One of the biggest challenges nursing students face on exams is answering priority questions. These questions test your ability to determine which patient needs immediate attention and which can wait. They require critical thinking and a deep understanding of nursing principles. Here’s a stepwise approach to help you break down these questions and improve your chances of selecting the correct answer.

Step 1: Identify the Type of Question

• Is it a priority question? Look for keywords like “first,” “best,” “most important,” or “immediate.” These signal that the question is asking you to prioritize care.
• Example: “Which patient should the nurse see first?”

Step 2: Assess the Options Using the ABCs (Airway, Breathing, Circulation)

• Airway: A blocked airway is life-threatening and requires immediate intervention.
• Breathing: If a patient is not breathing effectively, they need quick attention.
• Circulation: Issues with circulation, like severe bleeding or shock, are critical.

• Example Question: “The nurse is caring for four patients. Which patient should the nurse assess first?”
  • A. A patient with a history of asthma reporting shortness of breath.
  • B. A diabetic patient with a blood glucose of 250 mg/dL.
  • C. A patient complaining of nausea after surgery.
  • D. A patient with a fever of 101.3°F (38.5°C).

Breakdown:

• A involves a potential airway or breathing issue, which is the highest priority.
• B is elevated glucose but not immediately life-threatening.
• C is discomfort but not critical.
• D is a concern but doesn’t outrank airway or breathing.
• Correct Answer: A (Airway/breathing issue).

Step 3: Apply Maslow’s Hierarchy of Needs

• Physiological needs come first: In Maslow’s hierarchy, physiological needs like breathing, food, water, and sleep are the most basic and crucial.
• Safety: Once physiological needs are met, safety concerns (e.g., falls, infection) take priority.

• Example Question: “Which of the following patients should the nurse assess first?”
  • A. A patient with chest pain who is diaphoretic.
  • B. A patient with an IV infiltrate.
  • C. A patient scheduled for discharge in the afternoon.
  • D. A patient requesting medication for a headache.

Breakdown:

• A involves chest pain, which is a physiological need and a potential life-threatening condition.
• B is a safety concern but not immediately life-threatening.
• C is non-urgent.
• D involves discomfort, but the condition isn’t as critical as chest pain.
• Correct Answer: A (Physiological need).

Step 4: Consider the Severity and Likelihood of Harm

• Who is at the greatest risk? Consider which patient is at risk of deterioration without immediate intervention.
• Example Question: “Which patient should the nurse assess first?”
  • A. A patient with a BP of 90/50 mmHg post-operatively.
  • B. A patient who received pain medication 30 minutes ago and rates pain 6/10.
  • C. A patient with an indwelling catheter complaining of discomfort.
  • D. A patient with a history of hypertension whose BP is 150/90 mmHg.

Breakdown:

• A involves hypotension, which could indicate shock or bleeding—requires immediate attention.
• B is important, but the patient is stable post-medication.
• C is uncomfortable but not critical.
• D shows high BP but less immediate risk than hypotension.
• Correct Answer: A (Risk of deterioration).

Step 5: Use the Nursing Process (ADPIE)

• Assessment comes first: Before implementing interventions, make sure you’ve assessed the patient. If a question asks about the next step, and assessment hasn’t been done, that’s your answer.
• Example Question: “A patient is admitted with shortness of breath and chest pain. What should the nurse do first?”
  • A. Administer oxygen at 2 L/min.
  • B. Obtain a chest X-ray.
  • C. Check the patient’s vital signs.
  • D. Notify the healthcare provider.

Breakdown:

• C is the correct answer because assessment (vital signs) is the first step in the nursing process. You need to gather information before acting.

Conclusion

Mastering priority questions on nursing exams takes practice and a solid understanding of critical thinking frameworks like the ABCs, Maslow’s hierarchy, and the nursing process. By breaking down each question step by step, you can approach these challenging scenarios with confidence and accuracy. Remember, these skills are not just for passing exams—they’re essential for providing safe and effective patient care in your nursing career.