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Management of Care

NCLEX Prioritization Practice Questions

Quick answer

Prioritization questions ask you to decide which client to see first or which action to take first when several things need doing at once. They sit inside Management of Care, the largest category on the exam (15 to 21 percent of questions), and almost every other category borrows the same "what comes first" format.

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Prioritization is where good students lose points, because the question is not testing whether you know the disease. It is testing whether you can rank four clients who all need something. The exam leans on a small set of rules: airway before breathing before circulation, physical needs before emotional ones, acute problems before chronic ones, unstable before stable, and unexpected findings before expected ones. The trap most students fall into is picking the sickest-sounding diagnosis instead of the client whose findings have changed. A client with heart failure who looks the same as yesterday is lower priority than a client with a hernia repair who is suddenly confused. Read every option for what is new, what is out of range, and what will kill the client fastest if nobody goes in that room.

Practice questions

1

A nurse on a surgical unit has four clients who are all one day post abdominal surgery. Which client should the nurse assess first?

  1. AA client with a blood pressure of 98/60 mm Hg and a heart rate of 110 beats per minute who is drowsy but easy to wake
  2. BA client who received IV hydromorphone 20 minutes ago, now has gurgling, snoring respirations, an oxygen saturation of 86 percent, and is hard to arouse
  3. CA client with a respiratory rate of 26 breaths per minute and an oxygen saturation of 91 percent on room air who is sitting upright
  4. DA client reporting incisional pain of 9 out of 10 who last had pain medication 5 hours ago
Show answer

Answer: B

Gurgling, snoring respirations in a sedated client mean the airway is partly obstructed, most likely by the tongue and secretions after an opioid dose. Airway comes before breathing, circulation and pain, so this client is seen first with a jaw thrust, suction and naloxone at the bedside.

Why the others are wrong

Option A is a circulation problem and is second in line, but the client is still rousable and perfusing. Option C is a breathing problem in a client who is awake and compensating. Option D is real and needs attention soon, but pain does not outrank an obstructed airway.

2

A nurse on a pediatric unit is told four children are waiting. Which child should the nurse see first?

  1. AA 2-year-old with gastroenteritis who has had no wet diaper for 10 hours and has sunken eyes
  2. BA 15-year-old who is crying about how a new leg cast will look at school
  3. CA 9-year-old whose parent is asking for help with discharge teaching for a new inhaler
  4. DA 6-year-old who is bored and asking to go to the playroom
Show answer

Answer: A

Maslow puts physical needs ahead of emotional and social needs. No urine for 10 hours with sunken eyes in a toddler is moderate to severe dehydration and can progress to shock quickly in a small child.

Why the others are wrong

Options B and D are psychosocial needs that matter but can wait a few minutes. Option C is teaching, which is a learning need and sits above basic physical needs on Maslow's pyramid, so it comes after the dehydrated child is managed.

3

A nurse receives report on four clients on an orthopedic unit. Which client should the nurse see first?

  1. AA client with long-standing rheumatoid arthritis reporting the usual 45 minutes of morning stiffness
  2. BA client with chronic low back pain rated 5 out of 10, unchanged from the past three days
  3. CA client three days after a total knee replacement with new calf pain, warmth and swelling in the operative leg
  4. DA client with diabetic peripheral neuropathy reporting ongoing numbness in both feet
Show answer

Answer: C

New calf pain, warmth and swelling after knee surgery points to a deep vein thrombosis, an acute problem that can throw a clot to the lungs. Acute and new always outranks chronic and unchanged, so this client is assessed first and the provider is notified.

Why the others are wrong

Options A, B and D are all chronic conditions at the client's baseline. Nothing in them has changed, so none of them is a threat in the next hour.

4

Four clients arrive in the emergency department within minutes of each other. Which client should the nurse assess first?

  1. AA client who fell from a ladder, is restless, has a heart rate of 128 beats per minute and a blood pressure of 88/52 mm Hg
  2. BA client with a wrist deformity after a fall, with good distal pulses and pain rated 7 out of 10
  3. CA client with a scalp laceration where bleeding stopped after pressure, who is alert and oriented
  4. DA client with a cough, a temperature of 101.4 F, and an oxygen saturation of 94 percent on room air
Show answer

Answer: A

Tachycardia, hypotension and restlessness after a fall from height are signs of shock, probably from internal bleeding. This client is unstable and can deteriorate within minutes, so they are seen first. The other three are stable.

Why the others are wrong

Option B is painful but perfusion to the hand is intact. Option C has controlled bleeding and a normal mental status. Option D has an infection but is oxygenating adequately and shows no sign of instability.

5

A nurse on a postpartum unit has four clients. Which client should the nurse assess first?

  1. AA client 2 hours after a vaginal birth with moderate lochia rubra and a firm fundus at the umbilicus
  2. BA client 1 day after a cesarean birth reporting incisional pain rated 4 out of 10
  3. CA client 6 hours after a vaginal birth whose fundus is boggy, deviated to the right, and who soaked a perineal pad in 15 minutes
  4. DA client who is breastfeeding and reporting mild nipple tenderness with each feeding
Show answer

Answer: C

A boggy, deviated fundus with a pad soaked in 15 minutes is early postpartum hemorrhage, usually from uterine atony with a full bladder pushing the uterus aside. This is an unexpected finding and a circulation threat, so the nurse massages the fundus, has the client empty her bladder and calls for help first.

Why the others are wrong

Option A describes a normal fundus and normal lochia at 2 hours. Option B is expected pain after surgery. Option D is a common early breastfeeding finding that needs latch teaching, not an urgent response.

6

A nurse is assigned four clients on a medical unit. Which client should the nurse see first?

  1. AA client who had a thoracentesis 30 minutes ago and now reports sudden sharp chest pain and shortness of breath
  2. BA client one day after hernia repair who is asking for a scheduled oral pain medication
  3. CA client with a urinary catheter who wants to know when it can be removed
  4. DA client with stable cellulitis whose IV antibiotic is due in 45 minutes
Show answer

Answer: A

Sudden chest pain and dyspnea shortly after a thoracentesis suggests a pneumothorax, a known complication of the procedure. It is a breathing problem that can progress to a tension pneumothorax, so this client is assessed first, placed on oxygen and the provider is called.

Why the others are wrong

Option B is a routine medication request that can be handled within the scheduled window. Option C is a question, not a clinical change. Option D is a stable client whose medication is not yet due.

7

A nurse is triaging victims at the scene of a building collapse using a four-color disaster tagging system. Which client should be tagged red and treated first?

  1. AA client who is walking, talking, and has several small cuts on both arms
  2. BA client with a closed leg fracture, strong radial pulse, alert, and respiratory rate of 20 breaths per minute
  3. CA client with a respiratory rate of 34 breaths per minute, a weak radial pulse, and confusion
  4. DA client who is not breathing after the airway is repositioned once
Show answer

Answer: C

In mass casualty triage, a client who cannot walk, breathes faster than 30 per minute, has poor perfusion or cannot follow commands is tagged red (immediate). This client has three of those markers and will likely survive with fast treatment, so resources go here first.

Why the others are wrong

Option A is green (minor, walking wounded). Option B is yellow (delayed), with a serious injury but stable breathing and perfusion. Option D is tagged black (expectant) because a client who does not breathe after one airway attempt is not resuscitated when resources are limited.

8

A nurse on a surgical unit has just received a client back from the recovery unit one hour ago after a bowel resection, and the charge nurse says a new admission with a stable urinary tract infection has arrived from the emergency department. Which action should the nurse take first?

  1. AComplete the admission assessment on the new client so the admission orders can be started
  2. BAssess the post-operative client's vital signs, dressing, pain and level of consciousness
  3. CAsk the unlicensed assistive personnel to get vital signs on both clients and report back
  4. DCall the provider to ask which client should be seen first
Show answer

Answer: B

A client in the first hours after major surgery is at the highest risk for bleeding, airway problems and hypotension, so the fresh post-op client is assessed before a stable new admission. The new admission is already medically screened and stable from the emergency department.

Why the others are wrong

Option A puts a stable client ahead of one who can change quickly. Option C delegates the initial post-operative assessment, which must be done by the RN. Option D passes a nursing decision to the provider and wastes time.

9

Four children are in the pediatric emergency department waiting room. Which child should the nurse bring back first?

  1. AA 4-year-old with ear pain and a temperature of 101.2 F who is drinking juice
  2. BA 7-year-old who fell off a bicycle 3 hours ago, has vomited twice, and is now hard to keep awake
  3. CA 10-year-old with a visibly bent forearm, pink fingers and a strong pulse at the wrist
  4. DA 2-year-old with a barking cough who has no stridor while sitting quietly on a parent's lap
Show answer

Answer: B

A new change in level of consciousness after a head injury is the most urgent finding in the room. Increasing sleepiness with vomiting hours after a fall suggests rising intracranial pressure or a bleed, and the window to act is short.

Why the others are wrong

Option A is a likely ear infection in a child who is still drinking. Option C is a fracture with intact circulation and nerve function, which is painful but not urgent. Option D is croup with no stridor at rest, which is mild and stable for now.

10

A nurse on a telemetry unit sees a client's monitor alarm for ventricular fibrillation. Which action should the nurse take first?

  1. AGo to the bedside and check the client for responsiveness and a pulse
  2. BCall a code and bring the crash cart to the room
  3. CCharge the defibrillator and deliver one shock
  4. DStart chest compressions at a rate of 100 to 120 per minute
Show answer

Answer: A

Monitor alarms are often caused by a loose lead, movement or a client brushing their teeth, so the first step is always to assess the client. If the client is talking, there is no code. If the client is pulseless and unresponsive, then the code, compressions and defibrillation all follow at once.

Why the others are wrong

Options B, C and D are all correct actions for a real pulseless rhythm, but each of them acts on the monitor instead of the client. Shocking or compressing a client who is awake and talking causes harm.

Quick tips

  • Rank by the rule the question is really testing. Look at the four options and ask whether they differ by ABC, by physical versus emotional need, by acute versus chronic, by stable versus unstable, or by expected versus unexpected. One of those will separate the answer.
  • "Hard to arouse" and "new confusion" beat almost everything that is not an airway problem. A change in level of consciousness is the exam's favorite way of saying "this client is getting worse."
  • Expected findings for the client's condition or stage of recovery are never the priority, even when they sound alarming. Lochia rubra on day one, pain after surgery and a low-grade fever after a procedure are expected.
  • When the question says "first action," check whether an assessment option exists. If the nurse does not yet know what is going on with the client, assess before you call, medicate, shock or document.
  • In disaster triage, think in reverse from your normal instinct. The client with no pulse or no breathing after one airway attempt is tagged black, and the walking wounded go last. The red tag belongs to the client who is sick but saveable.

Related topics

FAQ

How do I answer "which client should the nurse see first" questions on the NCLEX?

Cross out any client whose findings are expected for their condition, then rank what is left by ABC. If two clients both have airway or breathing problems, the one who is unstable or getting worse wins. Practice saying out loud why each wrong option can wait, because that is the skill the exam is testing.

Is Maslow or ABC the priority framework for NCLEX questions?

Both are used, but they apply to different questions. ABC decides between physical problems (airway beats circulation). Maslow decides between a physical need and a psychosocial one (dehydration beats anxiety). When every option is physical, use ABC. When some options are emotional or teaching needs, use Maslow.

How many prioritization questions are on the NCLEX-RN?

There is no fixed number, but prioritization shows up throughout Management of Care, which is 15 to 21 percent of the exam, and it also appears inside pharmacology, physiological adaptation and risk reduction questions. On a 75 to 145 question exam you can expect a prioritization decision every few questions.

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