Test Taking StrategiesJanet Whitworth DNP, RN, FNP-BC

Key StrategiesUnderstanding The QuestionConsidering The Nursing ProcessReferring To Maslows Hierarchy Of NeedsReviewing Patient SafetyUnderstanding Principles Of Therapeutic Communication

Elements of the QuestionQuestion StemTHE OPTIONSKEY WORDSClientIssue

Understanding The QuestionDetermine what the question is asking.Determine relevant facts about the client.Rephrase the question in your mind.Choose the best option(s) before entering your answer.

HOW TO AVOID READING INTO THE QUESTION

KEY WORDSEarly or lateBest First InitialImmediatelyMost likely or least likelyMost appropriate or least appropriateOn the day ofAfter several days

EXAMPLES: ISSUE OF THE QUESTIONA medication or intravenous (IV) therapyA side effect of a medication An adverse or toxic effect of a medicationA treatment or procedure A complication of a health care problem, treatment, or procedureA specific nursing action

A 74 year-old client with a history of heart failure is admitted to the coronary care unit with pulmonary edema. He is intubated and placed on a mechanical ventilator. Which parameters should the nurse monitor closely to assess the clients response to a bolus dose of furosemide IV?

A. Daily WeightB. 24 Hour intake and outputC. Serum sodium levelsD. Hourly urine output

Nursing ProcessAssessmentAnalysisPlanningImplementationEvaluation

KEY WORDS: ASSESSMENT

Ascertain AssessCheck Determine Find outIdentify Monitor Observe Obtain information

A client returns from an endoscopic procedure during which he was sedated. Before offering the client food, which action should the nurse take first?

A. Assess the clients airwayB. Check the clients gag reflexC. Place the client in a side-lying positionHave the client drink a few sips of water

Maslows Hierarchy of Needs

A client complains of severe pain 2 days after surgery. Which action should the nurse perform first?

A. Offer reassurance to the client that he will feel less pain tomorrow?

B. Allow the client time to verbalize his feelings

C. Check the clients vital signs

D. Administer an analgesic

A 26 year-old male is admitted to an inpatient psychiatric hospital after having been picked up by the local police while walking around his neighborhood at night without shoes in the snow. He Appears Confused and disoriented. Which of the following actions should take priority?

A. Assess and stabilize the clients physical needs. B. Assess and stabilize the clients psychological needs C. Attempt to locate the nearest family to get an accurate history. D. Arrange a transfer to the nearest medical facility.

A nurse is caring for a client who is preoperative for right cataract surgery for the right eye. The nurse would place highest priority on which of the following nursing diagnoses at this time?

1. Disturbed Sensory Perception 2. Anxiety 3. Self-care Deficit 4. Imbalanced Nutrition

CLIENT NEEDS

PHYSIOLOGICAL INTEGRITYPSYCHOSOCIAL INTEGRITYHEALTH PROMOTION AND MAINTENANCE

Patient SafetyWhich answer will best ensure the safety of the client?

Use patient safety criteria for situations involving lab values, drug administration, and nursing care procedures.

Put the Client 1st and the Equipment 2nd

The nurse enters a clients room where the infusion pump is sounding. What should the nurse do first?

A. Silence the alarmB. Check the tubing for airC. Check the pump settingsD. Check the catheter insertion site

Strategies For SuccessIf the question asks what you should do in a situation, use the nursing process to determine which step in the process would be next.

If the question asks what a client needs, use Maslows hierarchy to determine which need to address first.

Strategies For SuccessIf the question does not indicate an urgent physiologic need, focus on patient safety.

If the question involves communicating with a patient, use the principles of therapeutic communication.

Therapeutic CommunicationListening IntentlyRephrasingUsing Broad Openings and General StatementsClarifyingFocusingUsing SilenceSuggesting CollaborationSharing Impressions

Principles of Therapeutic Communication:Avoid asking Why questions.Seek clarificationDo not assume you know how someone feels. If they do not say that they feel a particular way, then always ask them if your interpretation is correct.Use broad openings.Do not ask yes/no questions.Seek corrective feedback.Do not tell anyone what to do.Do not give false reassurance.Do not answer a question with a question. If the client asks a questions answer it.Use silence to give the patient time to reflect.Encourage the client to do things for him/herself. Assist them in doing things for themselves.Be aware of your own feelingsEncourage the client to take ownership of their feelings and actions: Use I statementsAvoid accusatory speech.

A 35 year-old client tells the nurse that he never disagrees with anyone and that he has loved everyone he has ever known. What would be the nurses best response to this patient? A. Is this hard for you to do?

B. That is hard to believe. Most people couldnt do that.

C. What do you do with your feelings for dissatisfaction and anger?

D. How did you come to adopt this way of life?

A 60 year-old widower is hospitalized after complaining of difficulty sleeping, extreme apprehension, SOB, and a sense of impending doom. Which response by the nurse would be best? A. You have nothing to worry about. You are in a safe place. Try to relax.

B. Has anything happened recently or in the past, that may have triggered these feelings?

C. We have given you a medication that will decrease these feelings of anxiety.

D. Take some deep breaths and try to calm down.

A client on the unit tells the nurse that his wifes nagging really gets on his nerves. He asks the nurse if she will talk to his wife about the nagging during the next family session. Which response would be the most therapeutic? A. Tell me more about her complaints. B. Can you think why she might nag you so much?

C. I will help you think about how to bring this up, during the session, yourself.

D. Why do you want me to initiate this discussion in the session rather than you?

A nurse is working with a client who has just stimulated her anger by using a condescending tone of voice. Which of the following responses would be the most therapeutic?A. I feel angry when I hear that tone of voice

B. You make me so angry when you talk to me like that.

C. Are you trying to make me angry?

D. Why do you use that condescending tone of voice with me?

ADDITIONAL PYRAMID STRATEGIES

NCLEX vs. The REAL WORLDNCLEX is a textbook examination.Check your practical experiences against textbook care. Choose the answer that follows the textbook!

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