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NCLEX-RN Prioritization & Delegation | 100
Questions with Rationales
Introduction
This comprehensive practice exam is designed to challenge nursing students on critical
prioritization and delegation skills, essential for success on the NCLEX-RN. It features 100
questions, including "Who do you see first?" scenarios, delegation tasks appropriate for
Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Unlicensed Assistive
Personnel (UAP), and various emergency situations. Each question is accompanied by a
detailed rationale to facilitate learning and reinforce clinical judgment.
Exam Structure Overview (100-item)
Item Type Quantity
Prioritization (Who do you see first?) 35
Delegation (RN vs LPN vs UAP) 35
Emergency Scenarios 30
Total Scored Items 100
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Questions
Prioritization Questions
Question 1: Prioritization (Who do you see first?)
The nurse receives report on four clients. Which client should the nurse assess first?
a) A client with chronic heart failure who has 2+ pitting edema in the ankles.
b) A client with diabetes mellitus whose blood glucose is 150 mg/dL before lunch.
c) A client with pneumonia who has a new onset of confusion and restlessness.
d) A client recovering from surgery who reports pain of 6 on a 0-10 scale.
Correct Answer: c
Rationale: A new onset of confusion and restlessness in a client with pneumonia (c) can
indicate hypoxemia or worsening respiratory status, which is a life-threatening condition
requiring immediate assessment and intervention. The other clients present with stable or
expected findings that do not require immediate attention over the client with potential
respiratory compromise.
Metadata:
• Content Category: Physiological Adaptation, Reduction of Risk Potential
• Cognitive Level: Prioritization, Analysis
• Item Type: Multiple Choice (Single Response)
• Estimated Difficulty: Hard
• Source/Reference: Medical-surgical nursing textbook, respiratory assessment.
Question 2: Prioritization (Who do you see first?)
The nurse is making rounds on a medical-surgical unit. Which client should the nurse see
first?
a) A client with a colostomy who has not had a bowel movement in 24 hours.
b) A client with a fractured femur who is complaining of numbness and tingling in the
affected leg.
c) A client with hypertension whose blood pressure is 140/90 mmHg.
d) A client with a urinary tract infection who reports burning on urination.
Correct Answer: b
Rationale: Numbness and tingling in an extremity with a fractured femur (b) can indicate
compartment syndrome, a serious condition that can lead to permanent tissue damage if
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not addressed promptly. This is a circulatory compromise and takes priority. The other
clients have less urgent issues.
Metadata:
• Content Category: Reduction of Risk Potential
• Cognitive Level: Prioritization, Analysis
• Item Type: Multiple Choice (Single Response)
• Estimated Difficulty: Hard
• Source/Reference: Medical-surgical nursing textbook, orthopedic nursing.
Question 3: Prioritization (Who do you see first?)
The nurse is receiving change-of-shift report. Which client should the nurse assess first?
a) A client with a new ostomy who is concerned about body image.
b) A client with a history of asthma who has an SpO2 of 90% on 2 L/min nasal cannula.
c) A client with a scheduled dressing change for a surgical wound.
d) A client who is requesting pain medication for chronic back pain.
Correct Answer: b
Rationale: An SpO2 of 90% on 2 L/min nasal cannula in a client with asthma (b) indicates
potential respiratory distress and inadequate oxygenation, which requires immediate
assessment and intervention to prevent further decline. The other clients have important
but less urgent needs.
Metadata:
• Content Category: Physiological Adaptation, Reduction of Risk Potential
• Cognitive Level: Prioritization, Analysis
• Item Type: Multiple Choice (Single Response)
• Estimated Difficulty: Moderate
• Source/Reference: Medical-surgical nursing textbook, respiratory assessment.
Question 4: Prioritization (Who do you see first?)
The nurse is caring for four clients. Which client requires immediate intervention?
a) A client with a feeding tube who has residual volume of 150 mL.
b) A client with a urinary catheter who has not voided in 4 hours.
c) A client with a new onset of chest pain radiating to the left arm.
d) A client with a rash who is requesting a topical cream.
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Correct Answer: c
Rationale: New onset of chest pain radiating to the left arm (c) is a classic symptom of
myocardial infarction and requires immediate assessment and intervention to prevent
cardiac damage. The other situations are important but not immediately life-threatening.
Metadata:
• Content Category: Physiological Adaptation, Reduction of Risk Potential
• Cognitive Level: Prioritization, Analysis
• Item Type: Multiple Choice (Single Response)
• Estimated Difficulty: Hard
• Source/Reference: Medical-surgical nursing textbook, cardiac assessment.
Question 5: Prioritization (Who do you see first?)
The nurse is reviewing laboratory results for four clients. Which client's result requires the
most immediate attention?
a) A client with a hemoglobin of 10 g/dL.
b) A client with a potassium level of 6.0 mEq/L.
c) A client with a white blood cell count of 12,000/mm³.
d) A client with a blood glucose of 200 mg/dL.
Correct Answer: b
Rationale: A potassium level of 6.0 mEq/L (b) indicates hyperkalemia, which can lead to life-
threatening cardiac dysrhythmias and requires immediate intervention. While the other
values are abnormal, they are not as immediately life-threatening as severe hyperkalemia.
Metadata:
• Content Category: Physiological Adaptation, Reduction of Risk Potential
• Cognitive Level: Prioritization, Analysis
• Item Type: Multiple Choice (Single Response)
• Estimated Difficulty: Hard
• Source/Reference: Medical-surgical nursing textbook, fluid and electrolyte balance.
Question 6: Prioritization (Who do you see first?)
The nurse is assigned to care for four clients. Which client should the nurse assess first?
a) A client who is scheduled for discharge today and needs final teaching.
b) A client who is complaining of nausea after receiving chemotherapy.
NCLEX-RN Prioritization & Delegation | 100
Questions with Rationales
Introduction
This comprehensive practice exam is designed to challenge nursing students on critical
prioritization and delegation skills, essential for success on the NCLEX-RN. It features 100
questions, including "Who do you see first?" scenarios, delegation tasks appropriate for
Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Unlicensed Assistive
Personnel (UAP), and various emergency situations. Each question is accompanied by a
detailed rationale to facilitate learning and reinforce clinical judgment.
Exam Structure Overview (100-item)
Item Type Quantity
Prioritization (Who do you see first?) 35
Delegation (RN vs LPN vs UAP) 35
Emergency Scenarios 30
Total Scored Items 100
,ESTUDYR
Questions
Prioritization Questions
Question 1: Prioritization (Who do you see first?)
The nurse receives report on four clients. Which client should the nurse assess first?
a) A client with chronic heart failure who has 2+ pitting edema in the ankles.
b) A client with diabetes mellitus whose blood glucose is 150 mg/dL before lunch.
c) A client with pneumonia who has a new onset of confusion and restlessness.
d) A client recovering from surgery who reports pain of 6 on a 0-10 scale.
Correct Answer: c
Rationale: A new onset of confusion and restlessness in a client with pneumonia (c) can
indicate hypoxemia or worsening respiratory status, which is a life-threatening condition
requiring immediate assessment and intervention. The other clients present with stable or
expected findings that do not require immediate attention over the client with potential
respiratory compromise.
Metadata:
• Content Category: Physiological Adaptation, Reduction of Risk Potential
• Cognitive Level: Prioritization, Analysis
• Item Type: Multiple Choice (Single Response)
• Estimated Difficulty: Hard
• Source/Reference: Medical-surgical nursing textbook, respiratory assessment.
Question 2: Prioritization (Who do you see first?)
The nurse is making rounds on a medical-surgical unit. Which client should the nurse see
first?
a) A client with a colostomy who has not had a bowel movement in 24 hours.
b) A client with a fractured femur who is complaining of numbness and tingling in the
affected leg.
c) A client with hypertension whose blood pressure is 140/90 mmHg.
d) A client with a urinary tract infection who reports burning on urination.
Correct Answer: b
Rationale: Numbness and tingling in an extremity with a fractured femur (b) can indicate
compartment syndrome, a serious condition that can lead to permanent tissue damage if
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not addressed promptly. This is a circulatory compromise and takes priority. The other
clients have less urgent issues.
Metadata:
• Content Category: Reduction of Risk Potential
• Cognitive Level: Prioritization, Analysis
• Item Type: Multiple Choice (Single Response)
• Estimated Difficulty: Hard
• Source/Reference: Medical-surgical nursing textbook, orthopedic nursing.
Question 3: Prioritization (Who do you see first?)
The nurse is receiving change-of-shift report. Which client should the nurse assess first?
a) A client with a new ostomy who is concerned about body image.
b) A client with a history of asthma who has an SpO2 of 90% on 2 L/min nasal cannula.
c) A client with a scheduled dressing change for a surgical wound.
d) A client who is requesting pain medication for chronic back pain.
Correct Answer: b
Rationale: An SpO2 of 90% on 2 L/min nasal cannula in a client with asthma (b) indicates
potential respiratory distress and inadequate oxygenation, which requires immediate
assessment and intervention to prevent further decline. The other clients have important
but less urgent needs.
Metadata:
• Content Category: Physiological Adaptation, Reduction of Risk Potential
• Cognitive Level: Prioritization, Analysis
• Item Type: Multiple Choice (Single Response)
• Estimated Difficulty: Moderate
• Source/Reference: Medical-surgical nursing textbook, respiratory assessment.
Question 4: Prioritization (Who do you see first?)
The nurse is caring for four clients. Which client requires immediate intervention?
a) A client with a feeding tube who has residual volume of 150 mL.
b) A client with a urinary catheter who has not voided in 4 hours.
c) A client with a new onset of chest pain radiating to the left arm.
d) A client with a rash who is requesting a topical cream.
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Correct Answer: c
Rationale: New onset of chest pain radiating to the left arm (c) is a classic symptom of
myocardial infarction and requires immediate assessment and intervention to prevent
cardiac damage. The other situations are important but not immediately life-threatening.
Metadata:
• Content Category: Physiological Adaptation, Reduction of Risk Potential
• Cognitive Level: Prioritization, Analysis
• Item Type: Multiple Choice (Single Response)
• Estimated Difficulty: Hard
• Source/Reference: Medical-surgical nursing textbook, cardiac assessment.
Question 5: Prioritization (Who do you see first?)
The nurse is reviewing laboratory results for four clients. Which client's result requires the
most immediate attention?
a) A client with a hemoglobin of 10 g/dL.
b) A client with a potassium level of 6.0 mEq/L.
c) A client with a white blood cell count of 12,000/mm³.
d) A client with a blood glucose of 200 mg/dL.
Correct Answer: b
Rationale: A potassium level of 6.0 mEq/L (b) indicates hyperkalemia, which can lead to life-
threatening cardiac dysrhythmias and requires immediate intervention. While the other
values are abnormal, they are not as immediately life-threatening as severe hyperkalemia.
Metadata:
• Content Category: Physiological Adaptation, Reduction of Risk Potential
• Cognitive Level: Prioritization, Analysis
• Item Type: Multiple Choice (Single Response)
• Estimated Difficulty: Hard
• Source/Reference: Medical-surgical nursing textbook, fluid and electrolyte balance.
Question 6: Prioritization (Who do you see first?)
The nurse is assigned to care for four clients. Which client should the nurse assess first?
a) A client who is scheduled for discharge today and needs final teaching.
b) A client who is complaining of nausea after receiving chemotherapy.
