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1 Emma’s Test Taking Strategies

• ABCs (Airway, Breathing, Circulation)
• When in distress DO NOT ASSESS! Unless 2

nd hand information is received.

• Scenario

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• Mini Maslow’s

1) ABCs (& Pain unrelieved by meds) 2) Safety 3) Comfort (Pain) 4) Psychological 5) Social 6) Spiritual

• STAT words ® Pick the answer that failing to do so will kill or cause great harm

¥ Highest Priority ¥ Most Important ¥ Immediate Action

• *Least Invasive First*
• Second Hand Info ® Any time you have 2

nd hand info, the right answer is asses ¥ UAP ¥ Family ¥ Labs ¥ EMR ¥ EKG ¥ BP machine

• Never ever take away the coping mechanism a patient uses during a crisis, except if the mechanism puts the

patient or others @ risk

• Eliminate answer choices & DNR
• Never withhold Tx! If you’re left with two answer choices and the options are to Tx, or watch the patient,

Pick Tx!

• Anytime there’s a reversal from the norm, you must worry!

Ex: rebound tenderness (pain after you relieve pressure)

• Stable Patients

¥ UAP ¥ LPN ¥ New nurse ¥ Graduate Nurse ¥ Float Nurse ¥ Travel nurse

• Anytime you see excessive findings, That’s not normal!
• Always empower your patient
• If a question has “ ”, pick an answer that has what they’re feeling & not what they’re saying
• 3 R’s of Psych

1) Reality – Functional psych patient 2) Reassure – Delirium 3) Redirect – Dementia

Emma’s Default Answers

• Give meds either 1 hour before meal or 2 hours after meal
• Give antacids 1 hour before med or 4 hours after med
• When in doubt pick K (potassium)
• 2 – 3 L of fluids
• When in doubt pick answer that has you stay with patient

2

• Anytime you see restless & ¯ level of consciousness = early sign always pick
• Head of Bead ® 30-45 degrees for any neuro patient
• Elderly with acute onset confusion ® UTI
• Secretions will turn Orange/Red for meds
• Anytime you have GI problem/exacerbation = NPO
• All surgeries

1 st 24 hrs – bleeding 48 hrs – infection

• Check daily weights if it’s a fluid problem
• Lateral position for maternity
• Remove answer choices that are ‘absolutes’

Kaplan NCLEX Strategies Kaplan’s RN Decision Tree Step 1 – Can you identify the topic of the question Step 2 – Are the answers assessment (get data) or implementation (to effect change)?Step 3 – Apply Maslow: Are the answers physical or psychosocial? (Physical trumps psychosocial) Step 4 – Are the answer choices related to ABCs?Step 5 – What is the outcome of each of the remaining answers?

Rules for Delegation

RN ASSIGNMENT

¥ Cannot delegate assessment, teaching, or nursing judgement

LPN/LVN ASSIGNMENT

¥ Assign stable with expected outcomes

UAP ASSIGNMENT

¥ Delegate standard, unchanging procedures

Five Rights of Delegation RIGHT TASK – scope of practice, stable client RIGHT CIRCUMSTANCES – workload RIGHT PERSON – scope of practice RIGHT COMMUNICATION – specific task to be performed, expected results, follow-up communication RIGHT SUPERVISION – clear directions, intervene if necessary

Therapeutic Communication Tips

DO: DO NOT:

¥ Do respond to feeling tone ¥ Do provide information ¥ Do focus on the client ¥ Do use silence ¥ Do use presence ¥ Do not ask ‘why’ questions ¥ Do not ask ‘yes/no’ questions, except in the case of possible self-harm ¥ Do not focus on the nurse ¥ Do not explore ¥ Do not say, “Don’t worry!”

Who Do You See First?

Consider:

¥ Unstable vs. Stable ¥ Acute vs. Chronic

3 ¥ Unexpected vs. Expected ¥ Actual vs. Potential ¥ ABCs Common NCLEX Traps ¥ Do not ask “Why?” ¥ Do not ‘do nothing.’ ¥ Do not leave the client. ¥ Do not read into the question ¥ Do not persuade the client. ¥ Do not pass the buck.¥ Do not say, “Don’t worry!”

Strategies ¥ Only use textbook nursing – textbook knowledge ¥ Pain is psychosocial, unless, it’s severe, acute, & unrelenting ¥ If it’s a position question, is it going to prevent or promote something – position, prevent, promote ¥ Teaching/learning – use T/F on each answer ¥ Risk Questions – use Risk Factors ¥ If the answers have an absolute in them, do not pick them ¥ Question that have the phrase ‘And Then’ – did they miss something

Important Lab Values

WBC 4K – 11K

RBC 4 – 6

Hgb 12 – 16 Hct 36 – 48 Plt 150K – 400K

Therapeutic PTT: 1.5 – 2x the normal value

(46 – 76 Seconds) Cholesterol HDL > 50 LDL < 100 Triglycerides < 150 Total Cholesterol < 200

Albumin level 3.5 to 5.5

Acid-Base Balance From the ass (diarrhea) – Metabolic Acidosis From the mouth (vomitus) – Metabolic Alkalosis

Potassium & Alkalosis – ALKALOSIS: K is LOW

– Acidosis is just the opposite: K is High

Arterial Blood Gases

• Prior to drawing an AGB, perform the Allen’s Test to check for sufficient blood flow

BUN 8 – 20

Cr/Lithium 0.6 – 1.2 Urine Clearance 85 – 135 Uric Acid 250 – 750 mg Na 135 – 145 Cl 98 – 106 Ca 8.5 – 10.5

K 3.5 – 5.0

PO 2.5 – 4.5

PO 1.5 – 2.5

Warfarin INR 2.0 – 3.5 Heparin PT 10 – 13 Seconds PTT 25 – 35 Seconds Therapeutic Ranges Dilantin Theophylline Acetaminophen

10 – 20

Dig 0.5 – 2.0

4

• When drawing an ABG, the blood needs to be put in a heparinized tube.

¥ Ensuring there are no bubbles.

• Put on ice immediately after drawing, with a label.

¥ The label should indicate if the pt was on room air, or how many liters of O2.

General Notes ¥ The person who hyperventilates is most likely to experience respiratory alkalosis.

Antidotes ¥ Aspirin ® Activated Charcoal ¥ Coumadin (Warfarin) ® Vitamin K ¥ Heparin ® Protamine Sulfate ¥ Tylenol (Acetaminophen) ® Mucomyst (acetylcysteine) – administered orally ¥ Digoxin (Lanoxin) ® Digibind (immune Fab) ¥ Opioids ® Narcan ¥ Iron overdose ® Deferoxamine ¥ PCP ® Activated charcoal ¥ Magnesium Sulfate ® Calcium Gluconate ¥ TPA ® Amicar ¥ Pancuronium Bromide ® Neostigmine/Atropine

Blood

For blood types:

¥ "O" is the universal donor (remember "o" in donor) ¥ "AB" is the universal recipient

Blood transfusion – sign of allergies in order:

1)Flank pain 2)Frequent swallowing 3)Rashes 4)Fever 5)Chills

Thrombocytopenia – Bleeding precautions!1)Soft bristled toothbrush 2)No insertion of anything! (c/i suppositories, douche) 3)No IM meds as much as possible!

Sickle Cell Anemia During sickle cell crisis there are two interventions to prioritize: fluids and pain relief.

Iron deficiency anemia – easily fatigued 1)Fe PO - give with Vitamin C or on an empty stomach 2)Fe via IM- Inferon via Ztrack

Pernicious Anemia - s/s include pallor, tachycardia, and Sore Red, Beffy tongue; will take Vit.B12 for life!Shilling Test – test for pernicious anemia/ how well one absorbs Vit b12

General Notes ¥ A patient with a low hemoglobin and/or hematocrit should be evaluated for signs of bleeding, such as dark stools.