evidence
• Principles for Implementation of Prioritization, Delegation, and Assignment
• Part 2. Prioritization, Delegation, and Assignment in Common Health Scenarios
• Chapter 1. Fundamentals of Nursing
• Chapter 2. Respiratory Problems
• Chapter 3. Cardiovascular Problems
• Chapter 4. Changes in Level of Consciousness
• Chapter 5. Pressure Injuries
• Chapter 6. Patients With Dementia
• Chapter 7. Diabetes
• Chapter 8. Problems of Older Adults
• Chapter 9. Gastrointestinal and Nutritional Problems
• Chapter 10. Infection Control and Safety
• Chapter 11. Fluid, Electrolyte, and Acid–Base Balance
• Chapter 12. LPN/LVN in the Rehabilitation Setting
• Chapter 13. LPN/LVN in the Long-Term Care Setting
• Chapter 14. LPN/LVN in the Urgent Care Setting
• Chapter 15. LPN/LVN on the Medical-Surgical Unit
• Chapter 16. LPN/LVN in the Postpartum Setting
• Chapter 17. LPN/LVN in the Pediatric Clinic Setting
• Chapter 18. Pharmacology
• Chapter 19. Medication Administration
• CHAPTER 20. Next-Generation NCLEX Questions
• Part 3. Prioritization, Delegation, and Assignment in Complex Health Scenarios
• Case Study 1. Patient With a Urinary Tract Infection
• Case Study 2. Nutritional Problems
• Case Study 3. Patient With Immobility
• Case Study 4. Patient With Pneumonia
• Case Study 5. Patient With a Brain Attack (Stroke)
• Case Study 6. Patient With Chronic Obstructive Pulmonary Disease
• Case Study 7. Patient With Heart Failure
• Case Study 8. Patient in a Memory Care Unit
• Case Study 9. Patients With Incontinence
• Case Study 10. Patient With Altered Level of Consciousness
• Case Study 11. Patient With Mental Health Disorder
• Case Study 12. Patient in Hospice, Grief, and Loss
• Case Study 13. Patient With Benign Prostatic Hyperplasia
• Case Study 14. Patients With Sexually Transmitted Infections
• Case Study 15. Patient With Parkinson Disease
• No. of pages : 240
• Language : English
• Edition : 1
• Published : January 22, 2022
• Imprint : Elsevier
• Paperback ISBN : 9780323779166
• eBook ISBN : 9780323779173

Linda A. LaCharity

Candice k. kumagai, shirley m. hosler.