Prioritization is the most common reasoning skill on the NCLEX. Practice deciding which client or action comes first, then check the rationale.
Which client should the nurse on a medical-surgical unit assess first?
Correct answer: C
A falling oxygen saturation in a client with pneumonia signals worsening gas exchange and needs immediate assessment. The others are stable.
Source: Lewis's Medical-Surgical Nursing, 13th ed. (prioritization)
Which client should the nurse assess first?
Correct answer: A
A cool, pale extremity with a weak pulse below a fracture suggests vascular compromise or compartment syndrome, which threatens the limb. The others are stable.
Source: Lewis's Medical-Surgical Nursing, 13th ed. (fracture complications)
A chemical splashes into a staff member's eye. What is the priority action?
Correct answer: C
Immediate, prolonged irrigation limits tissue damage. The safety data sheet guides follow-up care but should not delay flushing.
Source: OSHA 29 CFR 1910.151(c); ANSI Z358.1 Emergency Eyewash
Which client should the nurse on a postpartum unit see first?
Correct answer: C
Saturating a pad in 15 minutes indicates hemorrhage. Afterpains during breastfeeding and a firm fundus at the umbilicus are expected.
Source: ACOG. Practice Bulletin 183: Postpartum Hemorrhage
Fifteen minutes after a vaginal birth, the nurse finds a soft, boggy fundus and heavy bleeding. What should the nurse do first?
Correct answer: A
Uterine atony is the most common cause of postpartum hemorrhage. Fundal massage stimulates contraction and is the first step, followed by uterotonic drugs and calling for help.
Source: ACOG. Practice Bulletin 183: Postpartum Hemorrhage
The negative pressure wound therapy device alarms for an air leak. What should the nurse do first?
Correct answer: C
Most alarms come from breaks in the seal or tubing. Restoring the seal quickly maintains therapy. If therapy is interrupted for an extended time (often about 2 hours), the dressing is replaced per policy.
Source: Manufacturer guidance; WOCN Society NPWT recommendations
Four hours after surgery, a client's urine output has been 20 mL/hr for 2 hours. The client has no catheter and reports lower abdominal discomfort. What should the nurse do first?
Correct answer: A
Lower abdominal discomfort with low output after surgery suggests urinary retention. A bladder scan is a quick, noninvasive assessment that guides next steps such as straight catheterization per protocol.
Source: Lewis's Medical-Surgical Nursing, 13th ed. (urinary retention)
During a central line dressing change, the client suddenly becomes short of breath with chest pain. The nurse suspects an air embolism. What should the nurse do first?
Correct answer: A
Clamp the line to stop air entry and position the client left side down with the head lowered (if tolerated) to trap air in the right atrium. Give oxygen and notify the provider.
Source: INS. Infusion Therapy Standards of Practice, 9th ed. (air embolism)
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