How To Answer NCLEX® Prioritization Questions (It's Not Just The ABCs!)

Prioritization questions are some of the trickiest ones to get right on your nursing school exams and the nclex. So in this video today we are going to walk through seven nursing prioritization principles that you've got to know to pick the right answers and pass your exams. Plus, I'm going to give you a lot of key critical thinking points here and fun memory tricks to really help you remember it all. So hit that subscribe button and click the notification bell and let's dive, dive in. So here's your number one key critical thinking point that we need to remember. Safety always, always, always, always comes first. So the NCLEX is going to test you on how safe you're going to be for your patients. It's that little computer that's trying to decide if it can trust you out in the real world. And there's one question that you should always be asking yourself for every single exam question. Here it is. Which of these answers keeps my patient the absolute most safe? And I have several prioritization principles that we're going to walk through here in this video. So I wanted to let you know that I actually put all of these in a free cheat sheet download for you so that you can use it as you go to clinical and then while you study for your exam. So the link is down below in the description for you to snag that. I think it'll be really, really helpful for you. Now, the first must know principle is the ABCs. But there's key principle here that's super important to know and we'll talk about that in just a second. Now you've probably already heard about the ABCs of nursing school like a million times, right? Like it's a big deal. But this principle has been expanded, so we need to make sure that you have it down solid. All right, my friend, so here it is. A is for airway. So is the airway open and clear? Is there anything blocking it? So remember to no airway, no life, right? This is always priority number one. So a key critical thinking point for you here is if your patient can't maintain their airway, then nothing else matters. That's your priority. Now B is for breathing. Are they breathing effectively? What is their respiratory rate? What's their respiratory pattern? Are they using their accessory muscles? Are their oxygen sats good? Are they dropping? Now, big NCLEX point here for you. Breathing problems are almost, almost always going to be your second priority after the airway issue. So A, B, airway breathing. All right, now the third One circulation for the C. How's their heart rate, their blood pressure, their pulse, any bleeding that they're having? Are their extremities warm or cold? Now, key critical thinking point for you here. The heart and the lungs, they are BFFs, my friends. They work together. So if one of them is struggling, the other one will try to compensate. So if there's any issues with either their airway or their breathing or their circulation, you're going to want to assess the other one, too. Now, D is for disability. What is their level of consciousness? Are they alert and oriented? Are they having any neurological problems that need to be solved? And then E is for exposure. Are there any obvious injuries or rashes or abnormal findings that we can see? But here's the secret twist to this, all right? Sometimes what looks like a D problem is actually telling you about an A, B or C problem. So, for example, if a patient suddenly becomes confused, that would be a D problem. It might actually be a sign of hypoxia, which would be a B problem. So while you're working through your ABCs, you want to be thinking about how each of the areas might be affecting the others with your patients. That's critical thinking. Now, my friend. Now here's a couple of memory tricks to help you out with this. For the ABCs, you can think always before comfort, okay? Airway, breathing, and circulation always come before the patient's comfort. These would be things like pain control and the nclex. Oh, my goodness, the nclex. And your nursing exams love to throw you off sometimes by saying that the patient is in a lot of pain and needs pain control. But just remember, the ABCs always come first, right? Always before comfort. Always. Always the ABCs before comfort. And here are some really important warning signs to look for with the ABCs. So you can think acute for this, for recognizing these priority signs. So be watching for absent or diminished breath sounds, chest tightness, and any critical changes that could be happening. Use of accessory muscles and unstable vitals, tachypnea and tachycardia, expir issues and emergency situations. Those are the things you're going to want to be looking for. Now, this next one is a massive NCLEX key point, and that's Maslow's hierarchy of needs. And this is so, so important. It's your secret weapon, my friend, for prioritization. I remember learning this, like, first thing in nursing school from an upperclassman, and she was right. It's so, so important. At the bottom of the pyramid here we have physiological Needs. These are things like air, water, food, elimination. These are the basics that everyone needs for survival. Now the ABCs, they fall into this category here. And then there's safety needs. This is, is their bed in the lowest position? Should they be on seizure precautions if they aren't already? Do they have their call light every time you leave the room? Are we keeping them safe from any tripping hazards in their room? Are we keeping them safe from falls as much as we can. Are we following the proper infection precautions and protocols? Then we have love and belonging and friendship and intimacy and connection. Then we have self esteem. These are things like respect, recognition and status. And here at the top we have self actualization. So this is things like personal growth and fulfillment. Now here's how I use this principle on exams. When I see a question with multiple options, I like to figure out which level of maslow's each answer choice kind of speaks to. Then I prioritize based based on the bottom of that pyramid first we want to look for those physiological and the safety needs first. So for example, if one answer is about helping a patient breathe easier, which would be physiological needs and another is about addressing more about their anxiety about their diagnosis, perhaps that would be more of like a safety security need. Then I'm choosing the breathing intervention first my friend. Now the NCLEX loves this concept. Physiological needs almost always like almost always go above psychosocial needs. So that's how you'll want to use that pyramid. Now the next prioritization principle is the nursing process, of course. And it goes like this. Adpy, think addpie, assessment, diagnosis, planning, implementation and evaluation. That's your nursing process. Now the nursing process gives us a really nice step by step process plan for prioritizing patient care. And here are some key NCLEX rules to follow when it comes to using that nursing process for patient prioritization. Nursing process rule number one, Assessment comes first before nursing interventions. Okay, this is huge. The nursing process is in this order for a reason, a reason. We've got assessment first. Then we have diagnosis, planning, implementation, which is your nursing interventions and then evaluation. Now that means that you have to assess your patient first before you can make a judgment call and do something about it. Which is that implementation part, that nursing intervention part. Now nursing process rule number two, and this is a big critical thinking point for you as well. We want to be actively looking for patterns and changes from the patient's baseline. This is that evaluation part of the nursing process. Now the NCLEX loves to test you on recognizing really subtle Changes that indicate a patient is perhaps becoming more unstable or their condition is worsening in some way. Now, nursing process rule number three, we want to figure out which problems you can do as a nurse versus which problems must have a physician intervention. Now, the NCLEX will try to trick you by putting in an answer to call the doctor, right? You've probably already seen this and sometimes that's the right answer, but only if there's absolutely nothing else that you can do as the nurse. So if there is something, something truly important that you should assess for before calling the doctor, then, my friend, that's the answer you're going to want to choose. But if there really is nothing else that you can do about that situation, then calling the doctor would be the best option in that situation. In that case scenario, on the exam. Now, nursing process rule number four is to figure out your time frame for your nursing interventions and which ones need to be done immediately. Now, these would be things like anything life threatening or any acute needs or changes that your patient's having. And then which ones can be done later? Which ones are more routine interventions or patient education things? And a big NCLEX point for you here is that the NCLEX is a perfect world, my friend. So when you are prioritizing your patient care on your exams, you have to really imagine that you are in perfect NCLEX land with unlimited resources at your disposal and no time constraints, okay? That is key. So make sure that you choose the answers that are the absolute best at keeping that patient safe. And you're not even thinking about any other possible patients that you might have, right? Or any other time constraints that you might have, or staffing constraints or resource constraints. Not going to be thinking about any of that, okay? On the nclex, you have unlimited time and unlimited resources to dedicate to that one patient that the question is talking about. So remember, the NCLEX is a perfect world. Now let's get into more of the nitty gritty of some things that I have for you. I have four 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 and in the description for you to snag it. So rule number one. 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 pressing than a condition the patient's had for a while. So here's the critical thinking point here. The word sudden on an exam, it's 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. Now rule number two, unstable conditions that your patients have take priority over more stable conditions. And there's a few red flags to look for here. Anything vital signs that are outside normal limits, any declining or changing in condition for the worse signs of shock or severe pain, or especially new onset pain, respiratory distress or active bleeding, those are things you're going to want to watch for. Now 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 three 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 that 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 a wound that the patient has. And rule number four, 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, 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 your prioritization. So this question says a nurse caring for four patients, which patient should the nurse assess first? Now this is a common wording for the NCLEX. So A, a patient with a FE of 100.2 degrees Fahrenheit 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 one 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 un 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, that's really 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 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 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.