NCLEX Priority Questions: ABCs, Maslow, and the Nursing Process
Part 3 covered reading the stem and eliminating options. This final article covers what comes next: choosing between the options that survive. The most common shape on the NCLEX is the item where every choice is defensible and only one is the priority. There is a method for that, and it is largely mechanical. Ten original practice items are included.
1. The three-stage priority method
Here is the whole approach up front. When an item asks for priority, apply these in order.
- Decide which step of the nursing process is being tested
→ knowing whether it wants assessment or implementation often halves the options - Compare the survivors using ABCs
→ choose whatever is closest to life-threatening - If ABCs does not separate them, apply Maslow
→ physiological needs outrank psychosocial ones
2. Using the nursing process as a filter
A large share of NCLEX items become answerable simply by identifying which step of the nursing process is being asked about. The nursing process is foundational clinical thinking; on this exam it doubles as an answering framework.
| Step | NCJMM skill | What it involves |
|---|---|---|
| 1. Assessment | Recognize cues | Gathering data: observing, measuring, checking |
| 2. Analysis | Analyze cues / Prioritize hypotheses | Interpreting data and ranking problems |
| 3. Planning | Generate solutions | Deciding on interventions |
| 4. Implementation | Take action | Carrying out the plan |
| 5. Evaluation | Evaluate outcomes | Comparing result against expectation |
first, initial or immediate, assessment is the default answer. The exception is a life-threatening situation, where action outranks gathering more data. Decide by asking whether the stem contains findings that constitute an emergency.
A client returns to the unit after an arteriogram performed through the right femoral artery. The client reports increasing pain in the right thigh.
Which action would the nurse take first?
- Apply additional pressure to the insertion site.
- Administer the prescribed analgesic.
- Inspect the groin site and assess the right pedal pulses.
- Document the client's report of pain.
Answer: 3. Increasing pain distal to an arterial puncture suggests bleeding or haematoma with neurovascular compromise — but nothing is confirmed yet. Options 1, 2 and 4 all sit in the implementation step. The nursing process begins with assessment, so inspecting the site and palpating the pedal pulses is the first action.
The nurse reviews the arterial blood gas results of a client and notes: pH 7.49, Pco₂ 30 mm Hg, HCO₃ 23 mEq/L.
The nurse analyzes these results as indicating which condition?
- Respiratory alkalosis, uncompensated
- Respiratory acidosis, compensated
- Metabolic alkalosis, uncompensated
- Metabolic acidosis, compensated
Answer: 1. Reference ranges: pH 7.35–7.45, Pco₂ 35–45 mm Hg, HCO₃ 22–26 mEq/L. Work it in order.
① pH 7.49 is high → alkalosis.
② Pco₂ 30 is low.
③ pH and Pco₂ are moving in opposite directions → respiratory in origin.
④ HCO₃ 23 is within range → no compensation has occurred → uncompensated.
Remember one rule and you can rebuild this on the spot: pH and Pco₂ opposite means respiratory; same direction means metabolic.
A client with type 1 diabetes mellitus is found diaphoretic, shaky, and confused. The blood glucose is 52 mg/dL. The client is awake and able to swallow.
Which action would the nurse take next?
- Administer intramuscular glucagon.
- Give 15 g of a fast-acting carbohydrate by mouth.
- Start an intravenous infusion of dextrose 50%.
- Recheck the blood glucose in 30 minutes.
Answer: 2. This is a case where action, not assessment, is correct — the glucose value is already given, so hypoglycaemia is established rather than suspected.
The decisive phrase is awake and able to swallow. With an intact swallow, 15 g of oral fast-acting carbohydrate is first line; glucagon (1) and IV dextrose (3) are reserved for impaired consciousness or an unsafe swallow. Option 4 delays treatment altogether.
The nurse is evaluating a client's response to fluid resuscitation for hypovolemia. Over the shift the blood pressure rose from 92/54 to 116/70 mm Hg, the heart rate fell from 118 to 84 beats per minute, and urine output increased from 15 mL/hour to 45 mL/hour.
Which interpretation would the nurse make?
- The client is responding well to fluid resuscitation.
- The client is developing fluid overload.
- The infusion rate should be increased.
- The client is showing early signs of acute kidney injury.
Answer: 1. All three parameters moved the right way. Rising blood pressure, resolving tachycardia and improving urine output together indicate restored circulating volume.
Note the "do not add information" rule at work. Nothing in the stem mentions crackles, oedema (2) or a rising creatinine (4) — those would have to be imagined.
3. ABCs
Identifying the nursing process step often still leaves two or more options inside the same step. ABCs is what separates them.
- A — Airway (highest)An obstructed airway kills fastest
- B — BreathingSecuring oxygenation
- C — CirculationCardiac output, bleeding, blood pressure
The nurse is caring for a client who received intravenous midazolam for a bedside procedure.
Which action would the nurse take as the priority?
- Monitor the client's bowel sounds.
- Encourage oral fluids once the client is alert.
- Assess the respiratory rate and oxygen saturation continuously.
- Measure the client's urine output hourly.
Answer: 3. The strategic word is priority. Midazolam is a benzodiazepine and its most dangerous adverse effect is respiratory depression. Continuous monitoring of respiratory rate and saturation sits at B, which outranks the gastrointestinal, fluid and renal concerns in the other options. A useful reflex: ask what would kill this client, then find where that sits on ABCs.
4. Maslow's hierarchy
ABCs is a physiological instrument. But the NCLEX also asks you to weigh physical care against psychological care, and that is where Maslow applies.
The rule is simply that a lower level must be met before a higher one matters.
| Level (from the base) | Covers | Example |
|---|---|---|
| 1. Physiological | Airway, breathing, circulation, nutrition, elimination | Oxygen therapy, pain control |
| 2. Safety and security | Preventing harm, creating a sense of safety | Fall prevention, infection control |
| 3. Love and belonging | Support systems, protection from isolation | Family visits, group participation |
| 4. Esteem | Sense of control and competence | Supporting autonomous decisions |
| 5. Self-actualisation | Hope, spiritual wellbeing, growth | Spiritual care |
The nurse is planning care for a client newly admitted to a long-term care facility who has moderate dementia.
Which action would the nurse identify as the priority?
- Introducing the client to other residents at mealtime
- Encouraging the client to display personal photographs in the room
- Ensuring that the client's nutritional intake and hydration are adequate
- Arranging for the client to attend the weekly music program
Answer: 3. All four are appropriate care for a person with dementia — which is exactly why you rank them by level. Options 1 and 4 address love and belonging; option 2 addresses esteem. Nutrition and hydration are physiological, the base of the hierarchy, and intake is frequently compromised in dementia.
5. Spotting the abnormal value
Whenever an item hands you data — laboratory results, vital signs — the first move is to decide normal or abnormal. The second is to ask how that abnormality relates to this client's situation. Those two steps solve most data items.
The nurse is caring for a client who takes lithium carbonate and reports a coarse hand tremor and vomiting. The nurse reviews the most recent laboratory results.
Which laboratory value indicates a need for follow-up?
- Sodium 138 mEq/L
- Lithium level 2.1 mEq/L
- Creatinine 0.9 mg/dL
- White blood cell count 7,500/mm³
Answer: 2. Need for follow-up means find the abnormal value (see Part 3). Sodium 138 (135–145), creatinine 0.9 (0.6–1.2) and a white cell count of 7,500 (5,000–10,000) are all normal. The therapeutic range for lithium is 0.6–1.2 mEq/L, so 2.1 is frankly toxic — and the coarse tremor and vomiting described in the Event match lithium toxicity precisely.
6. Therapeutic communication
The exam repeatedly asks what a nurse should say. These items are often answerable without any clinical knowledge — imagine how the client would feel hearing each response and the answer emerges.
| Therapeutic | Non-therapeutic |
|---|---|
| Focuses on the client's feelings | False reassurance ("Don't worry, it will be fine") |
| Invites the client to say more (open-ended) | Questions beginning with Why, which put the client on the defensive |
| Contains no judgment or evaluation | Changing the subject or setting the feeling aside |
A client who has just been told that a breast biopsy showed cancer says to the nurse, "I don't know how I'm going to tell my children."
Which response by the nurse is most appropriate?
- "Your children are adults. I'm sure they will understand."
- "Why do you think telling them will be so difficult?"
- "Telling your children feels overwhelming right now. Would you like to talk about it?"
- "Let's focus on your treatment plan first and worry about that later."
Answer: 3. Option 1 is false reassurance. Option 2 opens with Why and demands the client justify a feeling. Option 4 redirects away from the emotion entirely. Option 3 reflects the feeling back and invites the client to continue. When you are unsure, ask: which response lets this client keep talking?
7. Delegation rules
Delegation items are frequent, and the role boundaries may not match the ones you trained under. The underlying question is simple: does this client's condition match this staff member's scope of practice?
| Role | Abbreviation | Scope |
|---|---|---|
| Assistive personnel | AP | Non-invasive care: bathing, ambulation, range-of-motion exercises, grooming, hygiene |
| Licensed practical / vocational nurse | LPN / LVN | AP scope + focused assessment + some invasive procedures (suctioning, catheterisation, dressing changes) + oral, subcutaneous and intramuscular medications |
| Registered nurse | RN | LPN/LVN scope + comprehensive assessment + intravenous medications + initiating teaching + supervision of care |
The charge nurse on a medical unit is making assignments for the shift.
Which task would the charge nurse assign to the licensed practical nurse (LPN/LVN)?
- Administering a unit of packed red blood cells
- Developing the plan of care for a newly admitted client
- Reinserting an indwelling urinary catheter for a stable client
- Teaching a client to self-administer insulin for the first time
Answer: 3. Catheterisation is invasive, but for a stable client it falls within the LPN/LVN scope. Blood administration and other intravenous therapy (1), developing the care plan (2) and initiating client teaching (4) are RN responsibilities. Option 4 deserves particular attention: the RN initiates teaching; the LPN may reinforce teaching already begun.
8. Pharmacology without memorising every drug
Pharmacology carries a lot of items, but you do not need hundreds of drug names. Two things do most of the work.
Learn the suffix patterns
The suffix gives you the class; the class gives you the actions, adverse effects and cautions.
| Suffix | Class | Examples | Common use |
|---|---|---|---|
-lol | Beta blocker | atenolol, metoprolol | Hypertension, dysrhythmias |
-pril | ACE inhibitor | lisinopril, enalapril | Hypertension, heart failure |
-sartan | Angiotensin receptor blocker | losartan | Hypertension |
-statin | Lipid-lowering agent | atorvastatin | Hyperlipidaemia |
-azepam | Benzodiazepine | diazepam | Anxiety, seizures |
-prazole | Proton pump inhibitor | omeprazole | Peptic ulcer, GERD |
Learn the universal rules
- Antacids interfere with the absorption of other drugs; do not give them together
- Enteric-coated and sustained-release forms are never crushed
- Clients do not adjust or stop medications on their own judgment
- Nor does the nurse adjust or withhold a dose independently
- Over-the-counter drugs and herbal supplements are not combined without provider approval
- Avoid alcohol
- If a prescription is illegible or the dose is unusual, verify before administering
Metoprolol is prescribed for a client with newly diagnosed hypertension.
Before administering the first dose, which assessment is the priority?
- Apical heart rate and blood pressure
- Serum potassium level
- Daily weight
- Bowel sounds
Answer: 1. Metoprolol ends in -lol, so it is a beta blocker. Beta blockers lower both heart rate and blood pressure, which makes bradycardia and hypotension the principal risks, and checking the apical rate and blood pressure before administration is standard practice. You did not need to know this specific drug — the suffix was enough.
Summary of the whole series
| Part | Topic | Core idea |
|---|---|---|
| Part 1 | The exam | The NCLEX asks how you judge and act, not what you know |
| Part 2 | Study planning | Won by designing six months you can complete, not by volume |
| Part 3 | Reading and elimination | Stems have a protocol; without it, knowledge is not enough |
| Part 4 | Priority and judgment | Three frameworks, applied in order, decide the answer |
That is the complete method. What remains is practice — putting these habits into your hands until they run without effort.
One last thing, from Part 2: practising in volume without the method is pouring water into a bucket with a hole in it. The reverse is also true. With the method in place, the same hundred questions teach you something completely different.
We hope these four articles help, right up until the day "RN" appears after your name.
Frequently asked questions
How do I answer NCLEX priority questions?
Work through three stages. First decide which step of the nursing process the item is testing, which often halves the options. Then compare the survivors using ABCs, choosing whatever is closest to life-threatening. If ABCs does not separate them, apply Maslow's hierarchy and place physiological needs above psychosocial ones.
Should I always choose assessment when a question asks what to do first?
Usually, but not always. In a life-threatening situation, action takes precedence over gathering more information. If a transfusion reaction is developing, stopping the transfusion is correct even though it is an intervention rather than an assessment. Decide based on whether the stem contains findings that indicate an emergency.
How do NCLEX delegation questions work?
Ask two questions: is this client stable, and is the outcome of this care predictable? Stable clients needing predictable care can be assigned to assistive personnel. Licensed practical nurses may perform invasive procedures such as suctioning and catheterisation and give oral, subcutaneous and intramuscular medications. Registered nurses handle comprehensive assessment, intravenous medications, initiating client teaching, and supervision.
Do I have to memorise every drug name for the NCLEX?
No. Learn the suffix patterns and you can infer the drug class, and from the class the actions and adverse effects. The suffix -lol indicates a beta blocker, -pril an ACE inhibitor, -statin a lipid-lowering agent, -sartan an angiotensin receptor blocker, -azepam a benzodiazepine and -prazole a proton pump inhibitor.
Put the method into your hands
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