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How to Answer Nursing Priority Questions on the NCLEX From A Nursing ProfessoR

Updated: Jul 14, 2023

In the nursing profession, prioritizing patient care is essential for ensuring optimal outcomes. When faced with challenging situations, nurses must possess the ability to identify the most urgent or critical actions to take. This is probably why priority questions are a common type of question on the NCLEX exam and any exam you take at school.

Follow these tips to master nursing priority question types!

 
 

Tip #1 - Identify Priority Questions

The stem of these questions often contains words like "priority," "first," "initial," "immediate," or "best." The NCLEX bolds those and other key words, so pay close attention. You might have four correct answer choices, but you need to select what the nurse needs to do first.


The stem of the question might end with:

  • Which client should the nurse assess first?

  • Which cue is the greatest concern?

  • What is the most important intervention?

  • Which is the priority action by the nurse?

With the Next Generation NCLEX, there is now a question type that will ask you to order answer choices by clicking and dragging them into the correct order. You can also use the following strategies for this question type- In what order should the nurse provide this care?


Tip #2 - Use Maslow's Hierarchy

According to Maslow's Hierarchy of Needs, physiological needs are the foundation and come first in priority. Maslow's Hierarchy is a psychological theory that categorizes human needs into a hierarchical structure, with the most basic physiological needs at the bottom and higher-level needs at the top. The hierarchy consists of five levels:

  1. Physiological Needs: These are the most fundamental needs necessary for survival, including air, water, food, shelter, clothing, sleep, and basic bodily functions. Meeting these needs takes precedence over all other needs.

  2. Safety Needs: Once physiological needs are met, individuals seek safety and security. This includes physical safety, stability, protection from harm, a secure environment, employment, and access to resources that promote well-being.

  3. Love and Belonging Needs: After achieving safety, individuals have a need for social connection, love, affection, and a sense of belonging. This includes relationships, friendships, family, and a sense of community.

  4. Esteem Needs: Once the lower-level needs are fulfilled, individuals seek self-esteem, recognition, respect, and a sense of accomplishment. This includes self-confidence, achievements, reputation, and being valued by others.

  5. Self-Actualization Needs: At the top of the hierarchy are self-actualization needs, which refer to the desire for personal growth, fulfillment, and reaching one's full potential. This includes personal development, creativity, problem-solving, and pursuing meaningful goals.

When applying Maslow's Hierarchy in prioritization questions, look for the answer choice that indicates a physiological need is being met. If there are no physiological needs in the answer choices, look for the answer choice that indicates a safety need is being met.


Below is a diagram of Maslow's Hierarchy that I've flipped upside-down to help remind you to address physiological needs first, and then safety.

Maslow's Hierarchy- Flipped
Try it!

A client arrives to the emergency department with a 8-inch self-inflicted laceration to their left forearm. Which is the nurse's priority action?

A. Encourage the client to take deep breaths

B. Assess and dress the laceration

C. Collect a detailed history from the client

D. Encourage the client to express their feelings


Answer: B. This is the only answer that addresses the physiological need of bleeding. Once the laceration is treated, the nurse can address other needs.


Tip #3 - Use the ABC's

The ABC's of nursing, also known as the ABC prioritization framework, is a fundamental concept in nursing that helps prioritize patient care based on the urgency and significance of the patient's condition. The ABC stands for Airway, Breathing, and Circulation. These three elements are considered the vital functions necessary for life and take precedence over other aspects of care.

  1. Airway: The airway refers to the passage through which air travels into and out of the lungs. Maintaining a clear and patent airway is crucial for adequate oxygenation. In emergency situations, ensuring a patent airway takes priority. This involves assessing for any obstructions, positioning the patient to optimize airway patency, and providing interventions such as suctioning or administering oxygen.

  2. Breathing: Breathing involves the process of inhaling oxygen and exhaling carbon dioxide. Adequate breathing is necessary for oxygen exchange and maintaining optimal oxygenation levels. Monitoring the patient's respiratory rate, rhythm, and effort is important. Promptly addressing any signs of respiratory distress, such as labored breathing, decreased oxygen saturation, or abnormal breath sounds, is crucial in prioritizing nursing interventions.

  3. Circulation: Circulation refers to the continuous flow of blood throughout the body, delivering oxygen and nutrients to cells and removing waste products. Assessing and maintaining adequate circulation is vital for ensuring tissue perfusion. Monitoring the patient's blood pressure, heart rate, and peripheral pulses helps identify any signs of compromised circulation. Immediate interventions may include administering medications to support blood pressure, initiating cardiopulmonary resuscitation (CPR) if necessary, or managing external bleeding.

The ABC prioritization framework serves as a quick assessment tool to identify and address life-threatening conditions promptly. By focusing on the patient's airway, breathing, and circulation, nurses can prioritize interventions that aim to stabilize the patient's condition and prevent further deterioration. It is important to note that other aspects of care, such as pain management or psychological support, are essential but may be addressed after ensuring the patient's ABC's are stable.


By understanding and applying the ABC's of nursing, we can successfully answer prioritization questions on the NCLEX when there are more than 1 physiological answer choices to choose from and Maslow's cannot help you. Airway issues come first, then Breathing issues, then Circulation issues, then physical safety or safety from infection, then pain, then education.

ABC's of Nursing
Try it!

After assessing the client, the nurse formulates the following diagnoses. Number them in order of priority.

Constipation

Anticipated grieving

Ineffective airway clearance

Ineffective tissue perfusion

Answer: 3, 4, 1, 2. Ineffective airway clearance= AIRWAY. Ineffective tissue perfusion= BREATHING. Constipation= CIRCULATION. Anticipated grieving = FEELINGS.


Tip #4 - Use the Nursing Process

The nursing process is a systematic problem-solving approach used by nurses to deliver patient-centered care. It consists of five essential steps: Assessment, Diagnosis, Planning, Implementation, and Evaluation (ADPIE). By utilizing the nursing process, we can address priority questions because we know that the nurse always ASSESSes FIRST. The only exception is in emergency situations which may require an intervention first (like giving naloxone for someone with respiratory depression).

Try it!

The nurse is administering IV procainamide to a client when the client starts to complain of dizziness. What should the nurse do first?

A. Auscultate the client’s apical pulse

B. Call the telemetry monitor for the latest heart rate

C. Administer the prescribed nitroglycerin tablets

D. Obtain a 12-lead electrocardiogram


Answer: A. Using the nursing process, we can immediately eliminate C because it is an intervention. We can also eliminate B and D because we want to assess the CLIENT first. We can get the most accurate pulse by auscultating the client's apical pulse.



Remember to read each question carefully, identify keywords or cues, and analyze the given options before selecting the best response. Practice solving a variety of priority questions, review nursing concepts and principles, and use critical thinking strategies to enhance your ability to prioritize patient care effectively.

By practicing and applying these strategies, you can confidently approach these types of questions on the NCLEX exam and provide safe and efficient care as a professional nurse.


Good luck!

Professor C.


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