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How to Use Prioritization in Exam Questions

List of Prioritizes and Exam
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Prioritizing patient care is a key skill that nurses utilize when having to balance patient care demands. Nursing exams will test students on prioritization to analyze whether they can recognize patients requiring more urgent care. Prioritization can be categorized into first priority, second priority and third priority. On a nursing exam, a patient experiencing a first priority issue must be attended to first. These issues include a patient experiencing ABC difficulties; airway, breathing and circulation. After these patients are managed, or if none of the patients are experiencing ABC issues, patients experiencing second priority problems are the next focus. Patients with altered LOC, sepsis, acute pain and untreated medical problems fall into the second category. Finally, after all the patients experiencing health issues are cared for, the nurse can focus on third priority questions. Third priority questions include patients requiring education, help understanding and dealing with feelings, and any patients waiting to be discharged. Maslow’s Hierarchy of Needs can be remembered as a test-taking strategy to help remember the different priority categories and how to prioritize patients in exam questions.             
11 KEY FACTS
PRIORITIZE FIRST
Airway
Airway

Airway should be your first priority. If the patient is unable to ventilate, they will not live. Signs of airway obstruction to look for in an exam question include paradoxical chest and abdomen movement, blue or mottled skin, and expiratory wheezing or gurgling.

Breathing
Breathing

Breathing function should be assessed after the airway is managed. Assessment of breathing is intended to identify signs of respiratory difficulty or poor ventilation. In an exam question, look for general signs of respiratory distress such as abdominal breathing, central cyanosis, shallow and rapid breathing and unequal chest movement.

Circulation
Circulation-symbol

Circulation should be assessed after the airway and breathing have been evaluated and managed. Some of the causes of poor circulation include shock, heart failure, and pulmonary embolism. Signs to look for in an exam are low blood pressure, cold peripheral skin temperature, and poor capillary refill.

PRIORITIZE SECOND
Change in LOC (Altered Mental Status)
Delta Halo

Altered level of consciousness (LOC) is considered a patient safety concern and is prioritized if ABC’s are not a concern. A patient with altered LOC should receive a more in-depth assessment. The patient is at risk for falls and may hurt themselves. Further investigation of LOC may indicate a brain injury, narcotic use, or hypoglycemia. Altered LOC can lead to issues with ABC’s if not managed.

Sepsis
Sepsis-snake

Sepsis is next on the priority list. Sepsis can cause confusion, breathing changes, and elevated heart rate. It is important to manage sepsis because it can lead to additional health issues.

Acute Pain
Acute-angle Pain-bolt

Acute pain is next on the prioritization list. Pain is a low priority because it is manageable, and the discomfort can be tolerated. The patient will not die from the pain.

Untreated Medical Problems
Unsolved Medical Problem-cube

The next prioritization is untreated medical problems. On an exam, these may include diabetic needing insulin, abnormal pathology lab results, and risks of infection.

PRIORITIZE THIRD
Education
Educator

Education is prioritized after all of the health concerns are handled. Education is important, but postponed education will not directly deteriorate a patient's health.

Feelings
Feelings Chart

A patient’s feelings are important when it comes to overall health. However, feelings can wait until more critical problems are managed.

Patient Waiting to be Discharged
Patient Waiting

A patient waiting to be discharged is the last priority. The patient may become irritated and impatient about waiting but patient’s with health concerns are a more important priority.

TEST-TAKING STRATEGIES
Maslow’s Hierarchy of Needs
Marshmallow's Hierarchical-pyramid of Needs

Maslow’s hierarchy of needs can help prioritize questions on an exam. For ABC’s think physiological/basic human needs, for altered LOC and sepsis think safety and security because altered LOC and sepsis can lead to confusion/safety issues, for acute pain and untreated medical problems think love and belonging because love and affection goes into helping people with pain and untreated medical problems, for education and feelings think esteem because esteem needs deal with achievement and respect, and for a patient waiting to be discharged, think self-actualization and reaching one’s full “health” potential.

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