Before we get rolling into HOW to answer these kinds of questions let’s talk about WHY the NCLEX cares so much about your ability to answer priority questions.
The NCLEX® is structured around a framework called the “Bloom’s Taxonomy”. At its core, Bloom’s Taxonomy is a method for determining cognitive levels of conceptual understanding.
Cognitive levels increase from the most basic understanding to in-depth mastery of a concept.
The above chart demonstrates the increasing levels of cognitive domains. The most base would be “Remember” all the way up to “Analyze“.
Think about it this way . . . which question sounds more difficult?
What is the normal value for Sodium?
Your patient has voided 2 liters in the previous 24 hours. Which of the following lab values would you expect?
Both questions are essentially asking about normal Sodium levels, however, question two requires the test taker to analyze assessment findings and apply knowledge about various disease processes to infer the need for checking sodium.
Passing the NCLEX® requires answering questions at the analysis level. Priority questions are generally written at the analysis level, so it is highly important that you have a good understanding of how to recognize and answer them.
How to Spot Priority Style NCLEX Questions
The first thing we need to talk about it how to recognize these questions as you take the NCLEX. Spotting them on the test allows you to know what you should be looking for and answer the question accordingly.
Here are a few keywords you can expect to find in the stem of the question:
PRIORITY NCLEX QUESTION KEYWORDS:
When you see one of these phrases in an NCLEX question, you know it is a priority style question, and you can apply the tips discussed below (so write these down 📝).
Priority: Which patient is a priority? What is the nurse’s first priority?
Emergency: A patient arrives in the emergency room. . .
Ambulance: A patient arrives by ambulance. . .
Returning to the Floor: A nurse is caring for a patient after returning to floor. . .
Important: What’s the most important intervention?
See First: Which patient should the nurse see first?
Any variation of these words is a clue that the question is assessing your ability to prioritize as a nurse.
The Nursing ABCs Staircase. . .
So what should you prioritize? What action should you take first?
I’m gonna share a quick secret with you . . . this is the easy part!
Once you KNOW what’s most important, it becomes easy to identify and select the correct answer. When you work as a nurse you will need to learn how to juggle 1,354,367 tasks all at the same time. You will be managing 2-8 patients all with different needs and concerns of varying urgency so it’s critical that you have a simple method for determining the order of importance.
So here is the simple framework I’m going to give you:
The Nursing ABCs . . . DEF
I’m assuming you’ve heard of the nursing ABCs before. Many people leave it at ABC, but we are going to add the “S” to the end of it to include SAFETY.
So really, just remember ABCsDEF – with that simple trick, nursing priority questions just became 1000% easier. Now let me show you the staircase so you can visually see it in your brain during your next exam:
Airway: without a patent airway, your patient can ventilate or live for very long.
Breathing: without being able to breath, your patient can’t oxygenate or live for very long.
Circulation: no circulation = no bueno
Safety: once the patient’s physiological needs are met you must address the safety of your patient. Safety can be divided into physical and physiological (as outlined below).
Not only do you have to address these four things, but you have to do it in this exact order; A before B, B before C, C before S . . . does that make sense?
If you are trying to decide between a patient with a circulation issue and a patient with an airway issue . . . you address the airway patient first.
Once you’ve addressed the ABCs you can move on to the patient’s other concerns in the following order:
Ranking the patients’ needs in hierarchical order is not to detract from those concerns. Of course, we want to address our patients’ psycho-social needs, but if they are experiencing an airway problem, the feelings take the backseat.
By the same token, one of the most critical functions of a nurse is to educate their patient, however, if they are experiencing pain of “9” our education is going to fall on deaf ears.
Long story short . . . we address our patients issues or rank which patient we should see first in the following order:
Essentially we are working through Maslow’s Hierarchy of Needs as we determine our priorities. This applies to priority NCLEX® questions just as it does to “real life” nursing care.
Recognizing ABCs (or, which patient is a priority)
Okay . . . are you ready? I’m going to give you a list of “keywords” that you can use to identify an ABCs problem and which of the ABCs it is.
When you identify that you are dealing with priority style question, the next thing you need to do is to determine which of the ABCs you patient is experiencing.
HINT . . . write these down.
AIRWAY: npo, gag reflex, breathing, water after surgery, dysphagia after stroke, airway BREATHING: breath sounds, o2 admin, o2 status pulse ox, raise hob, incentive spirometry CIRCULATION: hr, bp, cpr, fluid status (fluid deficit or overload), diarrhea, pulses, iv fluids, tpn, central lines, bleeding hemorrhage SAFETY: physical (rugs, nightlight, phone, falls, walking after narcotic) infection (assessing, temp, hand washing, cultures, antibiotics, wounds, drainage)
When to Call the Doctor (or, “oh shit, I’m screwed”)
Okay, we’ve made it this far, now we need to discuss when you should call the provider. One of the NCLEX® favorite traps is to give you a complex situation and then put “contact the provider” as an answer option. While this needs to be done (especially in complex settings) it might not always be the FIRST thing a nurse should do . . . Sooooo, how do you know when it is?
You can answer this by asking yourself a very simple question.
Does the patient have an immediate/significant need that I need to address before leaving the room? (airway issue, hemorrhaging, fallen)
Think about it this way. If a patient is struggling to breath, will leaving the room to call the provider be the FIRST thing you should do? Probably not. There are immediate needs the patient has that YOU can address prior to calling the provider. You could raise the HOB, administer O2, etc.
If you leave a patient alone that is having an airway problem you are putting them into immediate danger.
Does that make sense?
Test Taking for Nursing Students – online course
Okay, I realize that is a lot of information to digest, but understanding how to answer NCLEX priority questions is one of the most important things you can do as a nurse and will help you decades into your career.
Test-taking as a nursing student is a unique skill . . . and you are going to see test questions unlike anything you’ve ever seen. For that reason, we developed our Test Taking for Nursing Students course inside the Nursing Student Academy. The course is designed to help nursing students conquer the skill of taking tests and passing the NCLEX. Click below to start watching now: