PN 154 NCLEX Review Spring 2010 Instructor: Lisa Lee Rohm, RN, BSN Creator of this fabulous...

PN 154NCLEX Review

Spring 2010

Instructor: Lisa Lee Rohm, RN, BSN

Creator of this fabulous PowerPoint: Amber Lee, RN, BSN!!

Concorde’s Process

A preliminary “Candidate list” is made and sent to OSBN, who then sends the list to Pearson Vue

Applications (both for OSBN and Pearson Vue), fingerprinting, & passport photo will be sent by Concorde to the appropriate places

You may receive your Authorization to Test (ATT) prior to OSBN receiving the official transcripts, however if you take the exam before your transcripts are received, you will not receive a nursing license until after the entire process has been completed

On the graduation date, Concorde will send the official “Candidate List” to OSBN

When all of the grades and SIGNED (by you and the instructors) evaluation forms are turned in, the official transcripts will be sent to OSBN

Application Hints

Do not change your name or you appearance from the time you fill out the application and take your passport picture until you receive your license

Do not fill out the blue fingerprinting card until you are in the presence of the “fingerprinter”

For the fingerprinting day: Make sure you are well hydrated and your hands are

moisturized If you have callouses, seriously consider a

(wo)manicure

Application Hints (Just say, Yes!)

If you have any “yes” answers on your BON app. A short, one paragraph, explanation is sufficient

On the chemical substances question, say “yes” even if you have a prescription.

The question reads “Have you ever been arrested, charged with, entered a plea of guilty, no contest, convicted of or been sentenced for ...” Answer “yes” even if the record has been

expunged (juvenile or adult) If you say “no” and it somehow shows up on your

background check, this will delay your process

How to apply for an Oregon Nursing License(step by step process)

www.osbn.state.or.us/OSBN/newgraduates.shtml

How to apply for initial licensure in another state

www.ncsbn.org(Click on “Boards of Nursing”, then “member

boards,” then click on the state you want to be licensed in)

How to register for the NCLEX

https://www.ncsbn.org/2009_NCLEX_Candidate_Bulletin.pdf

or

www.ncsbn.org/Eight_steps_of_NCLEX.pdf (for overview)

Scheduling Your Exam

Concorde will send OSBN a “Candidate list” who will then send Pearson Vue a “Candidate List”

After your board of nursing declares you eligible, you will receive your Authorization to Test (ATT)

Pearson Vue will mail each person their ATT. After you receive your ATT, you may schedule your

test with any Pearson Vue Testing Center (200 locations) Oregon testing centers: Beaverton, Salem, Medford Average test date is 27 days from the date of scheduling

You must take the exam within 90 days of receiving your ATT (but after graduation date 6/25/10)

Scheduling Your Exam

Each ATT is valid for the period of time specified by the board of nursing (BON) (90 days).

Once the BON has declared you eligible to test and your ATT is issued, you must test within the validity dates of your ATT.

These validity dates cannot be extended for any reason. If you do not test within these dates, you will have to re-register and you are responsible for the $200.00 payment.

Before the day of the test:

Expect and prepare for stress Be prepared for others to leave the testing

center before or after you Bring water and snack to keep in the locker Plan alternate routes to the testing facility You can take a virtual tour of your testing

facility by going to: www.pearsonvue.com/index Do not carpool, do not make any other plans

Day of Test:Bring to Testing Center

ATT letter – You will not be admitted to the exam without your ATT. You will be required to re-register and re-pay to take the exam ($200.00).

2 forms of ID, one with photo, both with signature First and Last name must exactly match the

name on your ATT letter VALID Driver’s License or State ID or Passport

(MUST NOT BE EXPIRED) and must include a photograph and signature

A small storage space is provided

Day of Test

Plan to arrive 30 minutes before your scheduled testing time. (If you arrive late you may be required to forfeit your appointment. Your failure to take the exam will be reported to the BON!)

The test administrator (TA) will provide you with an erasable note board that may be placed

Day of Test: Do Not Bring

Any study materials! Hats, Scarves, Coats, Phones, Watches, Pager Paper/Pen/Pencil/Calculator (Dry Erase Board,

Marker, and Calculator are provided) Do not take textbooks or notebooks containing

NCLEX study materials to the test center as such items are considered prohibited testing aids; doing so may result in dismissal or cancellation of your testing results.

Day of Test

You will be fingerprinted, photo taken, and asked to illustrate your signature.

Earplugs provided if needed.

Clock starts as soon as you are “logged in”.

You have 5 hours to complete the NCLEX-PN.

You will receive a tutorial before the exam to familiarize you with the computer.

Day of Test

Optional Breaks provided at 2 hours, and at 3.5 hours

Breaks count against your testing time, when you return from break, you will be fingerprinted again

You will be asked to complete a survey at the end of the exam

Do not give any information about the exam to anyone, including instructors!

Day of Test

The test administrator (TA) will provide you with an erasable board that may be replaced as needed during testing.

The TA will give you a short orientation and then will escort you to a computer terminal. You must remain in your seat during the exam, except when authorized to leave by test center staff.

You may not change your computer terminal unless a TA directs you to do so.

Day of Test

Raise your hand to notify the TA if You: Believe you have a problem with your computer Need to change note boards Need to take a break Need the administrator for any reason

When you have finished the test and questionnaire, raise your hand. The TA will collect and inventory all note boards.

The TA will dismiss you when all requirements are fulfilled.

~48 hours after the NCLEX

Results will not be released until the Board of Nursing receives you official transcripts from Concorde

Oregon License Verification (free): www.oregon.gov/OSBN or call 971-673-0679

You may also obtain unofficial NCLEX exam results two business days after taking the exam by phone (1-900-776-2539) or on the web at www.pearsonvue.com/nclex. The cost is $7.95 via the website or $9.95 per phone call.

If results are taking longer than 2 weeks, contact the Board of Nursing

Common Questions and Myths About the NCLEX

Passing Score depends on what the average score of all people taking the test across the nation

There’s lots of drug questions

Can you have a piece of scratch paper/pencil/calculator?

Passing Score is 77%

If you think you failed, you passed

Common Questions and Myths About the NCLEX It is hard!

Can you take the NCLEX in another state?

How many times can you retake the exam?

Test-takers are selected randomly to take a certain number of questions.

If you miss a question on a particular subject, you will get more questions on that topic.

FYI

OSBN is now requiring that you notify them of name changes, address changes, email changes, employment changes, and lost card

You must work 960 hours/5 years (about 1 weekend a month) to maintain your license May be any employment that is at a nurse level May be volunteer work (if volunteer or self-

employment, you are responsible for keeping track of your hours)

Your employer may narrow your scope of practice, but may not broaden your scope of practice

Test Breakdown

85- 205 questions (There are thousands of questions in the test bank)

25 pre-test questions on every NCLEX-PN exam (60 official plus 25 pre-test questions make up your first 85 questions)

Pre-test questions are written by nurses Questions are reviewed by “Item Reviewers” who

are nurses that are currently practicing nursing Questions must be approved by a “Panel of

Judges” Then the questions will be “pre-test” questions You will not know which questions count towards

your exam

NCLEX Breakdown

Up to 5 hours to take the exam (Speed per question is not a factor in the final score, but figure approx. 1 minute per question)

Exam will end when: At least the minimum number of questions

(85) questions are answered and there is a 95% certainty the test-taker will pass or fail

Maximum number of questions (205) have been answered

Maximum time (5 hours) has passed

Pass or Fail?

It is impossible to take a test which will cover every subject, it would be way too long and take too much time.

Instead the computer decides based off your answers to a minimum amount of questions whether it is 95% certain you would pass or fail if you answered every question on every subject.

Passing with 95% Confidence

Failing with 95% Confidence

Pass or Fail?

After 85 questions the computer will begin to determine the 95% confidence

If at 85 questions, the test taker is not passing or failing, you will continue to answer questions until there is 95% confidence, on way or another.

OR

Pass or Fail?

If the maximum number of questions (205) has been reached or 5 hours has passed, and the computer can still not determine a 95% confidence: The computer will look back at the last 60

questions. If at any point the test taker falls below the

standard- the test taker fails. If the test taker remains above the

standard for the last 60 questions, they pass

Should you “give up” if you take more than 85 questions?

NO! Stay focused. Relax. You still have

plenty of opportunities to pass. Test takers who took 205 questions

have passed

Questions About How CAT works?

National Council of State Boards of Nursing, Inc. (NCSBN) www.ncsbn.org Toll free: 1.866.293.9600 E-mail: [email protected]

Pass Rates

2007 87% test takers

passed on the first time

75% of all the test takers in 2007 passed the NCLEX

2008 85% of test takers

have passed on the first time

78% of test takers have passed the NCLEX so far

*Your best chance to pass is to take the exam sooner than later* (<1month)

What If I Fail?

You will receive a performance report in the mail, which will show you your weak areas

You may retake the exam after 45 days as many times as it takes for up to three years

NCLEX REVIEW

NCLEX TEST PLAN

www.ncsbn.org

Components of Test Plan

Each exam question addresses: A level of cognitive ability A client needs category An integrated process

Levels of Cognitive Ability

Knowledge Recall Comprehension Application Analysis


Knowledge: recall A nurse reviews the laboratory results of a

client’s blood glucose level. The nurse knows that which of the following is a normal level?

1.) 40mg/dL 2.)100 mg/dL 3.) 180 mg/dL 4.) 220 mg/dL


Knowledge: recall A nurse reviews the laboratory results of a

client’s blood glucose level. The nurse knows that which of the following is a normal level?

1.) 40mg/dL *2.)100 mg/dL 3.) 180 mg/dL 4.) 220 mg/dL


Comprehension: understand information and draw inferences based on that information

A hospitalized client with Type 1 diabetes mellitus complains of hunger and nervousness and the nurse notes that the client is diaphoretic. The nurse understands that the client is most likely experiencing:

1. anxiety related to the hospitalization 2. signs related to an infection 3. a hyperglycemic reaction 4. a hypoglycemic reaction


Comprehension: understand information and draw inferences based on that information

A hospitalized client with Type 1 diabetes mellitus complains of hunger and nervousness and the nurse notes that the client is diaphoretic. The nurse understands that the client is most likely experiencing:

1. anxiety related to the hospitalization 2. signs related to an infection 3. a hyperglycemic reaction *4. a hypoglycemic reaction


Application: Intervention, nursing action, decision or problem that needs to be addressed

A client is experiencing a hypoglycemic reaction. The nurse administers which best item to the client to treat the reaction?

1. water 2. diet soda 3. milk 4. one sugar-free cookie


Application: Intervention, nursing action, decision or problem that needs to be addressed

A client is experiencing a hypoglycemic reaction. The nurse administers which best item to the client to treat the reaction?

1. water 2. diet soda *3. milk 4. one sugar-free cookie


Analysis: Consider/examine possibly several concepts in order to answer the question correctly

The nurse administers 10 units of Regular insulin at 0700 to a client with Type 1 diabetes mellitus. The nurse monitors the client most closely for a hypoglycemic reaction during which hours?

1. 0900 to 1000 2. 1300 to 1900 3. 0900 to 1500 4. 1100 to 1200


Analysis: Consider/examine possibly several concepts in order to answer the question correctly

The nurse administers 10 units of Regular insulin at 0700 to a client with Type 1 diabetes mellitus. The nurse monitors the client most closely for a hypoglycemic reaction during which hours?

*1. 0900 to 1000 2. 1300 to 1900 3. 0900 to 1500 4. 1100 to 1200

Client Needs

1 Safe, effective care environment 2. Health promotion and maintenance 3. Psychosocial integrity 4. Physiological integrity

Client Needs

Safe and Effective Care Environment Coordinated Care Safety and Infection Control

Health Promotion and Maintenance Psychosocial Integrity Physiological Integrity

Basic Care and Comfort Pharmacologic Therapies Reduction of Risk Potential Physiological Adaptation

Clients are defined as individuals,

families and significant others.

Safe and Effective Care

The practical nurse provides nursing care that contributes to the enhancement of the health care delivery setting and protects clients and health care personnel by: Collaborating with health care team

members to facilitate effective client care. Contributing to the protection of clients and

health care personnel from health and environmental hazards.

Safe and Effective Care Environment:Coordinated Care (12-18%)

Client Rights Client includes individuals, families, and

significant others Advance Directives Advocacy Client Care Assignments (delegation) Ethical Practice Informed Consent Information Technology

Safe and Effective Care Environment:Coordinated Care cont… Legal Responsibilities Collaboration with the Interdisciplinary Team Concepts of Management and Supervision Confidentiality/Information Security Continuity of Care Establishing Priorities Performance Improvement/Quality

Improvement Referral Process Resource Management Staff Education

Safe and Effective Care Environment: Safety and Infection Control (8-14%)

Accident/Error/Injury Prevention Ergonomic Principles Handling Hazardous and Infectious Materials Home Safety (clients’ home) Internal and External Disaster Plans

(Implementation) Medical and Surgical Asepsis

Safe and Effective Care Environment: Safety and Infection Control (8-14%) con’t

Reporting of Incident/Event/Irregular Occurrence or Variance

Restraints and Safety Devices (correct use) Safe Use of Equipment Security Plan (implementation) Standard/Transmission Based/Other

Precautions

Coordinated Care

A client scheduled for surgery tells the nurse that he signed an informed consent but was never told about the risks of the surgery. The nurse serves as the client’s advocate by:

1. posting a note on the chart for the surgeon will see it when the client arrives in the OR.

2. documenting in the chart that the client was not told about the risks of the surgery.

3. notifying an RN and requesting that the surgeon to be contacted and asked to explain the surgical risks to the client.

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

Health Promotion and Maintenance

The practical/vocational nurse provides nursing care for clients that incorporates knowledge of expected stages of growth and development and prevention and/or early detection of health problems.

Health Promotion and Maintenance (7-13%) Aging Process Ante/Intra/Postpartum and Newborn Care Data Collection Techniques Developmental/Growth Stages and

Transitions Disease Prevention Expected Body Image Changes

Health Promotion and Maintenance (7-13%)

Family Planning Health Promotion and Screening Programs

High Risk Behaviors (Identification) Human Sexuality Immunizations (Identifies schedules) Lifestyle Changes Self Care

Health Promotion & Maintenance

A nurse is preparing to care for a hospitalized teenager who is in skeletal traction. The nurse plans care knowing that the most likely primary concern of the teenager is:

1. Obtaining adequate nutrition

2. Body image

3. Keeping up with schoolwork

4. Obtaining adequate rest and sleep

Psychosocial Integrity

The practical/vocational nurse provides care that assists with promotion and support of the emotional, mental and social well-being of clients

Psychosocial Integrity (8-14%)

Abuse or Neglect Recognition and nursing responsibilities

Behavioral Management Sensory/Perceptual Alterations Situational Role Changes

Psychosocial Integrity cont…

Coping Mechanisms (identifications) Crisis Intervention Cultural Awareness (considerations of care) End of Life Concepts Grief and Loss (assist with process)


Mental Health/Illness Concepts Care of a client with a mental health disorder

Religious or Spiritual Influences on Health Considerations of care

Stress Management (techniques) Substance Related Disorders (identification)


Suicide/Violence Precautions Support Systems Therapeutic Communication Therapeutic Environment Unexpected Body Image Changes


A male child is brought to the school nurse’s office with c/o abdominal pain. On data collection, 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 the bruises noted on the child

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


A male child is brought to the school nurse’s office with c/o abdominal pain. On data collection, 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 the bruises noted on the child

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

Physiologic Integrity

The practical nurse assists in the promotion of physical health and well-being by providing care and comfort, reducing risk potential for clients and assisting them with the management of health alterations by:

Physiologic Integrity cont…

Providing comfort to clients and assistance in the performance of their activities of daily living

Providing care related to the administration of medications and monitors clients receiving parenteral therapies

Reduces the potential for clients to develop complications or health problems related to treatments, procedures, or existing conditions

Provides care for clients with acute, chronic or life threatening physical health conditions

Physiologic Integrity:Basic Care and Comfort (11-17%)

Alternative and complementary therapy Elimination (monitoring patterns) Assistive Devices (canes, crutches, walkers, etc) Mobility/Immobility (monitoring for complications) Nonpharmacological Comfort Interventions Nutrition and Oral Hydration (therapeutic diets) Palliative/Comfort Care Personal Hygiene (identifying issues) Rest and Sleep

Basic Care and Comfort

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

1. “I should eat foods that will make my urine acid.”

2. “I should try to hold my urine in 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.”

Physiologic Integrity: Pharmacological Therapies (9-15%)

Adverse (or toxic) Effects Contraindications and Compatibilities Dosage Calculations Expected Effects Medication Administration (6 rights) Pharmacological Actions Pharmacological Agents Side Effects Client Teaching

Physiological Integrity:Pharmacological Therapies cont… Blood transfusions (monitoring for complications)

Counting narcotics/controlled substances Discontinuing an IV line IV therapy Monitoring IV sites/flow rates Administering medication via various routes

including a gastrointestinal tube Pharmacological pain management Phoning in client prescriptions to the pharmacy

Pharmacological 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 he client that which of the following is most important to monitor?

1. Apical heart rate

2. Peripheral Pulses

3. Platelet count

4. Temperature

Physiological Integrity: Reduction of Risk Potential (10-16%) Diagnostic Tests (preparing the client) Laboratory Values (monitoring results) Potential for Alterations in Body Systems

(recognition of) Therapeutic Procedures Vital Signs

Physiological Integrity: Reduction of Risk Potential (10-16%) Potential for Complications of (pre and

post-procedure care) Diagnostic Tests Treatments Procedures Surgery Health Alterations

Physiological Integrity: Reduction of Risk Potential (10-16%) A nurse assists a physician with performing a

liver biopsy on a client. Following the procedure, the nurse assists the client to which position?

1. Prone

2. On the right side

3. On the left side

4. Left Sim’s

Physiological Integrity:Physiological Adaptation (11-17%) Alterations in Body Systems

Wound care/dressing changes Care of supportive devices (trach/vent) Identifying abnormalities on cardiac telemetry

Basic Pathophysiology Fluid and Electrolyte Imbalances (interventions

for) Infectious Diseases (interventions for) Medical Emergencies (responding to) Radiation Therapies Unexpected Response to Therapies

Physiological Integrity:Physiological Adaptation (11-17%) A nurse is reviewing the medical records of

the 4 clients she will be caring for. The nurse determines that which client is at risk for deficient fluid volume?

1. A client on long-term corticosteroid therapy

2. A client with congestive heart failure

3. A client with syndrome of inappropriate anti- diuretic hormone

4. A client with a nasogastric tube attached to suction

Integrated Processes

The following processes fundamental to the

practice of practical/vocational nursing are

integrated throughout the Client Needs

categories and subcategories:


1. Caring 2. Clinical problem-solving process 3. Communication and documentation 4. Teaching and learning


Caring It is very easy to become involved with the

technological viewpoint when answering a question; however, always think about the process of caring when answering a question


Caring ..– interaction of the practical/vocational nurse and clients, families, and significant others in an atmosphere of mutual respect and trust. In this collaborative environment, the practical/vocational nurse provides support and compassion to help achieve desired therapeutic outcomes.

Integrated Processes - Caring

An infant is brought to the emergency department by emergency medical services (EMS) with suspected sudden infant death syndrome (SIDS). 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.

Integrated Processes - Caring

An infant is brought to the emergency department by emergency medical services (EMS) with suspected sudden infant death syndrome (SIDS). 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.


Clinical Problem-Solving Process (Nursing Process) – a scientific approach to client care that includes data collection, planning, implementation and evaluation.


Clinical Problem Solving (Nursing Process) 1. Data collection

Subjective: information given by the client Objective: observable, measurable First step If you are asked to identify the initial or first action;

follow the steps of the nursing process, if a data collection action is one of the options, that option is most likely correct

If the question addresses an emergency situation, read carefully; an intervention may be the priority

Integrated Processes: Data Collection

A postoperative asks the nurse for pain medication. The nurse should take which action first?

1. Ask the client how long it has been since the last dose of pain medication was administered.

2. Gather data from the client about the pain

3. Prepare the prescribed dose of pain medication

4. Ask the client if the last dose of the medication was effective.

Integrated Processes:Data Collection

A postoperative client asks the nurse for pain medication. The nurse should take which action first?

1. Ask the client how long it has been since the last dose of pain medication was administered.

2. Gather data from the client about the pain

3. Prepare the prescribed dose of pain medication

4. Ask the client if the last dose of the medication was effective.


Clinical Problem Solving 2. Planning

Setting priorities Assisting in determining goals/outcome

criteria for goals of care Assisting in developing plan of care Collaborating with other health team members Communicating the plan of care Actual problems are usually more important

than Risk for

Integrated Processes: Planning

A nurse is reviewing the nursing diagnoses written in a nursing care plan for a client with chronic obstructive pulmonary disease. The nurse determines that which nursing diagnosis is the priority?

1. Ineffective Role Performance r/t role loss

2. Disturbed Thought Processes r/t sleep deprivation

3. Anxiety r/t loss of control during dyspneic episodes

4. Imbalanced Nutrition: Less Than Body Requirements r/t dyspnea and fatigue.


Clinical Problem Solving 3. Implementation

Client in test question is your only assigned client

Client in test question is only client you are concerned about

Answer question from textbook/ideal perspective, rather than reality one

Answer the question, remembering you have all the time, resources and supplies needed and readily available at the client’s bedside

Integrated Processes: Implementation

A nurse is assisting in monitoring a client following a cardiac catheterization procedure. The client suddenly complains of a feeling of wetness at the injection site. The nurse quickly checks the site and discovers that the client is bleeding. The best initial nursing action is to:

1. Apply firm pressure to the site using a sterile gauze pad.

2. Apply firm pressure to the site using a bath towel.

3. Ask the client to place pressure on the site.

4. Check the client’s blood pressure


Clinical Problem Solving 4. Evaluation

Ongoing, continual process of comparing actual with expected outcomes

Provides means for determining need to modify plan of care

Frequently written in false response format; ie the question may ask for a client statement that indicates inaccurate information related to the issue of the question

Integrated Processes: Evaluation

Ibuprofen (Motrin) has been prescribed for a client. On a follow-up physician’s visit, the nurse determines that the medication is effective if the client states relief of:

1. Abdominal bloating

2. Constipation.

3. Joint stiffness.

4. Heartburn.

Integrated Processes: Evaluation

Ibuprofen (Motrin) has been prescribed for a client. On a follow-up physician’s visit, the nurse determines that the medication is effective if the client states relief of:

1. Abdominal bloating.

2. Constipation.

3. Joint stiffness.

4. Heartburn.


Communication and Documentation – verbal and nonverbal interactions between the practical/vocational nurse and clients, families, significant others and members of the health care team. Events and activities associated with client care are validated in written and/or electronic records that reflect standards of practice and accountability in the provision of care.


Communication Therapeutic communication techniques

indicate a correct option Nontherapeutic communication techniques

indicate an incorrect response If an option reflects a client’s feelings,

anxieties, or concerns, select that option

Integrated Processes: Communication A client says to a nurse, “ I’m scared about

my surgery that I am having tomorrow.” The nurse makes which appropriate response to the client?

1. “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.”


Documentation Review documentation guidelines-legal and ethical Sample question:

A nurse discovers that she needs to make a correction to a written entry in a clients chart. The nurse would appropriately:1) Contact the nursing supervisor to cosign the

correction2) Remove the page, recopy the data to a new page,

and add the correct entry3) Draw a single line through the entry that needs

correction followed by his/her (the nurse’s) initials4) Erase the entry that needs correction and add the

correct entry

Sample question: A nurse discovers that she needs to make a

correction to a written entry in a clients chart. The nurse would appropriately:1) Contact the nursing supervisor to cosign the

correction2) Remove the page, recopy the data to a new

page, and add the correct entry3) Draw a single line through the entry that needs

correction followed by his/her (the nurse’s) initials

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


Teaching and Learning ..– facilitation of the acquisition of knowledge, skills and attitudes to assist in promoting positive changes in behavior


Teaching and Learning If a test question addresses client teaching,

remember that client motivation and readiness to learn is the FIRST priority

See handout

Integrated Processes: Teaching & Learning

A nurse has reinforced teaching with a client’s spouse about how to change the client’s colostomy bag. The nurse best determines that the spouse understands the procedure by:

1. Asking the spouse if she has any questions about the procedure.

2. Asking the spouse is 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 is she feels comfortable performing the procedure.

Types of Test Questions

Multiple Choice (majority ~85-90%) Only one correct answer

Fill in the blank Numerical response (question will tell you how

to round your answer and what units) Multiple response (must have all correct answers

to receive credit) ~ 5-6 potential answer choices

Prioritizing (Ordered response) Figure or illustration (hot spot) Chart/exhibit

Fill in the Blank

The nurse is preparing to administer digoxin (Lanoxin) 0.25mg orally. The label on the medication bottle reads digoxin (Lanoxin) 0.125 mg per tablet. How many tablet(s) does the nurse plan to administer to the client? (round to the nearest 0.5)

_____________ tablet(s)

Multiple Response

Select all nursing interventions that apply in the care of an infant following a cleft lip repair (cheiloplasty)

__Position the child on the abdomen

__Cleanse the suture line gently after feeding the infant

__Keep elbow restraints on the infant at all times

__Institute measures that will prevent vigorous and sustained crying

__Observe for bleeding at the operative site

__Assist the mother with breastfeeding if this is the feeding method of choice

Using a Figure or Illustration

The nurse is performing CPR on a 6 month old infant. Using the computer mouse, click on the anatomical area that the nurse would palpate to assess circulation.

www.atitesting.com http://www.studygs.net/schedule/index.htm

Prioritizing

List in order of priority the interventions that the nurse would take in the care of a client who develops acute pulmonary edema. (Number 1 indicates the first action and number 4 indicated the last action.)

__Place the client on pulse oximetry

__Place the client in high-Fowler’s position

__Prepare the client for endotracheal intubation and mechanical ventilation

__Prepare for the administration of oxygen

Using a Chart or Exhibition

The nurse reviews the client’s laboratory results for electrolyte levels. The nurse reports which abnormal result?

1. Sodium

2. Potassium

3. Chloride

4. Bicarbonate

Client’s ChartMeds NotesLabs

Sodium 150mEq/L

Potassium 4mEq/L

Chloride 102 mEq/L

Bicarbonate 26 mEq/L

Avoid Reading into the Question: Multiple Choice Identify parts of the question Read carefully Look for key words or phrases Identify the issue Use the process of elimination Avoid asking yourself “What if?”

Parts of the Question

1. Case situation- The heart of the question; provides with information needed to answer

2. Question stem- Statement that generally follows the situation and asks something very specific about the info in the case situation

3. Options- All answers presented with the question (usually 4)

Key Words/Phrases

Focus your attention on critical and specific points

May indicate there is only one option May indicate you may need to prioritize May indicate a true response question May indicate a false response question

Key Words or Phrases That…

Indicate there is only one correct option

Early sign Late sign Understands Goal has been

achieved Adequately tolerating Avoid Needs reinforcement

of the instructions

Lack of understanding

Goals have not yet been fully met

Has not met the outcome criteria

Ineffective Inadequate Unable to tolerate


Indicate the need to prioritize

Best First Initial Immediately Most or least likely Most or least

appropriate

Highest or lowest priority

Order of priority At highest risk At lowest risk Best understanding


Indicate a true response

Early sign Late sign Best First Last Initial Immediately Most likely Most appropriate

Highest priority Order of priority All nursing

interventions that apply

Goal has been achieved

Adequately tolerating


Indicate a false response

Least likely Least appropriate Least priority Least helpful At lowest risk Avoid Needs

reinforcement of the instructions

Needs additional teaching

Lack of understanding

Goals have not yet been fully met

Has not met the outcome criteria

Ineffective Inadequate Unable to tolerate

The Issue of the Question

Specific subject content that the question is asking about

Look back at the Client Needs

The Issue of the Question

Sample Question A client with metastatic cancer is receiving

morphine sulfate to alleviate pain. The nurse monitors the client for which adverse or toxic effect of the medication?

1. Dizziness

2. Sedation

3. Skeletal muscle flaccidity

4. Nausea

Random Strategies

Process of elimination Likely to eliminate two of the options; you

have two remaining With those two remaining:

Read the question again Identify the case situation Look for key words/phrases Ask again “What is the question asking?” Read options again

What if?

Sample question A nurse is caring for a hospitalized client with

a diagnosis of congestive heart failure who suddenly complains of shortness of breath and dyspnea. The nurse takes which immediate action?

1) Prepares to administer furosemide (lasix)

2) Calls a respiratory therapist

3) Prepares to administer oxygen

4) Elevates the head of the client’s bed

Prioritizing Questions

General Guidelines Note key words/phrases The ABCs Maslow’s Hierarchy of Needs The steps of the nursing process

Prioritizing Key Words

Best Essential First Highest priority Immediately Initial Most appropriate Most effective

Most important Most likely Nest Order of priority Priority Primary Vital

Maslow’s Hierarchy

Maslow’s Hierarchy of Needs Theory

A nurse is assisting with the admission of a client to the mental health unit with a diagnosis of post-traumatic stress disorder. The client is confused and disoriented. During the data collection, the nurse’s primary goal for this client is to:

1. Stabilize the client’s psychiatric needs

2. Orient the client to the unit

3. Explain the unit rules

4. Make the client feel safe

Maslow’s

A nurse has helped develop a plan of care for a client diagnosed with anorexia nervosa. Which nursing diagnosis would the nurse select as the priority in the plan of care?

1. Disturbed Body Image

2. Defensive Coping

3. Deficient Knowledge

4. Imbalanced Nutrition: Less Than Body Requirements

Maslow’s

A nurse is preparing to reinforce instructions with a client about using crutches. Before reinforcing the instructions, the nurse collects which priority information from the client?

1. The client’s fear related to the use of crutches

2. The client’s understanding of the need for increased mobility

3. The client’s muscle strength and previous activity level

4. The client’s feelings about the restricted activity

Prioritizing Questions

Highest Priority: A client need that is life-threatening or if untreated could result in harm to the client

Intermediate Priority: Non-emergency or non life-threatening client need that does not require immediate attention

Low Priority: Client need that is not directly related to the client’s illness or prognosis, is not urgent or does not require immediate attention

Prioritizing

A nurse is caring for a client with angina pectoris who begins to experience chest pain. The nurse administers a sublingual nitroglycerin (Nitrostat) tablet as prescribed, but the pain is unrelieved. What action should the nurse take next?

1. Call a Code Blue

2. Call the client’s family

3. Administer another nitroglycerin tablet

4. Reposition the client

Prioritizing

An infant with tetralogy of Fallot experiences a hypercyanotic spell during a blood draw. List in order of priority the actions that the nurse would take (number one is the first priority and number four is the lowest priority).

__Administer morphine sulfate subcutaneously as prescribed

__Administer 100% oxygen by face mask as prescribed

__Place the infant in a knee-chest position__Administer intravenous fluids as prescribed

The ABCs

The client with a diagnosis of cancer is receiving morphine sulfate 10 mg subcutaneously every 3 to 4 hours for pain. When preparing a plan of care for the client, the nurse includes which priority action?

1. Monitor stools 2. Monitor the urine output3. Encourage the client to cough and deep

breathe4. Encourage fluid intake

The ABCs

A nurse is monitoring a client’s condition after cardioversion. Which of the following observations is the highest priority to the nurse?

1. Status of airway

2. Oxygen flow rate

3. Level of consciousness

4. Blood pressure

The ABCs

A nurse is reinforcing preoperative instructions to a client scheduled for a cholecystectomy. Which intervention is of the highest priority in the preoperative teaching plan?

1. Teaching coughing and deep breathing exercises

2. Teaching leg exercises

3. Instructing regarding fluid restrictions

4. Determining the client’s understanding of the surgical procedure

When to Select “Notify an RN”

If the question DOES NOT describe a life-threatening client situation or one that indicates a change in the client’s condition AND there is an option that directly relates to a nursing action relevant to the situation, then it best to select that option and NOT the option that reads “Notify the RN”

If the question DOES describe a life threatening client situation or one that indicates a change in client’s condition, then select the option that reads “Notify the RN”

Notify RN?

A nurse is caring for a postoperative client who becomes restless. The nurse should take which initial action?

1. Check the client’s vital signs

2. Notify a registered nurse

3. Medicate the client for pain

4. Talk to the client in a calm voice

Notify RN?

A nurse is caring for a client who just returned from the recovery room following a tonsillectomy and adnoidectomy. The client is restless and the pulse rate is elevated. The nurse prepares to collect additional data on the client but the client begins to vomit large amounts of bright red blood. The immediate nursing action is to:

1. Notify an RN2. Continue with data collection3. Check the client’s blood pressure4. Obtain a flashlight and gauze

Key Words That Indicate…

Data Collection Check Collect Determine Find out Gather Identify Monitor Observe Obtain Information

Data Collection

A nurse is teaching a client with coronary artery disease about dietary measures to follow. During the session, the client expresses frustration in learning the dietary regimen. The nurse should initially:

1. Identify the cause of frustration2. Continue with the dietary teaching3. Notify a registered nurse4. Tell the client that the diet needs to be

followed

Planning

A nurse is reviewing the plan of care for a pregnant client with a diagnosis of sickle cell anemia. Which nursing diagnosis, if stated on the plan of care, should the nurse select as receiving the highest priority?

1. Anxiety

2. Ineffective coping

3. Disturbed body image

4. Deficient fluid volume

Implementation

ANSWER THE QUESTION FROM AN IDEAL TEXTBOOK PERSPECTIVE, YOU HAVE ALL THE TIME AVAILABLE TO CARE FOR THE CLIENT AND ALL THE RESOURCES AT THE CLIENT’S BEDSIDE!

Implementation

A nurse is caring for a preoperative male client who verbalizes a great deal of anxiety about the surgical procedure scheduled in two hours. Which action by the nurse would best alleviate the client’s anxiety?

1. Tell the client that you will spend some time answering question as soon as you get your other tasks completed

2. Talk to the client for 15 minutes and return shortly thereafter to check on him

3. Call the client’s wife and ask her to visit the client before surgery

4. Stay with the client until he is taken to the operating room

Implementation

A nurse is caring for a client following a cardiac catheterization. The client suddenly complains of a feeling of wetness in the groin at the catheter insertion site. The nurse checks the site, notes that the client is actively bleeding, and takes which best action?

1. Don a clean glove and places pressure on the insertion site with the gloved hand

2. Dons a sterile glove and places pressure on the insertion site using sterile gauze

3. Checks the client’s blood pressure4. Checks the client’s peripheral pulse in the affected

extremity

Evaluation

A client recovering from an exacerbation of left-sided heart failure has a nursing diagnosis of Activity Intolerance. The nurse determines that the client best tolerates mild exercise if the client exhibits which of the following changes in vital signs during activity?

1. Pulse rate increased from 80 beats/minute to 104 beats/minute

2. Respiratory rate increased from 16 breaths per minute to 19 breaths per minute

3. Oxygen saturation decreased from 96% to 91%

4. Blood pressure decreased from 140/86 mm Hg to 112/72 mm Hg

Delegation/Assignment Making Questions Always ensure client safety Match tasks based on Nurse Practice Act Think about individual variations in work

abilities Always provide clear direction to the

delegatee

General Guidelines: Who Can Do What UAP

Ambulation Bathing Grooming Hygiene measures Positioning ROM exercises Skin care Some specimen collection (urine, stool) Transporting a client

General Guidelines: Who Can Do What LPN

All that UAP can do AND Administering PO meds Administering IM meds Administering SQ meds Dressing changes Irrigating wounds

General Guidelines: Who Can Do What LPN (continued)

Monitoring IV flow rate Performing urinary catheterization Suctioning Teaching about basic hygiene/nutritional

measures Using nursing process: data collection,

planning, implementing, evaluating

General Guidelines: Who Can Do What RN can do

ALL that UAP and LPN can do AND Administer IV medications Leading others and managing client care

environment Teaching Using nursing process: assessment,

analyzing data, planning client care, implementing and evaluating care

Delegation/Assignments

A licensed practical nurse is planning client assignments for the day and has another licensed practical nurse and a nursing assistant on the nursing team. The nurse most appropriately assigns which client to the licensed practical nurse?

1. An older client recovering from pneumonia who requires ambulation every 3 hours

2. A client with a tracheostomy who requires frequent suctioning

3. An older client who requires turning and repositioning every 2 hours and range of motion exercises every 4 hours

4. A client who requires the collection of urine for a 24-hour period

Delegation/Assignments

A licensed practical nurse employed in a long term care facility is assigning client care activities to a nursing assistant. The nursing assistant is a first-semester senior nursing student and works at the facility as a nursing assistant part-time on week-ends. The facility position description for a nursing student who is employed as a nursing assistant indicates that he or she may perform procedures learned in nursing school if supervised by a licensed nurse. Based on the facility’s position description, the nurse assigns which most appropriate activity to the nursing assistant?

1. Hang an IV solution of 0.9% normal saline2. Insert an IV catheter3. Change a sterile abdominal dressing4. Administer digoxin (Lanoxin)

Time Management

Must do Should do Nice to do Focus on beginning the daily tasks, working

on the most important first while keeping goals in mind

Think Organize Plan Prioritize

Time management

A nurse on the day shift is assigned to care for the four clients. Following report from the night shift, the nurse plans to perform client rounds and collect data from each client. Number in order of priority how the nurse will plan the client rounds. (Number 1 is the first client that the nurse will check and collect data from and number 4 is the last client that the nurse will check and collect data from.)

__Client scheduled for a cardiac catheterization at 11 am__Client diagnosed with diabetes mellitus who is scheduled

for discharge to home at 12 noon__Client with emphysema who is receiving oxygen therapy__Client scheduled to have an electrocardiogram (ECG) at

2:00 pm

Communication Questions

May be in any clinical setting and in any patient care area!

Focus on client’s feelings, concerns, anxieties or fears

Consider cultural differences: communication styles, use of eye contact, meaning of touch

Nontherapeutic techniques impede or block the flow of communication; shut down or shut off conversation

Pharmacological Questions

Medication Rights Always :

Check for allergies hypersensitivities Ask the client about existing medical disorders that are

contraindicated with the administration of a prescribed med

Check for potential interactions related to the med Check pertinent lab values Check vital signs, particularly if

antihypertensive/cardiac meds Monitor for intended, side, adverse, toxic effects of

meds Monitor client’s response

Pharmacological Questions Intended effect: desired effect Side effect: Not a desired effect

Not usually life-threatening Can usually be alleviated with specific measures

Adverse effect: more severe than a side effect Always an undesirable effect Always reported to an RN and MD

Toxic effect: Medication level in the body exceeds the therapeutic level Tylenol, Tegretol. Lanoxin, Gentamycin, Lithium,

Magnesium sulfate, Dilantin, Salicylate, Theophylline


Refer to FON Appendix C pg 1281 Look to the trade name /generic

name/medical terminology for help in determining use of medication example: Brethine; Lopressor

See handouts


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 medication2. Ask the client about an allergy to

sulfonamides3. Check the medication supply room to find out

if the medication needs to be ordered4. Inform the client about the need to increase

fluid intake

Pharmacology

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

1. Take the medication with an antacid2. Stop the medication for 2 days and then

resume the prescribed medication schedule3. Take the medication on an empty stomach4. Take the medication with food

Dosage Calculations

Total Volume X gtt Factor Time in minutes

Available mg Desired mg

Available mL* Desired mL*

mL/hr volume in mL

60 minutes minutes to give

* mL may be substituted with capsules/tablets

= gtt/ minute

=

=

Dosage Calculation Tips

Use the on-screen calculator Convert the unit of measure is necessary Follow the formula Place the decimal points in the correct places Place a zero before a decimal point if the

value lacks a number before the decimal point (0.5 not .5)

Avoid placing a decimal point and a zero after a whole number (5 not 5.0)

Recheck the accuracy of the calculation!!

Dosage Calculations

A physician’s order reads phenytoin (Dilantin) 0.2 g orally twice daily. The medication label states 100 mg capsules. A nurse prepares how many capsule(s) to administer one dose?

1. 1 capsule

2. 2 capsules

3. 3 capsules

4. 4 capsules

Dosage Calculations

A physician orders 1000mL of one-half normal saline to infuse over 8 hours. The drop factor is 15 drops (gtt) per 1 mL. The nurse sets the flow rate at how many drops per minute? (round to the nearest whole number)

1. 18 drops per minute2. 31 drops per minute3. 44 drops per minute 4. 100 drops per minute

Additional General Strategies:Absolute Words Absolute

All Always Can’t Every Must Never None Not Only Won’t

Not-So-Absolute Words Generally May Possibly Usually

In general, if an option contains an absolute word, it is incorrect

Absolute Words

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

1. Never use butter in their cooking

2. Read the labels on food items to determine their fat content

3. Eat only foods that have less than 1% fat content

4. Drink fluids only if they are fat free

Not-So-Absolute Words

A client scheduled for a computed tomography (CT) scan of the abdomen asks the nurse when the results of the test will be available. The nurse make which appropriate response to the client?

1. “The results won’t be available for at least one week”

2. You must ask the CT technician for that information

3. Your physician may have the results in about 3 days

4. Every scan is read by a radiologist and this process always takes 1 week

Additional General Strategies: Medical vs Nursing Interventions Select the option that is a nursing intervention

and not a medical one The only situation in which you may need to

select a medical intervention is if the question indicates to do so, i.e. “Which intervention does the nurse anticipate the physician will prescribe?”

Eliminating Options That Contain Medical Rather Than Nursing Interventions A nurse is caring for a client with a diagnosis

of congestive heart failure who suddenly experiences severe dyspnea, and the nurse suspects that the client developed pulmonary edema. The nurse immediately:

1. Obtains a vial of furosemide (Lasix) and a syringe

2. Places the client in the high-Fowler’s position

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

4. Inserts a foley catheter

Additional General Strategies:Eliminating Similar Options Note options that are similar in regards to

their content or context; if they are present, they are both wrong—multiple choice questions have only ONE right answer

Additional General Guidelines: All Parts of an Option are Correct 2 part answers: connected by “and” “or” Both must be correct

The nurse expects to collect the following data on a client with a cataract of the right eye:

1. Complaints of blurred vision AND excessive tearing of the eye

2. A cloudy white pupil AND complaints of eye pain

3. Complaints of a gradual loss of vision AND photophobia

4. Complaints of a frontal headache AND photophobia

Additional General GuidelinesSelect the Umbrella Option General statement that may incorporate the

content of the other options with it When you are answering a question and note

that more than one option appears to be correct, LOOK FOR THE UMBRELLA OPTION

Umbrella Option

Sample question A nurse in the emergency department receives a

phone call from EMS and is told that several victims who survived a plane crash and are suffering from cold exposure will be transported to the hospital. The initial nursing action is which of the following?1) Supply the trauma rooms with bottles of sterile water

and normal saline2) Call the laundry department and ask to send as

many warm blankets as possible to the emergency department

3) Call the nursing supervisor to activate the agency disaster plan

4) Call the ICU to request that nurses be sent to the emergency department

Additional General Guidelines:Visualize the Information

Form a mental image of the situation and place yourself into the situation

Visualizing

Sample question A nurse prepares to perform a sterile

dressing change on a PICC line. The nurse explains the procedure to the client, washes her hands, and sets up the sterile field. The nurse would take which action next?1) Don sterile gloves2) Don clean gloves and remove the old dressing3) Clean the site with Chloraprep4) Inspect the integrity of the skin around the

insertion site

Additional General Strategies:Similar Concepts Look for similar concepts in the question and

in one of the options Sample question

A client is admitted to the hospital with a diagnosis of pericarditis. A nurse monitors the client for which manifestation that differentiates pericarditis from other cardiopulmonary problems?1) Chest pain that worsens on inspiration

2) Pericardial friction rub

3) Anterior chest pain

4) Weakness and irritability

Laboratory Values

Identify whether the laboratory value is normal or abnormal

Note the disorder presented in the question Identify the associated body organ that is

affected as a result of the disorder

Laboratory Values

A client with a diagnosis of sepsis is receiving antibiotics by the intravenous route. The nurse monitors for nephrotoxicity by checking the results of which laboratory value most closely?

1. Blood urea nitrogen

2. White blood cell count

3. Platelet count

4. Lipase level

Additional General Strategies:Client Positioning Always review physician orders Focus on client’s diagnosis Identify the anatomical location of the client’s

diagnosis Consider the pathophysiology of the disorder

and the goals of care Think about what complications you want to

prevent See handout

Client Positioning

A nurse assists a physician in performing a liver biopsy. After the biopsy, the nurse plans to place the client in which of the following positions?

1. Supine

2. Prone

3. A left side-lying position with a small pillow or or folded towel under the puncture site

4. A right side-lying position with a small pillow or folded towel under the puncture site

PN 154 NCLEX Review Spring 2010 Instructor: Lisa Lee Rohm, RN, BSN Creator of this fabulous...

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Transcript of PN 154 NCLEX Review Spring 2010 Instructor: Lisa Lee Rohm, RN, BSN Creator of this fabulous...