KAPLAN DECISION TREE FOR ANSWERING QUESTIONSSTEP ONE: Can you identify the topic of the question?

NO

YES

Read answer choices for clues

Proceed to Step2

Identify the topic of the question

Proceed to Step2

STEP TWO: Are the answers assessments or implementations?

A mix of assessments and

Are answers all

Implementations?

Assessment or

Implementation?

Read stem of question to

Determine if you should

Proceed to Step3

Assess or implement

Select correct answer.

STEP THREE: Does Maslow fit?

NO YESAre all answers physical?

Eliminate Psychosocial answers

Proceed to Step4

Are all answers psychosocial?

Do the physical needs make Proceed to Step5

sense?

Apply ABCs.STEP FOUR: Are all answers physical?

NOYES

Proceed to Step5

Apply ABCsSTEP FIVE: What is the outcome of each of the remaining answers?

Determine outcome of each answer. Is it desired?Select correct answerANSWERING STRATEGIES

1. Read word for word.2. Determine what the question is asking>FIGURE IT OUT, ANALYZE, THINK!3. Look for danger words: FIRST, INITIALLY, HIGHEST PRIORITY, MOST IMPORTANT, BEST, MOST CONCERNED4. Picture the question, use imagery5. Clang Association- sometimes a word/phrase in the question comes out exactly at the correct answer6. Hold the phone- if the doctor is on the phone, you should not answer it, care for the PATIENT FIRST7. Think before calling physician- do independent nursing actions first then assess outcome then report to physician. Ie: If px has fracture on upper and lower extremity, assess first for neurologic/circulatory defects. If px complains(subjective assessment), do an objective assessment (vital signs) THEN call doctor. Tip: get complete assessment, subjective and objectiveif subjective only, its unreliable.

8. Know whats normal, know lab values9. Look for clues, DO EVERYTHING BY THE BOOK!10. Reword/rephrase the question11. 2 choices of same content, ELIMINATE!12. Umbrella answer is the right answer13. Choose HERE and NOW answer

14. Use nsg process15. Use Maslow16. Real prob is a priority vs. potential prob17. Predict outcomes18. Ask yourself, does this answer make sense? Does it answer the question?19. Dont choose answers with absolutes: ALL, ABSOLUTELY, ENTIRE, ONLY, ALWAYS, TOTAL, EVERY, EACH, MUST etc.NCLEX TOPICS

I. Chain of Command- probs associated with co-workers>inform to YOUR NSG SUPERVISOR BUT if the outcome of the action of the co-worker is harmful to the patients rights in the HERE and NOW, you can call their attention. Ie. If you hear two nurses talking about a patient in the elevator, mentioned the name and case, you call their attention then report to nsg supervisor.

II. Rule of Cohorting- patient with infection put in a room with another patient with the same infection.

III. Rules of Delegation1. RNs: a. dont delegate assessment, teaching, evaluation to LPN, UAP (unlicensed assistive

personnel), Nsg aide

b. delegate STABLE patient with EXPECTED outcomes

TIP: 24hr post-op patient is considered stable

c. delegate tasks that involve STANDARD UNCHANGING tasks ie. Bed bath, feeding, bed

making

2. RNs communicate to health team about changes in patients condition3. LPNs CAN: a. perform STERILE dressing changes, sterile technique

b. give SQ, IM, PO meds but NOT IV, NEBU & TOPICAL

c. give supplementary health teachings

d. do suctioning, catheterization

IV. Pleur-Evac Dislodgment

1. If youre asked what to do when its dislodged FROM THE PATIENT:Question asks What to do: a. FIRST: choose Cover opening on patients chest with any CLEAN

Material possible.

b. BEST: choose Cover opening on patients chest with STERILE

VASELINIZED GAUZE

GOAL: prevent air from entering

2. If youre asked what to do when its dislodged FROM THE CHAMBER:

Question asks What to do: a. FIRST: choose Insert/Submerge tube tip in a container with STERILE

NSS

b. BEST: choose CLAMP tube farthest from the patient.

V. Fetal Heart Rate

1. Early deceleration- normal finding; due to head compression

- FHR decelerates at the BEGINNING of contraction then return to baseline AFTER

Contraction

2. Variable deceleration- due to cord compression

- FHR decelerates without regard with the contraction

-Intervention: decrease perineum; knee-chest position, elevate foot of bed

3. Late deceleration- due to utero-placental insufficiency

- FHR decelerates at the PEAK or AFTER peak of contraction then returns to baseline

after contraction

- Intervention: turn mom to left side

VI. AV Fistula

Assessment for: a. Thrill- put finger over fistula and feel

b. Bruit- auscultate

VII. Immunization

Birth- Hep B

1 mo- Hep B

2 mos- IPV, Dtap , Hib

4mos- IPV, Dtap, Hib

6mos- IPV, Dtap, Hib, HepB12-15mos- Hib, MMR

12-18mos-Dtap, Varicella Zoster 4-6yrs-IPV, Dtap, Hib11-12yrs- MMR(if not given at 4-6yrs)

11-16yrs- Td

Legend: IPV-Inactivate Polio Virus (via IM)Dtap-Diptheria, tetanus, pertussis

Hib- Hemophilus Influenza B

Td- Tetanus toxoidTypes of Vaccines:

a. Component Vaccines- Hib, Pneumococcal, Hep A/B

b. Live Vaccines- MMR, OPV, Chicken Pox/Varicella

*cant be given to immunocompromised patients

c. Killed/Inactivated Vaccines- Inactivated influenza vax, IPV(Salk Vaccine)

d. Toxoid Vaccine- DPT, Td

VIII. Cultural Differences

A. Chinese Amer may nod head to indicate yes or shake head to mean no Excessive eye contact means rudeness

Excessive touching is offensive

Nsg implications: ask questions carefully and clarify responses

YIN- cold/ negative force

YANG- hot/positive force

B. Islam- no pork and alcoholic beverages allowed

- prefer foods with HALAL seal

- prior to death, family members are asked to be present so they can read the Koran and

Pray with the client.

- must face Mecca(where the sun rises) and confess sins, beg for forgiveness in the

presence of the family

- burial is done ASAP before sundown

-donation of organs is prohibited

C. Amer Indian/ Native Amer

- prone to accidents, alcohol abuse, TB, arthritis

-lactose intolerant

-does yoga (mind body therapy) D. Jehovahs Witness

- blood transfusions violate Gods law, prefer to die than transfuse blood

-food with blood is prohibited

-can consume animal meat that has been drained from blood

-give plasma expander instead of blood transfusion

E. Orthodox Jews

Kosher Diet- prohibit mixing of meat and milk in one meal

-if both meat and milk eaten at the same meal, body should not be touched for

48hours .

-utensils used for meat cant be used for milk or non-kosher food

-fish, eggs, fruits, vegetables and grains can be eaten with either meat or dairy

-meats allowed: animals thatre vegetable eaters, cloven-hoofed animals,

animals thatre ritually slaughtered (sheep, cattle, goats, dear)

-fish with scales are allowed

-During Yom Kippur-24 hour fasting

- Passover week, only unleavened bread is eaten

F. Russian Orthodox

-abstain from meat and dairy products on Wed, Fri and Lent

-during Lent, all animal products, including dairy are prohibited

-fasting during Advent, exception are illness and pregnancy

-can transplant organs except HEART

Trap: NCLEX hides the topic of the question

Trap: Is validation required?

Trap: Physical needs take priority over psychosocial needs. Eliminate pain, its considered as psychosocial need.

Trap: Dont automatically select respiratory answers.

Trap: Dont select answers that sound right. Do evaluation, ask yourself, If I do this, what will the outcome be?