An LPN has four patients. Which patient should the LPN see first?

A patient with oxygen saturation of 88% on room air. Using the ABC framework, the patient with low oxygen saturation (breathing problem) is the priority. An O2 sat of 88% indicates hypoxia requiring immediate assessment and intervention. Pain and scheduled medications are important but not life-threatening.

An LPN asks a CNA to check vital signs on all assigned patients. Later, the CNA reports that a patient has a blood pressure of 78/50. What should the LPN do?

Immediately assess the patient personally. A blood pressure of 78/50 indicates potential shock or hemodynamic instability. The LPN must immediately assess the patient because this represents a significant change that requires nursing judgment. The LPN cannot delegate assessment of an unstable patient.

Which delegation instruction from the LPN to the CNA is most appropriate?

"Take Mr. Smith's blood pressure at 1400 and report if systolic is over 160". Specific instructions with clear parameters and reporting criteria ensure safe delegation. The instruction includes what to do, when to do it, and what to report. Option D is incorrect because CNAs cannot assess - they can measure and report data, but assessment requires nursing judgment.

2.6 Prioritization and Delegation | NCLEX-PN (Practical Nurse) | Free Exam Prep

Prioritization and Delegation

LPN/LVNs must manage multiple patients and work effectively with nursing assistants. Understanding how to prioritize care and delegate tasks safely is critical for patient safety and NCLEX-PN success.

Prioritization Frameworks

ABC Framework (Airway, Breathing, Circulation):

Priority	Focus	Examples
1st - Airway	Patent airway	Choking, stridor, obstruction
2nd - Breathing	Adequate ventilation	Respiratory distress, low O2 sat
3rd - Circulation	Adequate perfusion	Chest pain, severe bleeding, shock

After ABCs:

Safety threats (falls, suicide risk)
Pain (especially acute/severe)
Other urgent needs

Maslow's Hierarchy for Prioritization:

Level	Needs	Priority
1. Physiological	Oxygen, fluids, nutrition, elimination	Highest
2. Safety	Physical safety, security	High
3. Love/Belonging	Social needs, family	Medium
4. Esteem	Self-esteem, recognition	Lower
5. Self-actualization	Growth, learning	Lowest

Prioritizing Multiple Patients

When you have several patients needing attention:

Assess urgency - Life-threatening vs. routine
Apply ABCs - Airway issues first
Consider timing - Time-sensitive medications or treatments
Stable vs. unstable - See unstable patients first
New vs. known - New symptoms need assessment

Scenario	Priority
Patient with respiratory distress	See immediately
Patient requesting pain medication	See after acute needs
Patient ready for discharge teaching	See after clinical needs
Patient requesting water	Can delegate to CNA

Delegation Basics for LPN/LVNs

In many states, LPN/LVNs may delegate to CNAs/UAPs for stable patients.

Key Delegation Principles:

The RN supervises the LPN
The LPN may supervise CNAs under RN direction
Cannot delegate nursing judgment or assessment
Must verify competency of the delegatee

Five Rights of Delegation

Right	Question to Ask
Right Task	Is this task within the CNA's scope?
Right Circumstance	Is the patient stable? Is the setting appropriate?
Right Person	Is this CNA trained and competent for this task?
Right Direction	Have I given clear, specific instructions?
Right Supervision	Am I providing appropriate oversight?

What LPN/LVNs Can Delegate to CNAs

Can Delegate	Cannot Delegate
Vital signs on stable patients	Vital signs on unstable patients
ADLs (bathing, dressing, grooming)	Medication administration
Feeding (no aspiration risk)	Feeding patients with swallowing difficulties
Ambulation (stable patients)	Initial ambulation post-procedure
Specimen collection	Invasive procedures
Intake and output measurement	Assessment of findings
Routine turning and positioning	Wound care

Giving Clear Direction

Effective delegation communication includes:

Element	Example
What to do	"Take Mrs. Johnson's blood pressure"
When	"At 2:00 PM"
Parameters	"Report immediately if systolic is over 160 or under 90"
Expected findings	"Her usual BP is around 130/80"
How to reach you	"I'll be in room 204, call me if you need anything"

Vague vs. Specific Direction:

Vague (Avoid)	Specific (Use)
"Check on the patient later"	"Check vital signs at 1400 and 1600"
"Let me know if something seems wrong"	"Report temperature over 101°F immediately"
"Keep an eye on him"	"Check on him every 30 minutes and report any breathing changes"

Supervision Requirements

Factor	Less Supervision	More Supervision
Patient stability	Stable, predictable	Unstable, changing
Task complexity	Simple, routine	Complex, unfamiliar
CNA experience	Experienced, competent	New, learning
Setting	Adequate staffing	Short-staffed

Accountability in Delegation

Person	Accountable For
LPN	Decision to delegate, providing direction, follow-up
CNA	Performing the task correctly, reporting findings
RN	Overall supervision of the care team

Critical Point: The LPN/LVN retains accountability for the outcome of delegated tasks. Delegation does not transfer accountability.

When NOT to Delegate

Do not delegate when:

The patient is unstable
The task requires nursing judgment
The CNA has not demonstrated competency
You cannot provide appropriate supervision
The situation is changing rapidly

On the NCLEX-PN

Expect questions about:

Which patient to see first
What can be delegated to CNAs
Providing appropriate direction
When delegation is inappropriate

NCLEX-PN

1Introduction to the NCLEX-PN

2Chapter 2: Coordinated Care

3Chapter 3: Safety and Infection Prevention and Control

4Chapter 4: Health Promotion and Maintenance

5Chapter 5: Psychosocial Integrity

6Basic Care and Comfort

7Pharmacological and Parenteral Therapies

8Reduction of Risk Potential

9Physiological Adaptation

Key Takeaways