Priority Setting Practice: 10 NCLEX-RN Questions with Rationales

By Jasmine Torres, LPN

Understanding Priority Setting on the NCLEX-RN

Priority setting is one of the most tested skills on the NCLEX-RN, reflecting the nurse’s ability to determine which patient needs come first. According to the 2023 NCLEX-RN Test Plan (National Council of State Boards of Nursing, 2023), candidates must be able to organize and prioritize care based on patient needs, using frameworks like the ABCs (Airway, Breathing, Circulation) and Maslow’s Hierarchy of Needs.

These principles apply across acute care, community health, and specialty settings.

In my experience as an NCLEX coach, the most common mistakes happen when students rush to act without considering life-threatening priorities. Practicing with realistic questions strengthens your ability to quickly identify the most urgent need.

If you need a refresher, read Priority, Safety, and Maslow: How to Answer NCLEX-RN Questions and Master NCLEX-RN Prioritization: Who Comes First? before tackling these scenarios.

Question 1

A nurse is caring for four clients. Which client should the nurse see first?

1. A client with asthma requesting a PRN inhaler.
2. A client with pneumonia and a fever of 101.2°F (38.4°C).
3. A client with a tracheostomy who has thick secretions and SpO₂ of 86%.
4. A client scheduled for surgery needing consent signed.

Correct Answer: 3

Rationale: Airway issues always take precedence over breathing or circulation problems when applying the ABC framework. A tracheostomy patient with low oxygen saturation and thick secretions is at high risk for airway obstruction, which can quickly progress to respiratory arrest. Immediate suctioning is needed to restore ventilation and oxygenation. While the other clients have needs, none are as time-sensitive or life-threatening as compromised airway patency.

Question 2

Which client requires the most urgent assessment?

1. A client with DVT reporting sudden shortness of breath.
2. A client with anemia reporting fatigue.
3. A client with chronic kidney disease and potassium 5.1 mEq/L.
4. A client with a stage 2 pressure injury requesting a dressing change.

Correct Answer: 1

Rationale: Sudden dyspnea in a patient with a known DVT is a red flag for pulmonary embolism, which can cause rapid cardiovascular collapse if not treated emergently. This scenario reflects the “acute vs. chronic” principle—new, severe symptoms take priority over stable chronic issues or non-urgent tasks like wound care.

Question 3

During morning rounds, which client should be assessed first?

1. Post-op hip replacement with pain 8/10.
2. Client with chest pain radiating to jaw and diaphoresis.
3. Client with glucose of 60 mg/dL, alert.
4. Client awaiting discharge teaching.

Correct Answer: 2

Rationale: Chest pain radiating to the jaw with diaphoresis suggests myocardial infarction, a cardiac emergency requiring immediate EKG, oxygen, and provider notification. While pain and hypoglycemia require attention, this cardiac presentation is most urgent due to its potential for sudden deterioration.

Question 4

Which task can be delegated to a UAP?

1. First-time ambulation post-op.
2. Feeding a dementia client at aspiration risk.
3. Obtaining vital signs on a stable client.
4. Assessing skin integrity of a new admission.

Correct Answer: 3

Rationale: Vital signs collection in a stable patient falls within UAP scope and does not require nursing judgment. High-risk feeding, initial ambulation, and skin assessment demand an RN’s clinical expertise.

Question 5

A COPD client is short of breath, anxious, and SpO₂ 88% on 2L nasal cannula. What is the first action?

1. Increase O₂ to 4L.
2. Place in high Fowler’s position.
3. Call respiratory therapy.
4. Obtain ABG.

Correct Answer: 2

Rationale: Placing the patient in high Fowler’s position is a rapid, non-invasive intervention that maximizes lung expansion and improves oxygenation immediately. Oxygen changes in COPD require careful consideration to avoid suppressing respiratory drive.

Question 6

A type 1 diabetic is diaphoretic, confused, glucose 45 mg/dL. What is the priority?

1. Give 15g fast-acting carbohydrate.
2. Notify healthcare provider.
3. Recheck glucose in 15 minutes.
4. Administer scheduled insulin.

Correct Answer: 1

Rationale: Severe hypoglycemia can lead to seizures, coma, or death within minutes. The priority is immediate administration of a fast-acting carbohydrate to restore glucose levels.

Question 7

Which client requires immediate intervention?

1. Fractured femur with severe pain.
2. Post-thyroidectomy with stridor and difficulty breathing.
3. Migraine headache.
4. Client awaiting discharge teaching.

Correct Answer: 2

Rationale: Stridor following thyroid surgery indicates potential airway compromise from swelling or hematoma. This is a life-threatening emergency requiring rapid airway management.

Question 8

Which client should the nurse assess first?

1. Chemotherapy patient with temp 100.4°F (38°C).
2. COPD client requesting breathing treatment.
3. Foley catheter client reporting mild discomfort.
4. Blood transfusion patient with no symptoms.

Correct Answer: 1

Rationale: In immunocompromised patients, even a low-grade fever can indicate sepsis, requiring immediate cultures and antibiotics.

Question 9

Which task can be delegated to a UAP?

1. Repositioning a spinal cord injury patient.
2. Teaching incentive spirometer use.
3. Monitoring chest tube air leaks.
4. Assessing pain after ambulation.

Correct Answer: 1

Rationale: UAP can reposition patients with assistance and training, while teaching, monitoring, and assessing require nursing judgment.

Question 10

Which patient should be seen first after morning report?

1. Pneumonia client SpO₂ dropped from 95% to 88%.
2. Post-op client needing dressing change.
3. Diabetic patient awaiting routine glucose check.
4. Chronic back pain patient requesting medication.

Correct Answer: 1

Rationale: Acute oxygen desaturation signals urgent respiratory compromise, requiring prompt assessment and intervention.

Key Takeaways

• Apply ABCs and Maslow’s for priority setting.
• Acute changes take precedence over chronic issues.
• Match delegation decisions to scope of practice.
• Practice with rationales to build speed and accuracy.

FAQ

1. How common are priority questions? Very frequent across all client needs categories.
2. Which frameworks matter most? ABCs, Maslow’s, acute vs. chronic.
3. Does delegation affect prioritization? Yes.
4. Best study method? Combine review with realistic practice.
5. Do NGN questions change the rules? No, but they may require multi-step reasoning.

Glossary Links: ABCs (Airway, Breathing, Circulation), Priority Setting Framework