NCLEX Review Guide: Leadership Management, Prioritization & Clinical Judgment

Delegation and Supervision

• Five Rights of Delegation: Right task, right person, right circumstances, right direction/communication, and right supervision/evaluation must be considered before delegating any nursing task.
• Scope of practice determines what tasks can be delegated to UAPs (unlicensed assistive personnel) versus LPNs versus RNs, with RNs retaining accountability for all delegated tasks.
• Tasks requiring nursing judgment, assessment, teaching, or evaluation cannot be delegated and must be performed by the registered nurse.

ABC Priority Framework

• Airway always comes first, followed by breathing, then circulation - this hierarchy guides all emergency and routine care prioritization decisions.
• Maslow's Hierarchy supports ABC prioritization, with physiological needs (oxygen, circulation) taking precedence over safety, love/belonging, and self-actualization needs.

Clinical Decision-Making Process

1. Recognize cues and gather relevant data
2. Analyze cues and prioritize hypotheses
3. Generate solutions and take action
4. Evaluate outcomes and modify plan as needed

Patient Safety Priorities

• Fall prevention includes risk assessment using standardized tools, environmental modifications, and appropriate use of restraints only as a last resort with physician orders.
• Medication safety requires adherence to six rights: right patient, drug, dose, route, time, and documentation, plus right reason and right response.
• Infection control measures include standard precautions for all patients and transmission-based precautions based on specific pathogens and routes of transmission.

Error Prevention and Reporting

• Just culture promotes error reporting without fear of punishment, focusing on system improvements rather than individual blame to enhance patient safety.
• Near-miss events should be reported and analyzed to prevent actual adverse events from occurring in similar circumstances.