ตัวอย่างข้อสอบ Prioritization and Delegation

Section 1: Prioritization Questions

Question 1: ABCs and Critical Thinking

A nurse in the emergency department is assessing four patients. Which patient should the nurse see first?

A. A 40-year-old patient with a history of asthma who reports mild shortness of breath and an O2 saturation of 94%.
B. A 60-year-old patient with diabetes who has a blood glucose of 250 mg/dL.
C. A 35-year-old patient with chest trauma and tracheal deviation to the left.
D. A 50-year-old patient who reports nausea and vomiting for the past 12 hours.

Question 2: Maslow’s Hierarchy of Needs

A nurse is caring for multiple patients on a medical-surgical floor. Which patient should be seen first?

A. A 55-year-old patient who is nervous about an upcoming cancer diagnosis.
B. A 67-year-old patient who has not had a bowel movement in two days.
C. A 70-year-old patient with a low oxygen saturation of 88% on room air.
D. A 45-year-old patient requesting spiritual support after a family loss.

Question 3: Unexpected vs. Expected Findings

A nurse is reviewing laboratory values for assigned patients. Which finding is most concerning and requires immediate intervention?

A. A patient on warfarin with an INR of 3.0.
B. A patient with chronic kidney disease and a creatinine of 2.8 mg/dL.
C. A patient with new-onset confusion and a sodium level of 120 mEq/L.
D. A patient with diabetes who has a fasting blood sugar of 180 mg/dL.

Question 4: Acute vs. Chronic Conditions

The charge nurse is making rounds on a telemetry unit. Which patient requires immediate attention?

A. A patient with chronic atrial fibrillation who has an irregular heart rate of 90 bpm.
B. A patient with a history of stable angina who reports mild chest discomfort after climbing stairs.
C. A patient with a heart rate of 40 bpm and dizziness.
D. A patient with a blood pressure of 160/90 mmHg and no symptoms.

Section 2: Delegation Questions

Question 5: Delegating to a UAP

The nurse is supervising a UAP. Which task can the nurse delegate?

A. Checking blood glucose for a patient with diabetes.
B. Assessing lung sounds of a patient with pneumonia.
C. Instructing a patient on incentive spirometer use.
D. Monitoring a post-op patient’s pain level.

Question 6: LPN Scope of Practice

The RN is working with an LPN/LVN. Which patient should be assigned to the LPN?

A. A patient receiving continuous IV heparin with aPTT monitoring.
B. A patient who had a total knee replacement and requires wound care.
C. A patient with new-onset stroke symptoms needing assessment.
D. A patient who requires IV morphine for severe pain.

Question 7: RN Responsibilities

A nurse is delegating tasks to a UAP and an LPN. Which task must the RN perform personally?

A. Repositioning a bedridden patient every two hours.
B. Administering an enema to a constipated patient.
C. Initiating a blood transfusion.
D. Assisting a patient with ambulation.

Question 8: Prioritization and Delegation Combined

The RN is managing a UAP and an LPN. Which task should the RN handle first?

A. A patient on telemetry with a new-onset irregular heartbeat.
B. A stable post-op patient who needs ambulation assistance.
C. A patient with a dressing that needs reinforcement.
D. A patient requesting assistance with feeding.

Key NCLEX Tips for Prioritization & Delegation

Always prioritize life-threatening conditions using ABCs.
Maslow’s hierarchy helps determine patient needs.
Acute > Chronic; Unexpected > Expected symptoms.
UAPs handle routine, non-clinical tasks (ADLs, vital signs, blood glucose checks).
LPNs can administer some medications and perform wound care but cannot assess or teach.
RNs must handle initial assessments, blood transfusions, IV medications, and critical care.

1. Correct Answer: C
Rationale: Tracheal deviation is a sign of a tension pneumothorax, which can cause airway compromise and circulatory collapse. This is a life-threatening emergency requiring immediate intervention (ABC principle: Airway).

2. Correct Answer: C

Rationale: Oxygenation is a physiological need (Maslow’s first level), making it the highest priority. The other concerns, while important, are not immediately life-threatening.

3. Correct Answer: C

Rationale: A sodium level of 120 mEq/L (hyponatremia) with new-onset confusion suggests potential seizure activity or cerebral edema, requiring urgent intervention.

4. Correct Answer: C

Rationale: Bradycardia (HR 40 bpm) with dizziness suggests hemodynamic instability, which may require a pacemaker or atropine administration. The other conditions are either chronic or not immediately life-threatening.

5. Correct Answer: A
Rationale: UAPs can perform basic tasks such as checking blood glucose, but they cannot assess, teach, or evaluate a patient’s response to treatment.

6. Correct Answer: B
Rationale: LPNs can perform wound care but cannot manage continuous IV heparin, assess new stroke symptoms, or give IV pain medication.

7. Correct Answer: C
Rationale: Only an RN can initiate a blood transfusion due to the risk of transfusion reactions. The other tasks can be delegated based on staff roles.

8. Correct Answer: A

Rationale: A new-onset irregular heartbeat is a potentially serious condition that requires RN assessment. The other tasks can be delegated:

LPN can reinforce dressings.
UAP can assist with ambulation and feeding.

Case Study 1: Prioritization in a Medical-Surgical Unit

Patient Information:

Mr. James, 62 years old
Diagnosis: Chronic obstructive pulmonary disease (COPD) exacerbation
Vital Signs:
- Temperature: 37.8°C (100.0°F)
- Heart Rate: 98 bpm
- Respiratory Rate: 24/min
- BP: 132/82 mmHg
- O2 Sat: 89% on room air
Current Symptoms: Productive cough, mild shortness of breath, audible wheezing
Medications: Albuterol nebulizer PRN, Prednisone 40 mg PO daily

Question 1: Matrix Multiple Choice

Which orders should the nurse implement first? Select all that apply.

Order	Implement First	Implement Later
Administer albuterol nebulizer	✅
Encourage deep breathing exercises	✅
Initiate IV fluids at 125 mL/hr		✅
Obtain sputum culture before antibiotics		✅
Administer acetaminophen for fever		✅

✅ Correct Answers:

Administer albuterol nebulizer: This is the priority because it directly improves airway and breathing.
Encourage deep breathing exercises: Helps mobilize secretions and improve oxygenation.
Other interventions (IV fluids, sputum culture, and fever management) can be done after addressing the patient’s respiratory status (ABC prioritization).

Case Study 2: Delegation in a Post-Surgical Unit

You are the charge nurse on a surgical floor with an RN, LPN, and UAP on your team. The following four patients need attention:

Mr. Lewis, 45 years old - Post-op day 1 after a total knee replacement, reports pain 7/10.
Ms. Rodriguez, 67 years old - Post-op day 2 after a cholecystectomy, with a temperature of 38.3°C (100.9°F).
Mr. Singh, 55 years old - Ready for discharge, needs teaching about wound care.
Ms. Carter, 30 years old - Admitted with appendicitis, awaiting surgery.

Question 2: Drag-and-Drop Prioritization

Rank the patients in the order they should be assessed:

🔲 First: _______________
🔲 Second: _______________
🔲 Third: _______________
🔲 Fourth: _______________

✅ Correct Answer:
1️⃣ Ms. Rodriguez (Fever post-op) – FIRST:

Fever on post-op day 2 suggests infection, which requires immediate assessment.
2️⃣ Mr. Lewis (Pain 7/10) – SECOND:
Post-op pain management is important but not immediately life-threatening.
3️⃣ Mr. Singh (Discharge teaching) – THIRD:
Teaching is important but can be done later in the shift.
4️⃣ Ms. Carter (Awaiting surgery) – FOURTH:
She is stable and waiting for surgery, requiring the least immediate intervention.

Question 3: Select the Best Delegation Option

Which task can the RN safely delegate to the LPN?

A. Conducting initial assessment on a new admission
B. Administering IV morphine for pain
C. Reinforcing discharge teaching for Mr. Singh
D. Evaluating Ms. Rodriguez’s surgical wound for infection

✅ Correct Answer: C
Rationale:

LPNs can reinforce patient education, but the RN must do the initial teaching and discharge planning.
LPNs cannot perform initial assessments (A) or IV medication administration (B).
The RN must evaluate potential post-op complications (D).

Case Study 3: Acute vs. Chronic Prioritization

Scenario: The nurse receives report on four patients in the emergency department.

Patient	Symptoms	Priority Level
Mr. Brown, 75 years old	Acute confusion and sodium level of 120 mEq/L	🔴 High
Ms. Wong, 50 years old	Chronic COPD, baseline O2 Sat of 88%, no new symptoms	🟢 Low
Mr. Lopez, 65 years old	BP of 190/98 mmHg, reports a mild headache	🟡 Moderate
Ms. Patel, 30 years old	Reports leg pain after a minor fall, swelling noted	🟡 Moderate

Question 4: Highlight the Correct Answer

Which patient should be seen FIRST?

✅ Correct Answer: Mr. Brown (Hyponatremia & Confusion)
Rationale:

Acute hyponatremia with confusion is life-threatening and can cause seizures.
Chronic COPD with stable vitals (Ms. Wong) is lowest priority.
Moderate hypertension (Mr. Lopez) and leg pain (Ms. Patel) are not immediately life-threatening.

Case Study 4: Recognizing an Unsafe Delegation

You are supervising a new graduate RN. Which of the following delegation actions require intervention?

Question 5: Select All That Apply

✅ Unsafe Delegations:
☑ The RN assigns an LPN to assess a newly admitted patient.
☑ The RN allows a UAP to administer an enema.
☑ The RN asks a UAP to document a patient’s pain level.

🚫 Safe Delegations:
⬜ The RN asks an LPN to reinforce a patient's dietary education.
⬜ The RN assigns a UAP to obtain vital signs on a stable patient.

Rationale:

Assessment must always be done by an RN (LPN cannot assess new admissions).
UAPs cannot administer enemas or document pain levels, as these require clinical judgment.

NCLEX NGN Strategy Recap

1️⃣ Use the ABCs (Airway, Breathing, Circulation) to prioritize emergencies.
2️⃣ Maslow’s Hierarchy helps differentiate urgent from non-urgent needs.
3️⃣ Chronic conditions are lower priority than acute, life-threatening symptoms.
4️⃣ LPNs can reinforce teaching, administer PO meds, and perform wound care but cannot assess or do discharge planning.
5️⃣ UAPs can assist with ADLs, take vital signs, and document intake/output but cannot assess or administer medications.
6️⃣ Always intervene when an unsafe delegation occurs!

Yaneen