Prioritization and triage questions — deciding who to see first and what to do first — are among the most common and most challenging on the NCLEX. Work through these 10 practice questions on the ABCs, Maslow, expected vs. unexpected findings, recognizing deterioration, and START disaster triage, each with a full rationale.
Prioritization & Triage: Frameworks That Decide Who Comes First
Prioritization questions ask "who or what comes first," and a small set of frameworks resolves most of them. Start with the ABCs: airway before breathing before circulation. Then apply Maslow, physiologic needs before safety and security, and both before psychosocial needs. When two clients seem equally physiologic, choose the one who is acute or unstable over the one who is chronic or stable, the actual problem over the potential or at-risk problem, and the unexpected finding over the expected finding. A client with normal post-op pain, expected serosanguineous drainage, or a low-grade fever the day after surgery is stable; a client with sudden dyspnea, a cool pulseless limb, chest pain, or a falling level of consciousness is deteriorating and is seen first.
Recognize the deteriorating client by change and trend, not by a single number. New or worsening symptoms, vital signs trending the wrong way (a blood pressure sliding from 128/78 to 88/50), a weakening pulse, rising respiratory rate, or a declining level of consciousness all signal instability. On "first action" items, act on the physiologic problem yourself (reposition the airway, raise the head of the bed, apply oxygen) before you notify the provider or document, because those steps do not treat the patient.
Disaster and mass-casualty triage inverts everyday logic. Using START, the goal shifts from "sickest first" to the greatest good for the greatest number. Assess in order: can the patient walk (GREEN/minor)? Respirations, absent after repositioning the airway is BLACK/expectant, over 30/min is RED/immediate. Perfusion, absent radial pulse or capillary refill over 2 seconds is RED. Mental status, cannot follow simple commands is RED. RED means life-threatening but salvageable with a quick airway, breathing, or circulation fix. BLACK means dead or unsalvageable given available resources, which is the opposite of daily care where the near-dead are treated first.
Prioritization & Triage NCLEX Practice Questions
Question 1 · Which patient first (ABCs)
A nurse begins the shift with four assigned clients. Which client should the nurse assess first?
- A A postoperative client rating incisional pain 6 on a 0-to-10 scale
- B A client with a fractured femur reporting itching under the cast
- C A client with pneumonia whose oxygen saturation dropped from 94% to 86% on room air
- D A newly admitted client with type 2 diabetes and a fasting glucose of 140 mg/dL
Show answer & rationale
Correct answer: C
Apply the ABCs: airway and breathing outrank everything else. The client with pneumonia whose oxygen saturation fell from 94% to 86% has a breathing problem that is both unexpected and trending downward, signaling deterioration and possible hypoxemia. This client is assessed first so the nurse can reposition, apply oxygen, and evaluate work of breathing. The postoperative client with pain of 6/10 has an expected finding; incisional pain is anticipated after surgery and, while it deserves treatment, it is not life-threatening and does not outrank an airway or breathing concern. Itching under a cast is a common, expected complaint with an intact fracture; it is a comfort issue, not a circulatory emergency (the nurse would only worry if there were signs of neurovascular compromise such as absent pulse, pallor, or paresthesia). A fasting glucose of 140 mg/dL in a newly admitted client with type 2 diabetes is mildly elevated but expected and stable; it warrants routine follow-up, not urgent assessment. Clinical pearl: when comparing clients, rank a falling oxygen saturation or any downward-trending vital sign above expected postoperative discomfort. Change plus the wrong direction equals instability. Remember the sequence airway, breathing, circulation, then Maslow physiologic needs, then acute-over-chronic and unexpected-over-expected. A number that is drifting away from normal beats a number that is merely abnormal but stable.
Question 2 · First nursing action
A postoperative client suddenly develops shortness of breath, and the pulse oximeter reads 88% on room air. Which action should the nurse take first?
- A Raise the head of the bed and apply supplemental oxygen
- B Notify the surgeon of the client's sudden change in status
- C Document the finding and reassess the client in 30 minutes
- D Administer the ordered PRN antianxiety medication
Show answer & rationale
Correct answer: A
On a 'first action' item, do something that directly treats the physiologic problem before you communicate or document. Raising the head of the bed improves lung expansion and diaphragmatic excursion, and applying oxygen directly addresses the hypoxemia causing the 88% saturation and the dyspnea. These are immediate bedside interventions to stabilize breathing (repositioning is fully independent; emergency oxygen is nurse-initiated under protocol). Notifying the surgeon is important and will happen quickly, but it does not raise the oxygen level; the nurse should intervene first, then report with useful data such as the response to oxygen. Documenting and waiting 30 minutes is unsafe, delaying care for a client who is actively deteriorating; documentation follows action, it never replaces it. Giving an antianxiety medication treats a symptom the nurse has assumed rather than the confirmed problem, and sedation could further depress respiratory drive in a hypoxic client, potentially worsening the situation. Clinical pearl: when a client is decompensating, assess and intervene at the bedside first, then notify, then document. For sudden dyspnea, think reposition (high Fowler's) and oxygenate before anything else. Reassess the saturation after these steps; if it does not improve, escalate promptly. This reflects current standards that place airway and breathing support, the nurse's immediate bedside interventions, ahead of provider notification and charting.
Question 3 · Multi-patient prioritization (SATA)
A nurse receives handoff report on several clients. Select all clients who require immediate assessment.
- A A client one day postoperative with pain of 5 on a 0-to-10 scale that is relieved by medication
- B A client with COPD who has a respiratory rate of 28, is using accessory muscles, and is newly confused
- C A client whose scheduled dressing change is due this hour
- D A client with a reported serum potassium of 6.8 mEq/L
- E A client awaiting routine discharge paperwork
- F A client whose telemetry now shows new-onset third-degree (complete) heart block
Show answer & rationale
Correct answer: B, D, F
Immediate assessment goes to clients who are unstable, have unexpected findings, or show dangerous trends. The COPD client with a respiratory rate of 28, accessory muscle use, and new confusion is showing a breathing problem plus a falling level of consciousness, an early sign of hypoxemia or hypercapnia and impending respiratory failure. New-onset third-degree heart block is a life-threatening dysrhythmia in which the atria and ventricles beat independently; it can cause hemodynamic collapse and may require pacing, so it demands immediate evaluation. A potassium of 6.8 mEq/L is critically high (normal 3.5 to 5.0); severe hyperkalemia risks lethal dysrhythmias and needs urgent assessment, an ECG, and treatment. The postoperative client with pain of 5/10 relieved by medication has an expected, controlled finding, not an emergency. A scheduled dressing change and routine discharge paperwork are planned, stable tasks that can wait. Clinical pearl: scan report for the words new, sudden, changing, or a critical lab value, those flag the clients to see first. Both a new dysrhythmia and a critical potassium tie together, because severe hyperkalemia is a common cause of peaked T waves and fatal rhythms. Stable, expected, and scheduled items are deprioritized behind any client who is actively unstable.
Question 4 · Disaster triage (START)
During a mass-casualty incident using the START triage system, a responder finds a victim who is not breathing even after the airway is repositioned. Which triage tag should the responder assign?
- A Red / immediate
- B Yellow / delayed
- C Green / minor
- D Black / expectant
Show answer & rationale
Correct answer: D
In START (Simple Triage And Rapid Treatment), the first respiratory check is decisive: if a victim is apneic and does NOT begin breathing after a single airway repositioning maneuver, the victim is tagged Black/expectant. This is the deliberate inversion of everyday care. In daily practice this near-dead patient would receive the most aggressive resuscitation, but in a mass-casualty event the goal shifts to the greatest good for the greatest number, so resources are not spent on someone unlikely to survive when others are salvageable. Red/immediate is wrong here; Red is reserved for a life-threatening but correctable problem such as respirations over 30/min, absent radial pulse or capillary refill over 2 seconds, or inability to follow simple commands, a victim who breathes only after repositioning would be Red, but this victim does not breathe at all. Yellow/delayed applies to serious injuries that can wait, such as a stable fracture in a victim who follows commands. Green/minor is the walking wounded, which this apneic victim clearly is not. Clinical pearl: in START the ONLY reason to open an airway is to see if breathing resumes; there are no rescue breaths and no CPR during triage. Memory aid, RPM: Respirations, Perfusion, Mental status. Apnea after repositioning stops the algorithm at R with a Black tag, the opposite of sickest-first daily triage.
Question 5 · Disaster triage RED tags (SATA)
A nurse is triaging victims at a mass-casualty scene using the START system. Select all victims who should be tagged Red (immediate).
- A A victim walking around the scene with a laceration to the forearm
- B A victim who is breathing 20/min but has no palpable radial pulse and capillary refill of 4 seconds
- C A victim with a respiratory rate of 36/min
- D A victim who remains apneic after the airway is repositioned
- E A victim who is breathing but cannot follow the simple command to squeeze the responder's hand
- F A victim with a closed femur fracture, respirations 18/min, a present radial pulse, who follows commands
Show answer & rationale
Correct answer: B, C, E
START tags a victim Red/immediate for any single life-threatening but salvageable problem in respirations, perfusion, or mental status. A respiratory rate of 36/min exceeds 30 and signals respiratory distress, that is Red. A victim breathing at 20/min but with no radial pulse and capillary refill of 4 seconds has a perfusion deficit (absent radial pulse or refill over 2 seconds), also Red. A victim who is breathing but cannot follow the simple command to squeeze a hand fails the mental-status check and is Red. Each of these is correctable with rapid intervention such as positioning, hemorrhage control, or airway support. The walking victim with a forearm laceration is the classic walking wounded, tagged Green/minor, and would be directed away from the immediate area. The victim with a closed femur fracture who breathes at 18/min, has a radial pulse, and follows commands is serious but stable and can wait, tagged Yellow/delayed. The victim who stays apneic after airway repositioning is Black/expectant, not Red, because breathing did not return. Clinical pearl, RPM thresholds for Red: Respirations over 30, Perfusion with no radial pulse or cap refill over 2 seconds, or Mental status that cannot follow commands. Green is 'can walk,' Yellow is serious-but-stable, Black is apneic after repositioning. Do not upgrade Green or Yellow victims, and do not spend immediate resources on Black.
Question 6 · Expected vs. unexpected finding
A nurse is caring for four clients. Which client should the nurse assess first?
- A A client receiving a blood transfusion who reports new low back pain and chills
- B A client two hours after a laparoscopic cholecystectomy with scant serosanguineous drainage
- C A client with a chest tube showing tidaling in the water-seal chamber
- D A client one day postoperative with an oral temperature of 99.8 degrees Fahrenheit
Show answer & rationale
Correct answer: A
Prioritize the unexpected finding over expected ones. New low back pain and chills during a blood transfusion are classic early signs of an acute hemolytic transfusion reaction, a life-threatening emergency. This client is assessed first, and the nurse's priority action is to stop the transfusion immediately, keep the line open with normal saline, and notify the provider and blood bank. The other three clients all show expected findings. Scant serosanguineous (pink, thin) drainage two hours after a laparoscopic cholecystectomy is normal early postoperative drainage, not hemorrhage. Tidaling, the gentle rise and fall of fluid in the water-seal chamber with respiration, is an expected and reassuring sign that a chest tube system is patent and functioning; its absence (not its presence) would be concerning. An oral temperature of 99.8 degrees Fahrenheit one day after surgery reflects the expected mild inflammatory response and is low-grade; it warrants monitoring, not urgent intervention. Clinical pearl: memorize that back pain, chills, fever, flank pain, and dark urine during a transfusion mean STOP the blood, hemolytic reactions can occur within minutes and become fatal. When a question mixes anticipated postoperative findings with one abnormal, sudden symptom, the sudden symptom is your client. Expected drainage, expected tidaling, and a low-grade postoperative temperature are all stable; a possible transfusion reaction is not.
Question 7 · Maslow prioritization
A nurse must decide which client to see first. Which client should the nurse prioritize?
- A A client scheduled for discharge teaching on home medications within the hour
- B A client who is tearful and requesting to speak with the hospital chaplain
- C A client with new-onset shortness of breath and an oxygen saturation of 89%
- D A client asking the nurse for assistance setting up and completing a meal tray
Show answer & rationale
Correct answer: C
Maslow's hierarchy and the ABCs converge on the same answer: physiologic needs, especially airway and breathing, come before safety, love and belonging, esteem, and self-actualization. The client with new-onset shortness of breath and an oxygen saturation of 89% has an acute breathing problem and is hypoxemic; this is the highest-priority physiologic emergency and must be seen first for repositioning, oxygen, and assessment. Discharge teaching is important but is a scheduled educational need that can safely wait while the unstable client is managed. A request to speak with the chaplain addresses spiritual and psychosocial needs; these matter deeply but rank below physiologic threats, and the nurse can arrange it after stabilizing the unstable client. Assistance with a meal tray is a lower-level physiologic and comfort need, but eating is not urgent and can be delegated to assistive personnel; it does not outrank active respiratory distress. Clinical pearl: when answer choices mix a psychosocial or teaching need with a physiologic one, the physiologic need usually wins, and among physiologic needs, airway and breathing top the list. Ask, 'Which client could deteriorate or die soonest if I do not act?' New dyspnea with a saturation of 89% is that client. Delegable, scheduled, and psychosocial tasks are addressed once the airway and breathing emergency is managed.
Question 8 · Recognizing deterioration (SATA)
A nurse is monitoring a client for signs of deterioration. Select all findings that indicate the client is deteriorating and needs immediate intervention.
- A A blood pressure that has trended from 128/78 to 88/50 mmHg
- B A pain rating that decreased from 8 to 3 on a 0-to-10 scale after medication
- C A respiratory rate that has increased from 16 to 32 breaths per minute
- D New-onset chest pain radiating to the jaw
- E A gradual decrease in level of consciousness
- F A pulse that has become weak, thready, and difficult to palpate
Show answer & rationale
Correct answer: A, C, D, E, F
Deterioration is recognized by change and trend across the ABCs and neurologic status. A gradual decrease in level of consciousness is an early, ominous sign of inadequate cerebral perfusion or oxygenation and demands immediate action. New-onset chest pain radiating to the jaw suggests myocardial ischemia, a circulatory emergency. A blood pressure trending downward from 128/78 to 88/50 shows evolving hypotension and possible shock, the direction of change is the red flag, not just the single value. A weak, thready pulse that is becoming difficult to palpate reflects falling cardiac output and poor perfusion. A respiratory rate climbing from 16 to 32 signals respiratory distress or compensation for a worsening problem. The one finding that is NOT deterioration is the pain rating that dropped from 8 to 3 after medication; that is an expected, positive response showing the intervention worked, so it needs no urgent action. Clinical pearl: trend beats snapshot. Two normal-looking numbers can hide danger if they are moving the wrong way, so always compare current values to the prior ones. Watch the pattern of a rising respiratory rate, a falling blood pressure, a weakening pulse, and a declining level of consciousness, together these describe a client sliding toward shock or arrest and warrant rapid assessment and escalation.
Question 9 · START algorithm logic
During a mass-casualty incident using START triage, a responder assesses a victim who is not able to walk, is breathing 24 breaths per minute, has a present radial pulse, but cannot follow the simple command to open both eyes. Which triage tag is correct?
- A Yellow / delayed
- B Green / minor
- C Black / expectant
- D Red / immediate
Show answer & rationale
Correct answer: D
Work the START algorithm in order using RPM: Respirations, Perfusion, Mental status. This victim cannot walk, so is not automatically Green. Respirations are 24/min, which is under 30, so the victim passes the respiratory check. Perfusion is adequate because a radial pulse is present and (implied) capillary refill is acceptable, so the victim passes the perfusion check. The algorithm then moves to mental status: the victim cannot follow the simple command to open both eyes. Failure of the mental-status check makes the victim Red/immediate, because altered mental status with intact breathing and perfusion signals a serious, potentially correctable problem such as a head injury or hypoxia that needs prompt intervention. Yellow/delayed is wrong; Yellow is for serious injuries in victims who DO follow commands and are otherwise stable. Green/minor is wrong because the victim cannot walk and cannot follow commands, so is not the walking wounded. Black/expectant is wrong because the victim is breathing and perfusing; Black is reserved for those who remain apneic after airway repositioning. Clinical pearl: in START, any ONE failed RPM parameter, respirations over 30, no radial pulse or capillary refill over 2 seconds, OR inability to follow commands, sends the victim straight to Red. You do not need all three to fail. Here, normal respirations and perfusion still yield Red because mental status failed.
Question 10 · Acute/unstable over chronic/stable
A nurse is assigned four clients at the start of the shift. Which client should the nurse assess first?
- A A client with type 1 diabetes whose blood glucose is 130 mg/dL before lunch
- B A client with a heart rate of 38 beats per minute who reports dizziness and near-syncope
- C A client two days postoperative who is ambulating in the hallway without difficulty
- D A client with stable angina requesting a scheduled pain reassessment
Show answer & rationale
Correct answer: B
Choose the acute, unstable client over the chronic or stable ones. A heart rate of 38 beats per minute with dizziness and near-syncope is symptomatic bradycardia, a circulatory emergency; the low rate is reducing cardiac output and cerebral perfusion, and the client is at risk for loss of consciousness or arrest. Per current ACLS-aligned practice, symptomatic bradycardia requires immediate assessment and may need atropine or transcutaneous pacing, so this client is seen first. A pre-lunch blood glucose of 130 mg/dL in a client with type 1 diabetes is essentially within an acceptable range and stable; it needs routine attention, not urgency. A client two days postoperative ambulating without difficulty is demonstrating expected, reassuring recovery and is stable. A client with stable angina requesting a scheduled pain reassessment has a chronic, controlled condition and a planned, non-urgent task; 'stable' in the description signals lower priority. Clinical pearl: the difference between stable and symptomatic bradycardia is the presence of hypoperfusion signs, dizziness, near-syncope, hypotension, chest pain, or altered mental status. A slow rate the client tolerates without symptoms is far less urgent than one causing symptoms. When a question pairs an unstable vital sign accompanied by symptoms against chronic, stable, or expected findings, the symptomatic and unstable client is always assessed first.
Want more practice questions? Create a free NCLEX Key account — NCLEX-style questions with a full rationale on every answer. No credit card.
Start practicing free →
Prioritization & Triage FAQ
What order do I use to decide which patient to see first on the NCLEX?
Work through the frameworks in order. First the ABCs: airway before breathing before circulation. Then Maslow: physiologic needs before safety, then psychosocial. Then tie-breakers: acute or unstable over chronic or stable, actual over potential problems, and unexpected findings over expected ones. The client whose condition is changing, trending the wrong way, or unanticipated is almost always the one to see first.
How is disaster triage different from everyday prioritization?
Everyday care is sickest-first: the most unstable client gets the most resources. Mass-casualty triage using START flips this to serve the greatest good for the greatest number. A victim who is apneic after the airway is repositioned is tagged Black/expectant rather than resuscitated, because limited resources go to salvageable victims. Red/immediate is reserved for life-threatening but correctable airway, breathing, or circulation problems.
What do the START triage colors mean?
Green/minor is the walking wounded. Yellow/delayed is seriously injured but stable enough to wait. Red/immediate is a life-threatening but salvageable problem, respirations over 30/min, no radial pulse or capillary refill over 2 seconds, or inability to follow simple commands. Black/expectant is dead or apneic after airway repositioning, or injuries incompatible with survival given available resources. Remember RPM: Respirations, Perfusion, Mental status.
Why is an expected finding lower priority than an unexpected one?
Expected findings, such as normal post-op incisional pain, scant serosanguineous drainage, tidaling in a chest-tube water seal, or a low-grade fever the day after surgery, are anticipated parts of recovery and signal stability. An unexpected finding, such as sudden dyspnea, new chest pain, a cool pulseless limb, or a falling level of consciousness, may signal deterioration. On prioritization questions, the surprising or new finding usually identifies the client you assess first.