Nurse will examine own feeling about something-so do not counter transfer

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Mark Klimek Complete Notes 2023 How to guess

• Use knowledge
• Common sense
• Guessing strategy

Psych

⚫ Nurse will examine own feeling about something-so do not counter transfer ⚫ Establish trust relationship

Nutrition

⚫ Pick chicken not fried chicken ⚫ Fish but not shellfish ⚫ Never pick casseroles for kids ⚫ Never mix meds in food ⚫ Toddlers-finger foods ⚫ Preschool-one meal a day is OK. Leave them alone

• expectations to have

⚫ Do not expect 75 questions-think 265 ⚫ Do not expect to know everything ⚫ Do not expect everything will go right

Pharm

⚫ Most tested area is side effects ⚫ Do not worry about route or dose ⚫ If know what drug does but do not know side effect-pick a side effect in same body system this drug is working ⚫ No idea what this drug is-look to see if it is PO-pick GI side effect ⚫ Never tell kids that med is candy

OB-check fetal HR Med Surg ⚫ 1 st thing assess-LOC ⚫ 1 st thing do-establish airway

Peds

⚫ All based on principle-give child more time to grow and develop ⚫ When in doubt-call it normal ⚫ When in doubt-pick this older age ⚫ When in doubt-pick this easier task-more time to do this harder one

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General

⚫ Rule out absolutes ⚫ If 2 answers say same thing-neither is correct ⚫ If 2 answers are opposite-one is probably right ⚫ Umbrella strategy ⚫ If questions has 4 right answers and ask for priority of needs of a patient-worse consequences game-worst outcome ⚫ When stuck between two answers-read this question

Sesame street rule-use only as last option

⚫ Right answer tends to be different than this rest ⚫ Wrong answers are usually all similar ⚫ Right answer is most unique or different

Answer based on what you know, not what you don’t know

⚫ If you dont know something in a question-pull it out of this equation-use common sense ⚫ Nclex also testing on common sense-do not overanalyze-do not think like a nurse ⚫ Go with gut answer-only if other answer is superior Prioritization

⚫ Decide who is sickest or healthiest--->based on question ⚫ ABC does no work with prioritization questions

⚫ Answers will have 4 parts ◼ Age ◼ Gender ◼ Diagnosis ◼ Modifying phrase

⚫ 2 are irrelevant ---- >age and gender ⚫ In Peds pay attention to age but in prioritization age is not important ⚫ Modifying phrase most important

⚫ Ex: pt has angina pectoris vs MI ---- > MI is high priority

⚫ Pt has angina pectoris and unstable BP vs MI with stable VS ---- >angina with unstable BP is now the priority

• rules to prioritization

• Acute beats (higher priority than) chronic

Example: COPD versus appendicitis--->appendicitis is this priority

• Fresh postop (<12 hrs) beats medical or other surgical

Example: 2 hr post op versus appendicitis--->2 hr post op is this priority

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• Unstable beats stable

Stable words Unstable words ⚫ Stable ⚫ Chronic illness ⚫ Post op >12 hrs ⚫ Local or regional anesthesia ⚫ Lab abnormalities A or B level ⚫ Unchanged assessments ⚫ To be discharged ⚫ Ready for discharge ⚫ Admitted longer than 24 hrs ago ⚫ Experiencing this typical expected S/S of disease with which they were diagnoses ⚫ Unstable ⚫ Acute illness ⚫ Post op <12 hrs ⚫ General anesthesia (1 st 12 hrs) ⚫ Lab abnormalities C or C level ⚫ Changed/changing assessment ⚫ Not ready for discharge ⚫ Newly diagnosed ⚫ Newly admitted ⚫ Experiencing unexpected S/S

Example:

⚫ 16 yo w/ meningococcal meningitis who has had temp of 103.8 F since admission 3 days ago.⚫ 61 yo male w/IBS who spiked temp of 103 F this afternoon.⚫ Who is higher priority and why?--->2 nd option is priority-->have more high priorities than 1 st

Always unstable no matter what-even if expected

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⚫ Hemorrhaging (not bleeding) ⚫ High fever over 105 F--->patient can have seizure ⚫ Hypoglycemia ⚫ Pulselessness (vfib or asystole) or breathlessness

Note: at scene of accident (unwitnessed)- they are death-low priority

• things that causes blacktag

@ scene of accident ⚫ Pulselessness ⚫ Breathlessness ⚫ Fixed and dilated pupils (even if still breathing)

• Tiebreaker---> this more vital this organ, this higher this priority.

⚫ Organ in which this modifying phrase is referring to ⚫ Most vital organs

• Brain
• Lungs
• Heart
• Liver
• Kidneys
• Pancreas