Mark Klimek NCLEX Review 2026
200 Practice Questions & Detailed Answers
Nursing Exam Prep with Prioritization, Delegation & HighYield
Concepts | A+ Rated
1. A nurse receives handoff report on four patients. Which patient should the nurse assess FIRST?
A. A 45yearold with stable angina admitted 3 days ago
B. A 60yearold with COPD who is ready for discharge
C. A 30yearold 2 hours postcholecystectomy
D. A 55yearold with chronic kidney disease
Answer: C. A 30yearold 2 hours postcholecystectomy
Explanation: According to Mark Klimek's prioritization rules, fresh postop (within the first 12 hours)
beats medical or other surgical patients. The 2hour postop patient is the highest priority.
2. Which patient should the nurse see FIRST based on prioritization rules?
A. A patient with angina pectoris and stable vital signs
B. A patient with a myocardial infarction and stable vital signs
C. A patient with unstable blood pressure and angina
D. A patient with chronic back pain
Answer: C. A patient with unstable blood pressure and angina
,Explanation: Unstable beats stable. Even though the MI patient has a more serious diagnosis, the patient
with unstable vital signs takes priority. Acute beats chronic, and unstable beats stable.
3. A nurse is caring for four patients. Which patient has the HIGHEST priority?
A. A 16yearold with meningococcal meningitis who has had a temperature of 103.8°F for 3 days
B. A 67yearold with IBS who spiked a temperature of 103.4°F this afternoon
C. A 40yearold with pneumonia who is on room air
D. A 50yearold with hypertension who is stable
Answer: B. A 67yearold with IBS who spiked a temperature of 103.4°F this afternoon
Explanation: A newly spiked fever (change in assessment) indicates instability. The patient with the
newonset fever (unexpected sign) takes priority over the patient with a chronic, stable fever.
4. What are the 4 rules of prioritization according to Mark Klimek?
A. Age, Gender, Diagnosis, Modifying Phrase
B. Acute beats chronic, Fresh postop beats medical, Unstable beats stable, Tiebreaker by vital organs
C. Maslow's hierarchy only
D. ABCs only
Answer: B. Acute beats chronic, Fresh postop beats medical, Unstable beats stable, Tiebreaker by vital
organs
,Explanation: The four rules are: 1) Acute beats chronic, 2) Fresh postop (first 12 hours) beats
medical/other surgical, 3) Unstable beats stable, 4) Tiebreaker: brain, lung, heart, liver, kidney,
pancreas.
5. In a prioritization question, which information is MOST important?
A. The patient's age
B. The patient's gender
C. The modifying phrase (what is happening to the patient)
D. The diagnosis
Answer: C. The modifying phrase (what is happening to the patient)
Explanation: Age and gender are irrelevant in prioritization questions (except in pediatrics). The
diagnosis is important, but the modifying phrase—what is actually happening to the patient right now—
is the most important.
6. Which of the following words indicates that a patient is STABLE?
A. Unstable
B. Acute illness
C. Ready for discharge
D. Postop less than 12 hours
Answer: C. Ready for discharge
, Explanation: Words indicating stability include: "stable," "chronic illness," "postop >12 hours," "ready for
discharge," "to be discharged," "admitted >24 hours ago," "unchanged assessment," and "experiencing
typical expected signs/symptoms."
7. Which of the following words indicates that a patient is UNSTABLE?
A. Chronic illness
B. Local anesthesia
C. Changed assessment
D. Ready for discharge
Answer: C. Changed assessment
Explanation: Words indicating instability include: "unstable," "acute illness," "postop <12 hours,"
"general anesthesia in first 12 hours," "changed/changing assessment," "newly diagnosed," "newly
admitted," and "experiencing unexpected signs/symptoms."
8. What are the four things that ALWAYS make a patient unstable, even if they are expected?
A. Fever, pain, nausea, fatigue
B. Hemorrhage, fever >105°F, hypoglycemia, pulseless/breathless
C. Hypertension, tachycardia, tachypnea, fever
D. Anxiety, confusion, diaphoresis, pallor
Answer: B. Hemorrhage, fever >105°F, hypoglycemia, pulseless/breathless
200 Practice Questions & Detailed Answers
Nursing Exam Prep with Prioritization, Delegation & HighYield
Concepts | A+ Rated
1. A nurse receives handoff report on four patients. Which patient should the nurse assess FIRST?
A. A 45yearold with stable angina admitted 3 days ago
B. A 60yearold with COPD who is ready for discharge
C. A 30yearold 2 hours postcholecystectomy
D. A 55yearold with chronic kidney disease
Answer: C. A 30yearold 2 hours postcholecystectomy
Explanation: According to Mark Klimek's prioritization rules, fresh postop (within the first 12 hours)
beats medical or other surgical patients. The 2hour postop patient is the highest priority.
2. Which patient should the nurse see FIRST based on prioritization rules?
A. A patient with angina pectoris and stable vital signs
B. A patient with a myocardial infarction and stable vital signs
C. A patient with unstable blood pressure and angina
D. A patient with chronic back pain
Answer: C. A patient with unstable blood pressure and angina
,Explanation: Unstable beats stable. Even though the MI patient has a more serious diagnosis, the patient
with unstable vital signs takes priority. Acute beats chronic, and unstable beats stable.
3. A nurse is caring for four patients. Which patient has the HIGHEST priority?
A. A 16yearold with meningococcal meningitis who has had a temperature of 103.8°F for 3 days
B. A 67yearold with IBS who spiked a temperature of 103.4°F this afternoon
C. A 40yearold with pneumonia who is on room air
D. A 50yearold with hypertension who is stable
Answer: B. A 67yearold with IBS who spiked a temperature of 103.4°F this afternoon
Explanation: A newly spiked fever (change in assessment) indicates instability. The patient with the
newonset fever (unexpected sign) takes priority over the patient with a chronic, stable fever.
4. What are the 4 rules of prioritization according to Mark Klimek?
A. Age, Gender, Diagnosis, Modifying Phrase
B. Acute beats chronic, Fresh postop beats medical, Unstable beats stable, Tiebreaker by vital organs
C. Maslow's hierarchy only
D. ABCs only
Answer: B. Acute beats chronic, Fresh postop beats medical, Unstable beats stable, Tiebreaker by vital
organs
,Explanation: The four rules are: 1) Acute beats chronic, 2) Fresh postop (first 12 hours) beats
medical/other surgical, 3) Unstable beats stable, 4) Tiebreaker: brain, lung, heart, liver, kidney,
pancreas.
5. In a prioritization question, which information is MOST important?
A. The patient's age
B. The patient's gender
C. The modifying phrase (what is happening to the patient)
D. The diagnosis
Answer: C. The modifying phrase (what is happening to the patient)
Explanation: Age and gender are irrelevant in prioritization questions (except in pediatrics). The
diagnosis is important, but the modifying phrase—what is actually happening to the patient right now—
is the most important.
6. Which of the following words indicates that a patient is STABLE?
A. Unstable
B. Acute illness
C. Ready for discharge
D. Postop less than 12 hours
Answer: C. Ready for discharge
, Explanation: Words indicating stability include: "stable," "chronic illness," "postop >12 hours," "ready for
discharge," "to be discharged," "admitted >24 hours ago," "unchanged assessment," and "experiencing
typical expected signs/symptoms."
7. Which of the following words indicates that a patient is UNSTABLE?
A. Chronic illness
B. Local anesthesia
C. Changed assessment
D. Ready for discharge
Answer: C. Changed assessment
Explanation: Words indicating instability include: "unstable," "acute illness," "postop <12 hours,"
"general anesthesia in first 12 hours," "changed/changing assessment," "newly diagnosed," "newly
admitted," and "experiencing unexpected signs/symptoms."
8. What are the four things that ALWAYS make a patient unstable, even if they are expected?
A. Fever, pain, nausea, fatigue
B. Hemorrhage, fever >105°F, hypoglycemia, pulseless/breathless
C. Hypertension, tachycardia, tachypnea, fever
D. Anxiety, confusion, diaphoresis, pallor
Answer: B. Hemorrhage, fever >105°F, hypoglycemia, pulseless/breathless
