How to answer priority questions?

Nothing sends pure fear down the spine of a nursing student quit like the priority questions . . . you know what I’m talking about:

Which patient would you see first?
What is the nurse's first priority?
What is the most important intervention?

Here are a few keywords you can expect to find in the stem of the question:

KEYWORDS:

Priority: Which patient is a priority? What is the nurses first priority?
Emergency: A patient arrives in the emergency room. . .
Ambulance: A patient arrives by ambulance. . .
Returning to the Floor: A nurse is caring for a patient after returning to floor. . .
Important: What’s the most important intervention?
See First: Which patient should the nurse see first?

Any variation of these words are a clue that the question is assessing your ability to prioritize as a nurse.

(A) Prioritizing and providing care for a variety of hospitalized clients.

FIRST LEVEL PRIORITY PROBLEMS:

1.Airway: No ventilation (Blocked airway: tongue, foreign body, vomit, secretions, bronchoconstriction)

2.Breathing: No/abnormal breathing or oxygenation (Respiratory efforts problems: distress, non breathing patients, abnormal breathing pattern, audible adventitious sounds, chest deformities)

3.Circulation: No circulation (absence of pulse, bleeding/hemorrhaging, Myocardial infarction, Angina)

4.Vital signs problem (abnormal v\s) or laboratory values that are life threatening

Note: Cardiac or circulation (first if cardiac arrest “follow CAB”)

SECOND LEVEL PRIORITY PROBLEMS:

1.Altered LOC

2.Acute pain (burst appendix, acute pancreatitis, burst ulcer)

3.Untreated medical problems (Safety, hyperglycemia, chronic pain, acute elimination issues, abnormal lab result, risk for infection).

Note: Last priority patients are discharge patients, needs teachings, or patients without problems “NORMAL”.

Here is a simple framework for you to follow:

(B) One of the basic guidelines to apply in nursing practice is the nursing process, which consists of five steps—assessment, nursing diagnosis, planning, intervention, and evaluation—usually completed in a systematic order. Many questions can be answered based on “assessment.” If a priority-setting question asks the test taker which step to implement first, the test taker should look for an answer that would assess for the problem discussed in the stem of the question.

When to Call the Doctor?

Okay, now we need to discuss when you should call the provider. One of the favorite traps is to give you a complex situation and then put “contact the provider” as an answer option. While this needs to be done (especially in complex settings) it might not always be the FIRST thing a nurse should do . . . Sooooo, how do you know when it is?

You can answer this by asking yourself a very simple question.

"Does the patient have an immediate/significant need that I need to address before leaving the room? (airway issue, hemorrhaging, fallen)"

Think about it this way. If a patient is struggling to breath, will leaving the room to call the provider be the FIRST thing you should do? Probably not.

There are immediate needs the patient has that YOU can address prior to calling the provider. You could raise the HOB, administer O2, taking the vital signs etc.

If you leave a patient alone that is having an airway problem you are putting them into immediate danger.

Does that make sense?

(C) Also follow Maslow's hierarchy of needs: (1. Physiologic, 2. Safety and security, 3. Belongingness and affection, 4. Esteem and self respect, 5. Self actualization).

Again, if you have four options (A, B, C, D) = Find the priority #1 then look for the least priority #4 and now decide who is #2 or #3.

Other things to consider and then finally decide: