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If you learn one question type cold, make it prioritization. "Which client should the nurse assess first?" and "Which task can the nurse delegate?" appear constantly, and they're winnable with a fixed decision process instead of a gut feeling.
Prioritization: the decision ladder
Walk every "who first / what first" question down this ladder, in order, and stop at the first rule that decides it:
- Airway โ Breathing โ Circulation (ABCs). A compromised airway (stridor, choking, gurgling) always wins. Then breathing (RR < 10 or falling SpOโ), then circulation (hemorrhage, no pulse, shock).
- Maslow. Physiological needs before safety before psychosocial. Oxygen and circulation before pain; pain before anxiety.
- Acute over chronic. A new problem outranks a stable long-standing one. New-onset confusion beats chronic dementia.
- Unstable over stable. The patient whose numbers are moving the wrong way beats the one who's stable, even if the stable one "sounds sicker."
- Unexpected over expected. Post-op day 1 with mild incisional pain is expected; post-op day 1 with a rigid, distended abdomen is not โ see them first.
Worked example
Which client should the nurse assess first?
- (A) A client 2 days post-op reporting incisional pain of 6/10
- (B) A client with COPD whose SpOโ is 91% on home oxygen
- (C) A client with new-onset slurred speech and facial droop
- (D) A client awaiting discharge teaching
Answer: C. New neuro deficits signal a possible stroke โ acute, unexpected, and time-critical (circulation/perfusion). B is stable-at-baseline for COPD; A is expected post-op pain; D is lowest acuity. The ladder settles it without any guessing.
Delegation: who can do what
Delegation questions test scope of practice. Anchor on a simple rule of thumb (always defer to your board of nursing's actual scope):
| Role | Can generally handle |
|---|---|
| RN | Assessment, teaching, evaluation, care planning, unstable patients, and anything requiring nursing judgment. |
| LPN/LVN | Stable patients with predictable outcomes: many meds (per scope), routine care, focused data collection, reinforcing teaching the RN started. |
| UAP / CNA | Standard, non-invasive tasks: vitals on stable patients, ADLs, ambulation, intake/output, positioning. |
The five rights of delegation
- Right task โ is it delegable at all?
- Right circumstance โ is the patient stable/predictable?
- Right person โ is it within that role's scope and competence?
- Right direction โ clear, specific instructions.
- Right supervision โ follow-up and evaluation stay with you.
Turn it into a reflex
Prioritization and delegation are pattern-recognition skills โ they get automatic with reps. Drill a focused set of "who first" and "delegate to whom" items until the ladder runs on autopilot. You can practice exactly these in CinnaRN's question bank, and pair it with our first-try study plan.