Test Taking SkillsSuccessfully Preparing for

HESI & NCLEX-RN

Test Taking SkillsSuccessfully Preparing for

HESI & NCLEX-RN

LeeAnn Danner-Wilson

LeeAnn Danner-Wilson

Worth your time, paper, and ink to download! • NCLEX Examination Candidate

Bulletin• http://www.pearsonvue.com/nclex/

• Will provide you with all the information you need about testing and filling out your paperwork!

Taking the NLCEX-RN

Testing Center– Plan to arrive 30 minutes early. If you are 30 minutes

late you forfeit your appointment. – Will need your Authorization to Test (ATT) Form– 2 forms of ID that are signed and current – Names must match – A digital fingerprint, signature, and photograph will be

taken at the test center and accompany the NCLEX results to confirm your identity.

Taking the NLCEX-RN

– If you leave the room, you will be required to have your fingerprint taken to re-enter

– Personal belongings are not allowed in the testing area

– Family members or friends are not allowed to wait at the testing center.

Testing Center Continued

• Once you complete the admission process and a brief orientation, the proctor will escort you to your assigned computer.

• Work space• No electronic devices are allowed• No items are allowed in the room • You will be observed at all times (video and audio recordings) • If typing bothers you, request ear plugs • MUST follow directions of the test center staff; can not leave your

seat unless authorized by the proctor.

Taking the NCLEX-RN• Time

– 6 hours which includes: tutorial, two preprogrammed optional breaks (2 hours, 3.5 hours), any unscheduled breaks.

• How many questions? – Minimum is 75; of those 75- 60 will be scored and 15 will be unscored– Maximum is 265

• The computer cut me off…….– You are now finished. At this point you will complete a questionnaire about

your testing experience. • Pass or Fail

– All of the examination questions are categorized by test plan area and level of difficulty.

Test Plan

Each Examination Question will address: Levels of Cognitive Ability

Client needs categoryIntegrated Process

Levels of Cognitive Ability• Knowledge

• Comprehension

• Application

• Analysis

Client Needs

• Categories/Subcategories– Safe, Effective Care Environment

• Management of Care• Safety and Infection Control

– Health Promotion & Maintenance– Psychosocial Integrity– Physiological Integrity

• Basic Care and Comfort• Pharmacological & Parental Therapies• Reduction of Risk Potential• Physiological Adaptation

Integrated Processes

• Caring• Communication & Documentation• Nursing Process• Teaching/Learning

Preparation• Developing a Study Plan

– Good Time Management – Calendar

• Study Sessions– Quality vs. Quantity

• Materials needed – Computer– Questions & Answers – Special Notebook

• HESI– Minimum of 100 Questions a day

• NCLEX-RN – Minimum of 200 Questions a day

Preparing the Night Before

• Good nights sleep• Be confident (positive self talk)• Eat Breakfast• Set your alarm early• Be prepared• Avoid conversations• Don’t study the day of!

MEMORY DUMPMEMORY DUMP

Just a few facts…..

• Nursing exams are difficult because the questions ask you to make judgments and apply information-not just recall facts.

• No matter how hard you study or how much you can recall, you will not pass unless you can apply your nursing knowledge and make good nursing judgments.

First Things First• Setting the Stage

–Glass House Theory Answer your questions as if the situation were ideal, and you had ALL the resources and time needed. The only client you need to be concerned with is the one in the question

–Perfect Medical World

Components of a Question

•Case Scenario•Stem•Four Answers

My New Routine

• After reading the Question ask:– What is the question telling me?– What is the question asking me?– Who is the patient in the question?– Are there any key words? – What is the issue?

First

• What is the question telling me?

• What is the question asking me?

• Look at the stem!!!!

Second

• The Client– Who is the focus of the question?

– You must identify the client in the question because the answer MUST relate to the client.

– The client is NOT always the patient, it sometimes is a family member.

Example

• A nurse will be going on vacation. To involve the patient in the excitement, what is the best thing the nurse should say ?– A. “Let me tell you about the plans for my vacation.”

– B. “Tell me about some of your past vacations.”

– C. “I’ll bring the brochures for you to see.”

– D. “What do you think about vacations.”

Third

• Key Words (Circle These)– The important phrases or words in a question

• Early• Late• Immediately• Most likely, least likely• Initial• After several days

Last

• What is the issue in the question?– The specific problem or subject which the

question is ASKING

• DrugProblem

• Toxic Effect Behavior• Disorder

Procedure

After Reading the Question

o Cover up the answerso Read each answer individuallyo Write out beside why that questiono Mark out the ones that are for sure incorrecto Question mark the maybes

Pitfalls•Reading into the question

•Asking “well what if….”

Reading into the Question based on REALITY

• A client is admitted to the hospital for an exploratory laparotomy. The client’s daughter says to the nurse, “I wish I could stay with my father, but I need to go home to see how my children are doing. I really hate to leave my father alone at this time.” The best nursing response is:

Answers

1. Your father needs opportunities to be independent. This will help him become self-sufficient.”

2. “Your father is capable of taking care of himself. Try allowing him more independence.”

3. “Stress is not good for your father at this time. Perhaps you could call your children.”

4. “You are feeling concern for both your father and your children. Let me know when you are leaving, and I’ll stay with him.”

Eliminating Incorrect Options

• Distracters are incorrect options that are designed to resemble the correct answer. They are intended to DISTRACT you from answering correctly.

• Read your answers– Cross out the no’s– Question mark the maybe’s

Misreading Test Questions

• Incorrectly analyze what is being “asked”

• Overlook key words

• “Read into” the question

• Incorrectly interpret a disorder

Helpful Tips

• To avoid reading into the question– Restate in your own words– Eliminate options that includes “new”

information– Eliminate options that require you to make

assumptions

ProblemoMy problem is I get narrowed down to 2 answers and I always pick the wrong one!

Guidelines

• If you are left with two questions marks and can’t make a decision go with your gut instinct!

• Using a selection procedure allows you to make educated guesses. When you narrow to 2, you have a 50% chance of guessing correctly!

How to Choose the between the best 2 options?

Use testing strategies Global Response Similar Distractors Similar words or phrases

Remember

• Testing is like playing a game! When you want to win, you need to strategize. The following are some of your strategies!

Global Response

• A global response is one that is a general statement and may include the ideas of other options within it.

• This option is often the correct answer when 2 or 3 more specific options appear equally correct.

Practice Using Global Response

The nurse assigned to care for a child with cerebral palsy should obtain information concerning the child’s abilities, limitations, interests, and habits, because the aim of therapy is to:

1. Assess the child’s assets and potentialities and capitalize on these in the rehabilitative process, while overlooking limitations.

2. Reverse abnormal functioning and restore the brain function through rehabilitation.

3. Provide a therapeutic program that avoids subjecting the child to frustrating experiences that decrease achievement.

4. Develop an individualized therapeutic program that uses the child’s assets and abilities to achieve success as well as develops the child’s ability to cope with frustration and failure.

Answer 4- This is an APPROPRIATE

goal for CP therapy. This is also a global option, since it includes recognizing the child’s assets and helping the child to cope with frustrations and failures due to limitations.

Similar Distracters

• Always remember there is only 1 correct answer.

• If 2 options say the same thing or include the same idea, they can’t be correct.

• Answer is the option that is different.

Practice using Similar Distracters

A newly diagnosed adult diabetic is demonstrating of the proper technique for insulin injection. The client draws the correct dose of insulin using the proper technique, but when ready to inject the needle, hesitates and says, “I am not sure I can do this.” Which response by the nurse would be best initially?

Answers1. “I will show you how to

inject the needle.”2. “I will inject the needle for

you this time.”3. “You are doing fine so far.

Give it a try.”4. “Why are you so nervous?

Do you need help?”

Answer 3- This is the correct answer because it focuses on the client being encouraged to do the procedure.

Similar Words

• First use Global Response• Second use Similar Distracters• If still no hope, try similar words, phrases. • If you find a word, feeling, or behavior used in the

stem or the case scenario that is repeated in one of the options, that option MAY be the correct answer.

• Not the most reliable strategy

Using Similar Words A client has sustained a fracture

of the tibia and fibula. In providing nursing care for this client, who has a newly applied long-leg cast, which consideration is vital?

Answers1. Elevation of the leg in the cast

on a pillow will minimize edema. 2. Healing of a fractured bone

requires an extended period of time.

3. A long period of immobility may lead to atrophy of the muscle.

4. Analgesics may be needed for pain associated with the fracture.

Answer!. When caring for a client with

a newly applied cast, it is IMPORTANT to keep the affected extremity above the level of the heart to reduce swelling.

Key words are “leg” and “cast”

Levels of Cognitive Ability Practice

Knowledge Questions

• Knowledge questions require you to “recall” or “remember” information. To answer a question you need to commit facts to memory.

Knowledge Question

• The first step of the procedure for making unoccupied bed is– A. Pulling the curtain– B. Washing your hands– C. Collecting the linen– D. Placing the bottom sheet

Answer

• B- because you need to know the sequence of steps in the procedure of making an unoccupied bed or the basic principles that your hands must be washed before ALL procedures.

Comprehension Questions

• Require you to understand information. To answer a comprehension question, you must commit facts to memory as well as translate, interpret, and determine the implications of that information.

Comprehension Question

• To evaluate the therapeutic effect of a cathartic, the nurse should asses the patient for:– A. Increased urinary output– B. A decrease un anxiety– C. A bowel movement– D. Pain Relief

Answer

• C- to answer this question you have to know not only that a cathartic is a potent laxative that stimulates the bowel but also that the increase in peristalsis will result in bowel movement.

Difference

• The difference between knowledge questions and comprehension questions is: to answer knowledge questions you must know facts. To answer comprehension questions you must understand the significance of the facts.

Application Questions

• Application questions require the learner to show solve, modify, change, use, or manipulate information in a real situation or presented scenario. To answer, you must apply concept you learned previously to concrete situations.

Application Question

• A client is experiencing a hypoglycemic reaction. The nurse should administer which of the following items to best treat the reaction?

1. Water2. Diet soda3. Milk4. One sugar-free cookie

Answer

• 3- In intervention questions you are asked about an intervention, a nursing action, a decision, or a problem that needs to be solved. Here you are asked to select the best item for treating a hypoglycemic reaction. Remember, if a hypoglycemic reaction occurs, the client should be given an item that contains 10 to 15 g carbohydrate.

Analysis Questions

• Require you to interpret a variety of data and recognize the commonalities, differences, and interrelationships among presented ideas. Make the assumption that you know, understand, and can apply information.

Analysis Question

• The nurse administers 10 units of Regular insulin at 0700 to a client with type I diabetes mellitus. The nurse monitors the client closely for a hypoglycemic reaction during which time frame?

1. 0900 to 10002. 1300 to 19003. 0900 to 15004. 1100 to 1200

Answer

• 1- For analysis you are required to consider and examine possibly several concepts in the question to answer it correctly. In this question, it is necessary to know that Regular insulin is short acting insulin (i.e. it peaks in 2 to 3 hours) and that a hypoglycemic reaction is most likely to occur during peak time.

Differences

• Analysis questions require an ability to examine information, which is a higher thought process than knowing, understanding, or applying information.

Example Studying Blood Pressure

• First memorize the parameters of a normal blood pressure (Knowledge)

• Then develop an understanding of what factors influence and produce a normal blood pressure (Comprehension)

• Identify a particular patient situation that would necessitate obtaining a BP (Application)

• Differentiate among a variety of situations and determine which has the highest priority for assessing the BP (Analysis)

Client Needs Questions

Categories/Subcategories Safe, Effective Care Environment

Management of Care Safety and Infection Control

Health Promotion & Maintenance Psychosocial Integrity Physiological Integrity

Basic Care and Comfort Pharmacological & Parental Therapies Reduction of Risk Potential Physiological Adaptation

Safe, Effective Care Environment

Management of Care A client scheduled for surgery tells the nurse

that he signed an informed consent but was never told about the risks or the surgery. The nurse serves as the client’s advocate by 1. Writing a note on the front of the client’s record so

that the surgeon will see it when the client arrives to the OR.

2. Documenting in the client’s record that the client was not told about the risks of surgery.

3. Contacting the surgeon and asking the surgeon to explain the surgical risks to the client.

4. Reassuring the client that the risks are minimal and unlikely to occur.

Answer

3- Use therapeutic communication techniques to eliminate option 4. Focus on “never told about the risks of surgery”. A nurse serves as a client advocate by protecting the rights of clients to be informed and to participate in decisions regarding their own care.

Safe, Effective Care Environment

Safety and Infection Control

• An emergency room nurse receives a telephone call from the police department and is told that several victims involved in a train accident will be brought to the emergency department. The nurse’s immediate action is to:

1. Call as many nurses as possible at home to have them come to the hospital to care for the victims.

2. Follow the directions outlined in the hospital’s disaster prepardedness plan (emergency response plan)

3. Ask the housekeeping and laundry department to deliver an extra cart of linen that contains several blankets.

4. Call the operating room and inform the staff that they may be receiving numerous victims that require surgery.

Answer

• 2- If the ED nurse is notified that several victims of a disaster will be arriving to the ED, the nurse would immediately activate the emergency response plan by notifying the supervisor and by following the directions in the plan.

• Test Taking hint- Option 2 is the global response- once this action is taken the others will follow

Health Promotion & Maintenance

• A nurse is preparing to care for a hospitalized female teenager who is in skeletal traction. The nurse plans care knowing that the most likely primary concern of the teenager is: 1. Obtaining adequate nutrition2. Body Image3. Keeping up with school work4. Obtaining adequate rest and sleep

Answer

• 2- note keyword “primary”. Focus on the client who is a teenager. Thinking about psychosocial development of a teenager, will direct you to option 2.

Psychosocial Integrity• A boy is brought to the school nurse’s office

with reports of abdominal pain. On assessment, the nurse notes the presence of several bruises on the child’s abdomen and back and several cigarette burn marks. The nurse suspects child abuse and plans for which priority action?

1. Calling the parents to ask them how the child’s bruises and burn marks occurred.

2. Removing the child from the abusive situation to prevent further injury.

3. Documenting about the bruises noted on the child.

4. Asking the child how long his parents have been abusing him.

Answer• 2- Maslow’s hierarchy of needs.

Physiological needs are the priority, and if a physiological need does not exist, then safety is priority.

Physiological Integrity Basic Care & Comfort

A nurse has provided information to a client about measures that will promote normal urination patterns and prevent urinary tract infections. Which statements by the client indicates a need for further information?

1. “I should eat foods that will make my urine acidic” 2. “I should try to hold my urine as long as I can

rather than expelling it when I feel the urge.” 3. “I should drink plenty of fluids during the day.” 4. “ I should take my furosemide (Lasix) in the

morning.”

Answer

2- Use the process of elimination and note the words “a need for further teaching”. Focusing on the issue (prevent urinary tract infections) and recalling that urinary stasis can lead to infection will direct you to option 2.

Physiological Integrity Pharmacological & Parental Therapies

• Cyclosporine (Sandimmune) oral solution is prescribed for a client who had a kidney transplant. The nurse provides information to the client about the medication and tells the client that which of the following is most important to monitor?

1. Apical heart rate

2. Peripheral pulses

3. Platelet count

4. Temperature

Answer

• 4- Use the process of elimination. Eliminate options 1 and 2 first because they are similar. From the remaining options, note the keywords “most important”. Recalling that infection is an adverse effect will direct you to option 4.

Physiological Integrity Reduction of Risk Potential

The nurse assists a physician in performing a liver biopsy on a client. After the procedure, the nurse assists the client to which position?

1. Prone

2. On the right side

3. On the left side

4. Left Sims’ position

Answer

2- Use knowledge regarding anatomy and the anatomic location of the liver to answer the question. Recalling that the liver is located on the right side of the upper abdomen will direct you to option 2.

Physiological Integrity Physiological Adaptation

A nurse is reviewing the medical records of the four clients she will be caring for. The nurse determines that which client is at risk for fluid volume deficit?1. The client receiving long-term corticosteriod therapy. 2. The client with congestive heart failure. 3. The client with a syndrome of inappropriate antidiuretic hormone. 4. The client with a nasogastric tube attached to suction.

Answer

4- Focus on the issue! The client at risk for fluid volume deficit. Think about the pathophysiology associated with each condition identified in the options. The only client that loses fluid is the client with a nasogastric tube attached to suction.

Integrated Processes

• Caring• Communication & Documentation• Nursing Process• Teaching/Learning

Integrated ProcessesCaring • An infant is brought to the ED by EMS with

suspected sudden infant death syndrome. The infant’s parents have accompanied EMS and are present when the infant is pronounced dead. The most important aspect of compassionate care for the parents is to: 1. Explain to the parents that the death was not their fault. 2. Allow the parents to say goodbye to the infant. 3. Gather data about the events that occurred before the infant was found. 4. Encourage the parents to attend a support group.

Answer•2-Focuse on the issue-

compassionate care. This directs you to option 2, because it is the only option that addresses this issue. The other answers are not specifically related to compassionate care.

Integrated Processes Communication Questions

• Thought is “If you cannot communicate therapeutically, it is difficult to practice safely. – Identify the Client in the Question– Identify the issue– Use the Communication Tools and Blocks

• Tools (enhance)

• Blocks (interfere)

Communication Tools

• Being SilentSitting quietly

• Offering Self“Let me sit with you.”

• Showing Empathy “You are upset.”

• Focusing“You say that…..”

• Restatement “You feel anxious?”

• Validation/clarification“What you are saying is…”

• Giving information“Your room is 423.”

• Dealing with the here and now“At this time, the problem

is….”

Communication Blocks

• Giving advice“If I were you, I would”

• Showing approval/disapproval“You did the right thing”

• Using clichés and false assurances“Don’t worry, it will be okay”

• Requesting an explanation“Why did you do that?”

• Devaluing client feelings“Don’t be concerned.It’s not a

problem.”

• Being Defensive“Every nurse on this unit is

exceptional.”

• Focusing on Inappropriate issues or person“Have I said something wrong”

• Placing the client’s issues on hold“Talk to your doctor about that.”

Cheating on Communication Questions

• NEVER answer “I”

• Always focus on feelings, thoughts, and behaviors.

• Usually the answer with “you feel” is correct.

• Always remember it is about the client

Integrated ProcessesCommunication

A client says to the nurse, “I’m scared about my surgery that I am having tomorrow.” The nurse should make which appropriate response to the client?

Answers1. “There is no reason to be scared.” 2. “You have plenty of reasons to be

scared. Surgery is a scary thing.” 3. “Scared?”

4. “Most people who have to have surgery are scared.”

Answer 3- Therapeutic communication techniques. In option 3, you are using reflection. Options 1,2, & 4 are nontherapeutic.

Integrated Process Documentation

A nurse discovers that she needs to make a correction to a written entry in a client’s chart. Which of the following is the most appropriate action?

Answers1. Contact the nursing supervisor to

cosign the correction. 2. Remove the page, recopy the data

to a new page, and add the correct entry.

3. Draw a single line through the entry that needs correction followed by his or her (RN’s) initials.

4. Erase the entry that needs correction and add the correct entry.

Answer 3- Use guidelines and principles related to documentation. No useful reasons for options 1 & 2.

Nursing Behaviors Associated with the Assessment Phase of

the Nursing Process • Gathering objective and

subjective data• Identifying manifestations• Evaluating environments• Identifying the nurse’s

reaction• Verifying Data• Communicating Information

Integrated Process Assessment

• A client is eight hours postoperative after a transurethral resection of the prostate gland (TURP). Which nursing assessment would be an early indication of a postoperative complication? – A. Pain in the operative site– B. Pulse rate of 88– C. Output of bloody urine– D. Oral temperature of 101.8F

Answer

• D- A temperature of 101.8F eight hours post-op is considered an early indication of a post-op complication.

• C- is a possibility, but bloody urine is expected post TURP.

Nursing Behaviors Associated with the Analysis Phase of the nursing Process (Diagnosis)

• Interpreting data• Validating data• Organizing related data• Identifying a nursing diagnosis• MOST DIFFICULT to answer• Require an understanding of the

principles of pathophysiology, pharmacokinetics, and psychopathology, as well as growth and development.

• Be sure you have the correctly identified the issue in the question

Integrated ProcessAnalysis/Diagnose

• The nurse is performing a developmental evaluation of a two-year-old child. Which observation would the nurse consider a good indicator of normal development?

Answers

A. Having command of a vocabulary of six words.

B. The ability to walk up and down stairs without help.

C. The ability to dress and undress.

D. The ability to point at something that is wanted.

Answer

• B- This is a good indicator of normal psychomotor development.

Behaviors Associated with the Planning Behaviors Associated with the Planning Phase of the Nursing ProcessPhase of the Nursing Process

Developing and modifying nursing Developing and modifying nursing care planscare plans

Cooperating with other health Cooperating with other health personnel for delivery of client carepersonnel for delivery of client care

Recording relevant information Recording relevant information

Integrated ProcessIntegrated ProcessPlanningPlanning

A nurse is caring for a patient A nurse is caring for a patient experiencing loss of appetite experiencing loss of appetite (anorexia) and nausea. Which (anorexia) and nausea. Which statement includes an expected statement includes an expected outcome? outcome?

AnswersAnswers

A. The patient will eat 50 percent of A. The patient will eat 50 percent of every meal during the next week.every meal during the next week.

B. The patient has altered nutrition B. The patient has altered nutrition less than body requirements.less than body requirements.

C. The patient’s privacy will be C. The patient’s privacy will be maintained when providing care.maintained when providing care.

D. The patient’s mouth will be D. The patient’s mouth will be cleaned every 4 hours. cleaned every 4 hours.

AnswerAnswer

A- In this question you have to A- In this question you have to recognize the differences among a recognize the differences among a goal, an expected outcome, a goal, an expected outcome, a nursing diagnosis, and a nursing nursing diagnosis, and a nursing intervention. intervention.

Behaviors Associated with the Implementation Behaviors Associated with the Implementation

Phase of the Nursing ProcessPhase of the Nursing Process Performing or assisting in performing activities of Performing or assisting in performing activities of

daily livingdaily living Counseling and teaching clients or familiesCounseling and teaching clients or families Using therapeutic communication skillsUsing therapeutic communication skills Providing care to achieve therapeutic goalsProviding care to achieve therapeutic goals Providing care to optimize achievement of health Providing care to optimize achievement of health

goals by the clientgoals by the client Supervising and checking the work of the staffSupervising and checking the work of the staff

Integrated ProcessIntegrated ProcessImplementationImplementation

•The registered nurse delegates The registered nurse delegates the implementation of a the implementation of a nasogastric tube feeding to a nasogastric tube feeding to a licensed practical nurse. Which licensed practical nurse. Which statement is accurate in terms statement is accurate in terms of the responsibility of the RN?of the responsibility of the RN?

AnswersAnswers

• A. The RN should implement the A. The RN should implement the planned care and not delegate.planned care and not delegate.

• B. The LPN should respectfully refuse B. The LPN should respectfully refuse to implement this care.to implement this care.

• C. The LPN is accountable for his or C. The LPN is accountable for his or her own actions.her own actions.

• D. The RN is responsible for D. The RN is responsible for delegated care. delegated care.

Behaviors Associated with the Evaluation Phase of the Nursing

Process Comparing actual outcomes with expected outcomes of therapyDetermining the impact of nursing actionsVerifying that tests or measurements were performed correctlyEvaluating client understanding of information given

Integrated ProcessEvaluation

A patient returns to the clinic after taking a 7-day course of antibiotic therapy and is still exhibiting signs of a urinary tract infection. What should be the nurse’s initial action?

Answers

A. Arrange for the MD to order a different antibiotic.B. Obtain another urine specimen for a culture and sensitivity.C. Determine if the patient took the medication as prescribed.D. Make an appointment for the patient to be seen by the MD.

Answer

C- This item is designed to teat your ability to recognize that the nurse must analyze the factors that influence outcomes of care. Options 1,2,4 can be eliminated because these actions immediately move to an intervention before collecting more information.

Integrated ProcessTeaching/Learning

If a test question addresses client teaching, remember that client motivation and client readiness to learn is the FIRST priority.

Teaching/LearningA nurse has taught a client’s spouse how to change the

client’s colostomy bag. The nurse would best determine that the spouse understands the procedure by1. Asking the spouse if she has any questions about the procedure2. Asking the spouse if she understands what items are needed to perform the procedure. 3. Asking the spouse to perform the procedure and observe her performing it. 4. Asking the spouse if she feels comfortable performing the procedure.

Answer3- Note the keyword “best” in the stem and

focus on the issue: the spouse’s ability to perform a procedure. The nurse would best evaluate learning by observing the performance of the behavior. Although 1,2, & 4 are things the nurse would ask, they do not evaluate.

Pharmacology Questions

• Utilize the Five Medications Rights and your knowledge on appropriate ways to give medication.

• Utilize the following assessment guidelines– Always assess

• Allergies or hypersensitivity to a med• Existing medical disorders that are contraindicated• Potential interactions • Pertinent lab• VS (esp for cardiac and BP meds) • Intended effects, side effects, adverse effects, or toxic effects• Client response to medication

Pharmacology Question

• The nurse notes that a physician has prescribed cotrimoxazole (Bactrim) for a client with a urinary tract infection. Which priority action will the nurse take before administering this medication? 1. Call the pharmacy to order the med. 2. Ask the client about an allergy to sulfonamides. 3. Check the medication supply room to find out whether the medication needs to be ordered.4. Inform the client about the need to increase fluid intake.

Answer

• 2- Note the issue: the action that the nurse will take

• Note the keyword: priority

• The steps of the nursing process help you here, option 2 is the only option that addresses client assesment.

Pharmacology Question

• A client taking amitriptyline (Elavil) calls the nurse at the physician’s office and reports that he has an upset stomach whenever he takes the medication. The nurse most appropriately tells the client to

1. Take the medication with an antacid. 2. Stop the med for 2 days, and then resume the

prescribed med schedule. 3. Take the med on an empty stomach. 4. Take the medication with food

Answer

• 4- Issue- upset stomach! Recall antacids are not usually administered with medication. Options 1 & 2, a nurse would not tell a patient to stop taking a medication.

Pharmacology Questions

• Have to know the differences between – Intended effects: a desirable effect– Side effects: no desired, not usually life-

threatening, alleviated with specific measures– Adverse effects: more severe than a side

effect, always undesirable, always reports to the health care provider

– Toxic effects: medication level in the body exceeds the therapeutic level.

Question

• Erythromycin (E-Mycin) has been prescribed for a client with a respiratory infection. The nurse tells the client that which frequent side effect can occur from this medication?

1. Yellow discoloration to the white part of the eye.

2. Abdominal cramping

3. Severe diarrhea

4. Yellow colored skin

Answer

• 2- Issue- side effect. Eliminate options 1 & 4 first because they are similar and both indicate the presence of hepatitis, and adverse side effect of the medication. Eliminate option 3 because of the word “severe”, which indicates an adverse effect.

Question

• A client with congestive heart failure is receiving furosemide (Lasix). The nurse monitors the client for which adverse effect of the medication?

1. Nausea

2. Increase in urinary output

3. Gastric upset

4. Muscle weakness

Answer

• 4- Issue- adverse effect. Eliminate 1 & 3 because they are similar and both relate to the GI System. Eliminate option 2 because it is an intended effect of the med.

Unfamiliar with the Medication

• Tips– Note whether the question identifies the client’s diagnosis. For

example: if the questions states: Cyclophosphamide (Cytoxan) has been prescribed for a client with metastatic breast cancer, focusing on the client’s diagnosis will help you to determine that cyclophosphamide is an anitneoplastic med.

– Break down the name of the med into parts (trade or generic) Ex: Terbutaline sulfate (Brethine) has been prescribed for a client. Think about “breath” when you look at the medication name Brethine to help you determine that it is respiratory med.

– Note the letters in the med name and look for those letters that identify a particular medication classification. (See handout)

Pharmacology QuestionsBreak the name down to help you

• A clinic nurse is taking a health history on a client seen at the health care clinic for the first time. When the nurse asks the client about current prescribed medications, the client tells the nurse that indinavir (Crixivan) is taken twice daily. Based on this finding, the nurse suspects the presence of which condition?

1. Peptic ulcer disease2. Inflammatory bowel disease3. HIV 4. Diverticulitis

Answer

3- Keyword “suspects the presence”

Issue- nurse’s findings

Remember that many antiviral medication names contain the letters vir will direct you to option 3.

Note the similarity in options 1,2, & 4

Delegation

• The Rules1. Do not delegate functions of assessment,

evaluation, and nursing judgment. 2. This is not the read world3. Delegate activities for stable patients with

predictable outcomes4. Delegate activities that involved standard,

unchanging procedures. 5. Remember priorities! Review your Nurse Practice Act

Who can do what?

• Unlicensed Personnel– Ambulate– Bathe– Transport– Groom– Hygiene measures– Position– ROM – Skin care– Some specimen

collections, such as urine or stool

• LPN – Administer

• Oral meds• IM’s• Sub Q’s

– Change Dressings– Irrigate wounds– Monitor IV flow rates– Suction– Teach basic hygiene and

nutritional measures– Urinary cath– Use nursing process: data

collection, plan, implement, evaluate

The RN

• Administer IV meds

• Leader others and manage client care environment

• Teach

• Use nursing process: assess, analyze data, plan, implement evaluate

Practice

• A nurse is planning client assignments for the day and needs to assign four clients. There is a RN, a LPN, and 2 CNA’s on the nursing team. Which client would the nurse most appropriately assign to the RN?

1. A client with a right leg amputation who requires a dressing change.

2. A client requiring a bed bath. 3. A client who required frequent ambulation. 4. A client who was admitted to the hospital during the

night after experiencing an acute asthma attack.

Answer

4- Keywords are most appropriate and RN assignment

1- the LPN can do

2- CNA

3- CNA

You HAVE GOT to Critically Think

• A nurse is planning the client assignments for the day and is reviewing client data and the needs of the clients on the nursing team. To maintain continuity of care, the nurse would ensure that which client is cared for by the nurse who cared for the client on the previous day?

Answers

1. A client with a cervical radiation implant

2. A client with active TB

3. A client with herpes zoster (chickenpox)

4. A client recently diagnosed with inoperable cancer

Answer

4- Issue- focus on continuity of care

Important are client needs and safe environment

Options 1, 2, & 3 present a risk to the healthcare provider

Option 4 is psychosocial needs that can be met with continuity of care!

Other Helpful Hints and Strategies

When do I select “Call the MD”?

• This is not always clear cut! You must read the question to determine what it is asking you. Is it asking you for a nursing intervention? Is the client situation life threatening?

Practice

• A nurse is caring for a postop client who suddenly becomes restless. The nurse would most appropriately:

1. Check the client’s vital signs

2. Notify the MD

3. Medicate the client for pain

4. Talk to the client in a calm voice

Answer

1- Keyword: most appropriate

Option 3- nothing tells us the patient is in pain

Option 4- pyschosocial issue

Down to 1 and 2.

First step in nursing process

Practice

• A nurse is caring for a client who just returned from the recovery room after a tonsillectomy and adenoidectomy. The client is restless and the pulse rate is increased. The nurse prepares to continue assessing the client, but the client begins to vomit large amounts of bright red blood. The immediate nursing action is to:

1. Call the surgeon2. Continue with the assessment3. Check the client’s BP4. Obtain a flashlight and gauze

Answer

1- Keywords- restless, pulse rate increased, large amounts bright red blood, immediate.

Options 2,3,4 would delay necessary interventions needed in this life threatening situation!

Eliminate Options that Contain Absolute Words

• Absolute Words– All– Always– Can’t – Every– Must– Never – None– Not– Only – Won’t * May indicate an incorrect

option

• Not So Absolute Words – Generally– May– Possibly – Usually * May indicate a correct

option

Practice

• A nurse is providing dietary instructions to a client about a low-fat diet. The nurse tells the client to:

1. Never use butter for cooking2. Read the labels on food items to

determine the fat content3. Eat only foods that have less than 1% fat

content4. Drink fluids only if they are fat free

Practice

• A client scheduled for a CT scan of the abdomen asks the nurse when the results of the test will be available. The nurse makes which most appropriate response to the client?

1. “The results won’t be available for at least one week.”2. “You must ask the CT tech for that information.”3. “Your MD may have the results in about 3 days.”4. “Every scan is read by a radiologist and this process

always takes one week.”

Medical vs Nursing Options

• Remember boards is testing YOUR knowledge as an RN! The only time you should give a medical intervention is if the question states “Which intervention does the nurse anticipate the MD to prescribe?”

Practice

• A nurse is caring for a client with a diagnosis of CHF who suddenly experiences severe dyspnea; the nurse suspects that pulmonary edema has developed. The nurse immediately:

1. Obtains a vial of Lasix and a syringe

2. Places the client in high Fowler’s position

3. Obtains a dose of morphine sulfate from the narcotic drawer

4. Inserts a Foley catheter

Answer

• 2- Options 1,3, & 4 all require MD orders!

Ensuring all parts of the option are CORRECT

• A nurse is performing an assessment on a client diagnosed with a cataract of the right eye. The nurse would expect to obtain which data on assessment?

1. Reports of blurred vision and excessive tearing of the eye.

2. A cloudy white pupil and reports of eye pain. 3. Reports of gradual loss of vision and

photophobia4. Reports of a frontal headache and

photophobia.

Lab ValuesHow do I ever remember them all? • Identify whether the lab value is normal or

abnormal.

• Note the disorder presented in the question

• Identify the body organ that is affected as a result of the disorder

Practice

• A client with a diagnosis of sepsis is receiving antibiotics by the intravenous route. The nurse assesses the nephrotoxicity by monitoring which lab value closely?

1. Blood urea nitrogen2. White blood cell count3. Platelet count4. Lipase Level

Answer

1- Keyword “most closely”

Issue “nephrotoxicity”

Option 1 is the only one that relates to renal!

2- immune

3- hematological

4- panreatic

Last minute Pointers

• Visualize the question• Only be concerned with the

client in the question• Remember the Glass House

Theory• Pace yourself, concentrate,

and focus

When you get Frustrated!

Stop

Deep breath

Positive self talk

DO NOT SECOND GUESS YOURSELF !!!!!!

DO NOT CHANGE ANSWERS !!!!!!!!!!!

Practice Makes Perfect

Remember these are “test taking skills”, like any skill you have to practice to get good at it!

Last but not Least A 3 hour lecture summarized in a few sentences

Read each case scenario carefully. It contains the information you need to answer the question.

Go with what you know! Formulate an answer before you look at them!

Client safety is NUMBER 1 priority.

Last but not Least A 3 hour lecture summarized in a few sentences

There is only 1 correct answer. If more than one seems correct, look at your key words.

Don’t focus on “trick” questions, there are none! NCLEX and HESI want to know that you are safe!

Go to the testing site

Last but not Least A 3 hour lecture summarized in a few sentences

Students who study by answering as many questions as possible are most likely to succeed. At minimum, you should answer at least 3,000 questions when preparing for the NCLEX exam.

Last but not Least A 3 hour lecture summarized in a few sentences

No substitute for baseline nursing knowledge.

Don’t panic! If you get to something you don’t know, use your test taking strategies.

Time flies, prepare for the marathon by training yourself for the potential of getting all 265 questions.

Resources• Websites • www.nscbn.org• http://caring4you.n

et/tests.html• http://www.nclexinf

o.com/• www.learningext.co

m• http://www.testprep

review.com/nclex_practice.htm

• Books • Kaplan (2005).

NCLEX-RN Exam 2005-2006 Edition.

• Silvestri, L. (2005). Strategies for Success for the NCLEX-RN Examination