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A Classic Prioritization Question You May Find on the NCLEX

A lot of studying for the NCLEX is reviewing what you already know and reorganizing it in your mind. You have probably seen these concepts in a lecture and in clinical practice, now just put them all together. This can make it seem deceptively easy, but there is a lot of information to cover, which makes it difficult!

An example question that might fall under this category is the classic where they outline four patients you are given at shift assignment and ask you which one you should go see first:

  1. The post-operative tonsillectomy patient asking for pain medication
  2. The type 2 diabetic patient whose pre-breakfast blood glucose is 199 and who has sliding scale insulin due.
  3. The stroke patient whose vital signs are 77 heart rate, 16 respirations, 125/77 blood pressure, and 95% saturation on room air
  4. The pneumonia patient whose vital signs are 92 heart rate, 22 respirations, 110/80 blood pressure, and 89% saturation on 2 liters of O2 nasal cannula

Here's how you could answer this question:

  1. Pain is a vital sign, so this answer should be high on the list. But do any other answers contain abnormal vital signs?
  2. The diabetic’s blood glucose is a little elevated and will probably warrant coverage with sliding scale insulin but keep reading. Sometimes the NCLEX will throw something that looks good as an answer to distract you from the best answer.
  3. A stroke patient is important but right now his vital signs are stable.
  4. His vital signs are outside of normal range. His heart rate is slightly elevated as well as his respiration, and his oxygen saturation is a little low. Remembering ABCs (airway, breathing, circulation) as significant priorities – this is the best answer.