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NCLEX prioritization practice questions

Which client do you see first? 20 free NCLEX-style prioritization questions with answers and rationales: ABCs, Maslow, stable vs unstable, and acute vs chronic, the way the exam asks them.

Tap an answer to check it, or open "Show the answer and rationale" under each question. Every client is fictional. For exam practice only, not medical advice.

Question 1 of 20

An emergency department nurse receives four new clients from triage. Which client should the nurse assess first?

  1. A 61-year-old on lisinopril for years whose lips and tongue are swelling
  2. A 25-year-old having a panic attack who is sobbing and breathing fast, with an SpO2 of 99%
  3. A 47-year-old with a deep forearm laceration whose bleeding is controlled by a pressure dressing
  4. A 34-year-old with a dislocated shoulder who is moaning and rates the pain 10/10
Show the answer and rationale

Answer: A

Swelling of the lips and tongue in a client taking an ACE inhibitor is angioedema. It is driven by bradykinin, usually appears without hives, can start after years of uneventful use, and may not respond to epinephrine, so the threat to the airway puts this client first. The dislocated shoulder is the strongest distractor: the pain is severe and needs prompt treatment, but airway, breathing, and circulation are intact. Fast breathing during a panic attack with an SpO2 of 99% is distress without hypoxemia, and a laceration with the bleeding controlled can wait.

📚 Learn it: Airway, Breathing, Circulation: The Tiebreaker

Question 2 of 20

A 70-year-old client is admitted from the emergency department with pneumonia. On arrival on the unit, the respiratory rate is 28 breaths/min, the SpO2 is 88% on room air, the temperature is 102.4°F (39.1°C), and the mucous membranes are dry. Prescriptions include oxygen by nasal cannula, acetaminophen, an IV infusion of 0.9% sodium chloride, and a sputum culture before the first antibiotic dose. Which prescription should the nurse implement first?

  1. Oxygen by nasal cannula
  2. Sputum culture before the first antibiotic
  3. Acetaminophen for the fever
  4. IV infusion of 0.9% sodium chloride
Show the answer and rationale

Answer: A

Within physiological needs, oxygenation comes first: an SpO2 of 88% with rapid breathing means the tissues are short of oxygen now, so oxygen is started before anything else. Acetaminophen is the strongest distractor, since fever raises oxygen demand, but lowering the temperature does far less for hypoxemia than oxygen itself. IV fluids treat the dehydration shown by the dry mucous membranes and follow right after, and the sputum culture is collected before the antibiotic so the dose is not delayed, but neither outranks oxygenation.

📚 Learn it: Maslow's Pyramid, Nurse Edition

Question 3 of 20

A nurse is reviewing the status of four clients on a surgical unit. Which client can the nurse safely see last?

  1. A client 2 days after surgery whose temperature is 101.2°F (38.4°C) and whose incision edges look redder than yesterday
  2. A client 1 day after a bowel resection whose heart rate has risen from 84 to 116
  3. A client with a nasogastric tube whose output has stopped for 4 hours and who reports new fullness and nausea
  4. A client with a new ileostomy that is draining liquid, greenish-brown stool
Show the answer and rationale

Answer: D

Liquid stool from a new ileostomy is expected because the colon, which absorbs water, has been bypassed, so this client is stable and can wait. The runner-up is the client 2 days after surgery with a temperature of 101.2°F and reddening incision edges, because a mild fever alone can be an early postoperative response, but new incisional redness raises concern for infection and still needs prompt assessment. A heart rate climbing to 116 the day after a bowel resection can signal bleeding, infection, or fluid loss. Output stopping for 4 hours with new fullness and nausea suggests the nasogastric tube is not draining, which can lead to vomiting and aspiration.

📚 Learn it: Unstable Beats Stable, Unexpected Beats Expected

Question 4 of 20

A 68-year-old client with coronary artery disease is 2 days after a total hip arthroplasty. At 0300 the client calls the nurse and says, 'I have bad indigestion. Can I have something for it?' Prescriptions include an antacid as needed and sublingual nitroglycerin as needed for chest pain. Which action should the nurse take first?

  1. Call the provider to report that the client may be having a heart attack
  2. Give the prescribed antacid and check back in 30 minutes
  3. Ask the client to describe the discomfort and check the vital signs
  4. Give a sublingual nitroglycerin tablet in case the pain is cardiac
Show the answer and rationale

Answer: C

'Indigestion' is a vague complaint, and in a client with coronary artery disease it may be an atypical presentation of acute coronary syndrome, so the nurse first asks about its location, spread, and accompanying symptoms and checks the vital signs. Nitroglycerin is the strongest distractor, but giving it on a guess skips the blood pressure check it requires, since it is usually held for a systolic pressure below 90 mm Hg. The antacid assumes a stomach problem and could hide cardiac pain, and calling the provider before gathering data leaves nothing to report but a guess.

📚 Learn it: Assess Before You Act (Unless the Stem Already Did)

Question 5 of 20

A charge nurse is making assignments for a licensed practical nurse (LPN) on a medical unit. Which client is most appropriate to assign to the LPN?

  1. A client who is receiving the second of two units of packed red blood cells and was stable through the first unit
  2. A client with a long-standing tracheostomy who needs routine suctioning
  3. A client with new diabetes who needs teaching before discharge today
  4. A client admitted 1 hour ago with a new onset of atrial fibrillation who needs an initial assessment
Show the answer and rationale

Answer: B

A client with an established tracheostomy and stable, predictable needs fits the LPN's scope, which includes tracheostomy care and suctioning. The runner-up is the client receiving the second unit of blood, because stability through the first unit makes the assignment look routine, but monitoring a client during a transfusion is generally kept with the RN, who must assess for a reaction. A new admission with a new dysrhythmia needs an RN's initial assessment before care can be delegated. First-time discharge teaching for a new diagnosis such as diabetes is an RN responsibility that the LPN may only reinforce.

📚 Learn it: The Five Rights of Delegation

Question 6 of 20 · Select all that apply

At the start of the shift on a thoracic step-down unit, a nurse checks the chest tube drainage systems of six clients. Which findings require the nurse's immediate follow-up? Select all that apply.

  1. Gentle, continuous bubbling in the wet suction-control chamber
  2. Continuous bubbling in the water-seal chamber that was not there last evening
  3. Brief bubbling in the water-seal chamber when a client with a pneumothorax coughs
  4. Drainage that stopped suddenly 6 hours after insertion, with new shortness of breath
  5. Fluid in the water-seal chamber rises and falls with each breath
  6. New crackling under the skin at the insertion site that has spread up to the neck
Show the answer and rationale

Answer: B, D, F

Continuous bubbling in the water seal means air is leaking into the system, from the client or a loose connection, and crackling under the skin that spreads toward the neck is subcutaneous emphysema from a worsening air leak or tension pneumothorax; the nurse checks the connections, marks the edge of the crackling, and notifies the provider. Drainage that stops suddenly in the first 24 hours suggests a kink or clot, and new dyspnea makes it urgent. Tidaling with each breath, gentle continuous bubbling in a wet suction chamber, and brief water-seal bubbling as air leaves the chest of a client with a pneumothorax are expected.

📚 Learn it: Airway, Breathing, Circulation: The Tiebreaker

Question 7 of 20

During START triage at a highway pileup, a nurse reaches a man sitting against a car who cannot walk. Bright red blood is spurting from a deep wound on his left thigh. His respirations are 26/min, a radial pulse is present, and he follows commands. What should the nurse do?

  1. Pack the wound with gauze and wrap a pressure dressing before tagging him
  2. Hold firm, direct pressure on the wound until a paramedic can take over
  3. Tag him yellow, since his breathing, pulse, and mental status allow a delay
  4. Apply a tourniquet high on the thigh, note the time, and finish triaging him
Show the answer and rationale

Answer: D

Arterial bleeding from the thigh can kill within minutes, and stopping life-threatening bleeding is one of the few lifesaving steps allowed during START. A tourniquet placed high and tight on the limb, with the time noted, controls it in seconds and frees the nurse to finish his triage and move on. Direct pressure is the runner-up because it does stop bleeding, but it ties the nurse to one victim while others wait unsorted. Tagging him without controlling the bleeding lets him bleed out while his other findings still look acceptable, and wound packing and dressings take longer and wait until everyone has been triaged.

📚 Learn it: Disaster Triage: Sickest First Is Sometimes Wrong

Question 8 of 20

A client with cirrhosis and known esophageal varices suddenly vomits a large amount of bright red blood. Which action should the nurse take first?

  1. Turn the client to the side with the head of the bed raised
  2. Prepare the client for emergency endoscopy to band the varices
  3. Draw blood for type and crossmatch once IV access is established
  4. Administer the prescribed IV octreotide infusion without delay
Show the answer and rationale

Answer: A

Airway comes first in massive hematemesis: turning the client to the side with the head raised keeps blood out of the airway while help and suction are mobilized. The runner-up is drawing blood for type and crossmatch once IV access is established, which is needed for possible transfusion but loses because it depends on first gaining access and leaves vomited blood free to obstruct or be aspirated meanwhile. Octreotide lowers portal pressure and is given promptly, but only after positioning and securing access. Endoscopy with banding can stop the bleeding, yet it requires a protected airway, resuscitation, and the endoscopy team.

📚 Learn it: Airway, Breathing, Circulation: The Tiebreaker

Question 9 of 20

A client receiving chemotherapy for acute leukemia has an absolute neutrophil count of 300/mm³. She tells the nurse that her daughter is bringing her 6-year-old grandson to visit this evening and adds, 'He's had a runny nose and a cough since Saturday, but I miss him so much.' Which response by the nurse is best?

  1. 'He can visit if he wears a mask and washes his hands well when he arrives.'
  2. 'Let's have him wait until his cold is gone and video call him tonight.'
  3. 'Visitors aren't allowed at all while your neutrophil count is this low.'
  4. 'Children can visit as long as they stay for less than 15 minutes.'
Show the answer and rationale

Answer: B

With a neutrophil count of 300/mm³ she has little defense against infection, and a child with a cough and runny nose who will want to hug and sit close is a direct source, so safety comes first, while a video call still meets her need to see him. The mask and handwashing option is the strongest distractor, since both reduce spread, but they do not make close contact with a sick child safe. Healthy visitors who clean their hands can usually visit, so banning all visitors takes away support she needs, and a short visit does not remove the risk of a respiratory virus.

📚 Learn it: Maslow's Pyramid, Nurse Edition

Question 10 of 20

At 1500, a nurse on a pediatric medical unit reviews the status of four children. Which child should the nurse see first?

  1. A 2-year-old with gastroenteritis who is sipping oral rehydration solution and had a wet diaper an hour ago
  2. A 10-year-old 1 day after an appendectomy who is crying and rates the pain 7/10
  3. A 12-year-old 6 hours into DKA treatment with a new headache and a pulse that fell from 110 to 64/min
  4. A 6-year-old with asthma who, 20 minutes after albuterol, speaks in full sentences with an SpO2 of 96%
Show the answer and rationale

Answer: C

A new headache with a heart rate that has slowed far more than rehydration explains, 4 to 12 hours into DKA treatment, warns of cerebral edema even though treatment is under way. Treatment, including raising the head of the bed, slowing IV fluids, and giving mannitol or hypertonic saline, starts before any imaging, so this child is seen first. The crying child after an appendectomy is the strongest distractor; the pain needs treatment soon, but it is expected after surgery. An SpO2 of 96% in full sentences shows a response to albuterol, and a toddler who is drinking and making urine is hydrating.

📚 Learn it: Unstable Beats Stable, Unexpected Beats Expected

Practice 10 more Prioritization questions free →

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Question 11 of 20

A client who takes apixaban for atrial fibrillation tells the nurse, 'There was some blood on the toilet paper after my bowel movement.' The next apixaban dose is due in 30 minutes. Which action should the nurse take first?

  1. Collect a stool specimen to test for hidden blood
  2. Hold the apixaban dose and notify the provider of the bleeding
  3. Reassure the client that hemorrhoids often cause a little bleeding
  4. Ask about the amount and color of the blood and check the vital signs
Show the answer and rationale

Answer: D

A streak of bright red blood on the tissue suggests a hemorrhoid or fissure, while a large amount, maroon or black stool, dizziness, or a rising heart rate suggests a significant bleed, so the nurse first asks about the bleeding, looks at the stool if possible, and checks the vital signs. Holding the dose and calling is the strongest distractor, but that decision depends on these data, and a needlessly missed dose leaves a client with atrial fibrillation less protected against stroke. Reassurance assumes the cause, and testing for hidden blood adds nothing when the blood is visible.

📚 Learn it: Assess Before You Act (Unless the Stem Already Did)

Question 12 of 20

The census on a medical unit is low, and the house supervisor asks the charge nurse to send one RN to the cardiac step-down unit for the rest of the shift. No float pool nurse is available. Which RN should the charge nurse send?

  1. The newly licensed RN, who finished orientation on this unit last week
  2. An RN who worked for 4 years on a telemetry unit before transferring here
  3. The RN whose four clients are the most stable on the unit this morning
  4. The RN who is certified in medical-surgical nursing with 10 years here
Show the answer and rationale

Answer: B

A float assignment should go to the nurse whose skills best match the receiving unit, and an RN with 4 years of telemetry experience can interpret rhythms and care safely for clients on a cardiac step-down unit. Choosing the RN with the most stable clients is the strongest distractor because it seems least disruptive, but stable clients are easy to reassign, while a nurse without telemetry skills would be unsafe there. A newly licensed RN just off orientation is the least prepared to work in an unfamiliar specialty, and years of experience or certification in medical-surgical nursing do not prepare a nurse for cardiac monitoring.

📚 Learn it: The Five Rights of Delegation

Question 13 of 20

After a stadium bleacher collapse, a nurse is watching victims tagged yellow (delayed) at the casualty collection point while they wait for transport. A 34-year-old tagged 40 minutes ago for a closed femur fracture now has respirations of 34/min, a radial pulse of 124 beats/min, and capillary refill of 3 seconds, and still follows commands. What should the nurse do?

  1. Splint the leg and give oxygen, then recheck the victim in 15 minutes
  2. Retag the victim black, because shock this late means survival is unlikely
  3. Retag the victim red and move the victim to the immediate area
  4. Keep the yellow tag, because the fracture is the same as it was at triage
Show the answer and rationale

Answer: C

Triage is repeated while victims wait, and the tag changes when the findings do: respirations over 30 and capillary refill over 2 seconds now meet START criteria for immediate (red), and with a femur fracture they suggest blood loss and early shock, so the victim moves up for treatment and transport. Splinting and oxygen are reasonable care, but they lose because the victim stays in the delayed group for another 15 minutes while shock progresses. A tag is not fixed at first triage, and a breathing victim in early shock who follows commands is salvageable, not expectant.

📚 Learn it: Disaster Triage: Sickest First Is Sometimes Wrong

Question 14 of 20 · Select all that apply

A 52-year-old client who has been living in his car is ready for discharge after 3 days of IV antibiotics for cellulitis of the right lower leg. He will take an oral antibiotic four times a day for 7 more days and needs a daily dressing change. Which needs should the nurse make sure are addressed before discharge? Select all that apply.

  1. A social work referral to be made at his first follow-up visit
  2. A safe place to sleep where he can rest and elevate the leg
  3. His agreement to enter a long-term housing program before discharge
  4. Instructions to come to the emergency department each day for the dressing change
  5. A place and supplies for the daily dressing changes
  6. A way to get the antibiotic filled and paid for before he leaves
Show the answer and rationale

Answer: B, E, F

A treatment plan fails when basic needs are not met, so before discharge the nurse makes sure he has a safe place to sleep and recover, the antibiotic in hand or a way to pay for it, and a realistic plan for daily wound care, which may mean a shelter bed and a clinic or home health visit. Making discharge depend on accepting long-term housing is coercive, and housing is his choice to make. Daily emergency department visits for a routine dressing are not a workable plan, and waiting until follow-up to involve social work leaves him without help when he needs it most.

📚 Learn it: Maslow's Pyramid, Nurse Edition

Question 15 of 20

On a step-down unit, the nurse hears about four clients in quick succession. Which client should the nurse go to first?

  1. A client with a tracheostomy whose cuff pressure is 34 cm H2O on the 0800 check; SpO2 97%
  2. A client who has had a tracheostomy for 3 years and whose tube came out during a coughing spell; SpO2 93%
  3. A client whose tracheostomy was placed yesterday and whose tube came out during a coughing spell; SpO2 93%
  4. A client whose tracheostomy was placed 2 days ago and whose suctioned secretions are blood-tinged; SpO2 96%
Show the answer and rationale

Answer: C

A tracheostomy that comes out before the tract matures, in about the first week, is a critical emergency: the opening can close, and blind reinsertion can push the tube into a false passage, so the nurse calls for emergency help, gives oxygen over the face and the stoma, and has the spare tube and obturator ready for reinsertion, even though the SpO2 is still 93%. The client with a 3-year-old tracheostomy is the strongest distractor and is seen next, because a mature tract stays open and a new tube can usually be inserted quickly and safely. Blood-tinged secretions are expected in the first days after placement, and a cuff pressure above 30 cm H2O should be lowered soon to protect the tracheal lining but does not threaten the airway.

📚 Learn it: Airway, Breathing, Circulation: The Tiebreaker

Question 16 of 20

An 82-year-old client admitted with a urinary tract infection has been confused at night and has tried twice to walk to the bathroom alone. At 0100 she asks the nurse to turn off her bed exit alarm because 'it goes off every time I roll over, and I can't sleep.' Which action by the nurse is best?

  1. Keep the alarm on and offer her regular help to the bathroom overnight
  2. Turn off the alarm and place the call light within her reach
  3. Ask the provider for a sleeping pill so that she sleeps through the night
  4. Raise all four side rails so that she cannot climb out of bed alone
Show the answer and rationale

Answer: A

Rest matters, but a confused client who keeps getting up alone is at immediate risk of falling, so safety comes first: the alarm stays on, and regular help to the bathroom removes the urge that drives her out of bed, which also means fewer alarms and better sleep. Turning off the alarm is the strongest distractor, but a client who is confused at night cannot be relied on to remember to call. A sleeping pill adds to confusion and fall risk in an older adult, and four raised side rails act as a restraint that she may try to climb over, which makes a fall more dangerous.

📚 Learn it: Maslow's Pyramid, Nurse Edition

Question 17 of 20

At the start of the night shift on a general surgery unit, which client should the nurse assess first?

  1. A client 1 day after a colostomy whose stoma is swollen, moist, beefy red, and slightly raised
  2. A client 3 days after an ileostomy who is tearful, will not look at the stoma, and refuses pouch teaching
  3. A client 1 day after a colostomy whose stoma, red at the last check, now looks pale and dusky
  4. A client 2 days after a bowel resection whose pain is 3/10 on the prescribed oral analgesic
Show the answer and rationale

Answer: C

A stoma that turns pale or dusky has lost its blood supply, and ischemia can progress to necrosis, so the nurse assesses it and notifies the surgeon immediately. The swollen stoma is the strongest distractor, but edema is expected after surgery, peaking at 24 to 72 hours and resolving over 6 to 8 weeks, and a moist, beefy red color shows good perfusion. The tearful client needs support in adjusting to a changed body but is physically stable, and pain of 3/10 on oral analgesics is well controlled.

📚 Learn it: Unstable Beats Stable, Unexpected Beats Expected

Question 18 of 20

The central telemetry monitor alarms and shows asystole for a client. When the nurse enters the room, the client is sitting up, talking, and eating breakfast. Which action should the nurse take first?

  1. Obtain a 12-lead ECG to confirm the rhythm
  2. Silence the alarm and chart it as artifact
  3. Check the electrodes and lead wires
  4. Have the monitor technician review the strip
Show the answer and rationale

Answer: C

A client who is alert and talking has a perfusing rhythm, so a flat line on the monitor is artifact until proven otherwise, most often from a loose electrode or a disconnected lead; the nurse checks the equipment and confirms the rhythm. A 12-lead ECG would also confirm the rhythm, which makes it tempting, but it takes longer and leaves the bedside monitoring down when reattaching a lead fixes it. Silencing the alarm and charting artifact leaves the client unmonitored, and the monitor technician sees the same flat line the nurse does. The nurse always looks at the client before reacting to the machine.

📚 Learn it: Assess Before You Act (Unless the Stem Already Did)

Question 19 of 20

A nurse on a medical unit is working with an assistive personnel (AP). Which client can the nurse ask the AP to feed at lunch?

  1. A stable client who returned from an upper endoscopy 30 minutes ago
  2. An alert client admitted this morning with a stroke who says he is hungry
  3. A client with stable dementia who has eaten pureed meals safely for 2 weeks
  4. A client with Parkinson disease whose voice sounded wet after drinking at breakfast
Show the answer and rationale

Answer: C

Feeding is a routine task the AP can perform when the client's swallowing is known and stable, as with a client who has safely eaten a prescribed pureed diet for weeks. The client with Parkinson disease is the strongest distractor, since the condition is chronic and familiar, but a wet, gurgly voice after swallowing suggests food or fluid entering the airway, a change that needs the nurse's assessment and likely a speech-language pathology referral. A client with a new stroke needs a swallow screen before anything is given by mouth, however alert or hungry, and after an upper endoscopy, sedation and any throat spray can blunt the gag reflex, so nothing is given by mouth until the nurse confirms it has returned.

📚 Learn it: The Five Rights of Delegation

Question 20 of 20

A nurse who is off duty hears on the news that a tornado has struck the city and that many injured people are being taken to the hospital where the nurse works. The hospital has activated its emergency operations plan. What should the nurse do?

  1. Stay reachable and report to the labor pool if the hospital calls
  2. Call the unit to ask the charge nurse whether extra nurses are needed today
  3. Go to the tornado site to help the rescue crews triage victims
  4. Drive to the hospital and go straight to the emergency department to help
Show the answer and rationale

Answer: A

An emergency operations plan calls in the staff it needs through its notification system and sends them to a labor pool, where they are assigned to the areas of greatest need, so an off-duty nurse stays reachable and reports when called. Calling the unit is the runner-up because it seems responsible, but it ties up phone lines the hospital needs during the response, and the plan asks staff to keep calls to a minimum. Going straight to the emergency department bypasses the assignments made through the labor pool, and showing up at the scene uninvited adds people the incident commanders did not request.

📚 Learn it: Disaster Triage: Sickest First Is Sometimes Wrong

Practice 10 more Prioritization questions free →

A timed or tutor-mode set in the app, scored by area, with every miss saved for review. Free, no sign-up needed.

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