Free NCLEX prioritization questions — who do you see first?
Prioritization questions are the highest-yield NCLEX category because they appear on every test and they're scored at the highest cognitive levels. Five free items below covering "who do you assess first," delegation, mass-casualty triage, post-op priority, and timing-critical medications. Full rationales included.
The 5 frameworks that decide every NCLEX priority question
1. ABCs (Airway, Breathing, Circulation)
The most-used framework. Apply when a question gives you multiple clients with physiologic problems. Pick the one whose airway, breathing, or circulation is most threatened. Be careful: not every "airway" answer is the right priority — sometimes the question is about whose airway is changing, not whose has been stable below baseline for hours.
2. Unstable beats stable
Even within ABCs, the client whose condition is actively deteriorating outranks the client who's been chronically lower. A client with a baseline SpO2 of 88% on COPD who is currently at 86% is more worrying than a non-COPD client at 92%. Trajectory matters.
3. Acute beats chronic
A new symptom always outranks an established baseline finding of the same type. New chest pain beats chronic chest pain. New confusion beats baseline dementia. The question is asking what's different from this client's normal.
4. Maslow's hierarchy
When all options seem physiologic, fall back to Maslow: physiologic needs trump safety, safety trumps love/belonging, etc. Useful in psych or mental health priority questions where the answers blur into communication therapy.
5. Nursing process (ADPIE)
Assess before intervene. The question often plants a tempting "give a med" or "call the provider" option when the right first step is reassessing. Default to assessment unless the situation is an obvious emergency requiring immediate action.
The 5-rights of delegation
Delegation questions test your understanding of the 5-rights framework from the NCSBN: right task, right circumstance, right person, right direction, right supervision. Quick rule of thumb for the test:
- RN tasks: assessment, teaching, evaluation, unstable clients, invasive procedures, blood administration, IV push meds, NG insertion.
- LPN tasks: stable client care, reinforcing teaching done by RN, dressing changes, oral and IM meds, sterile procedures (varies by state).
- UAP tasks: routine vital signs on stable clients, ADLs, I&O, ambulation, feeding (no swallow precautions), positioning.
Never delegate assessment, teaching, evaluation, or care of an unstable client. That's the single biggest test trap.
Mass-casualty triage on the NCLEX
The START triage system uses four colors:
- Red (immediate): life-threatening but salvageable with rapid intervention (e.g., respiratory distress with patent airway, arterial bleeding).
- Yellow (delayed): serious but stable for 1+ hours (e.g., closed fractures, abdominal injuries without shock).
- Green (minor): walking wounded, can be delayed for hours (e.g., superficial wounds, sprains).
- Black (expectant): no spontaneous respirations after airway opened; in a mass casualty event, resources go to those who can be saved.
Try these 5 questions now
No signup required. Tap an answer to reveal the rationale.
- Question 1 · Prioritization · MCQ
A nurse on a medical unit has received report on four clients. Which client should the nurse assess first?
- a.A client with pneumonia and a temperature of 101.2°F
- b.A client 1 day post-op who reports 6/10 incisional pain
- c.A client with COPD and an SpO2 of 86% on 2L oxygen
- d.A client with cellulitis awaiting IV antibiotics
Show answer + rationale
Correct: C. ABC principles: airway and breathing trump everything else. SpO2 of 86% on supplemental oxygen represents an acute oxygenation problem requiring immediate assessment. While the COPD client's baseline may be lower than 95%, 86% is dangerous and the trajectory matters. The other clients have problems that can be addressed in sequence after the unstable one is stabilized.
- Question 2 · Delegation · MCQ
Which task is most appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)?
- a.Assessing a new admission's pain level
- b.Teaching insulin injection technique
- c.Recording intake and output for a stable client
- d.Evaluating wound healing on a postoperative client
Show answer + rationale
Correct: C. Delegation rules: routine, predictable tasks for stable clients can go to UAP. Assessment, teaching, and evaluation are nursing process steps that require nursing judgment and cannot be delegated. I&O for a stable client is a measurable, repeatable task with no clinical judgment required.
- Question 3 · Triage · MCQ
In a mass casualty event, which client should the nurse triage as red (immediate)?
- a.An adult with a respiratory rate of 32 and active bleeding from the femoral artery
- b.A child with a closed fracture of the forearm
- c.An elderly adult with no pulse or respirations
- d.A teenager with superficial lacerations to the face
Show answer + rationale
Correct: A. START triage: red (immediate) = life-threatening but salvageable. Femoral arterial bleeding plus tachypnea is salvageable with rapid intervention. Black (expectant) = no pulse/respirations in mass casualty context. Yellow (delayed) = closed fractures. Green (minor/walking wounded) = superficial wounds.
- Question 4 · Prioritization · MCQ
A nurse is caring for four postoperative clients. Which client requires the most immediate intervention?
- a.Post-op day 1 hip replacement with hemoglobin 9.8 g/dL
- b.Post-op day 2 cholecystectomy with absent bowel sounds in all four quadrants
- c.Post-op day 0 thyroidectomy with stridor and difficulty swallowing
- d.Post-op day 3 hysterectomy with urine output of 35 mL/hr
Show answer + rationale
Correct: C. Stridor post-thyroidectomy signals airway compromise from hematoma or laryngeal edema — surgical emergency, ABC priority. Hgb 9.8 post-hip is anticipated. Absent bowel sounds on day 2 post-cholecystectomy is concerning but not immediately life-threatening. Urine output 35 mL/hr meets the 30 mL/hr minimum.
- Question 5 · Priority drug · MCQ
A nurse is preparing to administer four scheduled morning medications. Which should be given first?
- a.Levothyroxine 100 mcg PO to a client with hypothyroidism
- b.Furosemide 40 mg IV to a client with a potassium of 3.0 mEq/L
- c.Regular insulin 6 units subq to a client with glucose 142
- d.Metoprolol 25 mg PO to a client with a heart rate of 78
Show answer + rationale
Correct: C. Regular insulin acts in 30 minutes and the client needs coverage before breakfast — timing-critical. Levothyroxine should be held until labs are reviewed (or given but not first). Furosemide must be held: giving it with K+ of 3.0 will worsen hypokalemia — provider notification needed first. Metoprolol with HR 78 is acceptable but not urgent.
These are 5 of 5,000+ NCLEX questions in the Clarity bank. The full bank includes real NGN case studies, bow-tie items, AI tutor follow-up, and 5 readiness exams.
Get 5,000+ more questions free for 10/day →Frequently asked questions
Are NCLEX prioritization questions hard?
They're considered the hardest single item type because they're scored at the highest cognitive level (analyze and synthesize). Most failing students cite prioritization as their weakest category.
What's the ABC rule on the NCLEX?
Airway-Breathing-Circulation. When multiple clients need attention, assess the one whose airway, breathing, or circulation is most threatened first. Within ABCs, the actively deteriorating client outranks the chronically lower one.
What tasks can a nurse delegate to a UAP?
UAPs can perform routine, predictable tasks for stable clients: routine vital signs, ADLs, intake and output, ambulation, basic positioning, feeding (without swallow precautions). Never delegate assessment, teaching, evaluation, or care of an unstable client.
How many prioritization questions are on the NCLEX?
Management of care (which includes prioritization and delegation) makes up 15–21% of the NCLEX-RN — the largest single category, with roughly 11–30 items per test.
What's the difference between priority and first action?
Priority asks which client to see first; first action asks what to do for one specific client first. Priority questions use ABC and unstable-beats-stable rules. First-action questions use the nursing process (assess before intervene unless it's a clear emergency).