How to answer NCLEX priority questions

The frameworks

ABCs: Airway, Breathing, Circulation. Physiologic threats first. Maslow: physiological → safety → love/belonging → esteem → self-actualization. Acute vs chronic: acute changes beat chronic conditions. Stable vs unstable: unstable patients first. Expected vs unexpected: unexpected findings need intervention; expected findings can wait.

When frameworks disagree

ABCs supersede Maslow when they conflict. A chronic anxiety patient and a new shortness of breath patient, you address the SOB first regardless of Maslow level.

Unexpected supersedes severity-of-disease. A diabetic patient with a routine glucose check and a post-op patient with new chest pain, you go to the post-op chest pain even though the diabetic patient has a 'worse' disease.

The two patient question

Most priority questions give you 2-4 patients and ask who to see first. Mental algorithm: scan for the one with an airway issue. If none, scan for breathing. If none, scan for circulation. If none, scan for unexpected acute changes. The first patient who hits any of these is your answer.

The trap: stable post-op vs anxious patient

A 'stable' patient with new vital sign changes (HR 110, BP dropping) is unstable. A patient described as 'anxious about discharge' is psychosocial, see them later. Don't be fooled by the word 'stable' if the data conflicts.