Total Listening Time - 12:00 |
Nothing sends pure fear down the spine of a nursing student quit like NCLEX priority questions . . . you know what I’m talking about:
- Which patient would you see first?
- What is the nurses first priority?
- What is the most important intervention?
In this post/podcast (listen here) I’m going to give you a framework for answering these priority style questions successfully.
How to Answer NCLEX Priority Questions
Before we get rolling into HOW to answer these kinds of questions let’s talk about WHY the NCLEX cares so much about your ability to answer these types of questions.
The NCLEX® is structured around a framework called the “Bloom’s Taxonomy”. At it’s core, Bloom’s Taxonomy is a method for determining cognitive levels of conceptual understanding.
Cognitive levels increase from the most basic understanding to in depth mastery of a concept.
The above chart demonstrates the increasing levels of cognitive domains. The most base wold be “Remember” all the way up to “Analyze”.
Think about it this way . . . which question sounds more difficult?
- What is the normal value for Sodium?
- Your patient has voided 2 liters in the previous 24 hours. Which of the following lab values would you expect?
Both questions are essentially asking about normal Sodium levels, however, question two requires the test taker to analyze assessment findings and apply knowledge about various disease processes to infer the need for checking sodium.
Passing the NCLEX® requires answering questions at the analysis level. Priority questions are generally written at the analysis level, so it is highly important that you have a good understanding of how to recognize and answer them.
10 Practice Prioritization Questions
One of the best things you can do is simply practice. Here is a ten question quiz with rationales to give you a practice on how to answer these beasts.
Recognizing Priority Style Questions
The first thing we need to talk about it how to recognize these questions. Spotting them on the test allows you to know what you should be looking for and answer the question accordingly.
Here are a few keywords you can expect to find in the stem of the question:
- Priority: Which patient is a priority? What is the nurses first priority?
- Emergency: A patient arrives in the emergency room. . .
- Ambulance: A patient arrives by ambulance. . .
- Returning to the Floor: A nurse is caring for a patient after returning to floor. . .
- Important: What’s the most important intervention?
- See First: Which patient should the nurse see first?
Any variation of these words are a clue that the question is assessing your ability to prioritize as a nurse.
Nursing ABCs . . .
So what should you prioritize? What action should you take first?
I’m gonna share a quick secret with you . . . this is the easy part!
Once you KNOW what’s most important, it becomes easy to identify and select the correct answer. When you work as a nurse you will need to learn how to juggle 1,354,367 tasks all at the same time. You will be managing 2-8 patients all with different needs and concerns of varying urgency so it’s critical that you have a simple method for determining the order of importance.
So here is the simple framework I’m going to give you: ABCs
I’m assuming you’ve hear of the nursing ABCs before. Many people leave it at ABC, but we are going to add the “S” to the end of it to include SAFETY.
- A: airway
- B: breathing
- C circulation
- s: safety
Why are the Nursing ABCs so important?
- Airway: without a patent airway, your patient can ventilate or live for very long.
- Breathing: without being able to breath, your patient can’t oxyegnate or live for very long.
- Circulation: no circulation = no bueno
- Safety: once the patient’s physiological needs are met you must address the safety of your patient. Safety can be divided into physical and physiological (as outlined below).
Not only do you have to address these four things, but you have to do it in this exact order A before B, B before C, C before S . . . does that make sense?
If you are trying to decide between a patient with a circulation issue and a patient with an airway issue . . . you address the airway patient first.
Once you’ve addressed the ABCs you can move on to the patients other concerns in the following order:
Ranking the patients needs in hierarchical order is not to detract from those concerns. Of course we want to address our patients psycho-social needs, but if they are experiencing an airway problem, the feelings take the backseat.
By the same token, one of the most critical functions of a nurse is to educate their patient, however, if they are experiencing pain of “9” our education is going to fall on deaf ears.
Long story short . . . we address our patients issues or rank which patient we should see first in the following order:
Essentially we are working through the Maslow’s Hierarchy of Needs as we determine our priorities. This applies to priority NCLEX® questions just as it does to “real life” nursing care.
Recognizing ABCs (or, which patient is a priority)
Okay . . . are you ready? I’m going to give you a list of “keywords” that you can use to identify an ABCs problem and which of the ABCs it is.
When you identify that you are dealing with priority style question, the next thing you need to do is to determine which of the ABCs you patient is experiencing.
HINT . . . write these down.
AIRWAY: npo, gag reflex, breathing, water after surgery, dysphagia after stroke, airway
BREATHING: breath sounds, o2 admin, o2 status pulse ox, raise hob, incentive spirometry
CIRCULATION: hr, bp, cpr, fluid status (fluid deficit or overload), diarrhea, pulses, iv fluids, tpn, central lines, bleeding hemorrhage
SAFETY: physical (rugs, nightlight, phone, falls, walking after narcotic) infection (assessing, temp, hand washing, cultures, antibiotics, wounds, drainage)
When to Call the Doctor (or, “oh shit, I’m screwed”)
Okay, we’ve made it this far, now we need to discuss when you should call the provider. One of the NCLEX® favorite traps is to give you a complex situation and then put “contact the provider” as an answer option. While this needs to be done (especially in complex settings) it might not always be the FIRST thing a nurse should do . . . Sooooo, how do you know when it is?
You can answer this by asking yourself a very simple question.
Does the patient have an immediate/significant need that I need to address before leaving the room? (airway issue, hemorrhaging, fallen)
Think about it this way. If a patient is struggling to breath, will leaving the room to call the provider be the FIRST thing you should do? Probably not. There are immediate needs the patient has that YOU can address prior to calling the provider. You could raise the HOB, administer O2, etc.
If you leave a patient alone that is having an airway problem you are putting them into immediate danger.
Does that make sense?
Test Taking Webinar (learn how to answer priority style NCLEX questions)
Okay, I realize that is a lot of information to digest, but understanding how to answer nclex priority questions is one of the most important things you can do as a nurse and will help you decades into your career.
Scroll back up, take some notes, and crush the next test.
If you feel that you could benefit from additional assistance with priority questions and nursing test taking in general we actually have a free webinar that covers the topic . . . click below to register.
What is going on, everybody? This is John Haws, RN-CCRN, with NRSNG.com, and I am so excited to have you guys here today. I want to tell you really quickly about what happened last month with the podcast. You guys, we hit 2.6 million total downloads for the NRSNG podcast. Blows my mind. Last month alone, we had about 250,000 downloads. 250,000 downloads. That just blows my mind, you guys.
The right word for it is just truly humbled that you guys are finding value in what I’m telling you and the experiences I’m sharing, and the experiences that the NRSNG team is sharing with you guys.
At one point last month, the podcast reached number 187 in all podcasts, so there’s about 450,000 podcasts in iTunes, and NRSNG, little old NRSNG podcast reached number 187. I’m just truly blown away by that, guys. Thank you so much for listening. Thank you so much for sharing. Thank you so much for your reviews and the messages that you sent me. I got messages over Instagram and SnapChat and Facebook this month and through the email about how the podcast has helped you, whether it’s given you confidence, whether it’s given you a tip, whether it’s just been an ear to listen to as you’re driving to and from school. You guys, thank you so much. I don’t know how to thank you enough.
I want to try something, guys. I want to try something here. I want to try to see if we could reach 3,000,000 downloads before the end of February. That means we have to get about 400,000 downloads this month. I know that’s a huge stretch. I know that’s a huge stretch. I’m going to give away three NRSNG Academy memberships if we can reach 3,000,000 downloads. I don’t want to give that away, and I want to see if we can reach this. I just want to see, let’s bring the community together.
The way we get more downloads is if you listen to the podcast, first of all, so listen to the podcast. Make sure you subscribe to the podcast, and then make sure you share it with a friend. If there’s an episode that helps you, make sure you share it with a friend.
What I want to do, how we’re going to do this is, I want you to leave a review in iTunes for the podcast. Just click on iTunes, leave a review, and then head over to Instagram and post your review on a public post with the hashtag, #love NRSNG podcast. You’ll just leave that review in iTunes, take a screen shot of it, post a picture of that in Instagram with the #love NRSNG podcast. In the end of February, beginning of March, I’ll select three of those reviews, if we hit the 3,000,000 downloads, and we’ll give away the free NRSNG Academy membership.
I’ll remind you of this throughout the month, and I’ll let you know how we’re doing throughout the month, but just leave the review, take a picture, #love NRSNG podcast on Instagram, and that’s all you got to do. Really excited about today’s episode and let’s roll into the show.
Okay, for just one minute, I want you to close your eyes. I want you to imagine something for me. If you’re out driving or if you’re running right now, don’t close your eyes, but I want you to imagine something for me. I want you to think back to your pre-nursing education days and think about the tests that you used to get. Your tests were, which bone is this? What’s the answer to this chemistry equation?, etc., so your answers were really always based on correct or incorrect answers.
Now for those of you that are in nursing school now, I want you to try to remember back as much as you can, or as best as you can, to that first exam you got in fundamentals, or that first nursing school exam you got. No, I don’t want you to start having palpitations and sweating and getting diaphoretic and all that, but I want you to think about that frustration you felt when you took that first nursing school exam.
It can’t be overstated enough how different nursing exams are from any other exam you’ve taken in your life, and I try to express this to people. I try to tell this to people that you don’t see exams like this, exams that are asking which is the most correct? Or what would you do first? Which answer indicates that the patient didn’t understand?
You’re not used to getting these types of questions, but what nursing schools tried to do, and what nursing professors tried to do, and what the NCLEX is trying to do is it’s trying to gage how well you’re able to prioritize important information, important occurrences in your patient. It’s trying to understand how well you’re able to do that, because as a nurse, we’re confronted with [A and A Prime 00:04:46], right? We’re confronted with a patient who’s not breathing and a patient who’s not circulating.
That’s why there’s a couple different frameworks that have been designed and that are developed to help you really keep straight how you need to prioritize your patient care.
What I’m going to do is share with you one nursing test-taking tip. You might want to listen to this a couple times to try to keep it straight, but this is going to help you not just in test taking, but this tip is really going to help you in your care as a nurse when you’re on the floor, either on clinicals in school, or years down the road later on when you are a practicing nurse.
Before I say this, though, I want to let you guys know, those that are listening to this on Monday morning when this comes out, that we’re doing a webinar, we’re doing a live webinar where I’m going to be live, talking about 11 nurse test-taking tips, or 11 secrets of taking tests in nursing school.
If you want to get signed up for that, head over to NRSNG.com/webinar01. Tuesday night, so if you’re listening to this when this comes live on February 6th, we’re going to be doing this webinar on February 7, 2017, at 7 PM Central Standard Time, so 2/7/17, 7 PM. I’m going to be doing a live webinar where you can come and you can be a part of that and watch me talk about these 11 steps, these 11 secrets of nursing test taking that are really going to help you.
I’m going to have a freebie there. I’m also going to have an offer for the NRSNG Academy, and I really want you to be there. I really want you to see this, because these 11 steps, these 11 secrets that I discovered my first semester of nursing school, dramatically changed my experience in nursing school, or at least my experience with nursing school tests.
I remember when I discovered these, I stayed up late into the night, probably 2 AM on a “school night” reading over these and discovering these, and they really helped me. I want you to take the time. If you head over to NRSNG.com/webinar01, you can get signed up for that, and I’d love to have you there, ask questions and take notes, and I promise this is going to be really valuable information that’s going to help you.
For now, I’m going to share pieces of one of the most important tips. This is when we talk about priority questions. When we talk about priority questions, we’re going to talk about how to prioritize our care as a nurse. There’s two main things that you need to think of. Hopefully you’re thinking in your mind what those things are, but those things are a, b, c’s and Maslow’s hierarchy of needs.
What Maslow’s hierarchy of needs is, basically, it’s a pyramid. You’ve probably seen the pyramid, and it starts out with basic physiological needs at the bottom, and it goes up to like self-actualization at the very top. As we work up that, most basic things that we need are these physiological things, these a, b, c’s. That’s where the a, b, c’s fit in there. When we say a, b, c’s, what am I talking about? I’m talking about airway, breathing, and circulation.
When we say a, b, c’s, there’s a little ‘s’ at the end when you write it down. That ‘s’ you can refer to that as safety. So airway, breathing, circulation, and safety. Those are the four most important things to our patient, and they’re important in that order. Airway comes before breathing, breathing comes before circulation, and circulation comes before safety.
Then after that, we’re going to think about our patient’s pain, our patient’s education, our patient’s feelings. We obviously care about how our patient feels, but if our patient is feeling a little bit depressed or a little bit stressed, but at the same time their blood pressure is tanking to 20/10, that circulation issue becomes much more important.
Now we want to educate our patients. We want to teach our patients, but if our patient is having a pain 10 out of 10, we’re not going to have any sort of effective teaching. Again, that goes airway, breathing, circulation, safety, then pain, education, and feelings.
If we refer to test taking or working on the four, whatever option, whatever patient care, whatever plan you need to implement that becomes closest to a, to airway, is the most important thing. That’s what you need to do first.
How do we identify airway problems? How do we identify breathing problems? How do we identify circulation problems? A, b, c’s: airway, breathing, circulation, and safety. Some ways to identify airway problems. If you’re reading an NCLEX question, some ways to identify airway problems are going to be things like, if this patient is NPO, or testing for gag reflex, they’re breathing, drinking water after surgery, dysphagia after stroke, or flat out saying there’s an airway problem.
If you identify any of those problems in your patient, or you identify any of those words in a nursing question, an NCLEX question, you know you’re dealing with an airway problem.
How do you identify a breathing problem? Breathing problems are going to come out in things like breath sounds, O2 administration, pulse ox, raising the head of the bed and [inaudible 00:10:03] spirometry. That’s how you can identify a breathing issue.
Now circulation. Circulation can be a little bit tricky. Obviously, the obvious things are going to be like heart rate, blood pressure, CPR, but then also fluid status. Does the patient have a fluid volume deficit? Are they fluid overloaded? What’s other ways that a patient can lose fluid? Another way is diarrhea. Another way to think of it is like hemorrhage. If the patient’s hemorrhaging after surgery or if an OB patient after giving birth starts hemorrhaging, that’s going to be a circulation issue.
Another one’s going to be like testing pulses, IV fluids. Is the patient getting TPN? or their central lines? Those are all things that are going to help you identify that you’re dealing with a circulation problem.
Then our ‘s’, our safety. Two categories of safety. We can talk physical safety, and we can talk infection safety. Physical safety problem would be things like rugs for a dementia patient or an immobile patient, rugs, nightlights, phone, falling, walking after taking a narcotic. You don’t want to give your patient a bunch of morphine and take them on a walk or let them walk outside.
Then we deal with infection problems, so things like assessing for an infection, a patient’s temperature. If a patient has a temp of 101, we’re starting to think that this could be a safety issue. Hand hygiene, running cultures on a patient who’s on antibiotics and wound drainage. Those are all signs of infection or assessment of infection. That’s when you’re really going to be thinking this is the ‘s’ in our a, b, c’s.
How do you identify that a question is actually asking you about a priority question? How do you know it’s a priority question? How do you know to switch your mind into the a, b, c gear and think Maslow’s hierarchy of needs and think all this stuff? Well, some key words you’re going to find in a question that is asking about priorities. You’re going to see things like priority. Which of these patients is a priority? Or what should the nurse’s priority be?
You might also think things like an emergency. You’re in the emergency room, or a patient comes in off an ambulance. Or a patient is returning to the floor after surgery. That’s another priority issue. You might also see the question say something like, which is the most important? A very common one is if you see the question say, which of these patients should the nurse see first? That’s probably the most common one. Which patient should the nurse see first?
Then you might also see, should the nurse notify the physician? Something about notifying the physician. Those are kind of key words that are going to clue you in to the fact that you’re dealing with a priority question.
What I really want you to take from this, a couple things I want you to take from this. First of all, when we talk a, b, c’s, we’re talking airway, breathing, circulation, and safety. Whatever option is closest to airway, is your correct answer. Now after safety, after airway, breathing, circulation, and safety, we’re going to deal with pain. Then we’re going to deal with education, then we’re going to deal with feelings.
If you have the purely psychosocial question, you need to really use your critical thinking, your nursing judgment, and determine which option is most important for the patient psychosocially. However, if you have a patient who’s in pain, and you have a patient who has a psychosocial issue, you deal with the pain first.
Not every question’s going to be blatantly obvious like, you have a patient who stopped breathing, and you have a patient who’s a little upset about lunch. That’s an obvious one. You throw out the lunch one, right, and you’re dealing with a patient who’s not breathing. This is a really important skill to learn and it’s not just important for test taking, it’s important when you’re working on the floor.
I remember working in ICU and precepting nursing students and new nurses. I remember one night we got a patient, was a pretty basic patient, came in with COPD exacerbation. They bring the patient in, and we start going through our whole thing of assessing, getting the patient all set up, should’ve been really basic. We keep them for a little bit in ICU, put them on a CPAP, get their ABG good, send them over to med-surg.
With this patient, it was very clear that they were not responding. It was going down. They were starting to become less responsive. Run some ABGs, we assess their lung sounds, we assess their neural status. They’re just not responding. Being a critically thinking nurse and looking at your airways, breathing, and circulation, this patient is, their neural status is declining, because their airway is affected.
What we ended up having to do with this patient, specifically is we had to end up intubating this patient, correcting their blood gas, correcting their respiratory status, correcting that airway, correcting that breathing, and then we were able to pull them off of that, get them onto CPAP, get them onto BiPAP, get them onto oxygen, and take care of them.
What you need to do is, you need to realize that every patient is unique. Every patient is different, and you need to use these frameworks to help guide what you do, guide how you answer nursing questions, and guide how you practice as a nurse.
That’s what I want you to take from this. This was kind of a quick run-through. On Tuesday night, February 7th, I’m going to be giving you 11 tips. This is one of the 11 that I’m going to give you. I’m also going to give you a nice PDF handout that’s going to help you keep all these 11 things straight and kind of give you a framework for working through nursing questions.
I’d really love to have you there. If you can make it, please sign up. Please sign up anyway if you’re not sure if you can make it, because I’ll send out a couple emails before to remind you that it’s about to happen so that you’re able to be there if you can. If you can’t, no worries, but we’d really love to have you there. You can sign up for that at NRSNG.com/webinar01.
You guys, we love you, we’re so grateful for you. We are here to help you. We are here to make your nursing journey a success, to make your nursing journey a little bit less frustrating. We want to support you guys. Thank you so much for being part of this family. Find us on social media at NRSNG. You guys, we’ll talk to you soon. You know what time it is now, it’s time to go out and be your best self today. Happy nursing!
Date Published - Feb 6, 2017
Date Modified - Oct 3, 2017