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Bloom's Taxonomy

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1. analysis 2.application 3.comprehension 4.recall/recognition

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4 Essential Steps to Answering a NCLEX Style Test Question

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1. determine if the question is "positive" or "negative" focused 2.Find the key words in the question 3. Rephrase the question in your own words 4. Rule out options: be able to rationalize each option is either right or wrong

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Step 1 Positive or negative question

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Am I looking for a right or wrong answer?

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Positive style question

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include words in the stem of the question such as: early best most likely select all that apply order of priority

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Negatively worded stem

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asks you to identify an exception, detect an error or recognize nursing interventions that are unacceptable or contraindicated stem of the question may include words like: not except never contraindicated unacceptable avoid least

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a client wit suspected active lung tuberculosis is being scheduled for diagnostic tests. The RN anticipates that which diagnostic test will most likely be prescribed to confirm the diagnosis

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POSITIVE-strategic word "most likely"

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A client treated for an episode of hyperthermia is being discharged to home from the emergency department. The nurse determines that the client needs additional discharge instructions if the client states intention to

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NEGATIVVE-strategic phrase "needs additional teaching"

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Which action violates medical asepsis when the nurse makes an occupied bed?

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NEGATIVE- strategic pharase "violates"

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The nurse is assigned to care for a patient who is incontinent of urine and stool. What should the nurse apply to best protect the patient's skin

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POSITIVE-strategic phrase "best"

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Ste 2 Key words

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-As you read the question and note the key words determine what the question is asking -it is important to read EVERY word of the question -every word in the stem is important, but some words are more significant than others -each question usually contains no more than 3 key words -identify the central subject in the question

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the nurse is observing a mother administer eye drops to her 2-year old child. Which action by the mother indicates the need for re-teaching the skill?

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key words: eye- drops, 2-year old child, re-teaching

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to meet the patient's basic physiological needs according to Maslow's Hierarchy of Needs, what should the nurse do?

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key words: Maslow's theory, physiological

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Step 3- Rephrase the question in your own words

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Question: why is this important? Answer: Helps you eliminate non-essential information(distractors) helps you determine what the question is REALLY asking you

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an ambulatory female who is alert and oriented refuses to take a shower because she is experiencing menstrual bleeding, bust states that she would like the nurse to assist her with a bed bath. What action should the nurse implement first

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Rephrase: What is best to do for an alert, ambulatory client who refuses to shower?

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which snack is best to provide an adult client on prolonged bed rest?

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rephrase: what nutrients does an immobile client need most?

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Step 4 Rule out options

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-be able to rationalize why each option is either right or wrong -look for the patient centered response -identify specific determiners in options (just, always, never, all, every,none, and only are absolute) -identify opposites in the options -identify the global option-the answer that is more comprehensive and general that the other options -identify duplicate facts among the options (all pieces of the answer must be correct) -identify options that deny patient feelings, concerns and needs

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Prioritization questions

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-means ou need to rank the client's problems in order of importance -need to decide which client needs or problems require immediate action and which ones could be delayed until a later time

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use the ABC's first

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-airway, breathing, circulation -if the option addresses a patent airway-that will be the correct option -if none of the answers address airway, move to breathing, followed by circulation -ABC'S must be relevant to the situation

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Maslow's Theory

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-if ABC'S are not applicable to the question consider maslow's heirarchy of needs -maslow theorized that human needs are satisfied in a particular order -basic physiological needs -ABC'S, water,food,and elimination needs -safety and security-protection from injury, promoting feelings of security -love and belonging maintaining support systems, protect from isolation

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Heirarchy

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1.physicological needs 2. safety and security 3.love and belonging 4. self esteem 5. self-actualization

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safety needs

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can be both physical and psychosocial

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physical safety

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the threat may be an illess, accident or environmental

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physiological safety

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to attain this, client must have KNOWLEDGE about what to expect from others

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The nursing process

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if ABC'S and Maslow's are not applicable to the priority question consider nursing process ADPIE

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ADPIE

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Assess Diagnose Plan Intervention Evaluate

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strategic words in option that indicate assessment

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ascertain check determine monitor observe identify ask

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who do you see first?

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----first look at each option and determine whether the s/s the client is exhibiting are normal or expected for the disease process-if so you do not need to see this patient first ----if 2 or more of the options state s/s that are not normal or expected the select then select the answer that has the greatest potential for a poor outcome

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ask yourself

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---is the situation life threatening or life altering? if yes then highest priority ---situation unexpected for the disease process? if yes then this client is priority ----are the lab data normal? if yes then this client may be priority ----is the situation or data normal? if yes client can be seen last

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when do you call MD

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--more often than not this is wrong choice ---usually there is something the RN needs to do first BEFORE contacting the MD ---If the patient is post-operative and experiencing a complication after surgery --------ask "as a nurse can i fix this?" if not call DR

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Delegating and Assigning Care

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--when assigning care to a LPN, the RN can assign the administration of some medications --no initial assessments,teaching or evaluating --no delegation of care for an unstable patient --when delegating to an UAP, the nurse may not delegate any activity that requires nursing judgement --no assessing,teaching, evaluating or administering meds ----no delegation of care for unstable patients or patient's experiencing a change in condition

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Therapeutic Communication

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--therapeutic communication means listening to and understanding the client while promoting clarification and insight --authoritarian answer ------telling the client what to do without regard for feelings --close-ended answer (yes/no) --why questions ------any question that puts the client on defense -------any statement that seeks reasons or justification ---let's explore-not the psychiatrist ---dont worry answers--false reassurance ---nurse focused answer--happened to me once--know ffrom experience this is hard for you

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NCLEX

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MIN # questions-85 max #- 205 5 hours to complete exam with 2 15 min breaks both multiple choice and alternative format -multiple response -fill in the blank -ordered response -hot spots

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computerized adaptive testing

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exam starts at passing level -passing--using analysis and application -failure--using comprehension and knowledge

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passing NCLEX

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create a string of 10 to 15 correct answers above the passing line use analysis and application

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failing NCLEX

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exam starts at passing level but once get below line and use comprehension and knowledge only

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test plan structure- health promotion and maintenance

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7-13%

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test plan structure-psychosocial integrity

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8-14%

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test plan structure- physiological integrity

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basic care & comfort-7-13% pharmacological therapies-11-17% reduction of risk potential-10-16% physiological adaptation-7-13%

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test plan structure-safe and effective care environment

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coordinated care 16-22% safety and infection control 10-16%

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integrated process

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--clinical problem soling process --caring-- creating an atmosphere of mutual respect and trust --communication and documentation ---teaching and learning-facilitating knowledge, skills and attitudes to assist in promoting a change in behavior

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Safe and effective Care-Mgmt of care

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---Advanced directives --advocacy -assignment, delegation and supervision --case mgmt -client rights --collaboration w/ interdisciplinary team --concepts of mgmt --confidentiality/information security --continuity of care ---establishing priorities --ethical practice --informed consent --information technology --legal rights and responsibilities --quality improvement -referrals

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safety and infection control

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--accident/error/injury prevention --emergency response plan --ergonomic principles --handling hazardous and infections material --home safety --reporting of incident --restraints and safety devices --safe use of equipment --security plan --standard precaustions

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health promotion and maintenance

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--aging process --ante/intra/postpartum and newborn care --data collection techniques --developmental stages and transitions --health promotion/disease prevention --high risk behaviors --lifestyle choices --self-care --techniques of physical assessment

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psychosocial integrity

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--abuse and neglect --behavioral mgmt --chemical and other dependencies --coping mechanisms --crisis intervention --cultural awareness --end of life concepts --grief and loss --family dynamics --mental health concepts --religious and spiritual influences on health --sensory/perceptual awareness --stress mgmt --support systems --therapeutic communication --therapeutic environment

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physiological integrity-basic care and comfort

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--assistive devices --elimination --mobility/immobility --non-pharm comfort iterentions --nutrition and oral hydration --personal hygiene --rest and sleep

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pharmacological therapies

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--adverse effects/contraindications/se --dosage calculations --expected action/outcome --medication administration --pharmacological pain mgmt

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reduction of risk potential

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--changes/abnormalities in vs --diagnostic tests --lab values --potential alteration in body systems --potential for complications of diagnostic tests/treatments/procedures ---potential for complications from surgical procedures and health alerations --therapeutic procedures

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physiological adaptation

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--alterations in body systems --basic pathophysiology --fluid and electrolyte imbalances --medical emergencies --radiation therapy --unexpected responses to therapies

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critical thinking

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--validate and organize data --looking for patterns --transfer knowledge from one situation to another --evaluate and revise thinking

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level 1

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assumes the expert has the right answer assumes there is only one correct answer assumes the correct answer neer changes

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level 2

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analysis question or situation what is the question asking what is the safest nursing judgement what applies in this situation

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