Chapter 5

Strategies for Priority Questions

One of the biggest challenges facing you as a candidate for practical/vocational nursing licensure is to correctly answer priority questions. You will recognize these questions because they will ask you what is the “best,” “most important,” “first,” or “initial” response by the nurse.

Take a look at this sample question.

1. An hour after admission to the nursery, the LPN/LVN observes a newborn having spontaneous, jerky limb movements. The newborn’s mother had gestational diabetes mellitus (GDM) during pregnancy. Which of the following actions should the LPN/LVN take first?
   1. Administer dextrose water.
   2. Call the primary health care provider immediately.
   3. Determine the blood glucose level.
   4. Observe the newborn for associated symptoms.

As you read this question you are probably thinking, “All of these look right!” or “How can I decide what I will do first?” The panic sets in as you try to decide what the best answer is when they all seem “correct.”

As a licensed practical/vocational nurse, you will be caring for clients who have multiple problems and needs. You must be able to establish priorities by deciding which needs take precedence over other needs. You probably recognized the newborn’s spontaneous, jerky limb movements as a sign of hypoglycemia. Don’t forget that an important part of the data collection process is validating what you observe. You must complete data collection before you plan and implement nursing care. The correct answer is (3).

The following situation might sound familiar: You are called to a client’s room by a family member and find the client lying on the floor. The client is bleeding from a wound on the forehead, and the indwelling urinary catheter is dislodged and hanging from the side of the bed. Where do you begin? Do you call for help? Do you return the client to bed? Do you apply pressure to the cut? Do you reinsert the catheter? Do you notify the primary health care provider? What do you do first? This is why establishing priorities is so important.

Your nursing faculty recognized the importance of teaching you how to establish priorities. They required you to establish priorities both in clinical situations and when answering test questions. These are the type of questions that practical/vocational nursing students find most controversial.

Here is an example of a nursing school test question:

1. Which of the following would most concern the LPN/LVN during a client’s recovery from surgery?
   1. Safety.
   2. Hemorrhage.
   3. Infection.
   4. Pain control.

A conversation in class with your instructor may then go something like this:

• Instructor: “The correct answer is (2).”
• Student: “Why isn’t infection the correct answer? It says right here [pointing to textbook] that infection is a major complication after surgery!”
• Instructor: “Yes, infection is an important concern after surgery. But, if the client has a life-threatening hemorrhage, then the fact that the wound is infected is immaterial.”
• Student: “But it says here on page 106 that infection is a major complication after surgery. You can’t count this answer wrong!”

In some situations, the faculty member will give you partial credit for your answer, or will “throw the question out” because there is more than one right answer. But you won’t get the opportunity to argue about questions on the NCLEX-PN^® exam. You either select the answer the test makers are looking for, or you get the question wrong. In the question given, all of the answers listed are important when caring for a postoperative client, but only one answer is the best.

The critical thinking required for priority questions is for you to recognize patterns in the answer choices. By recognizing these patterns, you will know which path you need to choose to correctly answer the question. This chapter will present several strategies to help you establish priorities on the NCLEX-PN^® exam:

• Maslow strategy
• Nursing process strategy
• Safety strategy

We will outline each strategy, describe how and when it should be used, and show you how to apply these strategies to exam-style questions. By using these strategies, you will be able to eliminate the second-best answer and correctly identify the highest priority.