Why Prioritization & Delegation Matter
A huge share of exit-exam questions are really prioritization questions in disguise.
The LPN/LVN exit exam and NCLEX-PN are full of questions that hand you several patients (or several tasks) and ask "who do you see first?", "what do you do first?", or "which task can you delegate to the UAP?". You rarely need new clinical facts to answer them — you need a reliable order of operations. This guide gives you the frameworks the test is built on: the ABCs, Maslow, stable vs unstable, the 5 rights of delegation, and scope of practice.
Layer them in order: ABCs first → then Maslow → then safety/risk → then the least-restrictive or least-invasive option. Most prioritization questions fall apart cleanly once you apply them in that sequence.
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ABCs: Airway, Breathing, Circulation
The first filter for almost every "who comes first" question.
When more than one patient needs attention, the one with a threat to Airway comes before Breathing, which comes before Circulation, which comes before everything else. A blocked or threatened airway always wins.
- A — Airway
- Choking, stridor, gurgling, swelling of the throat, no airway after trauma.
- B — Breathing
- Respiratory distress, O₂ sat dropping, severe shortness of breath, absent breath sounds.
- C — Circulation
- No pulse, active hemorrhage, severe hypotension, signs of shock, chest pain.
Some versions extend this to ABCDE (adding Disability/neuro and Exposure) or remind you that for an unresponsive, pulseless patient, current CPR sequencing is C-A-B (compressions first). For prioritizing among stable patients, plain ABC ordering is what the exam wants.
If one patient has an airway problem and another is hemorrhaging, the airway patient comes first — you can't fix circulation if they can't breathe. Scan every answer choice for the most upstream ABC threat before anything else.
Maslow's Hierarchy of Needs
When no one has an ABC emergency, physical needs beat psychosocial ones.
Maslow ranks human needs. In nursing prioritization, physiologic needs come before safety, which comes before love/belonging, esteem, and self-actualization. Translation: a physical problem (oxygen, food, fluids, elimination, pain, rest) outranks an emotional or teaching need.
- Physiologic (first): airway, oxygen, circulation, food, fluids, elimination, pain, sleep.
- Safety/security: fall prevention, infection control, a safe environment, preventing injury.
- Love/belonging: relationships, support, feeling connected.
- Esteem: self-worth, independence, accomplishment.
- Self-actualization (last): reaching full potential.
Faced with a patient in pain or short of breath versus one who is anxious or wants to talk, choose the physiologic need first. The emotional need is real and important — it's just lower on Maslow when you can only do one thing first.
Stable vs Unstable, Acute vs Chronic
The second filter: see the changing patient before the predictable one.
After the ABCs, sort patients by how stable and predictable they are. The unstable, deteriorating, or newly changed patient comes first; the stable, chronic, expected one can wait.
- Unstable before stable: a patient with new or worsening symptoms outranks one whose condition is unchanged.
- Acute before chronic: a new problem (new chest pain) beats a long-standing, controlled one (chronic stable angina).
- Unexpected before expected: a finding that doesn't fit the diagnosis is a red flag — see it first. (Expected post-op pain is lower priority than sudden post-op shortness of breath.)
- Look for the most life-threatening complication: the patient most likely to deteriorate gets seen first.
The exam often lists one patient with an alarming-sounding but expected finding (post-op pain, a normal lab for their condition) and another with a quiet but unexpected change. The unexpected change is usually the right answer — it signals something is going wrong.
More Prioritization Rules
A few extra tiebreakers the exam rewards.
- Nursing process order: Assessment → Diagnosis → Planning → Implementation → Evaluation (ADPIE). Assess before you act — unless there's an obvious emergency in front of you.
- Acute vs chronic / actual vs potential: an actual problem usually outranks a potential (at-risk) one.
- Least restrictive / least invasive first: try the safest, least invasive intervention before escalating (e.g., reposition and re-oxygenate before assuming the worst).
- Safety: when choosing an intervention, the option that keeps the patient safest usually wins.
- Survival/triage (mass casualty): in disaster triage the goal flips to "the greatest good for the greatest number" — treat those who are salvageable with limited resources first.
If the question gives you a stable scenario and asks the first step, the answer is usually assess (gather data). If the patient is actively crashing — choking, no pulse, seizing — you act first. And if the question already states the assessment finding, pick the intervention, not "assess again."
The 5 Rights of Delegation
Delegation transfers the task — never the accountability.
Before handing off a task, the nurse runs through five checks. If any one fails, don't delegate.
- Right task
- Is this task appropriate to delegate (routine, predictable, within the helper's role)?
- Right circumstance
- Is the patient stable and the situation suitable for delegation?
- Right person
- Is this person competent and trained to do it for this patient?
- Right direction / communication
- Did I give clear, specific instructions and expected outcomes?
- Right supervision / evaluation
- Will I follow up, be available, and evaluate the result?
- The delegating nurse stays accountable for the outcome — delegation never removes responsibility.
- Never delegate the parts that require nursing judgment: assessment, teaching, evaluation, and an unstable patient.
Even after you delegate correctly, you must give clear directions, stay available, and check the result. If the helper isn't competent for it, or the patient is unstable, the task should not be delegated at all.
Scope of Practice: RN / LPN/LVN / UAP
Who can assess, who can teach, and who handles the routine, stable tasks.
The biggest delegation theme: keep tasks that need judgment (assessment, teaching, evaluation, unstable patients, the first of anything) with the RN, and push routine, stable, predictable tasks down. Exact scope varies by state — always follow your state nurse practice act.
- RN
- Initial & ongoing assessment, care planning, evaluation, patient teaching, IV push (many settings), blood transfusion, unstable/unpredictable patients, the first dose/first ambulation.
- LPN/LVN
- Monitors stable patients, reinforces teaching, gives most routine meds (per state), dressing changes, catheter & ostomy care, tube feedings, suctioning, collects data. Does NOT do initial assessment, care plan creation, evaluation of plan, most IV push meds, blood, or unstable patients (varies by state).
- UAP
- Bathing, feeding (stable), ambulating, positioning, ADLs, vital signs on stable patients, I&O, weights, hygiene. Cannot assess, teach, evaluate, give meds (generally), or care for an unstable patient.
If the task verb is assess, teach, evaluate, or plan — it stays with the RN. Reinforce, monitor a stable patient, give a routine med, change a dressing — the LPN/LVN can do it. Bathe, feed, ambulate, vitals on a stable patient — delegate to the UAP. And the first time anything is done (first dose, first ambulation after surgery) goes to the higher license.
Test-Taking Strategy
A repeatable order of operations for these questions.
- Watch for the word "first," "initial," "priority," or "most important" — every option may be correct, but only one is first.
- Beware answers that delegate a task requiring judgment, or that pick a psychosocial need over a physical one.
- "Stable, chronic, expected, and discharge-ready" patients are usually not the priority and are safe to delegate.
Prioritization questions are designed so all the answers are things you'd eventually do. Don't ask "which is correct?" — ask "which comes first?" Run ABC → unstable/acute → Maslow → assess-vs-act, and the order sorts itself out.
? You have four patients. One is anxious, one has chronic back pain, one is short of breath, one needs discharge teaching. Who do you see first?
Frequently Asked Questions
Common student questions on this topic.
How do I decide which patient to see first?
What are the 5 rights of delegation?
What can be delegated to unlicensed assistive personnel (UAP)?
What is the difference between what an RN and an LPN/LVN can do?
Should I always pick assessment as the first action on the exam?
Can a nurse delegate a task and then forget about it?
Quick-Reference Cheatsheet
Every key point from this guide on a single printable page.
Prioritization & Delegation Cheatsheet
One-page PDF — free download.