What's Your Priority Action?

Studying/Testing

Foundations

Thanks to Kurt for these words of wisdom:

If I could go back to the very beginning, I'd do what I
started to do in the final semester. I started to write the 
priorities RIGHT next to the title of whatever disorder I 
was on. That way, every time I studied it, the priority was 
the first thing I saw immediately after reading the name
of the disorder. That really helped.

Anyway, I would say to watch for 3 major things about "priority":

1. The "INITIAL" (thus, priority) action when
suspecting or identifying a complication or acute onset of a 
disorder. For example: "raise the HOB" if suspected 
hyperreflexia... or "place in lateral position," for the mom with 
hypotension, etc.

2. The "OVERALL" (thus, priority) specific to a
disorder: i.e. cerebral perfusion in IICP... indicating a priority
of maintaining adequate blood pressure, thus hypotension is 
worse than hypertension. The "overall" priority can often 
deduced if you know the pathophysiology of the disorder; 
Example: Broken ribs... PAIN. Pain from the fracture -  
secondary to broken and compressed tissues and nerves 
directly affects the ability to breathe. If you can't breathe, you
die. Control the pain so they can breathe.

3. The test LANGUAGE for "priority." such as:initial, first, 

necessary, primary, essential, etc. (when you see "priority," 

it's a game-changer:) It should immediately alert you to think 

of the one thing that you  MUST so the patient doesn't DIE or 

suffer major status change (or, a COMPLICATION). That is, 

all or most of the answer choices will be correct, but which 

one MUST be done?

Hurst put it well: The priority question is like telling the
Creators of the NCLEX that you know what is the most 

essential aspects of a given situation. Generally speaking, you 

should be thinking first of the ABCs,then Maslow's.

So, this is where you WILL see "Notify the physician" as a 

correct answer, because sometimes the only thing to be
done to save the patient is outside of the nursing scope of 

practice...

Example: the patient reports a "popping" sensation within their
suture site post-op, and you believe the surgical sutures have 

broken. You MUST call the MD, because you can't place new 

sutures yourself. The priority is to CALL THE MD

As a side note: any time you see a change in condition,
"be on the lookout for calling the MD." Because it's also 

important to know that there may be one quick nursing action 

that would be indicated to DIRECTLY address the change in 

condition before calling the MD. Those questions are 

especially tricky. My point was that they may hear that you 

shouldn't choose "call the MD" ever, but that is NOT true.. 

Example: You receive a post-op carotid endarterectomy 

patient in the PACU, whose previous assessment indicated 

adequate level of consciousness, but now he is not responding 

to verbal command or has bilaterally unequal hang grips

Anyway, the point is, you are not test ready if you don't AT
LEAST have an understanding of what the priorities are! If 

you go through the list of everything you're about to be tested 

on, and you don't actually know the priority for it, CALL THE 

MD! Just kidding. Seriously though, ASK YOUR 

INSTRUCTOR, or your favorite FB support group.