Nursing is both an art and a science, requiring quick decision-making, clinical reasoning, and prioritization of patient needs. In both exams like NCLEX, HAAD, DHA, or Indian Nursing Council tests and in real-life hospital practice, nurses are often faced with questions such as:
- What is the most important action?
- What should be done first?
- What is the initial response?
These are known as priority questions. They test not just knowledge but also the ability to think critically under pressure. To answer them correctly, nurses must apply two essential frameworks:
- The ABCs: Airway, Breathing, Circulation
- Maslow’s Hierarchy of Needs
Together, these tools provide a systematic method to ensure patient safety and effective care delivery.
Understanding the ABCs in Nursing
The ABCs are a universal rule for clinical priorities. Before considering pain, comfort, or psychological needs, a nurse must ask:
- Airway (A) – Is the patient’s airway open and clear?
- Breathing (B) – Is gas exchange happening in the lungs?
- Circulation (C) – Is blood circulating and reaching vital organs?
If any of these are compromised, the patient’s life is immediately at risk.
Step 1: Airway – The First Priority
A patent (open) airway is the foundation of survival. Without it, oxygen cannot enter the body and carbon dioxide cannot exit.
- Ask Yourself: Can the patient successfully breathe in oxygen and breathe out CO₂?
- Signs of Airway Compromise: Stridor, choking, inability to speak, cyanosis, foreign body obstruction.
- Nursing Interventions: Positioning (head-tilt, chin-lift), suctioning, inserting an airway, calling rapid response.
Clinical Example:
If a patient is gasping for air after choking, the nurse must clear the airway before administering oxygen or checking blood pressure.
Step 2: Breathing – Gas Exchange in the Lungs
Once the airway is open, the nurse checks if respirations are effective. The lungs must be able to exchange oxygen and carbon dioxide.
- Ask Yourself: Can gas exchange successfully happen inside their lungs?
- Signs of Breathing Problems: Low oxygen saturation, tachypnea, use of accessory muscles, cyanosis.
- Nursing Interventions: Administer oxygen, encourage coughing, position in Fowler’s position, prepare for mechanical ventilation if needed.
Clinical Example:
A patient with asthma wheezing severely should receive oxygen and bronchodilators before addressing pain or anxiety.
Step 3: Circulation – Blood Flow and Perfusion
Even if the patient can breathe, their blood must carry oxygen to vital organs.
- Ask Yourself: Can they circulate blood through their body, and are their organs being perfused?
- Signs of Circulatory Issues: Weak pulse, hypotension, cool skin, altered mental status.
- Nursing Interventions: Start IV fluids, control bleeding, administer CPR if pulseless, monitor heart rhythm.
Clinical Example:
If a patient’s blood pressure drops dangerously low after surgery, restoring circulation with fluids or blood products takes precedence over treating pain or fever.
Maslow’s Hierarchy of Needs in Nursing
While the ABCs ensure immediate survival, Maslow’s Hierarchy provides a broader framework for prioritizing patient care beyond emergencies.
Maslow’s pyramid has five levels of needs:
- Physiological Needs – Airway, breathing, circulation, fluids, nutrition, elimination, sleep.
- Safety and Security Needs – Protection from harm, infection prevention, trust in caregivers.
- Love and Belonging Needs – Emotional support, family connections, nurse-patient relationship.
- Self-Esteem Needs – Confidence, independence, recognition of progress.
- Self-Actualization Needs – Growth, spiritual well-being, fulfilling potential.
How Maslow’s Helps Nurses
- Always address physiological needs first (ABCs fall under this).
- Next, ensure safety (fall prevention, infection control).
- Then move to emotional and psychological care.
NCLEX-Style Example Question:
A patient reports severe pain (psychological need) but another patient is cyanotic and gasping for air (physiological need).
Correct Priority: Attend to the cyanotic patient first. Pain rarely kills, but lack of oxygen does.Integrating ABCs with Maslow in Priority Questions
When faced with multiple patients or exam options, use this stepwise thought process:
- Apply ABCs: Who has a life-threatening airway, breathing, or circulation issue?
- Check Maslow’s Hierarchy: Which need is the most basic and essential?
- Consider Safety: Even if ABCs are intact, is the patient at risk of immediate harm?
- Use Critical Thinking: Sometimes multiple needs overlap. Focus on what keeps the patient alive first.
Exam and Clinical Applications
You Know It’s a Priority Question When…
- The exam asks: “What is the most important?”
- “What should the nurse do first?”
- “What is the initial response?”
Tips for Nursing Students:
- Always think survival first. Oxygen > fluids > pain relief > emotional care.
- Eliminate distractors. If an option doesn’t address ABCs or physiological needs, it’s less likely correct.
- Don’t be misled by pain. Pain management is critical but rarely takes priority over airway or circulation.
- Practice NCLEX-style questions. They sharpen your decision-making.
Tips for Clinical Nurses:
- In real life, prioritization ensures patient safety during emergencies.
- Example: During a code blue, you wouldn’t start documenting or providing emotional support until airway and circulation are managed.
Real-World Case Studies
Case 1:
A post-op patient complains of severe pain at the incision site, while another patient suddenly develops shortness of breath.
Priority: Attend to the shortness of breath first (Airway/Breathing).Case 2:
Two patients need assistance: one requests water, while the other has blood pressure 70/40 mmHg.
Priority: Manage the hypotension (Circulation) before providing fluids for comfort.Case 3:
A confused elderly patient keeps trying to get out of bed without assistance, while another patient’s oxygen mask slips off.
Priority: Replace the oxygen mask (Breathing) before addressing fall risk.Quick Reference Table – Nursing Priorities
| Framework | First to Last Priority |
|---|---|
| ABCs | Airway → Breathing → Circulation |
| Maslow’s Hierarchy | Physiological → Safety → Love/Belonging → Esteem → Self-Actualization |
| Nursing Decision-Making | Survival → Safety → Comfort → Emotional/Spiritual growth |
Conclusion
Nursing priority questions test the ability to think like a nurse, not just memorize facts. By applying the ABCs and Maslow’s Hierarchy of Needs, students can answer exam questions confidently, and professionals can ensure safe, effective patient care.
- ABCs save lives by focusing on airway, breathing, and circulation.
- Maslow’s Hierarchy helps nurses balance physical and psychological needs in long-term care.
- Together, they create a reliable decision-making framework for any clinical scenario.
Frequently Asked Questions (FAQs)
Q1. What are nursing priority questions?
They are exam or clinical questions asking what the nurse should do first, focusing on critical thinking and patient safety.
Q2. Which comes first, pain or airway?
Airway. Pain is important but rarely life-threatening compared to oxygen deprivation.
Q3. How do I know when to use ABCs vs. Maslow’s Hierarchy?
Use ABCs first in emergencies, then apply Maslow’s for overall care planning.
Q4. What if two patients have airway issues?
Prioritize based on who has the most severe or life-threatening compromise.
Q5. Why is Maslow’s Hierarchy relevant to nursing exams?
It helps nurses prioritize holistic care, ensuring basic physiological and safety needs are met before psychological ones.
