NCLEX prioritization practice questions

Prioritization questions ask what comes first. Use airway–breathing–circulation, then safety, then Maslow. An unstable or unexpected finding beats a stable, expected one.

1. Question 1

   A nurse in a long-term care facility receives four reports from staff at the start of the shift. Which resident should the nurse assess first?

   • A.A resident with dementia who is wandering in the hallway and is calm
   • B.A resident whose speech became slurred with a facial droop 20 minutes ago
   • C.A resident with a stage 2 pressure injury whose dressing change is due
   • D.A resident with diabetes who refused breakfast and has a glucose of 118 mg/dL
   Show answer and explanation

   Answer: B

   Sudden neurologic changes suggest acute stroke. Clot-dissolving therapy and other treatments are only possible within a limited time window. The nurse assesses quickly, notes the time symptoms started, and arranges emergency transfer.

   • A. Wandering needs supervision, which staff can provide. The resident is calm and not in danger right now.
   • B. Correct. These are sudden stroke signs. Treatment depends on time, so this resident needs immediate assessment and emergency transfer.
   • C. Wound care is important but scheduled, and the resident is stable.
   • D. The glucose is normal. The nurse can follow up on intake later.

   Key concept: Acute, time-sensitive changes such as stroke signs take priority over chronic or scheduled needs.

   Tip: Time is brain: new face droop or slurred speech means go now.

2. Question 2

   A nurse is caring for clients on the first day after surgery. Which findings should the nurse report to the surgeon promptly? Select all that apply.

   Select all that apply.

   • A.Urine output of 20 mL/hr for the past 2 hours in a 70-kg client
   • B.Incisional pain of 4/10 one hour after an oral analgesic
   • C.Temperature of 99.5°F (37.5°C)
   • D.New shortness of breath with SpO2 88% on room air
   • E.Small amount of pink, watery drainage on the dressing
   • F.One calf that is swollen, warm and painful
   Show answer and explanation

   Answer: A, D, F

   The nurse separates expected post-operative findings from complications. Low urine output, new hypoxia and signs of deep vein thrombosis are unexpected and potentially dangerous. Mild pain, low-grade temperature and small serosanguineous drainage are expected early after surgery.

   • A. Correct. Output below 0.5 mL/kg/hr (35 mL/hr for this client) suggests poor kidney perfusion or low volume.
   • B. Moderate pain after surgery is expected and can be managed within existing orders.
   • C. A low-grade temperature on the first day after surgery is common and does not need urgent reporting by itself.
   • D. Correct. Sudden hypoxia after surgery may mean pulmonary embolism, atelectasis or fluid overload and needs prompt reporting.
   • E. Small serosanguineous drainage is expected early after surgery.
   • F. Correct. These signs suggest deep vein thrombosis, which can lead to pulmonary embolism.

   Key concept: Report unexpected findings that signal complications; manage expected post-operative findings within the plan.

   Tip: Expected = manage. Unexpected = report.

3. Question 3

   A triage nurse in the emergency department sees four clients arrive. Which client should be seen first?

   • A.A 25-year-old with a cut on the forearm that is bleeding slowly under a dressing
   • B.A 50-year-old with lower back pain after lifting a box
   • C.A 17-year-old with a sore throat and a temperature of 100.8°F (38.2°C)
   • D.A 3-year-old who is drooling, sitting forward, and has a muffled voice
   Show answer and explanation

   Answer: D

   Drooling, a tripod position and a muffled voice in a child suggest upper airway obstruction such as epiglottitis. The airway can close completely. The nurse keeps the child calm, does not examine the throat, and alerts the team immediately.

   • A. Bleeding is controlled, so this client is stable.
   • B. Back strain is painful but not life-threatening.
   • C. This teen is not showing signs of airway compromise.
   • D. Correct. These are signs of possible epiglottitis, which can block the airway quickly.

   Key concept: Signs of upper airway obstruction are the highest priority in triage.

   Tip: Drooling + leaning forward + muffled voice = airway emergency.

4. Question 4

   A nurse on a labor and delivery unit receives four calls at once. Which client should the nurse see first?

   • A.A client in early labor, dilated 3 cm, who is asking for an epidural
   • B.A client 1 day after cesarean birth who rates incisional pain 5/10
   • C.A client with mild preeclampsia, blood pressure 142/92 mmHg and no symptoms
   • D.A client at 39 weeks whose fetal monitor shows late decelerations and a baseline of 100/min
   Show answer and explanation

   Answer: D

   Late decelerations show uteroplacental insufficiency, and a baseline below 110/min is fetal bradycardia. The nurse acts right away: repositions the client, gives oxygen if ordered, stops oxytocin if running, increases IV fluids, and notifies the provider.

   • A. Pain management is important, but the client and fetus are stable.
   • B. Moderate pain after cesarean is expected and can be addressed after the emergency.
   • C. This client needs monitoring, but there are no severe features at this time.
   • D. Correct. Late decelerations with fetal bradycardia suggest the fetus is not getting enough oxygen. This needs immediate action.

   Key concept: Signs of fetal compromise take priority over stable maternal needs.

   Tip: Late decels + low baseline = fetus in trouble, go first.

5. Question 5

   The emergency department needs a bed for a new admission. The charge nurse asks which client could be discharged first. Which client is the best choice?

   • A.A client 2 days after laparoscopic gallbladder removal who is eating, walking and has pain controlled with oral medication
   • B.A client with new atrial fibrillation on a heparin infusion
   • C.A client admitted yesterday with diabetic ketoacidosis who just changed to subcutaneous insulin
   • D.A client with pneumonia who still has a fever on IV antibiotics
   Show answer and explanation

   Answer: A

   The most appropriate client for discharge is stable, has met recovery goals and can manage at home. Clients on continuous infusions, recently changed therapies or with ongoing fever still need hospital care.

   • A. Correct. This client has met typical discharge criteria and is stable.
   • B. A client on a continuous anticoagulant infusion still needs inpatient monitoring.
   • C. This client has just changed therapy and needs monitoring and teaching.
   • D. Ongoing fever on IV therapy shows the client is not yet ready.

   Key concept: Choose the most stable client who has met discharge criteria when beds are needed.

   Tip: Eating, walking, oral pain meds, stable = ready to go.