NCLEX-RN cheat sheet · Management of care
Prioritization and delegation
Assignment or delegation, the five rights, who does what, and who you see first
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Assign the stable and predictable; keep the new, the unstable, the teaching and the titration. When you rank clients, find the one who's changing, not the one who's loudest or busiest.
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At a glance
Assignment or delegation?
| Assignment | Delegation | |
|---|---|---|
| What | Routine care already inside the person's role, learned in basic training | A specific nursing activity beyond their usual role, after extra education and checked, documented competence |
| Example | An aide's vital signs; helping a stable client walk | In some settings, a trained aide gives certain medications, if policy allows |
| Who's accountable | The nurse still makes sure it's done, completely and correctly | The delegating nurse stays accountable for the client. The delegatee is responsible for doing the task correctly |
Ground rules: Only a licensed nurse with authority delegates, and only tasks inside their own scope. The delegatee can't pass it on. Assessing, deciding and evaluating stay with the nurse. RN to RN at shift change is a handoff.
The five rights of delegation
| Right | Answer yes to |
|---|---|
| Task | Is it in the person's job description, or the setting's written policies? |
| Circumstance | Is the client stable and predictable? This right changes fastest: a change sends the task back to you to reassess |
| Person | Does this person have the skills and knowledge? The nurse, the employer and the person share that check |
| Directions and communication | What to collect, how, by when to report, anything special. No changes without checking with you. Get a read-back, not a nod |
| Supervision and evaluation | Will you follow up, check the client's outcome, and be there to step in? |
In doubt: If delegating doesn't feel right in the moment, do it yourself.
Who usually does what
| Role | Usually takes |
|---|---|
| RN keeps | Initial assessments (admission, first after surgery); planned teaching and discharge; creating and evaluating the care plan; unstable or unpredictable clients; titrations, high-risk IV infusions, and IV push medications in most settings |
| LPN/VN | Stable clients with predictable needs: scheduled medications, routine dressings, enteral feedings, data collection. Reinforces the RN's teaching; doesn't plan it |
| Assistive personnel | Daily living care; vital signs and weights on stable clients; intake and output; moving and transporting clients. Can remind about teaching, not plan it |
Follow policy: These are typical patterns. Your state's practice act and your facility's policy decide.
Delegate it, or keep it?
| Request | Who | Why |
|---|---|---|
| Walk a stable client, day 2 after surgery | Assistive personnel | Stable, routine |
| Feed a client with dysphagia after a stroke | RN, or an aide with specific feeding training | Not routine: aspiration risk |
| Recheck blood pressure; client now dizzy and pale | RN | Unstable: needs assessment |
| Reinforce the RN's crutch teaching | LPN/VN | Reinforces; new teaching stays with the RN |
| Titrate a heparin infusion | RN | High-risk IV infusion, titration |
| Admission assessment of a new client | RN: you, or another RN by handoff | First assessment needs judgment |
Who first? The ranking tools
| Tool | What goes first |
|---|---|
| Maslow | Physiological needs (oxygen, fluids, food, sleep, elimination), then safety, then belonging, esteem, self-actualization |
| Airway, breathing, circulation | Two physical needs: the ABC problem first; send a team member to help the other client |
| CURE tool | Critical (act now: breathing trouble, chest pain, airway at risk), then urgent (discomfort, safety risk), then routine (medications, assessments), then extras |
| Cues | Acute before chronic; actual before potential, usually; unexpected before expected; a change from the client's own baseline |
Study tools: Useful teaching tools, not rules NCSBN publishes. When they seem to disagree, go back to the client's own cues.
Acuity or intensity?
| Means | Pushed up by | |
|---|---|---|
| Acuity | How much care a client needs because of how sick they are | Unstable vital signs, oxygen therapy, high-risk IV drugs, several drains, uncontrolled pain |
| Intensity | How much time the care takes | Help with bathing, wound care, many medication passes |
Watch: Busy isn't the same as sick: the exam cares most about acuity. A score is a starting point; the client may have changed.
Managing the shift
- Brain sheet: each client's key facts, times and tasks on one page.
- Assess during bedside handoff: what's infusing, what's nearly empty, how the client looks. Pick who's first right after report.
- Fixed times first: time-critical medications, scheduled procedures, a client leaving for dialysis or surgery.
- Estimate how long each task takes, group tasks in one visit, gather equipment first, and use your team.
- Re-rank after every change: a critical lab result means calling the provider before routine discharge teaching.
Assess first or act first?
- Usually assess first. A client who says she feels short of breath needs you to look, listen and measure before you act.
- Act first when the cue gives the action: no pulse, no breathing, or a closing airway.
- ABC ranks clients who are alive and breathing. Adult cardiac arrest runs CAB: compressions first.
- A breathing client who's getting worse: airway and breathing still come first.
Priority and safety calls
- ★ The client changes during a delegated task: the delegatee tells you now, and you reassess. The task comes back to you.
- ★ Measuring isn't evaluating: the aide can get the pain score, but you judge whether the pain medicine worked.
- Two clients need you: go to the airway, breathing or circulation problem, and send a team member to the other. Both get care.
- A change reported at handoff, like a client who needed new oxygen overnight, moves her near the top, even if she looks settled now.
- Supervision: direct means watching the care happen; indirect means checking results and records. Follow up with the person, then see the client yourself.
- Feedback: what went well, what didn't, and the plan. A correct reading reported an hour late is a reporting problem.
- Someone isn't competent for a task? Tell the nurse leader, so they get training before they're asked again.
- Assign by acuity, not head count. A float nurse gets clients who match her skills, an orientation, and pairing with someone who knows the unit.
How the NCLEX tests it
- Assign the stable and predictable; keep the new, the unstable, the teaching and the titration.
- Delegation traps: a routine task on an unstable client, and an evaluation hidden inside a measurement.
- Who-first distractors: the loudest client, the longest task, the most familiar diagnosis, a chronic value that's expected.
- Changed beats abnormal but stable: a heart rate that jumps from 82 to 118 bpm after surgery comes before chronic pain due a scheduled dose.
- The RN keeps assessment, teaching, evaluation and unstable clients, and stays accountable for every client.
- Assess first unless the cue gives you the action; adult cardiac arrest is compressions first.
Practice it next
This sheet comes from Delegation, assignment and supervision and Prioritizing care and managing time in our NCLEX-RN course. Try free practice questions, or see the lessons it was written from.
Quick self-quiz
- Right circumstance means a client who is stable and ___.
Show answer
predictable - RN to RN at shift change is a ___, not delegation.
Show answer
handoff - To confirm directions, ask the aide to repeat the plan ___.
Show answer
back - Acuity is how sick a client is; ___ is how much time the care takes.
Show answer
intensity - In the CURE tool, needs that mean act now are ___.
Show answer
critical - An adult in cardiac arrest gets chest ___ first.
Show answer
compressions
Sources
- NCSBN and ANA, National Guidelines for Nursing Delegation (2019)
- Open RN, Nursing Management and Professional Concepts 2e, 3.4 Delegation
- Open RN, Nursing Management and Professional Concepts 2e, 3.3 Assignment
- Open RN, Nursing Management and Professional Concepts 2e, 3.5 Supervision
- Open RN, Nursing Management and Professional Concepts 2e, 2.3 Tools for Prioritizing
- Open RN, Nursing Management and Professional Concepts 2e, 2.5 Time Management
- American Heart Association, Guidelines for CPR and ECC, Part 7: Adult Basic Life Support (2025)
More management of care cheat sheets
Educational use only. This sheet is a study aid for the NCLEX-RN, not a substitute for clinical judgment, your facility’s policy or the provider’s orders. Where practice varies, follow facility policy and state law. NCLEX® and NCLEX-RN® are registered trademarks of NCSBN, which does not endorse these materials.