NCLEX Priority Questions: 5 Rules to Pick the Right Answer

Priority questions are the ones students fear most: four options that all look reasonable, and you must choose what comes first. The trick is to stop guessing and use the same order of rules every time. Here are the first five rules I teach.

Rule 1: Read the last line first

The last line is the real question. Read it before the story so you know what you are hunting for. “Which finding needs immediate follow-up?” tells you to look for something abnormal and dangerous, not something normal.

Rule 2: Positive or negative?

Decide whether you are looking for a correct action or a wrong one. “Which statement shows a need for further teaching?” is a negative question: you are hunting the mistake. For a client on warfarin, the answer would be the statement “I take aspirin for my headaches.”

Rule 3: Find the key problem in one line

Strip the story down. “Day 2 after hip replacement, sudden chest pain and shortness of breath” becomes: post-op client with a possible pulmonary embolism. Now every option is judged against that one line.

Rule 4: Keep, eliminate or not sure

Judge each option on its own. Sure it is right: keep. Sure it is wrong: eliminate. Not sure: keep it for now. One option left is your answer. Two left means you move to the priority tools.

Rule 5: The killer option first

Ask: who is going to die right now if I do nothing? A stable client with a slightly high glucose can wait. A client with new noisy breathing (stridor) after thyroid surgery cannot, because the airway is at risk. See that client first.

Get all 10 rules free

I’ve put all ten rules, each with a quick example, into a free 4-page guide. Download the 10 NCLEX Priority Rules from our homepage.

The examples on this page are written for teaching and are not real exam questions.