NCLEX Priority and Sequencing Drills
Which client does the nurse see first
Airway, then breathing, then circulation. When every client is physiologically stable, drop to safety, then to psychosocial need. Read all four before you choose — the trap is a client who sounds dramatic next to one who is quietly deteriorating.
Which client needs the nurse first?
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A client with a peanut allergy who now has lip swelling and a hoarse voice
Lip swelling with a hoarse voice after allergen exposure is developing airway oedema. Airway beats everything.
Which client needs the nurse first?
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A client with a colostomy created yesterday whose stoma is dusky grey
A dusky stoma means compromised perfusion and possible necrosis. Everything else listed is expected.
Which client needs the nurse first?
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A client whose potassium is 6.8 mEq/L with peaked T waves
Hyperkalaemia with ECG changes is minutes away from a lethal dysrhythmia. Give calcium gluconate first.
Which client needs the nurse first?
Show answer and reasoning
A client with asthma whose wheezing has stopped but who cannot speak in full sentences
A silent chest with worsening distress means airflow is nearly absent. Quiet is not better in asthma.
Which client needs the nurse first?
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A client with a T4 spinal injury reporting a pounding headache with blood pressure 210/110
This is autonomic dysreflexia, which can cause stroke within minutes. Sit the client up and find the trigger.
Which client needs the nurse first?
Show answer and reasoning
A client three days after femoral fracture who is confused with a petechial chest rash and dyspnoea
Dyspnoea, confusion and a petechial rash after a long bone fracture is fat embolism syndrome.
Which client needs the nurse first?
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A client with a chest tube whose trachea has deviated and who is hypotensive
Tracheal deviation with hypotension is a tension pneumothorax needing immediate decompression.
Which client needs the nurse first?
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A client on chemotherapy with an ANC of 420 and a temperature of 38.3 C
Neutropenic fever is an emergency. Fever may be the only sign of infection the client can produce.
Which client needs the nurse first?
Show answer and reasoning
A client one day post-operative whose urine output has been 15 mL/hour for two hours
Output below 30 mL/hour signals inadequate perfusion and possible hypovolaemia or acute kidney injury.
Which client needs the nurse first?
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A client who states, "I have saved my tablets and I am taking them on Friday."
A specific plan with available means and a set time is the highest immediate risk and needs one-to-one observation.
Which client needs the nurse first?
Show answer and reasoning
A newborn who is 6 hours old with visible jaundice of the face and sclera
Jaundice within the first 24 hours is always pathological and usually indicates haemolysis.
Which client needs the nurse first?
Show answer and reasoning
A client 30 hours after their last drink who is tremulous, tachycardic and seeing insects on the wall
Alcohol withdrawal at this stage can progress to seizures and delirium tremens, which carry real mortality.
Put the steps in order
Cover the answer, write the sequence out, then compare. Ordering items are marked as a whole in most formats, so a single transposed step costs the entire mark — it is worth being slow here.
1. Applying personal protective equipment
- Perform hand hygiene
- Put on the gown
- Put on the mask
- Put on goggles or face shield
- Put on gloves over the gown cuffs
Gloves last so they cover the gown cuffs and are the dirtiest item on the outside.
2. Removing personal protective equipment
- Remove gloves
- Remove goggles or face shield
- Remove the gown
- Remove the mask
- Perform hand hygiene
Dirtiest first. The mask is removed last, ideally outside the room.
3. Responding to a fire in a client’s room
- Rescue the client from immediate danger
- Activate the fire alarm
- Confine the fire by closing the door
- Extinguish or evacuate as appropriate
RACE: Rescue, Alarm, Confine, Extinguish or Evacuate.
4. Responding to a suspected transfusion reaction
- Stop the transfusion
- Start normal saline through new tubing
- Assess vital signs and stay with the client
- Notify the provider and blood bank
- Return the bag and tubing to the laboratory
Stop, saline, stay, notify, return.
5. Mixing regular and NPH insulin in one syringe
- Inject air into the NPH vial without touching the solution
- Inject air into the regular insulin vial
- Withdraw the regular insulin dose
- Withdraw the NPH insulin dose
Air into cloudy, air into clear, draw clear, draw cloudy.
6. Managing an umbilical cord prolapse
- Lift the presenting part off the cord with a gloved hand
- Call for immediate assistance
- Position the client knee-chest or in Trendelenburg
- Administer oxygen by non-rebreather mask
- Prepare for emergency birth
Relieving cord compression restores fetal oxygenation immediately.
7. Responding to autonomic dysreflexia
- Raise the head of the bed to a sitting position
- Check for a distended bladder or kinked catheter
- Check for a bowel impaction and loosen tight clothing
- Notify the provider and give a prescribed antihypertensive if needed
Sit them up first using gravity, then hunt for the trigger.
8. Administering a subcutaneous injection
- Perform hand hygiene and verify the medication
- Select and clean the site
- Pinch a skin fold and insert at 45 to 90 degrees
- Inject the medication steadily
- Withdraw the needle and engage the safety device
- Dispose in the sharps container at the point of use
Never recap; dispose at the point of use.
9. Suctioning a tracheostomy
- Perform hand hygiene and don personal protective equipment
- Hyperoxygenate the client
- Insert the catheter without applying suction
- Apply suction only while withdrawing, for up to 10 seconds
- Allow the client to recover and reoxygenate before the next pass
Suctioning removes oxygen as well as secretions, so passes are short and spaced.
10. Managing an evisceration
- Stay with the client and call for help
- Cover the wound with sterile saline-soaked gauze
- Position the client supine with knees flexed
- Keep the client nil by mouth
- Monitor for signs of shock while awaiting the surgeon
Never attempt to replace eviscerated tissue.
11. Treating symptomatic hypoglycaemia in a conscious client
- Check the blood glucose
- Give 15 grams of fast-acting carbohydrate
- Wait 15 minutes and recheck the glucose
- Repeat the carbohydrate if still below target
- Provide a complex carbohydrate with protein once stable
The rule of 15, followed by a snack that sustains the correction.
12. De-escalating an agitated client
- Use a calm voice at a safe distance and offer choices
- Reduce environmental stimulation and move others away
- Offer a prescribed as-needed medication
- Initiate seclusion or restraint only if safety requires it
Least restrictive intervention first, escalating only as needed.
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