Introduction
Preparing for the NCLEX can feel overwhelming, especially when prioritization questions demand quick thinking and clinical clarity. These questions test how well you can recognize life-threatening situations, respond in the correct order, and make confident decisions under pressure. At Tiju’s Academy, we help students master this skill with structured practice, real-exam style scenarios, and clear reasoning for every answer. This set of curated prioritization questions will strengthen that instinct and boost your exam readiness.
1. The nurse has just received shift report. Which patient should the nurse assess first?
A. A 45-year-old with COPD with an O2 saturation of 91% on 2L NC.
B. A 60-year-old 2 days post-op hip replacement complaining of 7/10 pain.
C. A 24-year-old admitted for pyelonephritis with a fever of 101.2°F (38.4°C).
D. A 55-year-old post-thyroidectomy reporting "tightness" in the throat.
Answer: D
2. A nurse is caring for four patients. Which patient requires the most immediate intervention?
A. A patient with DVT on heparin with a PTT of 70 seconds.
B. A patient with pneumonia with a productive cough of green sputum.
C. A patient with a femur fracture who develops petechiae on the chest.
D. A patient with cirrhosis with asterixis and mild confusion.
Answer: C
3. The nurse is caring for a patient with a T3 spinal cord injury. The patient complains of a throbbing headache and has a BP of 210/110. What is the nurse’s priority action?
A. Administer hydralazine IV.
B. Check the bladder for distention.
C. Lower the head of the bed.
D. Notify the provider immediately.
Answer: B
4. A patient with heart failure returns from the cath lab. The nurse notes the pedal pulses are +1 and cool. The insertion site is soft. What is the priority?
A. Document the findings.
B. Apply a sandbag to the insertion site.
C. Assess the unaffected leg for comparison.
D. Notify the healthcare provider.
Answer: C
5. Which patient should the ED nurse triage as "Emergent" (Red Tag)?
A. A patient with a displaced wrist fracture screaming in pain.
B. A patient with diaphoresis and left-sided jaw pain.
C. A patient with a 3-inch laceration on the forehead bleeding freely.
D. A patient with a fever of 103°F and a stiff neck.
Answer: B
6. A client with Guillain-Barré syndrome has been stable. Which finding requires immediate action?
A. Bilateral paresthesia in the feet.
B. Absent knee-jerk reflexes.
C. Vital capacity drops to 12 mL/kg.
D. Heart rate of 98 bpm.
Answer: C
7. A burn patient (40% TBSA) is in the resuscitation phase (first 24h). Which lab value warrants immediate reporting?
A. Potassium 6.2 mEq/L.
B. Hematocrit 52%.
C. Sodium 133 mEq/L.
D. Glucose 150 mg/dL.
Answer: A
8. A patient is receiving a blood transfusion and reports back pain and chills. What is the nurse's first action?
A. Check the patient's temperature.
B. Stop the transfusion.
C. Notify the blood bank.
D. Administer diphenhydramine.
Answer: B
9. A patient with a chest tube has continuous bubbling in the water seal chamber. What does this indicate?
A. The lung has re-expanded.
B. The system is functioning normally.
C. There is an air leak in the system.
D. The suction pressure is too high.
Answer: C
10. A diabetic patient is found unresponsive. Skin is cool and clammy. What is the priority action?
A. Call a Code Blue.
B. Administer Insulin Lispro subcutaneously.
C. Administer Glucagon IM.
D. Check blood glucose.
Answer: C
11. In a mass casualty event, which patient receives a "Black Tag"?
A. Large open skull fracture with agonal breathing.
B. Traumatic amputation of the left leg, BP 90/60.
C. Open abdominal wound with exposed intestines, conscious.
D. 3rd-degree burns to 80% of the body, unconscious.
Answer: A
12. A patient on a ventilator has a High Pressure Alarm sounding. The nurse cannot immediately identify the cause. What is the priority?
A. Suction the patient.
B. Check for kinks in the tubing.
C. Manually ventilate with a bag-valve mask.
D. Increase the sedation.
Answer: C
13. A patient with a Potassium level of 2.8 mEq/L is scheduled for a dose of Digoxin. What is the priority?
A. Give the Digoxin as scheduled.
B. Hold the Digoxin and call the provider.
C. Give the Digoxin with orange juice.
D. Check the apical pulse for 60 seconds.
Answer: B
14. A patient with severe sepsis has a BP of 80/40 after receiving 2L of IV fluids. What is the next priority?
A. Administer IV antibiotics.
B. Start a Norepinephrine infusion.
C. Obtain blood cultures.
D. Give a dose of hydrocortisone.
Answer: B
15. A patient post-carotid endarterectomy has a BP of 180/100. Why is the nurse concerned?
A. Risk of incision rupture.
B. Risk of cerebral hemorrhage.
C. Risk of renal failure.
D. Risk of coronary ischemia.
Answer: B
16. Which task can the RN delegate to the LPN (LVN)?
A. Admission assessment for a new patient with pneumonia.
B. Developing the care plan for a patient with heart failure.
C. Administering IV push Morphine.
D. Reinforcing teaching on insulin administration.
Answer: D
17. The Charge Nurse is assigning patients. Which patient is appropriate for a Float Nurse from the Labor & Delivery unit?
A. A patient with a chest tube for hemothorax.
B. A patient receiving chemotherapy for leukemia.
C. A patient 4-hours post-hysterectomy.
D. A patient with intractable seizures.
Answer: C
18. Which task is appropriate for the UAP (Unlicensed Assistive Personnel)?
A. Feeding a patient with dysphagia.
B. Measuring urine output from a foley catheter.
C. Assessing the skin for breakdown during a bath.
D. Educating a patient on walker use.
Answer: B
19. An RN, LPN, and UAP are caring for a client with a CVA. Which task is best for the LPN?
A. Ambulating the patient for the first time.
B. Administering scheduled oral medications.
C. Assessing the swallow reflex.
D. Measuring vital signs every 4 hours.
Answer: B
20. The RN observes a student nurse suctioning a tracheostomy. The RN intervenes if the student:
A. Hyper-oxygenates with 100% O2 before suctioning.
B. Applies suction only while withdrawing the catheter.
C. Suctions for 20 seconds.
D. Uses sterile technique.
Answer: C
21. A pregnant client with preeclampsia is on Magnesium Sulfate. The nurse notes DTRs are absent and Resp Rate is 10. What is the priority?
A. Decrease the infusion rate.
B. Administer Calcium Gluconate.
C. Document the finding.
D. Stimulate the patient.
Answer: B
22. A child with Tetralogy of Fallot is having a "Tet Spell" (hypercyanotic episode). What is the first action?
A. Administer 100% Oxygen.
B. Place the child in a knee-chest position.
C. Administer Morphine.
D. Start an IV.
Answer: B
23. Which client requires the most immediate assessment by the post-partum nurse?
A. A client 2 hours post-delivery with a perineal pad saturated in 15 minutes.
B. A client with a boggy uterus that firms with massage.
C. A client complaining of severe afterpains while breastfeeding.
D. A client with a temperature of 100.2°F (37.9°C).
Answer: A
24. A 4-year-old with Epiglottitis is drooling and anxious. The nurse should NOT:
- A. Keep the child calm.
- B. Assess the throat with a tongue depressor.
- C. Have a trach kit nearby.
- D. Administer humidified oxygen.
Answer: B
25. A nurse checks the fetal monitor and sees Late Decelerations. What is the priority nursing action?
A. Turn the mother to the left side.
B. Increase the Pitocin infusion.
C. Administer Oxygen via nasal cannula.
D. Document the finding.
Answer: A
26. A 10-year-old with Sickle Cell Anemia is admitted for a Vaso-occlusive crisis. Which order should the nurse question?
A. IV Fluids at 1.5x maintenance.
B. Meperidine (Demerol) for pain.
C. Oxygen via nasal cannula.
D. Warm compresses to joints.
Answer: B
27. A nurse is caring for a patient with a Placenta Previa who begins to bleed profusely. What is the absolute contraindication?
A. Continuous Fetal Monitoring.
B. Vaginal Exam.
C. Bed rest.
D.
Answer:
28. A patient with schizophrenia says, "The FBI is listening to my thoughts through the radiator." What is the best response?
A. "The FBI has better things to do than listen to you."
B. "I don't hear any voices or devices, but it must be frightening for you."
C. "Let's turn off the radiator so they can't hear you."
D. "Why do you think the FBI is interested in you?"
Answer: B
29. A patient on Lithium has a level of 1.8 mEq/L and reports diarrhea and tremors. What is the nurse's action?
A. Administer the next dose.
B. Hold the dose and document.
C. Hold the dose and notify the provider.
D. Encourage fluid intake.
Answer: C
30. Which patient on the psych unit is the priority for the nurse to see?
A. A patient with BPD who is cutting their arms superficially.
B. A patient with depression who has suddenly given away their guitar.
C. A patient with bipolar mania pacing the halls.
D. A patient with schizophrenia hearing voices.
Answer: B
31. A patient with Alcohol Withdrawal Syndrome is 48 hours since their last drink. Vital signs are: HR 110, BP 160/95, Temp 100.8°F. What is the nurse concerned about?
A. Wernicke’s Encephalopathy.
B. Delirium Tremens.
C. Korsakoff’s Psychosis.
D. Liver Failure.
Answer: B
32. The nurse is caring for a patient with a Pulmonary Embolism. Which interventions are appropriate? (Select All That Apply)
A. Administer Heparin.
B. Place patient in High-Fowler's position.
C. Massage the calves to prevent further clots.
D. Administer Oxygen.
E. Restrict fluids.Answer: A, B, D
33. A patient with Addison’s Disease presents with weakness and hypotension. Which electrolyte imbalances does the nurse expect? (Select All That Apply)
A. Hyponatremia.
B. Hypernatremia.
C. Hypokalemia.
D. Hyperkalemia.
E. Hypoglycemia.
Answer: A, D, E
34. A patient is taking MAOIs (Phenelzine). Which dinner choice requires intervention?
A. Grilled chicken and rice.
B. Pepperoni pizza and a beer.
C. Cottage cheese and fruit.
D. Steamed vegetables.
Answer: B
35. A nurse is discharging a patient with SLE (Lupus). Which statement indicates a need for further teaching?
A. "I will wear sunscreen everyday."
B. "I should wash my rashes with a harsh soap to dry them out."
C. "I will report a fever immediately."
D. "I need to rest when I feel fatigued."
Answer: B
36. A patient with CKD has a potassium of 7.1 mEq/L. The EKG shows peaked T-waves. Which order should the nurse implement FIRST?
A. Sodium Polystyrene Sulfonate (Kayexalate) PO.
B. IV Insulin and Dextrose.
C. IV Calcium Gluconate.
D. Hemodialysis.
Answer: C
37. The nurse is caring for a patient on TPN. The bag runs out and the new bag has not arrived. What is the priority?
A. Hang Normal Saline.
B. Hang Dextrose 10% in water (D10W).
C. Cap the line and wait.
D. Slow the rate of the next bag.
Answer: B
38. A patient on a ventilator has an Endotracheal Tube cuff pressure of 35 mm Hg. What is the complication risk?
A. Aspiration pneumonia.
B. Tracheal necrosis.
C. Unplanned extubation.
D. Inadequate tidal volume.
Answer: B
39. A patient with a chest trauma has "paradoxical chest movement." What condition is this?
A. Tension Pneumothorax.
B. Flail Chest.
C. Cardiac Tamponade.
D. Hemothorax.
Answer: B
40. The nurse is assigning tasks. Which patient should NOT be assigned to a pregnant nurse?
A. A patient with HIV.
B. A patient with MRSA.
C. A 5-year-old with Fifth Disease (Parvovirus B-19).
D. A patient with Tuberculosis.
Answer: C
Conclusion
Strong prioritization skills are the backbone of excellent nursing practice, and mastering them makes the NCLEX far less intimidating. By regularly practicing scenario-based questions like these, you develop the confidence to act quickly, safely, and professionally in real clinical settings. At Tiju’s Academy, we guide you step-by-step so you can approach the exam with clarity and competence. Keep learning, keep practicing, and trust that every question brings you closer to becoming the nurse you’re meant to be. Join now at the best NCLEX-RN coaching center in Kerala!
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