Prioritization NCLEX-RN Practice Questions

Prioritization NCLEX-RN Practice Questions

Effective prioritization is a cornerstone of safe nursing practice and a vital competency tested on the NCLEX-RN. This topic-wise set of questions focuses on the Management of Care domain, emphasizing how to identify the most critical client, the safest first action, and appropriate delegation and assignment decisions. You will practice using frameworks such as ABCs (airway, breathing, circulation), Maslow’s hierarchy, safety and risk reduction, urgent vs. non-urgent, and stable vs. unstable assessments. The scenarios mirror real clinical complexity, including triage, post-operative care, infectious precautions, medication safety, and ethical decision-making. Work through these 30 NCLEX-style MCQs to sharpen your clinical judgment and strengthen your readiness to deliver timely, evidence-based care.

Q1. You are caring for four clients on a telemetry unit. Which client should you assess first?

• Client with COPD whose oxygen saturation is 88% and reports this is their baseline
• Client 24 hours post-appendectomy with a temperature of 100.2°F (37.9°C)
• Client with pneumonia who is short of breath but speaking in full sentences
• Client reporting 8/10 chest pain radiating to the jaw and left arm

Correct Answer: Client reporting 8/10 chest pain radiating to the jaw and left arm

Q2. Which task is most appropriate to delegate to an experienced unlicensed assistive personnel (UAP)?

• Feeding a client post-stroke who has not yet had a swallowing evaluation
• Collecting a stool specimen from a client on contact precautions for C. difficile
• Performing a fingerstick blood glucose on a newly admitted diabetic client
• Applying a rigid splint to a client with a suspected wrist fracture

Correct Answer: Collecting a stool specimen from a client on contact precautions for C. difficile

Q3. A client develops generalized urticaria and wheezing minutes after starting an IV antibiotic. What is the nurse’s first action?

• Administer IM epinephrine per protocol
• Stop the infusion and maintain IV access with normal saline
• Notify the rapid response team
• Apply high-flow oxygen via non-rebreather mask

Correct Answer: Stop the infusion and maintain IV access with normal saline

Q4. You are assigned to the postpartum unit. Which client should you assess first?

• Client 12 hours post-cesarean with pain rated 7/10 requesting medication
• Client 2 hours postpartum soaking one perineal pad every 15 minutes and reporting dizziness
• Client 24 hours postpartum passing quarter-sized clots with fundus firm at the umbilicus
• Client breastfeeding for the first time and requesting latch assistance

Correct Answer: Client 2 hours postpartum soaking one perineal pad every 15 minutes and reporting dizziness

Q5. During mass-casualty triage, which client should be tagged as immediate (red)?

• Client with an open femur fracture and stable vital signs
• Client who is apneic but begins breathing at 8/min after airway repositioning
• Client with full-thickness burns over 80% of total body surface area
• Client who is ambulatory with multiple superficial lacerations

Correct Answer: Client who is apneic but begins breathing at 8/min after airway repositioning

Q6. A client meets sepsis criteria: temperature 40.1°C, HR 130, BP 86/50, lactate 4.2 mmol/L. Which prescription should the nurse implement first?

• Administer acetaminophen 650 mg PO
• Obtain blood cultures from two sites
• Start broad-spectrum antibiotics
• Begin 30 mL/kg isotonic crystalloid bolus immediately

Correct Answer: Begin 30 mL/kg isotonic crystalloid bolus immediately

Q7. Which client is most appropriate to assign to an experienced LPN/LVN under RN supervision?

• New admission with chest pain and diaphoresis
• Postoperative day 2 client requiring dressing change to a stable wound
• Client with active GI bleeding and dropping blood pressure
• Client ready for discharge who needs complex heart failure education

Correct Answer: Postoperative day 2 client requiring dressing change to a stable wound

Q8. The charge nurse must cohort clients due to limited rooms. Which cohort is most appropriate?

• Two clients with suspected tuberculosis pending confirmatory testing
• Two clients with confirmed RSV infection on contact precautions
• A client with neutropenia and a client with influenza A
• A client with shingles and a client with varicella who is immunocompromised

Correct Answer: Two clients with confirmed RSV infection on contact precautions

Q9. Which call should the nurse return first?

• Critical lab reporting a potassium level of 6.3 mEq/L
• Client reporting mild incisional pain requesting an analgesic refill
• Parent requesting an update about their child’s plan of care
• Telemetry technician reporting intermittent occlusion alarm on an IV pump

Correct Answer: Critical lab reporting a potassium level of 6.3 mEq/L

Q10. Which postoperative client requires immediate assessment?

• Client 1 hour post-thyroidectomy reporting tingling around the mouth and fingertips
• Client 6 hours post-laparoscopic cholecystectomy with nausea
• Client post-hip replacement day 1 with pain 6/10 despite medication
• Client post-colectomy day 2 with absent bowel sounds

Correct Answer: Client 1 hour post-thyroidectomy reporting tingling around the mouth and fingertips

Q11. Which chest tube finding requires immediate intervention?

• Intermittent bubbling in the water seal chamber with coughing
• Serosanguinous drainage totaling 50 mL in 1 hour
• Continuous bubbling in the suction control chamber
• 200 mL of bright red drainage in the last hour

Correct Answer: 200 mL of bright red drainage in the last hour

Q12. The charge nurse needs to free a bed for a client from the ED with GI hemorrhage. Which inpatient is the best candidate for discharge now?

• Client with new-onset atrial fibrillation on amiodarone infusion
• Client with pneumonia needing 2 L/min oxygen and IV antibiotics
• Client with chronic migraines whose pain is controlled and has neurology follow-up
• Client 6 hours post-appendectomy with ongoing emesis

Correct Answer: Client with chronic migraines whose pain is controlled and has neurology follow-up

Q13. At shift start, which action should the nurse take first?

• Reassess a post-op client with urine output of 10 mL over the last 2 hours
• Hang a first dose of vancomycin that is scheduled now
• Review overnight laboratory results for all clients
• Delegate morning hygiene to the UAP

Correct Answer: Reassess a post-op client with urine output of 10 mL over the last 2 hours

Q14. A conscious diabetic client is diaphoretic, shaky, and anxious. Point-of-care glucose is 48 mg/dL. What is the nurse’s priority action?

• Administer 15 g of fast-acting oral carbohydrate
• Call the provider for new insulin orders
• Draw a serum glucose and send to the lab
• Start an IV and administer 50% dextrose

Correct Answer: Administer 15 g of fast-acting oral carbohydrate

Q15. Which pediatric client requires immediate attention?

• Child with asthma whose wheezing improved after albuterol
• Child with asthma who has abrupt cessation of wheezing and decreased level of consciousness
• Child with asthma with peak flow 55% predicted and speaking full sentences
• Child with asthma with oxygen saturation 92% on room air

Correct Answer: Child with asthma who has abrupt cessation of wheezing and decreased level of consciousness

Q16. On an oncology unit, which client should the nurse see first?

• Client receiving doxorubicin who reports burning and swelling at the IV site
• Client with ANC 900 asking about visitor restrictions
• Client on morphine reporting constipation
• Client with nausea rated 3/10 after chemotherapy

Correct Answer: Client receiving doxorubicin who reports burning and swelling at the IV site

Q17. On a mental health unit, which client is the priority?

• Client pacing and reporting mild anxiety before group therapy
• Client stating, “I have a plan to hurt myself and the means to do it”
• Client upset about discharge plans and requesting a meeting
• Client requesting a PRN sleep aid for insomnia

Correct Answer: Client stating, “I have a plan to hurt myself and the means to do it”

Q18. A client arrives with acute neurologic deficits that began 45 minutes ago. What is the nurse’s priority action?

• Administer aspirin 325 mg chewed
• Arrange immediate non-contrast head CT and activate the stroke team
• Place the client flat to promote cerebral perfusion
• Start a continuous heparin infusion

Correct Answer: Arrange immediate non-contrast head CT and activate the stroke team

Q19. In a burn unit, which client should be seen first?

• Client with facial burns, singed nasal hairs, and hoarseness
• Client with partial-thickness burns to both forearms reporting severe pain
• Client with circumferential full-thickness burns to the lower leg and weak pedal pulses
• Client with blisters on the chest and arms after a scald injury

Correct Answer: Client with facial burns, singed nasal hairs, and hoarseness

Q20. A postoperative client refuses incentive spirometry due to pain. What is the nurse’s best first action?

• Explain the importance of incentive spirometry to prevent pneumonia
• Administer the prescribed analgesic and then encourage incentive spirometry
• Notify the provider that the client is refusing therapy
• Document the refusal and reassess in 2 hours

Correct Answer: Administer the prescribed analgesic and then encourage incentive spirometry

Q21. For a client receiving continuous enteral feeding, which task is appropriate to delegate to the UAP?

• Verify tube placement before feeding initiation
• Measure and return gastric residual volume
• Position the client with head of bed at 30–45 degrees during and after feeding
• Adjust feeding rate based on residual volumes

Correct Answer: Position the client with head of bed at 30–45 degrees during and after feeding

Q22. A client develops fever, chills, and back pain 15 minutes after starting a blood transfusion. What is the nurse’s priority action?

• Notify the provider immediately
• Stop the transfusion and keep the IV line open with normal saline
• Send the blood bag and tubing back to the blood bank
• Obtain a urine specimen for hemolysis

Correct Answer: Stop the transfusion and keep the IV line open with normal saline

Q23. A client with a temporary transvenous pacemaker shows loss of capture with bradycardia and hypotension. What is the nurse’s first action?

• Increase the pacemaker output (mA) until capture is achieved per protocol
• Prepare for external pacing
• Notify the provider and await further orders
• Turn the client onto the left side to improve lead contact

Correct Answer: Increase the pacemaker output (mA) until capture is achieved per protocol

Q24. Which laboratory result should the nurse report to the provider first?

• INR 4.2 in a client on warfarin without bleeding
• Serum sodium 128 mEq/L in a client with mild confusion
• Troponin I 0.90 ng/mL in a client with vague chest discomfort
• WBC 2,000/mm³ in a client on chemotherapy

Correct Answer: Troponin I 0.90 ng/mL in a client with vague chest discomfort

Q25. In triage, who should be seen first?

• 67-year-old with sudden tearing abdominal pain radiating to the back and brief syncope
• 45-year-old with severe flank pain and hematuria
• 25-year-old with fever 39.2°C and sore throat
• 60-year-old with unilateral calf pain and swelling after a long flight

Correct Answer: 67-year-old with sudden tearing abdominal pain radiating to the back and brief syncope

Q26. A client presents with fever, severe headache, photophobia, and nuchal rigidity. Which initial prescription should the nurse implement first?

• Administer IV broad-spectrum antibiotics
• Initiate droplet precautions
• Prepare the client for lumbar puncture
• Administer acetaminophen 650 mg PO

Correct Answer: Initiate droplet precautions

Q27. The charge nurse must assign a client to a float nurse from a general medical-surgical unit. Which client is most appropriate?

• Client 2 hours post–carotid endarterectomy with labile blood pressure
• Client with DKA on an insulin infusion requiring hourly titration
• Client on dopamine infusion for cardiogenic shock
• Client 3 days post-stroke with a PEG tube receiving scheduled feedings

Correct Answer: Client 3 days post-stroke with a PEG tube receiving scheduled feedings

Q28. A client becomes unresponsive on the unit and no code status is documented in the chart. What is the nurse’s priority action?

• Call the family to clarify wishes
• Begin resuscitation per hospital policy while locating code status
• Wait for the provider to write a code status order
• Check the electronic record later while continuing routine care

Correct Answer: Begin resuscitation per hospital policy while locating code status

Q29. Which pediatric client in the ED requires the most immediate intervention?

• 5-year-old with fever 40.3°C and petechial rash
• 2-year-old with barky cough and mild stridor when crying
• 10-year-old with a deformed, swollen wrist after a fall
• 16-year-old with a unilateral throbbing headache relieved by a dark room

Correct Answer: 5-year-old with fever 40.3°C and petechial rash

Q30. After hemodialysis, which client finding requires immediate action?

• Muscle cramping in the calves
• Blood pressure 84/50 with lightheadedness
• Fatigue and somnolence
• Nausea and a poor appetite

Correct Answer: Blood pressure 84/50 with lightheadedness

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