Using Prioritization to Pass the NCLEX

Congratulations! You’ve graduated from nursing school! That’s a HUGE accomplishment. Now, the real work starts; you have to pass the NCLEX! Preferably, you pass it in 75 questions with no tears. The NCLEX is particularly challenging because despite you being an expert on all things nursing and healthcare if you don’t know how to answer the questions, you will face challenges. Perhaps the most important skill a nurse can have is prioritization. Which patient should you see first? Which medication must the patient receive immediately?

The NCLEX requires you to prioritize on nearly every question. Hopefully, your nursing program facilitated this type of critical thinking. The most excruciating statement a nursing student can hear after a test is, “Sure, that answer is correct, but this other answer is more correct.” In general, for a multiple choice question on the NCLEX, you will have one correct answer, one slightly less appropriate answer, and two that can be ruled out quickly. Other times, every single one of the distractors is appropriate for the patient, but one is most appropriate. How do you know the difference? Prioritization.

Clinical experience and lessons learned as a patient care technician can trip you up when using prioritization to answer NCLEX questions. The NCLEX hospital is unlike any other hospital in the world. Real-life hospitals wait for no one, are always understaffed, and have limited equipment. Conversely, in the NCLEX hospital, you, the nurse, will likely be the only nurse around but have access to all the unlicensed assistive personnel, equipment, and time you need to properly care for your patients. Keep these facts in mind when answering NCLEX questions. Only use information that is written in the question; don’t add information based on your experience.

Your first step when answering an NCLEX question is to ask yourself – “What do the exam writers want?” Is the patient’s problem related to his or her airway, breathing, and/or circulation? If that doesn’t help, consider Maslow’s Hierarchy of Needs. Are the patient’s physiological needs being met?

Here’s an example:

The nurse is planning care for a 68-year-old patient who underwent mandibular resection and tracheostomy two hours ago for throat cancer that had metastasized to his jaw. Which intervention is most important for this patient?

A. Administer scheduled intravenous pain medication as ordered
B. Place sequential compression devices (SCDs) on the patient’s legs
C. Arrange a meeting with a tracheostomy support group representative
D. Ensure tracheal suction catheters are present at the patient’s bedside

Clearly, at some point, the nurse should perform each of these interventions for the patient. A patient who has undergone surgery and has a new tracheostomy is at risk for significant pain, deep venous thrombosis due to immobility, ineffective airway clearance due to a new airway, and altered personal identity due to the tracheostomy. But what must be done first? Maintaining a patent airway is the most important patient need – without a patent airway, none of the other interventions are helpful because the patient would be dead. Therefore, the nurse should ensure he or she has adequate tools to maintain the patient’s airway, like suction catheters. After the suction catheters are obtained, the other patient needs can be addressed. This is where NCLEX hospitals and real-life hospitals differ. You’re probably saying, “How stupid! Obviously, I would do all those things at once, or delegate tasks to ensure all are done at once.” In the NCLEX hospital, however, you can only do one thing at a time. Horribly inefficient, but that’s the truth.

When studying for the NCLEX, the best method is to answer as many practice questions as possible. The NCLEX is stressful; exposing yourself to these questions over and over again will increase your familiarity with how NCLEX questions are written and must be answered. Despite being exhaustingly stressful, it’s important to remember that the vast majority of first-time testers pass the NCLEX on the first try – nearly 90%! It can be done, you just have to be willing to put in the work.

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