Always see acute before chronic unless the chronic is really showing serious signs of going down hill. For example, COPD, he's chronic but he is confused,restless and getting up wondering around, disoriented. You would want to see him first because he is showing signs of hypoxia.
Unfortanately ABC's don't always work and to be quite honest when I was answering questions, I would select my choices based on who will go down hill quicker/ first. Then I would double check my ABC's. I didn't really use ABC's and yes, some of the ?'s on the NCLEX dont' use ABC's because they know we like those first.
Try not to read into your choices. Use the information they are giving you. If they say you have a patient with a chest tube and the suction chamber is continously bubbling and another patient with with COPD with a BP of 165/110 or a patient with a fractured femur 2 days post op c/o of shortness of breath. Who would you see first? Don't say to yourself...well hmm I know the suction chamber should be bubbling but what is the other chamber fluctuating with breathing? Let me go check that! NO! NO! Use the information they are telling you. Your probably thinking airway..because they have that chest tub. They didn't say anything else except that the chamber is continously bubbling and you should know that the suction control should do that! Eliminate that one!!! The COPD is chronic and most have high BP, could be a sign of fluid volume excess but they didn't give you that information. They only told you that his BP was high. NO other symtoms. You can keep this choice because he should be checked on for other things like distended neck veins, shortness of breath, etc. But the Fractured Femur they told you that the client is having problems. She is complaining of SOB. She is 2 days post op and you know that patients with long bone fractures of pelvic fractures are at risk for PE. So see her first then the COPD.
My friend from school would always read into questions and ask more information. I know sometimes we want more information but on the NCLEX that is all you can get. You can't ask any questions to gain more information. So basically when I was answering these questions, UNLESS they gave me information to give me reason why this patient needed to be seen ASAP, I would go to the next choice. Then I would narrow it down to 2 answers and choose. 9 times out of 10, the one that displayed the symptoms was the one that was the answer because it told you that HEY this patient is going to be in big trouble real soon. So focus on the symptoms the patient is displaying to narrow down your choices.
#1 So look at the disease: Is it acute or chronic and what type of disease/illness
#2 Then look at the symptoms they are displaying: Are they serious? Do they need intervention NOW rather than later? Or are they normal for that patient.
They try to be sneaky and give you s/s's that are not in your top s/s's some books list. Medical Surgical Reviews and Rationales by Princeton Review did the best at listing ALL signs and symptoms for diseases. Other books would list the top 5 or 6 but on the NCLEX sometimes what you were looking for wasnt' there. I had this book almost my whole way through school, used it a little and then a week before my exam it popped out at me on my bookshelf. I looked through it for answers I couldn't find in other books or needed a better explanation then the rationale I got from the exams. This book was excellent at explaining it for me. I wish I had used it more.
I only knew this until after the exam because I would look through several books for the answer and this book always had that symptom listed. I use to think that book was too detail but I was wrong. Use it as a reference only though. It has great diagrams too.
I hope I didn't rap too much. Don't think I was yelling at you on the caps. Only emphasizing.
But let me know if you need more help. I do have some things on prioritzing I can email you that may help more.