NCLEX-RN Study Guide
NCLEX Prioritization: ABCs, Maslow, and Nursing Process Made Simple
By the NCLEX Up Team
6 min read · Reviewed for accuracy · Updated June 9, 2026
'Which patient should the nurse see first?' is one of the most common — and most missed — NCLEX question styles. These rarely test a fact; they test judgment. A few simple frameworks make them far more answerable.
The frameworks, in priority order
1. ABCs — Airway, Breathing, Circulation
When problems or patients compete, the one with a threat to airway comes first, then breathing, then circulation. A patient who can't maintain their airway outranks almost everything else.
2. Maslow's hierarchy
After life-threatening ABC issues, physiological needs — oxygen, fluids, nutrition, elimination, pain — come before psychosocial needs like safety, belonging, and self-esteem. Physical before emotional, but never ignore safety.
3. Safety and risk
Protect the patient from harm: falls, injury, infection, medication errors. Safety often decides between two patients who are otherwise physiologically stable.
4. The nursing process (ADPIE) — assess first
When the answer options are actions, assessment usually comes before intervention — you can't act correctly on incomplete data. The exception is a true emergency (for example, a patient with no pulse), where you act first.
Quick rule of thumb: acute beats chronic, unstable beats stable, unexpected beats expected, and a new problem beats a long-standing one.
A step-by-step approach to priority questions
- 1Identify what each option really is — a patient, an action, or a finding.
- 2Ask: is anyone's airway, breathing, or circulation threatened?
- 3If it's tied, who is least stable, most acute, or has the newest or most unexpected change?
- 4If the options are actions, decide: assess or act? Assess first unless it's an emergency.
- 5Choose the answer that protects life and safety soonest.
Watch the wording
- 'First,' 'priority,' 'most important,' 'initial' → rank them and pick the top one.
- 'Which patient is most stable / can be delegated' → flip it: you want the safest, most predictable one.
- Expected findings are usually NOT the answer to 'who do you see first.'
How to get good at these
Prioritization is a skill you build with reps, not memorization. Practice lots of 'who do you see first' and 'what is the priority action' questions, and read the rationale each time to see the reasoning — that's how the pattern becomes automatic on test day.
Drill prioritization and 'who do you see first' questions
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This article is for study purposes only and is not medical advice. NCLEX Up is not affiliated with the NCSBN or the NCLEX. Always verify exam details with the official NCSBN candidate bulletin and confirm clinical values with your nursing program.
Frequently asked questions
What comes first on NCLEX priority questions, ABCs or Maslow?
ABCs come first. Airway, breathing, and circulation are immediate life threats and outrank other physiological and psychosocial needs. Use Maslow to prioritize once ABC threats are ruled out.
When do you assess instead of act on the NCLEX?
When the answer options are nursing actions and there's no immediate emergency, assessment usually comes first — you need data before intervening. In a true emergency, such as a patient with no pulse, you act immediately.