Discussion 28
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NCLEXStrategiesthenursingprocessandsafety.pptxNCLEX Strategies: Getting ready (The Nursing Process)
By: Guillermo Londono RN, MSN/MHA
Dean / Director of Nursing
July 1, 2017
Objectives:
Recognizing Priority Questions key words
Nursing process strategy
Safety strategy
Physiological and Psychosocial Needs
NCLEX Strategies
Recognizing Priority Questions key words
You will recognize priority questions on the NCLEX-RN exam because they will ask you what is the:
“best,”
“most important,”
“first,”
or “initial response” by the nurse.
NCLEX Strategies
Recognizing Priority Questions
Students will be caring for clients who have multiple problems and needs.
Students must be able to establish priorities by deciding which needs take precedence over the other needs.
Example: Students probably recognized the baby’s jerky movements as an indication of hypoglycemia.
NCLEX Strategies
Recognizing Priority Questions
Don’t forget that an important part of the assessment process is validating what you observe.
Students must complete an assessment before you analyze, plan, and implement nursing care.
The critical thinking required for priority questions is for you to recognize patterns in the answer choices.
By recognizing these patterns, students will know which path you need to choose to correctly answer the question.
NCLEX Strategies
Recognizing Priority Questions
There are three strategies to help you establish priorities on the NCLEX-RN exam:
Maslow strategy
Nursing process strategy
Safety strategy
NCLEX Strategies
We will outline each strategy, describe how and when it should be used, and show you how to apply these strategies to exam-style questions.
By using these strategies, you will be able to eliminate the second-best answer and correctly identify the highest priority.
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Strategy Two: Nursing Process (Assessment versus Implementation)
Strategy Two: Nursing Process
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Strategy Two: Nursing Process (Assessment versus Implementation)
A second strategy that will assist you in establishing priorities involves the assessment and implementation steps of the nursing process.
On the NCLEX-RN exam, you will be given a clinical situation and asked to establish priorities.
The possible answer choices will include both the correct Assessment and Implementation for this clinical situation.
How do you choose the correct answer when both the correct assessment and implementation are given?
NCLEX Strategies
Think about these two steps of the nursing process.
As a nursing student, you have been drilled so that you can recite the steps of the nursing process in your sleep—assessment, analysis, planning, implementation, and evaluation. In nursing school, you did have some test questions about the nursing process, but you probably did not use the nursing process to assist you in selecting a correct answer on an exam.
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Assessment keywords
adaptations
ascertain
assess
check
collect
communicate
determine
find out
gather
identify
inform
inspect
monitor
nonverbal
notify
observe
obtain information
perceptions
question
verify
Strategy Two: Nursing Process (Assessment versus Implementation)
Assessment is the process of establishing a data profile about the client and his or her health problems.
The nurse obtains subjective and objective data in a number of ways:
talking to clients, observing clients and/or significant others
taking a health history, performing a physical examination
evaluating lab results
collaborating with other members of the health care team.
NCLEX Strategies
Strategy Two: Nursing Process (Assessment versus Implementation)
Once you collect the data, you compare it to the client’s baseline or normal values.
On the NCLEX-RN exam, the client’s baseline may not be given, but as a nursing student you have acquired a body of knowledge.
On this exam, you are expected to compare the client information you are given to the “normal” values learned from your nursing textbooks.
It is essential that you complete the assessment phase of the nursing process before you implement nursing activities.
This is a common mistake made by NCLEX-RN exam takers: don’t implement before you assess.
NCLEX Strategies
Assessment is the first step of the nursing process and takes priority over all other steps.
REMEMBER
Strategy Two: Nursing Process (Assessment versus Implementation)
Implementation is the care you provide to your clients.
Implementation includes:
assisting in the performance of activities of daily living (ADLs).
counseling and educating the client and the client’s family.
giving care to clients, and supervising and evaluating the work of other members of the health team.
NCLEX Strategies
Implementation Keywords
action
assist
change
counsel
delegate
dependent
facilitate
give
Implement
independent
inform
instruct
interdependent
method
motivate
perform
procedure
provide
refer
strategy
supervise
teach
technique
treatment
Strategy Two: Nursing Process (Assessment versus Implementation)
Nursing interventions may be independent, dependent, or interdependent.
Independent interventions are within the scope of nursing practice and do not require supervision by others.
Instructing the client to turn, cough, and breathe deeply after .
Dependent interventions are based on the written orders of a physician.
On the NCLEX-RN exam, you should assume that you have an order for all dependent interventions that are included in the answer choices.
NCLEX Strategies
This may be a different way of thinking from the way you were taught in nursing school.
Many students select an answer on a nursing school test (that is later counted wrong) because the intervention requires a physician’s order.
Everyone walks away from the test review muttering, “Trick question.”
It is important for you to remember that there are no trick questions on the NCLEXRN exam.
You should base your answer on an understanding that you have a physician’s order for any nursing intervention described.
Interdependent interventions are shared with other members of the health team. For instance, nutrition education may be shared with the dietitian. Chest physiotherapy may be shared with a respiratory therapist.
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Strategy Two: Nursing Process (Assessment versus Implementation)
The following strategy
Utilize the assessment and implementation phases of the nursing process.
It will assist you in selecting correct answers to questions that ask you to identify priorities.
NCLEX Strategies
Strategy Two: Nursing Process (Assessment versus Implementation)
STEP 1: use the Nursing Process (Assessment vs. Implementation) strategy.
Read the answer choices to establish a pattern.
If the answer choices are a mix of assessment/validation and implementation
STEP 2- Refer to the question to determine whether you should be assessing or implementing.
If after Step 2 you find that, for example, it is an assessment question, eliminate any answers that clearly focus on implementation.
STEP 3- Eliminate answer choices, and then choose the best answer (PRIORITY).
NCLEX Strategies
Class activity #3: Apply, analyze and use critical thinking
A boy was riding his bike to school when he hit the curb. He fell and hurt his leg. The school nurse was called and found him alert and conscious, but in severe pain with a possible fracture of the right femur. Which of the following is the FIRST action that the nurse should take?
Immobilize the affected limb with a splint and ask him not to move.
Make a thorough assessment of the circumstances surrounding the accident.
Put him in semi-Fowler’s position for comfort.
Check the pedal pulse and blanching sign in both legs.
NCLEX Strategies
Strategy Two: Nursing Process (Assessment versus Implementation)
Practice question.
A boy was riding his bike to school when he hit the curb. He fell and hurt his leg. The school nurse was called and found him alert and conscious, but in severe pain with a possible fracture of the right femur. Which of the following is the FIRST action that the nurse should take?
Immobilize the affected limb with a splint and ask him not to move.
Make a thorough assessment of the circumstances surrounding the accident.
Put him in semi-Fowler’s position for comfort.
Check the pedal pulse and blanching sign in both legs.
NCLEX Strategies
Assessment vs. Implementation
The answer choices are a mix of assessment/validation and implementation
The words “ first action” tell you that this is a priority question.
The Reworded Question: What is the highest priority for a fractured femur?
Step 1. Read the answer choices to establish a pattern.
The answer choices are a mix of assessment/validation and implementation. Use the Nursing Process (Assessment vs. Implementation) strategy.
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Strategy Two: Nursing Process (Assessment versus Implementation)
Practice question.
A boy was riding his bike to school when he hit the curb. He fell and hurt his leg. The school nurse was called and found him alert and conscious, but in severe pain with a possible fracture of the right femur. Which of the following is the FIRST action that the nurse should take?
Immobilize the affected limb with a splint and ask him not to move.
Make a thorough assessment of the circumstances surrounding the accident. (eliminate)
Put him in semi-Fowler’s position for comfort (no respiratory distress)
Check the pedal pulse and blanching sign in both legs. (eliminate)
NCLEX Strategies
Eliminate answer choices, and then choose the best answer.
Step 3. Eliminate answer choices, and then choose the best answer.
Eliminate answers (2) and (4) because they are assessments. This leaves you with choices (1) and (3).
Which takes priority: immobilizing the affected limb, or placing the boy in a semi-Fowler’s position to facilitate breathing?
The question does not indicate any respiratory distress.
The correct answer is (1), immobilize the affected limb.
Some students will choose an answer involving the ABCs without thinking it through. Students, beware. Use the ABCs to establish priorities, but make sure that the answer is appropriate to the situation. In this question, breathing was mentioned in one of the answer choices. If you thought of the ABCs immediately without looking at the context of the question, you would have answered this question incorrectly.
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Strategy Two: Nursing Process (Assessment versus Implementation)
A boy was riding his bike to school when he hit the curb. He fell and hurt his leg. The school nurse was called and found him alert and conscious, but in severe pain with a possible fracture of the right femur. Which of the following is the FIRST action that the nurse should take?
Immobilize the affected limb with a splint and ask him not to move.
Make a thorough assessment of the circumstances surrounding the accident (eliminate)
Put him in semi-Fowler’s position for comfort.
Check the pedal pulse and blanching sign in both legs (eliminate)
NCLEX Strategies
Determine whether you should be assessing or implementing.
The words “ first action” tell you that this is a priority question.
Implementation
Step 2. Refer to the question to determine whether you should be assessing or implementing. According to the question, the nurse has determined that the boy has a possible fracture.
This implies that the nurse has completed the assessment step. It is now time to implement.
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Strategy Three: Safety
Nurses have the primary responsibility of ensuring the safety of clients.
This includes clients in health care facilities, in the home, at work, and in the community.
Safety includes:
meeting basic needs (oxygen, food, fluids, etc.)
reducing hazards that cause injury to clients (accidents, obstacles in the home)
decreasing the transmission of pathogens (immunizations, sanitation).
NCLEX Strategies
Remember that the NCLEX-RN exam is a test of minimum competency to determine that you are able to practice safe and effective nursing care.
Always think safety when selecting correct answers on the exam.
When answering questions about procedures, this strategy will help you to establish priorities.
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Strategy Three: Safety
STEP 1- Are all the answer choices implementations? If so, use the Safety strategy.
STEP 2- Can you answer the question based on your knowledge? If not, continue to Step 3.
STEP 3- Ask yourself, “What will cause the client the least amount of harm?” and choose the best answer.
NCLEX Strategies
Strategy Three: Safety
Practice question
A child undergoes a tonsillectomy for treatment of chronic tonsillitis unresponsive to antibiotic therapy. After surgery, the child is brought to the recovery room. Which of the following actions should the nurse include in the child’s plan of care?
Institute measures to minimize crying.
Perform postural drainage every 2 hours.
Cough and deep-breathe every hour.
Give ice cream as tolerated.
NCLEX Strategies
Step 1- Are all the answer choices implementations?
YES
The Reworded Question: What should you do after a tonsillectomy?
Step 1. Are all the answer choices implementations? Yes.
Step 2. Can you answer the question based on your knowledge of a tonsillectomy? If not, continue to Step 3.
Step 3. Ask yourself, “What will cause the client the least amount of harm?”
Answer choice (1), minimizing crying, will help prevent bleeding. Keep in consideration. Answer choice (2), postural drainage, may cause bleeding. Eliminate. Answer choice (3), coughing and deep-breathing, may cause bleeding. Eliminate. Answer choice (4), giving ice cream, may cause the child to clear his throat, causing bleeding. Eliminate. The correct answer is (1). The nurse must prevent postoperative hemorrhage, a complication seen after this type of surgery. Crying would irritate the child’s throat and increase the chance of hemorrhage.
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Strategy Three: Safety
Practice question
A child undergoes a tonsillectomy for treatment of chronic tonsillitis unresponsive to antibiotic therapy. After surgery, the child is brought to the recovery room. Which of the following actions should the nurse include in the child’s plan of care?
Institute measures to minimize crying.
Perform postural drainage every 2 hours.
Cough and deep-breathe every hour.
Give ice cream as tolerated.
NCLEX Strategies
Step 2. Can you answer the question based on your knowledge of a tonsillectomy?
If not, continue to Step 3.
The Reworded Question: What should you do after a tonsillectomy? Step 1. Are all the answer choices implementations? Yes.
Step 2. Can you answer the question based on your knowledge of a tonsillectomy? If not, continue to Step 3.
Step 3. Ask yourself, “What will cause the client the least amount of harm?”
Answer choice (1), minimizing crying, will help prevent bleeding. Keep in consideration. Answer choice (2), postural drainage, may cause bleeding. Eliminate. Answer choice (3), coughing and deep-breathing, may cause bleeding. Eliminate. Answer choice (4), giving ice cream, may cause the child to clear his throat, causing bleeding. Eliminate. The correct answer is (1). The nurse must prevent postoperative hemorrhage, a complication seen after this type of surgery. Crying would irritate the child’s throat and increase the chance of hemorrhage.
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Strategy Three: Safety
Practice question
A child undergoes a tonsillectomy for treatment of chronic tonsillitis unresponsive to antibiotic therapy. After surgery, the child is brought to the recovery room. Which of the following actions should the nurse include in the child’s plan of care?
Institute measures to minimize crying.
Perform postural drainage every 2 hours (cause bleeding)
Cough and deep-breathe every hour (cause bleeding)
Give ice cream as tolerated (cause bleeding)
NCLEX Strategies
Step 3. Ask yourself, “What will cause the client the least amount of harm?”
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