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NCLEX-RN Prioritization practice questions

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These are original practice items written to the NCLEX-RN blueprint (4 options, no penalty for wrong answers), not actual exam questions. Try each one before you open the answer.

What this topic covers

Prioritization sits inside the Management of Care category of the NCLEX-RN. Our bank holds 38 verified items tagged to it, and the 4 below are a fixed sample so the page stays the same every time you open it. Each one shows the reasoning, not just the letter.

The topic tag comes from our own items rather than from a published syllabus, so treat it as a map of what we cover. For the official category breakdown see the NCLEX-RN page.

Prioritization sample questions

Question 1

The nurse on a medical-surgical unit is assigned to care for four clients after receiving the change-of-shift report. Which client should the nurse assess first?

  1. A A 72-year-old client with a hip fracture who is scheduled for surgery in 2 hours and has an empty preoperative checklist.
  2. B A 78-year-old client with dehydration who has a serum potassium of 3.1 mEq/L and is receiving intravenous fluids at 100 mL/hr.
  3. C A 66-year-old client with pneumonia who has a temperature of 38.2°C (100.8°F) and a pulse oximetry reading of 94% on 2 liters of oxygen.
  4. D A 55-year-old client with diabetes mellitus who has a blood glucose level of 245 mg/dL and reports feeling thirsty.
Show the answer and explanation

Correct answer: B

A potassium of 3.1 mEq/L in a dehydrated older adult can trigger dysrhythmias and muscle weakness. This physiologic risk makes this client the first to assess, including cardiac rhythm and the need for potassium replacement.

Why the other options are wrong:
A: The preoperative checklist is time-sensitive but poses no immediate physiologic threat, and 2 hours allows time to complete it.
C: A low-grade fever and 94% saturation on 2 L are expected and stable findings in pneumonia.
D: A glucose of 245 mg/dL with thirst needs treatment but is not immediately life-threatening.

Question 2

The nurse on a telemetry unit receives report on four clients at the start of the shift. Which client should the nurse assess first?

  1. A A client 3 days after myocardial infarction who reports chest pain rated 3 out of 10 that is relieved by rest
  2. B A client with a serum potassium level of 6.2 mEq/L and new-onset generalized muscle weakness
  3. C A client who has a heart rate of 110/min after receiving a new dose of a beta blocker
  4. D A client with a blood pressure of 150/90 mmHg who has no symptoms
Show the answer and explanation

Correct answer: B

A potassium level of 6.2 mEq/L with new muscle weakness indicates symptomatic hyperkalemia, which can quickly cause life-threatening dysrhythmias such as ventricular fibrillation. This client is the most unstable and must be seen first.

Why the other options are wrong:
A: Mild chest pain that is relieved by rest needs follow-up, but it is less urgent than symptomatic hyperkalemia.
C: Tachycardia after a beta blocker is unexpected and needs follow-up, but it is not immediately life-threatening.
D: An asymptomatic blood pressure of 150/90 mmHg needs monitoring but is not an emergency.

Question 3

A nurse on a medical surgical unit is beginning rounds after receiving report on four clients. Which client should the nurse assess first?

  1. A A 58-year-old client with cellulitis who has a temperature of 100.8 F and requests pain medication
  2. B A 63-year-old client with a hip fracture scheduled for surgery in 2 hours who appears anxious
  3. C A 45-year-old client 1 day post appendectomy who reports incisional pain of 6 out of 10
  4. D A 70-year-old client with pneumonia who has an oxygen saturation of 90% on 2 liters nasal cannula
Show the answer and explanation

Correct answer: D

An oxygen saturation of 90% while already receiving 2 L of oxygen indicates impaired gas exchange in a client with pneumonia. Following airway, breathing, and circulation priorities, this client must be assessed first.

Why the other options are wrong:
A: A low-grade fever and pain with cellulitis need attention but are less urgent than hypoxemia.
B: Preoperative anxiety needs support and teaching but is not time-critical compared with low oxygenation.
C: Moderate incisional pain 1 day after surgery is expected and can be managed after the hypoxemic client.

Question 4

A nurse is assigned to four clients on a medical-surgical unit. Which client should the nurse assess first?

  1. A A 58-year-old client 2 hours after knee replacement who reports pain rated 6 out of 10.
  2. B A 45-year-old client with a kidney stone who is requesting pain medication right now.
  3. C A 66-year-old client with pneumonia whose oxygen saturation is 89% on room air currently.
  4. D A 72-year-old client with cellulitis whose temperature is 100.8 F (38.2 C) this morning.
Show the answer and explanation

Correct answer: C

An oxygen saturation of 89% on room air indicates hypoxemia, a breathing problem that can deteriorate quickly in a client with pneumonia. Following airway, breathing, and circulation priorities, this client must be assessed first.

Why the other options are wrong:
A: Moderate pain 2 hours after knee replacement is expected and can be treated after the hypoxemic client is assessed.
B: Kidney stone pain is severe and needs prompt treatment, but it is not life-threatening like hypoxemia.
D: A temperature of 100.8°F (38.2°C) is expected with cellulitis and is less urgent than inadequate oxygenation.

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