How to Approach NCLEX Priority Questions

One of the most dreaded question formats for nursing students and NCLEX test-takers is PRIORITIZATION. Maybe just reading that word makes you groan? Maybe it makes you panic a little? Maybe it just makes you want to throw your hands in the air and quit? It doesn't have to be that way! There are a few ways you can evaluate a priority question to find the correct answer. And remember, this same prioritization is exactly what you'll be doing as a nurse in a real situation - it will become automatic, and you will think through this very quickly in real life.

Identify Prioritization Questions

The first thing to do when you're reading a question is to look for keywords to identify what it's asking you to prioritize. You should be looking for words like first, best, most important, priority, or initial response/action. Examples of these questions are:

1. Which client will the nurse see first?
2. Which intervention should the nurse complete first?
3. Which action by the nurse is most appropriate?
4. When the client returns from the procedure, what is the nurse's initial action?
5. Which client requires immediate intervention from the nurse?
6. Rank client needs in order of priority.

But here's where things get tricky - sometimes ALL of the answers are things that seem correct or will be actions that need to be completed by the nurse, but only one of the choices is MOST IMPORTANT/PRIORITY/WHAT NEEDS TO BE DONE FIRST.

At this point, you need to rely on the critical thinking skills you've been building throughout your nursing program!

If you are given multiple clients that need to be prioritized, there are a couple of ways to approach the question.

(Source: https://commons.wikimedia.org/wiki/ File:Maslow%27s_hierarchy_of_needs.svg)

Maslow's Hierarchy of Needs - First, review all the information provided and determine where each client falls on Maslow's Hierarchy of Needs. Physiological Needs are a priority - these are the matters of life and death. First, focus on the stability of the client - remember the ABCs (Airway, Breathing, Circulation) of client care. Ask yourself:

• Airway - Does the client have an obstructed or unstable airway?
• Breathing - Does the client have any alteration or complication in breathing?
• Circulation - Is the client's circulation compromised?

If the answer to any of these questions is "yes," then they take priority. (Hint: A client experiencing difficulty breathing always takes priority over the client requesting pain medicine!) After a client's physiological needs are met, your next priority is safety. Do any of the answers involve a safety risk to a client if they are placed at a lower priority? Many NCLEX priority questions can be answered just from these 2 levels of the hierarchy. After physiological and safety needs are met, you move up the hierarchy to evaluate the needs of love/belonging, esteem, and self-actualization.

Nursing Process - If there's no obvious correct answer at this point, evaluate the question with the nursing process. You should be able to go through the nursing process in your sleep at this point in your nursing program! The first step is Assessment. If you are given a list of actions for the nurse to do, remember that assessment comes before implementation in the nursing process.

Immediate action - If you are given a single client and are asked which action to take first, the question to keep in your mind is "what can I do NOW that will help this client?" All of the answer options may be correct actions the nurse needs to take, but one will be an action that will make an impact on the client and that the others might take time to implement.

An example of this is below:

The nurse responds to a client's SpO2 alarm and finds the client lying in bed with rapid, shallow breathing and a bedside SpO2 reading of 86%. Which action will the nurse take first?

1. Notify the healthcare provider
2. Raise the head of the bed to Fowler's position
3. Call respiratory therapy to administer PRN albuterol treatment
4. Call the rapid intervention team

Which of these actions can you do right now to take care of your client? Is notifying the healthcare provider going to immediately take care of your client, or is there something you could do before this? Calling respiratory therapy to administer PRN albuterol may help the client, but again, is there something you could do before this? What about calling the rapid intervention team? The rapid intervention team may be required, but you don't have assessment information yet to know if that's necessary. And again, is there something you can do right now to help prevent the need for the rapid intervention team? Raise the head of the bed to Fowler's position seems like it's too simple to be the right answer, right? But raising the HOB can be done immediately after entering the room, doesn't require a healthcare provider's order or waiting for anyone else to come help the client, and is better than lying supine for a client experiencing respiratory distress.

Let's review now: Read the question; determine what the question is asking for by looking for those keywords (first, best, most important, priority, or initial response/action); evaluate the A, B, C's; go through the nursing process; and look for the immediate action the nurse can take to help the client right now.

The best way to improve your ability to answer prioritization questions is to practice, practice, PRACTICE. Keep going through your practice questions and reviewing the rationales for both correct and incorrect answers to help understand why certain things are prioritized over others.

And remember, EduMind has a NCLEX Exam Prep course that will offer more help with answering prioritization questions and much more!

About the Author: Lana Wilkins, MSN, BSN, RN

Lana Wilkins is a Registered Nurse with over 16 years of professional nursing. She is a nursing educator, consultant, Subject Matter Expert, and writer with a passion for helping students and new nurses. She holds a B.S. in Nursing from the University of Oklahoma and a M.S. in Nursing Education from Western Governors University. Outside of the world of nursing she can be found managing the chaos of 2 kids, a husband, and a cat, being crafty, or spending time with friends.