Every nursing student studying for the NCLEX exam is always wanting to know what’s going to be on the NCLEX or tips and tricks to help them pass.
No NCLEX question type is more confusing, or dreaded, than the priority question.
Even the frustrating SATA (select all that apply) questions have got nothing on priority questions.
How do you answer a question where some or even all of the answers can be correct?
You prioritize – hence the name, priority question.
How do you prioritize? Good question. You use a few simple methods that will help you discern which patient to help first and which action is most urgent.
We’re going to give you 4 simple methods you can follow that will help you prioritize like a veteran nurse. These are:
- Nursing ABC’s
- Maslow’s Hierarchy
- Nursing Process
- Safety Strategy
But before we get into the ingredients of the secret sauce, let’s talk a little about what priority questions are and how to identify them.
What are priority questions?
NCLEX priority questions are simply asking you “What is the most urgent action you need to take?”:
- Who do you see first?
- What’s your top priority?
- What’s the most critical intervention?
They’ll give you a clinical situation, then ask you to prioritize your actions.
Priority questions require you to use all of your knowledge and critical thinking skills to prioritize what patient you see first and what should be the first thing you do.
You can easily recognize a priority question because it will often contain the words/phrases:
- Most important
- Best
- First
- Initial response
- Priority
- Emergency
- Ambulance
- Returning to the Floor
- Important
- See First
Often multiple options or even all of the answers will be correct – except only one answer will be what needs to be done first.
That’s where your critical thinking come in. You’ve got to figure out what is the most urgent action to take. So how do you decide what to do first?
Here’s our four easy methods to help you prioritize like a pro.
Remember Your ABC’s
How could you forget? The nursing ABC’s are drilled into every nursing student until you can recite them in your sleep:
- Airway
- Breathing
- Circulation
These are the 3 most vital concerns when assessing a patient. Is their airway obstructed? Are they respirating? Do they have adequate circulation?
Follow the order and it’ll help you decide what to do first. This is actually the first level of Maslow’s Hierarchy of Needs, which is the second part of your decision-making process.
Using Maslow’s Hierarchy Of Needs
Maslow’s Hierarchy of Needs categorizes everything a human needs for physical, psychological and psychosocial survival.
The first level covers the basics of the body: air to breathe, water to drink, food to eat, sleep, shelter and sex.
The highest level is self-realization – creativity, problem solving, morality, etc. Here’s a graphic with the basic levels:
For nursing, once the patient’s physiological needs are taken care of (ABC’s), you can move up the pyramid to include:
- Pain
- Health education
- Psychological well-being
This should also include the safety of the patient, which we’ll talk about more at the end.
The next step is following your nursing process.
Follow Your Nursing Process
The nursing process – another thing that’s hammered into your head so much it should be second nature. It’s the steps you take when assessing any new patient. It goes:
- Assessment
First you’ve got to find out what’s going on with your patient by asking questions, medical history and taking readings, measurements, etc.
- Analysis
What do the data show you? What does it suggest might be the situation?
- Planning
Now that you have adequate information, what’s your plan of action?
- Implementation
Putting your treatment plan to work.
- Evaluation
What was the outcome of your treatment actions?
Follow the nursing process with your priority question and ask questions of your own.
What information is the stem question telling you? What is the patient reporting? What do you know about what the information is telling you? What do you do in response? What is the likely outcome?
In priority questions, the assessment should be your primary focus. A trick to help you with assessment is the SAMPLE acronym:
- S – Symptoms/Signs
- A – Allergies
- M – Medications
- P – Past medical history
- L – Last meal/LMP (last menstrual period)
- E – Events preceding problem
The Safety Strategy
Safety – that’s what this is all about, right? The physical and psychological safety of your patients. That’s what you’re maintaining when you treat a patient. In fact, it’s the basic question that an NCLEX priority wants you to ask – in fact, you should ask it when you answer each question:
“What will cause my patient the least amount of harm?”
and
“What is the expected outcome of my actions?”
After all, that’s what the NCLEX wants to see – that you are at least minimally competent to provide SAFE, effective care to your patients.
Considering a patient’s immediate safety will actually help you sidestep that most tricky of traps on NCLEX questions:
When to call the physician
Call the physician.
They love to throw that in there because they know you aren’t going to know what to do in some situations. But watch out and remember the question:
“What will cause my patient the least amount of harm?”
If your patient is lying unresponsive on the floor, should you leave the room to get a physician if you don’t know what to do?
Not likely.
You’re going to check for breathing and a pulse and start CPR if necessary.
Just Remember . . .
When answering NCLEX priority questions, just remember your ABCs, your nursing process and safety strategy – and the two most important questions of all:
“What is the most urgent action I need to take?”
“What will cause my patient the least amount of harm?”
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