This free Prioritization & Delegation Practice Test #1 covers airway, breathing, and circulation first, expected versus unexpected findings, and early warning signs that cannot wait. Work through 10 timed questions, then check every answer with the full rationales below. No sign-up required.
All 10 Questions With Answers & Rationales
Prefer to work at your own pace? Every question from the timed quiz above is listed here in full. Choose your answer, then tap Show Answer & Rationale to check it.
Question 1: Airway
A nurse receives report on four clients. Which client should the nurse see first?
- A. A client with a hip fracture who rates pain 8/10 and is due for pain medication now
- B. A client with type 2 diabetes whose fasting blood glucose is 210 mg/dL
- C. A client 3 hours after a thyroidectomy who reports neck tightness and has new noisy, high-pitched breathing
- D. A client with COPD whose oxygen saturation is 89% on 2 L/min, which matches the baseline recorded on admission
Show Answer & Rationale
Answer: C. A client 3 hours after a thyroidectomy who reports neck tightness and has new noisy, high-pitched breathing
Rationale: Neck tightness with new stridor after thyroid surgery points to a developing airway obstruction, such as a hematoma or laryngeal edema. Airway comes first in the ABCs and this can become life-threatening within minutes. Pain and an elevated glucose need attention soon but are not immediately life-threatening. The client with COPD has a finding that matches the documented baseline, so it is expected rather than a change.
Question 2: Airway
A client is brought to the emergency department after a house fire. Which finding should the nurse act on first?
- A. Singed nasal hairs and a hoarse voice
- B. Pain rated 9/10 in both forearms
- C. Blisters on the backs of both hands
- D. Urine that is darker than usual
Show Answer & Rationale
Answer: A. Singed nasal hairs and a hoarse voice
Rationale: Singed nasal hairs and hoarseness suggest an inhalation injury. Swelling of the upper airway can progress quickly, so the airway is the priority and early intervention, such as preparing for intubation, may be needed. Pain, blisters, and dark urine all matter, but airway compromise is the most immediate threat to life.
Question 3: Breathing
Which client should the nurse see first?
- A. A client with pneumonia who has a temperature of 38.6°C (101.5°F) and a productive cough
- B. A client with asthma who used a rescue inhaler 1 hour ago and is speaking in full sentences
- C. A client with heart failure who has 2+ edema in both ankles
- D. A client 1 day after repair of a femur fracture who suddenly reports chest pain, shortness of breath, and feeling anxious
Show Answer & Rationale
Answer: D. A client 1 day after repair of a femur fracture who suddenly reports chest pain, shortness of breath, and feeling anxious
Rationale: Sudden chest pain, shortness of breath, and anxiety after a long-bone fracture or surgery are warning signs of a pulmonary embolism or fat embolism. This is a sudden change in breathing and needs immediate action. The fever and cough are expected with pneumonia, the client with asthma is speaking in full sentences after treatment, and ankle edema is a common finding in heart failure that does not need attention ahead of an acute breathing problem.
Question 4: Circulation
A nurse is caring for four postoperative clients. Which client should the nurse see first?
- A. A client 1 day after surgery who rates incisional pain 5/10
- B. A client 4 hours after a knee replacement whose dressing is saturated with bright red blood, with a heart rate of 118/min and a blood pressure of 92/54 mm Hg
- C. A client with a nasogastric tube draining green fluid
- D. A client who has not voided in the 4 hours since the urinary catheter was removed
Show Answer & Rationale
Answer: B. A client 4 hours after a knee replacement whose dressing is saturated with bright red blood, with a heart rate of 118/min and a blood pressure of 92/54 mm Hg
Rationale: A saturated dressing with bright red blood, a rapid heart rate, and a falling blood pressure point to hemorrhage and early shock, a circulation problem. Moderate pain and green gastric drainage are expected after surgery. Not voiding 4 hours after catheter removal is still within the time frame most facility protocols allow before further action, so it can wait.
Question 5: Airway
A client begins having a generalized tonic-clonic seizure in bed. What should the nurse do first?
- A. Turn the client onto the side
- B. Insert a padded tongue blade between the teeth
- C. Hold the client's arms and legs still
- D. Leave the room to get the prescribed anticonvulsant
Show Answer & Rationale
Answer: A. Turn the client onto the side
Rationale: Turning the client onto the side lets saliva drain from the mouth and helps keep the airway open. Nothing is placed in the mouth, because it can break teeth or block the airway. Restraining the limbs can cause injury. The nurse stays with the client, protects the head, times the seizure, and calls for help. Medication is given as prescribed if the seizure lasts longer than the time set by the provider's order or facility protocol.
Question 6: Breathing
A nurse has just started an IV antibiotic. Within minutes, the client reports itching and throat tightness, and the nurse hears wheezing. What is the nurse's first action?
- A. Notify the health care provider
- B. Take a full set of vital signs
- C. Stop the antibiotic infusion
- D. Give the prescribed diphenhydramine
Show Answer & Rationale
Answer: C. Stop the antibiotic infusion
Rationale: These are signs of anaphylaxis. The first step is to stop the drug that is causing the reaction so the client receives no more of it. The nurse then keeps the IV access open with normal saline using new tubing, supports the airway, calls for emergency help, and gives epinephrine according to the protocol or order. Calling the provider, taking vital signs, and giving an antihistamine are all appropriate, but each one delays removing the cause.
Question 7: Circulation
Which client should the nurse see first?
- A. A client with a leg cast who reports itching under the cast
- B. A client with a new colostomy whose stoma is pink and moist
- C. A client 2 days after surgery with a temperature of 37.8°C (100°F)
- D. A client with a forearm cast who reports pain not relieved by the prescribed opioid, with fingers that are pale, cool, and numb
Show Answer & Rationale
Answer: D. A client with a forearm cast who reports pain not relieved by the prescribed opioid, with fingers that are pale, cool, and numb
Rationale: Pain out of proportion to the injury that does not respond to opioids, along with pale, cool, numb fingers, suggests compartment syndrome. Circulation to the limb is at risk and permanent damage can occur within hours, so the provider must be notified right away. Itching under a cast is common, a pink moist stoma is expected, and a low-grade temperature 2 days after surgery needs monitoring but is less urgent.
Question 8: Breathing
A nurse is caring for four clients on a medical unit. Which client should the nurse see first?
- A. A client with COPD who has a barrel chest and an oxygen saturation of 90% on 2 L/min, unchanged since admission
- B. A client with myasthenia gravis who says it is getting harder to breathe and swallow, and whose voice is getting weaker
- C. A client with cystic fibrosis who is coughing up thick mucus
- D. A client with bruised ribs who reports pain with deep breaths and has an oxygen saturation of 96%
Show Answer & Rationale
Answer: B. A client with myasthenia gravis who says it is getting harder to breathe and swallow, and whose voice is getting weaker
Rationale: Worsening difficulty breathing and swallowing with a weakening voice in a client with myasthenia gravis suggests a myasthenic crisis. The muscles used for breathing are weakening and the client may need ventilatory support. The client with COPD has stable findings that have not changed, thick mucus is expected with cystic fibrosis, and the client with bruised ribs has adequate oxygenation.
Question 9: Breathing
A client is receiving an opioid by patient-controlled analgesia (PCA). Which finding needs the nurse's immediate action?
- A. Respiratory rate of 8/min and the client is difficult to arouse
- B. Pain rated 4/10
- C. Nausea after breakfast
- D. Itching on the face and chest
Show Answer & Rationale
Answer: A. Respiratory rate of 8/min and the client is difficult to arouse
Rationale: A slow respiratory rate with increasing sedation points to opioid-induced respiratory depression, a breathing problem. Sedation usually gets worse before breathing slows, so a client who is hard to arouse needs action now. The nurse stops the PCA, stimulates the client, supports the airway and breathing, gives oxygen and naloxone according to the order or protocol, and calls the provider. Mild pain, nausea, and itching are common opioid effects that are not life-threatening.
Question 10: Circulation
Four clients arrive in the emergency department at the same time. Which client should the nurse see first?
- A. A client with a scalp laceration whose bleeding is controlled with direct pressure
- B. A client with an ankle deformity after a fall who has a strong pedal pulse
- C. A client with crushing chest pain, sweating, and nausea
- D. A client with abdominal pain rated 7/10 who has vomited twice
Show Answer & Rationale
Answer: C. A client with crushing chest pain, sweating, and nausea
Rationale: Crushing chest pain with sweating and nausea is a warning sign of acute coronary syndrome, a circulation emergency where time to treatment affects survival. The laceration is already controlled, the ankle injury has a strong pulse below it, and the client with abdominal pain needs assessment soon but is not showing signs of an immediate threat to life.
Prioritization & Delegation Practice Tests
Free, timed tests on the hardest NCLEX skill: deciding who to see first and what to delegate. Every question has a full rationale. New tests are added to this series regularly.
Who to See First (ABCs)
Airway, breathing, and circulation first; expected versus unexpected findings; warning signs that cannot wait.
Delegation to AP and LPN
What the AP and the LPN can do, the five rights of delegation, and what stays with the RN.
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