NCLEX Prioritization Questions: Who to See First?

One of the most challenging aspects of the NCLEX-RN and NCLEX-PN exams is answering prioritization questions, often framed as “Who to see first?” These questions assess a nurse’s ability to prioritize patient care effectively, a critical skill in real-world nursing practice.

The NCLEX prioritization questions require an understanding of critical thinking, the nursing process, Maslow’s hierarchy of needs, ABCs (Airway, Breathing, Circulation), and patient safety principles. Mastering these concepts will help nursing students and graduates confidently answer prioritization and delegation questions.

This guide will break down how to approach NCLEX priority questions, including key strategies, examples, and practice scenarios.

How to Approach NCLEX Prioritization Questions

When faced with NCLEX prioritization questions, use the following strategies:

1. Apply the ABCs (Airway, Breathing, Circulation)

The ABCs (Airway, Breathing, Circulation) principle is a fundamental guideline in nursing assessment and intervention.

• Airway (A): Is the airway obstructed? Is the patient experiencing stridor or choking?
• Breathing (B): Is the patient’s oxygenation compromised? Are they in respiratory distress?
• Circulation (C): Are there signs of poor perfusion, such as hypotension, tachycardia, or shock?

Example:

• A patient with a severe asthma attack (airway obstruction) should be seen before a patient with mild chest pain (stable circulation).

2. Use Maslow’s Hierarchy of Needs

Maslow’s Hierarchy of Needs helps prioritize care based on patient needs:

1. Physiological Needs (Most Important) – Oxygenation, circulation, food, water, elimination.
2. Safety Needs – Fall risk, infection control, self-harm prevention.
3. Love & Belonging – Emotional support, social isolation.
4. Esteem Needs – Respect, confidence, dignity.
5. Self-Actualization (Least Important) – Personal growth, achieving potential.

Example:

• A patient with low blood pressure (circulation issue) takes priority over a patient who is anxious about a procedure (psychosocial need).

3. Acute vs. Chronic Conditions

Patients with acute conditions require more immediate attention than those with chronic, stable conditions.

• Acute conditions: Sudden deterioration, new onset symptoms, unstable vitals.
• Chronic conditions: Long-term management, stable vitals, routine care.

Example:

• A postoperative patient with sudden confusion and low oxygen saturation should be seen before a patient with a history of controlled hypertension.

4. Recognize Unstable vs. Stable Patients

• Unstable patients: Sudden change in condition, altered level of consciousness, abnormal vital signs, post-surgical complications.
• Stable patients: No recent changes, expected symptoms, controlled chronic conditions.

Example:

• A patient with worsening shortness of breath and dropping O2 saturation is a higher priority than a patient requesting pain medication for chronic arthritis.

5. Follow the Nursing Process (ADPIE)

The NCLEX prioritization questions often follow the ADPIE framework:

1. Assessment – Gather information (vital signs, symptoms).
2. Diagnosis – Identify the nursing problem.
3. Planning – Determine goals and priorities.
4. Implementation – Take nursing actions (medication, interventions).
5. Evaluation – Assess the patient’s response.

Example:

• If a patient suddenly deteriorates, ASSESS first before implementing interventions.

6. Consider Safety and Risk Reduction

• Patients at risk for falling, bleeding, infection, or airway obstruction should be prioritized.
• Patients with new-onset symptoms or life-threatening conditions take precedence over routine care.

Example:

• A post-op patient with signs of internal bleeding (tachycardia, low BP) is a higher priority than a patient waiting for discharge teaching.

NCLEX Prioritization Question Examples and Answers

Below are NCLEX-style prioritization questions to help you practice:

Question 1: Who Should the Nurse See First?

The nurse has four patients assigned. Which patient should be assessed first?

A) A 40-year-old post-op patient requesting pain medication.
B) A 70-year-old with chronic COPD and oxygen saturation of 90%.
C) A 55-year-old patient with a history of hypertension complaining of headache.
D) A 30-year-old patient who is diaphoretic, confused, and has a BP of 80/50.

Answer: D – The diaphoretic, confused patient with hypotension is showing signs of shock and requires immediate intervention.

Question 2: Who to Assess First?

A nurse in the emergency department receives the following patients. Who should be seen first?

A) A patient with a history of diabetes and a fasting blood sugar of 120 mg/dL.
B) A pregnant woman with severe abdominal pain and vaginal bleeding.
C) A patient with leg pain and a suspected deep vein thrombosis (DVT).
D) A patient with congestive heart failure (CHF) reporting mild shortness of breath.

Answer: B – A pregnant woman with severe abdominal pain and vaginal bleeding could be experiencing a placental abruption, which is a life-threatening emergency.

Question 3: Delegation and Prioritization

Which task is appropriate to delegate to a licensed practical nurse (LPN)?

A) Assessing a patient’s pain level after administering medication.
B) Teaching a new diabetic patient how to administer insulin.
C) Performing a sterile wound dressing change on a post-op patient.
D) Developing a care plan for a newly admitted patient.

Answer: C – LPNs can perform sterile procedures, but assessment, teaching, and care planning are RNs’ responsibilities.

Final Tips for NCLEX Prioritization Questions

• Always prioritize life-threatening conditions first (ABCs, unstable vitals, acute deterioration).
• Use Maslow’s Hierarchy to determine physiological vs. psychosocial needs.
• Remember that chronic and stable patients can wait.
• Look for signs of deterioration, such as hypotension, altered mental status, or abnormal vital signs.
• Assess before implementing interventions.
• Use critical thinking to eliminate incorrect answer choices.

Final Comments

Mastering NCLEX prioritization questions requires a solid understanding of critical thinking, nursing assessment, and patient safety principles. By applying the ABCs, Maslow’s hierarchy, nursing process, and risk reduction strategies, you can confidently answer “Who to see first?” questions on the NCLEX.

Practice as many NCLEX-style prioritization questions as possible, focus on unstable vs. stable patients, and always prioritize life-threatening conditions first. With the right strategies, you’ll be prepared to pass the NCLEX-RN or NCLEX-PN exam on your first attempt.