Christina Rafano breaks down four prioritization rules for NCLEX questions: acute beats chronic, unstable beats stable, systemic beats local, and actual problems beat potential ones. Watch for trigger words like sudden, severe, and changing. New-onset confusion in a patient signals the highest priority because it's acute, unstable, and systemic.
I have 4 quick rules to help you prioritize in any situation, and these are big, big NCLEX points for you here. And remember, all of these are in the free cheat sheet that I have for you. I know it's a lot, but these will be so helpful on your exam, so be sure to download that. The link is down below in the description for you to snag it. So rule number 1: acute conditions are usually a higher priority than anything that is chronic. All right, so a condition that is sudden or new is almost always more urgent and than a condition the patient's had for a while. So here's the critical thinking point here: the word "sudden" on an exam is like a big red flag to you, okay? Pay attention to it. That shows you that there's a sudden change. So here's an example: if there's a patient with sudden chest pain, they need attention before someone with perhaps their usual arthritis flare-up, even if their arthritis pain is rated higher on the pain scale than that chest pain is. Rule number 2: Unstable conditions take priority over more stable conditions. There's a few red flags to look for here: vital signs that are outside normal limits, any declining or changing in condition for the worse, signs of shock or severe pain, especially new onset pain, respiratory distress, or active bleeding. Those are things you're going to want to watch for. Here's a memory trick: when you see the words sudden, acute, or severe, or change in, like a changing condition on your exam, those are massive clues, my friend, about prioritization. These are prioritization questions. These are your priority trigger words, and you've got to watch for them. Now, rule number 3 is systemic issues. So full body issues are usually more important than local ones in a single place. So a problem affecting the whole body, that's generally going to be more serious than one that's just affecting a local area. So here's a critical thinking point for this. We want to think about what problem could kill our patient the fastest, and that's usually going to be something that's more systemic. So for example, something like sepsis, which is a systemic infection, that's more urgent than a local infection in a small wound or wound that the patient has. And rule number 4, actual problems should be fixed before potential ones, with one important exception here. The current bleeding patient they need attention before someone who is at risk for falling. But here's the thing: if the potential problem is imminent and it's life-threatening to the patient, like a patient with a known severe allergy to something that's about to receive a medication that could trigger that allergy, then that now becomes the priority. So let's walk through a quick NCLEX practice question to help kind of this all come together for you. For for your prioritization. So this question says, a nurse caring for 4 patients, which patient should the nurse assess first? Now, this is a common wording for the NCLEX. So A, a patient with a fever of 100.2°F and a productive cough. B, a patient complaining of 7 out of 10 incisional pain due for medication in 30 minutes. C, a patient with new onset confusion who was alert and oriented 1 hour ago. D) A patient with nausea requesting an antiemetic. So here we have patient A with a fever and a cough. It's concerning, but this patient is stable. It's a chronic issue. Now patient B has expected pain with their scheduled intervention soon. They're stable. That can wait a little while. Now patient C— ding, ding, ding! New confusion! This is an acute change in mental status, my friends. So this is our priority trigger word. Remember, it is new. Now patient D has nausea. They're uncomfortable, but they're stable. So using our VERSUS rule, Patient C has an acute change, so acute versus chronic, right? And this could indicate that they have an unstable condition, so unstable versus stable, right? Now, a new onset of confusion could indicate a serious problem with their ABCs, their airway, their breathing, or their circulation. Now, remember that secret twist, right, about the ABCs that we talked about?— those can show up as neurological changes. So the answer here is C. Now there's even a whole other level of figuring out how to answer NCLEX-style questions correctly, and patient prioritization is just one of the parts. But if you don't know the strategies behind answering NCLEX-style questions right, then you might still get them wrong. So click on this video here, and I'm going to walk you through my top nursing exam question hacks so so that you can choose the most correct answers on your exams. And be sure to hit that subscribe button and click the notification bell so you never miss a video. And as always, my friend, go become the nurse that God created only you to be. And I will see you over there in that next video.
