- It takes 3 things to pass the NCLEX exam

Mark Klimek Audio Lectures

• It takes 3 things to pass the NCLEX exam
• Knowledge
• Confidence
• Exam Proficiency
• You can’t apply what you don't know, but you have to be able to apply what

you do know.

- Go with majority: if something is 75% fatal, consider it fatal.

• If you try to learn everything you will master nothing.

Lecture 12 Prioritization, Delegation, and Staff Management Prioritizing patients

- With these questions you are trying to identify either:

• The highest priority clients
• The lowest priority clients
• The answers to prioritization questions always have four parts
• An Age
• A Gender
• A Diagnosis
• A Modifying Phrase

- Example: A 10-year-old male with hypospadias vomiting bile-stained emesis.

• 10 year old
• Male
• Hypospadias
• Vomiting bile-stained emesis
• The age of the client and their gender are irrelevant information.
• The diagnosis and the modifying phrase is important information.
• The modifying phrase is more important than the diagnosis.

- Example:

• A client with angina pectoris
• A patient with a myocardial infarction (MI)
• With just the diagnosis the MI patient is a higher priority.
• A client with angina pectoris with unstable blood pressure
• A patient with a MI having stable vitals
• With the modifying phrase the angina patient is a higher priority
• 4 Rules for prioritizing patients 1 / 2

• Acute is a higher priority than a chronic

- COPD

• CHF
• Appendicitis (highest priority, acute)

• Fresh post-op (within first 12 hours) is a higher priority than medical or other

surgical.

- COPD

• CHF
• Appendicitis
• 2 hours post op colectomy (Highest priority, 2-hours post-op)
• 2-day post op coronary bypass patient
• Unstable patients are a higher priority than stable patients.
• Words in an answer that makes a patient unstable or stable

Stable Unstable

• Use of the word stable - Use of the word unstable
• Chronic illness - Acute illness
• Post-op grater than 12 hours - Post-op less than 12 hours
• Local or regional anesthesia - General anesthesia in the first 12
• Lab abnormalities of an A or B level hours
• The phrase: “ready for discharge” or - Lab abnormalities of a C or D level

“admitted 24 hours ago” - The phrase “not ready for

• Unchanged Assessments discharge” or “newly admitted (less - Experiencing

the typical, expected than 24 hours ago)” or “newly signs and symptoms of their illness diagnosed” with which they were diagnosed - Changed assessments

• Experiencing unexpected signs and symptoms

- Applying Rule 3:

Example 1.

• A 16-year-old female with meningococcal meningitis who has had a

temperature of 40 0c since admission three days ago.

• Diagnosis is more severe but increased temp is expected (and 3 days is past 24

hour mark)

• A 67-year-old male with irritable bowel syndrome (IBS) that has a spiked

temperature of 39.6 0c this afternoon.

• Diagnosis is less severe but increased temp is unexpected (and this afternoon)

he is now the higher priority patient. He could have a ruptured bowl and is going septic.

- 4 criteria for being unstable even if expected:

• Hemorrhage (even if expected)
• Temperatures over 40.5

0c (high risk for seizures)

• Hypoglycemia (regardless of sugar reading)
• No pulse or not breathing
• This is a tiebreaker between patients that are all high priority. - The more

vital the organ (in the modifying phrase) the higher the priority.

• Brain
• / 2