How to Tackle NCLEX Priority Questions

This week, we’re focusing on NCLEX priority questions, which appear often on the National Council Licensure Examination. NCLEX priority questions can be tough. They’re meant to help you think critically, or to “think like a nurse,” which is a skill you will be using every day when assessing the needs of your patients. Using the right strategies when answering NCLEX priority questions can help guide your decision-making toward the right answer every time.

As we mentioned in our NCLEX study tips post about delegation, you may not see priority questions when you take your NCLEX exam. However, they’re pretty common so you need to be prepared for them. Read on to learn more about this type of question and our best tips for tackling them.

What are NCLEX Priority Questions?

Priority questions are designed to test your conceptual comprehension. They are generally written at the analysis level, meaning you’ll need to analyze the choices and apply your knowledge in order to answer the question correctly. As passing the NCLEX successfully requires answering questions at the analysis level, it is highly important that you have a good understanding of how to recognize and answer them.

So, how can you spot a priority question on your exam? The easiest way to recognize this question-type is by knowing that they will ask you what is the “best,” “most important,” “first,” or “initial response” by the nurse. Here’s an example:

Question:

An hour after admission to the nursery, the nurse observes a newborn baby having spontaneous jerky movements of the limbs. The infant’s mother had gestational diabetes mellitus (GDM) during pregnancy. Which of the following actions should the nurse take FIRST?

1. Give dextrose water.
2. Call the physician immediately.
3. Determine the blood glucose level.
4. Observe closely for other symptoms.

As you can see from the example, a priority question is specifically designed to test your ability to assess the right order of priority when you’re working in the field. So, now that you know what a priority question is and how to spot it, we present to you our best advice on how to answer this notoriously tricky question-type.

1. Remember: They might all be “right.”

NCLEX priority-type questions often begin with phrases like “Which action should the nurse take first?” or “What is the priority nursing action?” The operative words here are “first” and “priority.” They’re tricky, because with questions like these, all answers are often correct actions. In the scenario, you may have to perform all of the actions, but these questions test your knowledge about which to perform before the others. Even if they all look like proper clinical actions, they may be, but one of these actions will take priority over the others.

For more NCLEX study tips on how to tackle your exam, check out more helpful suggestions here: Test-Taking Strategies for the NCLEX.

2. Consider these categories:

As you’re studying the answer options, the first thing you should do is consider them in light of three categories: client safety, the nursing process, and Maslow’s hierarchy of needs. Ask yourself: Which of these actions will immediately improve the patient’s safety? Considering the basic tenets of the nursing process, and remembering Maslow’s hierarchy of needs during the NCLEX, you can often narrow which action to take first on priority questions. This can make your deliberation over the options a lot less complicated.

3. Address physiologic first.

At the bottom of Maslow’s hierarchy pyramid sits the physiological needs, because those are the most basic needs a person has to survive. In a given NCLEX scenario on priority questions, the client may be visibly distraught, and one of your answer options will probably involve calming her down. That’s important as a nurse, of course, but less so than physiology. Every time you come across priority questions, remember that according to Maslow’s hierarchy of needs, the client’s physiologic needs come before psychosocial needs. This is where the ABC’s (airway, breathing, circulation) come into play. Prioritize stabilizing your patient if that action applies to the scenario.

Related Resource: How to Address Therapeutic Communication Questions on the NCLEX

4. The answer isn’t always “airway.”

As you’re weighing your options, Maslow’s pyramid can be invaluable, but it can also trick you. While the hierarchy of needs will apply to many questions throughout the NCLEX, physiological needs aren’t always pertinent to the scenario at hand—even on priority questions. When using the ABC framework, you should know that “airway” is not always the correct answer. This is particularly true if the question does not give you an airway problem. So, if airway and breathing are not the problem, look to circulation and see if that applies. If it doesn’t, then look farther up the pyramid for a clue about which option takes priority.

5. Care should begin with the client.

Client safety is of the utmost importance when planning and implementing nursing care. This includes prevention of errors and accidents, standard precautions, and environmental safety. Client safety should take priority, so when analyzing NCLEX questions, think about first meeting the client’s basic needs (e.g., oxygen, nutrition, elimination). The answer to many priority questions is often the option that will benefit the client the most, even if it doesn’t involve direct nurse-to-patient treatment.

6. Assess first, unless…

When using the nursing process to answer questions, remember that the first step is assessment. Assessing the client and situation must be done first in order to plan and implement care. However, if in the question you receive data that indicates an assessment has already been done, it is now time to act! Read the stem of the question carefully to understand what is being asked. Is the question focusing on implementation or evaluation? This will help guide your answer.

Conclusion

At Joyce, we know nursing and we know the NCLEX. It’s why we have one of the highest NCLEX pass rates in all of Utah! After you pass the NCLEX, the learning never stops. Prioritizing situations is foundational to nursing, but you’ll continue to develop and refine skills and learn new information throughout your career. If you’re interested in further degrees, we developed our online RN to BSN degree completion program to fortify working nurses’ skills and improve patient outcomes.

Do you have any other questions or comments about the NCLEX? Reach out to us on our Facebook page. Or questions about our programs? Contact us here — we’d love to hear from you!

Happy studying!

– Cheryl Armstrong, MS, RN
– Britt Baer, RN, MSN-HCSM, SANE

About NCLEX Wednesday: Joyce’s NCLEX review course has helped our nursing students pass the NCLEX with flying colors. We’re spreading the love to all nursing students as part of a weekly series. For more NCLEX study tips, advice, and strategies, download our free NCLEX ebook. Nurses unite!