How to answer Priority Questions on the NCLEX?

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Hi Everyone, it seems that the NCLEX in high on PRIORITY QUESTIONS. Any advice on how to answer priority questions. Thank You.

Specializes in Hematology/Oncology.

btw.

If a patient is diagnosed with a particular disease and is exhibiting signature signs and symptoms. It is not a big deal.

Ex 1 . Diagnosed with hypertension and has a headache is expected. It is not an urgent response

Ex 2. Diagnosed with hypertension and diminishing LOC is unexpected and is urgent.

You may see Ex 1 combined with other patients and Ex1 is not a big deal. vs Ex 2 which is possibly showing bleeding.

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Specializes in Family Nurse Practitioner.
Ex 1 . Diagnosed with hypertension and has a headache is expected. It is not an urgent response

I don't know if that is true at all times. Headaches can be a a sign of hypertensive crisis which is an emergency. You have to know which symptoms are an exacerbation of their current ill health state.

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**Note*** I am unable to view the chart (below) which should be a part of my original post. I am not sure if others can see it either so I just wanted to update my post (hopefully the chart shows). This is from a handout from my Professor who taught Nursing Leadership & Management.

Prioritization of Patient Care

A - Airway

B - Breathing

C - Circulation

D - Disability, such as neurological deficits

[TABLE=width: 848]

[TR]

[TD]Principle[/TD]

[TD]Examples[/TD]

[/TR]

[TR]

[TD]Systemic before local - Think "life before limb"

[/TD]

[TD]Prioritize interventions for a patient in shock over those for a patient with a localized limb injury

[/TD]

[/TR]

[TR]

[TD]Acute (less opportunity for physical adaptation) before chronic (great opportunity for physical adaptation)

[/TD]

[TD]Prioritize care for a new injury/illness or acute exacerbation over care of a patient with a long-term chronic illness

[/TD]

[/TR]

[TR]

[TD]Actual problems before potential future problems

[/TD]

[TD]Prioritize administration of medication of patient with acute pain over ambulation of a patient at risk for DVT

[/TD]

[/TR]

[TR]

[TD]Listen carefully to clients and don't assume

[/TD]

[TD]The OB patient says "this is just how I felt with my last pregnancy when my baby was born 10 minutes after I got to the hospital"

[/TD]

[/TR]

[TR]

[TD]Recognize and respond to trends[/TD]

[TD]A decrease / change in Level of Consciousness

[/TD]

[/TR]

[TR]

[TD]Recognize sign of medical emergencies and complications vs. "expected client findings."

[/TD]

[TD]Noting signs of increasing ICP vs. the clinical findings expected following a stroke.[/TD]

[/TR]

[TR]

[TD]Apply clinical knowledge to priority setting[/TD]

[TD]Giving selected medications before a routine daily medication.

[/TD]

[/TR]

[/TABLE]

Marquis, B. & Huston, C. (2011). Leadership roles and management functions in nursing: Theory and application (7th ed.). Philadelphia: Lippincott Williams & Wilkins.

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Thank you everyone.

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I took NCLEX on 1/7/14 and passed. I had a lot of prioritization as well as SATA/PATA's. I was unable to use the ABC's with my prioritization questions. I had to read each answer choice carefully, figure out what the outcome would be if I did not see that patient STAT/ASAP. I was also told that in NCLEX's world that you must assume that every patient is dying and which patient will die if you do not see them right now. I took my time in reading and answering the questions. I also pretended/imagined that I was entering these patient's rooms and questioned, what would I do next, who would I see first, what complications could happen if I did not do anything or had them wait a little longer. GOOD LUCK!!!!

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Patient with acute and unexpected S&S are seen first.

I agree with this. There were a lot of times where I had to evaluate if something was an expected outcome vs an unexpected outcome. If it's an unexpected outcome, that needs to be addressed. A hip replacement shouldn't be complaining of abdominal pain.

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The only* time potential problems are worse than an actual problem is with psych. If the patient threatens to kill themself or hurt someone else, that's usually the priority. Suicide = no more patient. That's a problem.

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The only* time potential problems are worse than an actual problem is with psych. If the patient threatens to kill themself or hurt someone else, that's usually the priority. Suicide = no more patient. That's a problem.

Not disagreeing entirely, BUT I came across a question (from Kaplan), where this was my line of thinking... Here is the link to my original post https://allnurses.com/nclex-discussion-forum/nclex-rn-priority-895094.html

The nurse sees pts in the adolescent psych unit. Which of the following pts should the nurse see FIRST?

1. 13 yr old who c/o impulsivity & poor attention span

2. 14 yr old who frequently loses his temper & argues with his teachers

3. 15 yr old who wants to be a model & only drinks H20 & eats vegetables

4. 16 yr old who bullies, threatens, and intimidates other & initiates physical fights

ANSWER: 3

I understand that the individual needs assessment of nutritional status..BUT... why is option 3, a bigger concern than "option 4"...My thought was option 4 would be priority as it relates to safety The nurse should always make sure the patient is of no harm to themselves or others.

option 3...assessment of nutritional status will be the same if done "now" or 5 mins from now, after the nurse ensures the safety principle...

since all answer choices in the above question are psych pts..... I wonder what the priority would be if say for EXAMPLE:

(Totally making this question up)

The RN working in the ED Unit... the following 4 pts have just been admitted, who should the nurse see FIRST?

a. pt with DKA

b. pt with HX of CHF and showing signs of fluid volume overload

c. pt who states "I failed my college exam, but it will all be over soon."

d. pt with C/O HA, who states "George Washington is the current President of the U.S."

Look forward to reading everyone's thoughts.

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I had the question about the adolescent psych patients, too, and it said on mine that the correct answer was 4, because safety is a priority.

As for the ED question, I would personally choose option C as the priority, suicide is a greater priority than a patient in DKA, etc. I learned that I read into the questions, so unless they give you particular symptoms pointing out to distressing issues, don't assume someone with CHF has difficulties breathing at this moment in a priority situation, unless it is spelled out for you. Also, actual problems (active suicide risk) are more concerning than potential problems (DKA, fluid overload w/CHF).

Again, this was my biggest issue with test-taking, but thankfully I am starting to train myself NOT to do this, haha.

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Thank you. I am training my mind to think NCLEX style also.

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Specializes in Med/surg, Onc.

I'm so glad my school always did exams nclex style from a bank instead of writings their own. So we have been thinking nclex style since the beginning.

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Whether right or wrong, I would have said 4 for the Kaplan question you posted. You really don't want one patient punching another patient. Wanting to be a model and drinking water/eating veggies does not need an immediate intervention.

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