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NCLEX STRATEGIES
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Mary_GraceMcElveen Preview RN VATI Fundamentals Assessment 70 terms supergirl751Preview NCLEX 110 term kan What is the purpose of strategic words used in NCLEX questions?Strategic words focus your attention on a critical point to consider when answering the question and will assist you in eliminating the incorrect options.These words can be located in either the event or the query of the question.What does the strategic word "Early" indicate?The need to prioritize Often times with prioritization questions, all options provided as answers are correct and that it will be necessary to prioritize to select the correct option.What does the strategic word "Monitor" indicate? The need to Assess (Assessment usually indicates the need tt look for an option that is first step) What does the strategic phrase "Most likely" indicate? The need to prioritize What does the strategic word "Best" indicate?The need to prioritize What does the strategic word "Observe" indicate? The need to Assess What does the strategic word "Determine" indicate? The need to assess The nurse is caring for a client who just returned from the recovery room after undergoing abdominal surgery. The nurse would monitor for which early sign of hypovolemic shock?
Answer: Increased Pulse Rate
Rational: The strategic word Early indicates the need to prioritize. When
evaluating the S/Sx of shock, Restlessness would be the first sign (which is not an option), the next earlier signs of shock is cardiovascular changes (increased HR compensates for low BP). Increased depth of respirations does occur with shock but is not an early sign.
When prioritizing, what tools should we always use to determine the correct order of action?
- ABC's (Airway, Breathing, Circulation)
- Maslow's Hierarchy of Needs
- The steps of the nursing process, CJMM, and cognitive skills
the only time we do not use the ABC's is with CPR. The priority with CPR is CAB (compressions/circulation, Airway, Breathing)
When prioritizing, you should always assess and collect information if the patient is...stable When prioritizing, if the patient isn't stable and it is an emergency, your first step would be to...Act!Rational: Emergencies are a possible exception to the guideline—if the question presents as an emergency situation, read carefully; in an emergency situation, an action may be the priority rather than taking the time to collect further data.What are the levels of Maslow's Hierarchy of Needs? level 1: Physiological Needs
level 2: Safety and Security
level 3: Relationships, Love and Affection
level 4: Self Esteem
level 5: Self Actualization
When a physiological need is not addressed in an NCLEX question or noted as one of the options, how should you prioritize next?Continue to use Maslow's Hierarchy of Needs to sequentially guide and look for the option that addresses safety (which is the next level of Maslow's Hierarchy of Needs) What are the steps of the nursing process?ADPIE: A=assessment D=diagnosis P=planning I=implementation E=evaluation or according to the NCLEX book...
AAPIE: A=sssessment, A=analysis, P=planning, I=Implementation, E=evaluation
Implementing/ Taking action questions address what focus?The highest priority or hypothesis. You want to focus on the nursing action rather than on the medical action (unless the question is specifically asking what the prescribed medical action is anticipated) These questions address the process of organizing and managing care, counseling and teaching, providing care to achieve established goals, supervising and coordinating care, and communicating and documenting nursing interventions.Remember with all NCLEX questions the nurse has all of the time, all of the equipment needed to care for the client readily available at bedside, that all supplies are right accessible at bedside.
Evaluation/Evaluate outcomes nursing questions address what focus?The nurse compares observed outcomes with expected outcomes They also focus on assisting and determining the clients response to care and identifying factor that may interfere with achieving expected outcomes.With these questions watch for negative event queries because they are frequently used.Negative Event QueriesUses strategic words that ask the nurse to select an option that is an INCORRECT item or statement; for example, "which statement by a client indicates a need for further teaching about the side effects of the prescribed medication?" Determine Whether an Abnormality Exists types of questions In the event, the client scenario will be described. Use your nursing knowledge to determine whether any of the information presented is indicating an abnormality.If an abnormality exists , either further ASSESSMENT, or further INTERVENTION will be required. Therefore continuing to monitor or documenting WILL NOT be a correct answer; don't select these options if they are presented.The nurse is evaluating the clients response to treatment of a pleural effusion with a chest tube. The nurse notes a respiratory rate of 20 breaths per minute, fluctuation of the fluid level in the water seal chamber, and a decrease I the amount of drainage by 30mL since the previous shift.Based on this information, which interpretation would the nurse make?c1. The client is reposing well to treatment
- Suction should be decreased to the system
- The system should be assed for an air leak
- Water should be added to the water seal chamber
ANSWER: 1. The client is reposing well to treatment
Rational:
Use the steps of the nursing process and note that the nurse needs to evaluate the clients response to the treatment; therefore this question measures the cognitive skill, evaluate outcomes. Focus on the subject and the data in question.Also, determine whether an abnormality exists based on this data.-Fluctuation in the water seal chamber is normal and an expected finding. with a chest tube.-Because the patient is being treated for a pleural effusion, it can be determined that he or she is responding well to treatment if the amount of drainage is gradually decreasing because the fluid is being effectively removed. If the drainage were to suddenly stop, then the chest tube should be assessed for a kink.Remember evaluation is the fifth step of the nursing process Safe and Effective Care Environment types of questions Focus on SAFETY! Always remember the importance of hand washing, call lights, bed positioning, appropriate use of side rails, asepsis, use of standard and other precautions, triage, and emergency response planning According to the NCSBN, these questions are to test the concepts of providing safe nursing care and collaborating with other health care team members to facilitate effective client care. These questions also focus on the protection of clients significant others, and health care personnel from environmental hazards.
Physiological Integrity types of questionsFocus on Maslow's Hierarchy of needs with these questions and remember that physiological needs are a priority and are addressed first. Also use the ABC's and the steps of the nursing process when selecting and option addressing the patients physiological integrity.The NCSBN indicates that these questions test the concepts that the nurse provides care as it relates to comfort and assistance in the performance of ADL's as well as care related to the administration of medication and parenteral therapies.These questions also address the nurses ability to prevent or reduce the clients potential for developing complications related to procedures, tx, or existing conditions and to provide care to clients with acute, chronic, or life threatening physical health conditions.Psychosocial Integrity types of questionsIn these questions you may be asked a communication-type question that relates to how you would respond to a client, a clients family member or a significant other, or even to other healthcare team members.Use THERAPUTIC COMMUNICATION techniques to answer communication questions because of their effectiveness in the communication process.Remember to select the option that focuses on the thoughts, feelings, concerns, anxieties, or fears of the client etc.The NCSBN notes that these questions test the concepts of nursing care that promote and support the emotional, mental, and social wellbeing of the client and significant others. The nurse looks for the significant others ability to cope, adapt, or problem solve in these situations such as illness, disabilities or stressful events including abuse, neglect, or violence.Health Promotion and Maintenance types of questions Use the teaching learning theory if the questions addressed client teaching, remembering that the clients willingness, desire, and readiness to learn is the first priority. Watch for negative queries, because they are frequently used in questions that address health promotion and maintenance and client education.According to the NCSBN, these questions test the concepts that the nurse provides and assists in directing nursing care to promote and maintain health.Content addressed in these questions relates to assisting the client and significant others during the normal expected stages of growth and development, and providing client care related to the prevention and early detection of health problems.A clients scheduled for surgery states to the nurse, "Im not sure if I should have this surgery." Which response by the nurse is appropriate?
- "Its your decision."
- "Don't worry. Everything will be fine."
- "Why don't you want to have this surgery?"
- "Tell me what concerns you have about the surgery?"
ANSWER: 4. "Tell me what concerns you have about the surgery?"
RATIONAL: The questions measures the cognitive skill, take action. Use
therapeutic communication techniques to answer communication questions and remember to focus on the clients thoughts, feelings, concerns, anxieties, and fears. Option 1 is too blunt and does not address the clients concern. Option 2 provides false reassurance. Option 3 can make the client feel defensive and uses the nontheraputic communication technique of asking "why".Eliminate comparable or Alike OptionsWhen reading options in multiple choice Orr multiple-response questions, look for options that a are comparable or alike. These can be eliminated as possible answers because it is unlikely that both options will be correct.
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