NCLEX Prioritisation Questions: How to Use ABCs, Maslow and Acute vs Chronic (With 15 Practice Questions)

To answer NCLEX prioritisation questions, use a fixed order of frameworks: first Airway, Breathing, Circulation (ABCs); then Maslow’s hierarchy (physiological needs before safety, then psychosocial); then acute over chronic, unstable over stable, and assessment before intervention. The right answer is usually the patient or action where delay could cause death or permanent harm.

The prioritisation toolkit

1. ABCs: airway problems beat breathing problems, which beat circulation problems. Exception: in cardiac arrest, compressions start immediately (CAB).
2. Maslow: physiological needs (oxygen, fluids, glucose, pain) come before safety, then love and belonging, then self-esteem.
3. Acute vs chronic: a new, sudden change beats a long-standing, expected finding.
4. Unstable vs stable: unexpected findings beat expected ones. A post-op patient with pain is expected; a post-op patient with new confusion is not.
5. Actual vs potential: an actual problem beats a risk.
6. Assessment first: if you don’t have enough information, assess before acting, unless the situation is an emergency where action is obvious.
7. Safety: when physiological needs are met, protect the patient from harm (falls, infection, suicide).

15 practice questions

1. Which patient should the nurse see first?
A. A patient with COPD and SpO2 of 89%
B. A patient with new stridor after a thyroidectomy
C. A patient with pain 6/10 after appendectomy
D. A patient with diabetes asking for a snack
Answer: B. Stridor after neck surgery suggests airway compromise. SpO2 of 88–92% may be the target for some COPD patients.

2. A patient with a chest tube has the tube disconnect from the drainage system. The first action is:
A. Call the healthcare provider
B. Place the end of the tube in sterile water
C. Get a chest X-ray
D. Clamp for 24 hours
Answer: B. Restore an underwater seal immediately, then reassess and inform.

3. Which finding requires immediate action?
A. Blood glucose 9 mmol/L in a patient with diabetes
B. Potassium 6.8 mmol/L
C. Haemoglobin 105 g/L in chronic kidney disease
D. Low-grade fever after surgery
Answer: B. Severe hyperkalaemia can cause fatal arrhythmias.

4. Four patients need attention. Who comes first?
A. Patient wanting help to the bathroom
B. Patient on warfarin with an INR of 2.5
C. Patient with a sudden onset of slurred speech
D. Patient asking about discharge medicines
Answer: C. New neurological signs suggest stroke: time is brain.

5. A patient is anxious before surgery and has an SpO2 of 86%. The nurse should first:
A. Reassure the patient
B. Apply oxygen and assess breathing
C. Teach relaxation techniques
D. Call the family
Answer: B. Physiological need beats psychosocial.

6. Which postpartum finding is most concerning?
A. Lochia rubra on day 1
B. Fundus firm at the umbilicus
C. Saturating a pad in 15 minutes
D. Afterpains while breastfeeding
Answer: C. Suggests postpartum haemorrhage.

7. A child with epiglottitis is drooling and sitting upright. The nurse should:
A. Examine the throat with a tongue depressor
B. Keep the child calm and upright and prepare for airway support
C. Lay the child flat
D. Collect a throat swab immediately
Answer: B. Throat examination can trigger complete obstruction.

8. Which task can be delegated to a healthcare assistant (unlicensed staff)?
A. Assessing a new admission
B. Teaching insulin self-injection
C. Measuring vital signs on a stable patient
D. Evaluating response to pain medication
Answer: C. Assessment, teaching and evaluation stay with the registered nurse.

9. A patient receiving blood develops fever, chills and back pain after 10 minutes. The first action is:
A. Slow the transfusion
B. Stop the transfusion and keep the IV line open with normal saline via new tubing
C. Give paracetamol and continue
D. Call the lab
Answer: B.

10. Which patient is most stable for transfer to a lower acuity unit?
A. Patient 2 hours post-cardiac catheterisation
B. Patient with pneumonia on oral antibiotics, afebrile for 24 hours
C. Patient with DKA on an insulin infusion
D. Patient with a new chest drain
Answer: B.

11. A patient on morphine has a respiratory rate of 8 and is difficult to rouse. The first action is:
A. Document
B. Stop the opioid, support breathing and give naloxone as prescribed
C. Wait 15 minutes and recheck
D. Give oxygen only
Answer: B.

12. Which is expected after a total hip replacement?
A. Shortened, externally rotated leg
B. Moderate pain controlled with analgesia
C. Calf swelling and redness
D. Sudden chest pain and breathlessness
Answer: B. A, C and D suggest dislocation, DVT and pulmonary embolism.

13. The nurse receives handover on four patients. Who should be seen first?
A. Patient with heart failure who gained 0.5 kg overnight
B. Patient with asthma who is now quiet with a silent chest
C. Patient with a cast reporting itching
D. Patient with diabetes due for breakfast insulin
Answer: B. A silent chest is a life-threatening asthma sign.

14. A patient with suicidal thoughts asks to go outside alone. The priority is:
A. Allow it to build trust
B. Maintain safety and observation level
C. Discharge the patient
D. Ignore the request
Answer: B.

15. A newly admitted patient reports chest pain. The first action is:
A. Give morphine
B. Assess the pain and vital signs and obtain a 12-lead ECG quickly
C. Call the family
D. Document and reassess in an hour
Answer: B. Assess first; the ECG guides urgent treatment.

Exam tips

• Read the question stem for words like “first”, “priority”, “most important” and “immediate”.
• Look for the unexpected or acute finding.
• Eliminate answers that are true but not urgent, such as documentation or calling family.

Related reading: NCLEX Next Generation sample questions · NCLEX study plan for international nurses · Delegation and accountability