5/2011. avoid asking yourself, “well, what if….?” focus only on the information in the...

ASN 2905/2011

HOW TO AVOID READING INTO THE QUESTION Avoid asking yourself, “well, what if….?” Focus only on the information in the

question, read every word, and make a decision regarding what the question is asking.

Look for strategic words in the question.

HOW TO AVOID READING INTO THE QUESTION Always use process of elimination when

choices or options are presented; once you have eliminated options, reread the question before selecting your final choice or choices.

Determine if the question is a positive or negative event query.

Use all your nursing knowledge, your clinical expertise, and your test-taking skills and strategies to answer the question.

COMMON STRATEGIC WORDS Best Early Late First Immediately Initial Most Least Vital Next Primary Highest priority Essential

STRATEGIES FOR PRIORITIZATION QUESTIONS ABC’s

Airway, breathing, circulation Maslow’s hierarchy

Basic physiological needs, safety/security, love/belonging, self-esteem, self-actualization

Nursing processAssessment, analysis, planning,

implementation

ELIMINATING COMPARATIVE OR ALIKE OPTIONS When reading the options, look for

options that are comparative or alike; these options will include a similar concept or nursing action.

Comparative or alike options can be eliminated as possible answers.

LOOK FOR UMBRELLA OPTIONS The umbrella is one that is a broad or

universal statement and that usually contains the concepts of the other options within it.

The umbrella option will be the correct answer.

ELIMINATE OPTIONS CONTAINING CLOSE-ENDED WORDS All Always Every Must None Never Only

These words infer a fixed or extreme meaning; these types of options are usually incorrect.

One exception is when the question refers to safety…”patients in the PACU should never be left alone”

USE THE GUIDELINES FOR DELEGATING AND MAKING ASSIGNMENTS Focus on the information in the question

and what task or assignment is to be delegated

Match the client’s needs with the scope of practice of the health care providers indentified in the question

Generally non-invasive interventions such as skin care, range-of-motion exercises, ambulation, grooming, and hygiene measures can be assigned to a nursing assistant

USE THE GUIDELINES FOR DELEGATING AND MAKING ASSIGNMENTS A licensed practical nurse can perform

all of the tasks of a nursing assistant and can also usually perform certain invasive tasks such as dressings, suctioning, urinary catheterization, PO/SC/IM meds

The RN is responsible for assessment, planning care, analyzing client care, supervising care, initiating teaching, IV meds

ANSWERING PHARMACOLOGY QUESTIONS Try to determine the classification to

assist in determining the action and/or side effects

Generalities to rememberThe pt should not take an antacid with

medication because the antacid will affect the absorption of the medication

Enteric-coated and sustained-release tablets should not be crushed

ANSWERING PHARMACOLOGY QUESTIONS

Capsules should not be openedThe pt should never adjust or change a

medication dose or abruptly stop taking a medication

ANSWERING PHARMACOLOGY QUESTIONS

The nurse never adjusts or changes the pts medication dosage and never discontinues a medication

The client needs to avoid taking any over-the-counter medications/any other medications such as herbals unless they are approved by the health care provider

Medications are never administered if the order is difficult to read, is unclear, or identifies a medication dose that is not a normal one

REMEMBER Don’t answer questions based upon

what you may have seen in a clinical setting. Base your answer on what you have learned from class/lecture/text books.

SAMPLE QUESTION – AVOID READING INTO THE QUESTION A nurse is caring for a hospitalized pt

with a diagnosis of CHF who suddenly complains of shortness of breath and dyspnea. The nurse takes which immediate action?Calls the physicianAdministers oxygen to the ptElevates the HOBPrepares to administer furosemide (lasix)

RATIONALE Your initial thought may go to

pulmonary edema and administering a diuretic, but nothing in the question mentions pulmonary edema.

Not the strategic word ‘immediate’ an focus on the subject

Although the physician may need notification, that is not an immediate need

A physician order is needed for oxygen. The question is asking for a nursing

action Answer is to elevate the HOB

SAMPLE QUESTION – ELIMINATE COMPARATIVE OR ALIKE OPTIONS A nurse is caring for a group of pts. On

review of the pts medical records, the nurse determines that which of the pts is at risk for fluid volume excess?Pt on diureticsPt with renal failurePt with an ileostomyPt with gastrointestinal suctioning

RATIONALE Based on pathophysiology, you would

look at the fact that all but the pt with renal failure are alike in that they have disease processes that lose fluid. This would point you to the answer of renal failure and fluid retention

SAMPLE QUESTION – STRATEGIC WORDS A nurse is caring for a pt who just

returned from the recovery room after undergoing abdominal surgery. The nurse monitors the pt for which early sign of hypovolemic shock?Lethargy Increased pulse rate Increased depth of respirationDecreased deep tendon reflexes

RATIONALE Note the strategic word ‘early’. Focusing on this strategic word and

recalling that the earliest clinical signs of hypovolemic shock are cardiovascular changes will direct you to the correct option.

Although lethargy, increased depth of respirations, and decreased or absent deep tendon reflexes occur in hypovolemic shock, these are not early signs.

SAMPLE QUESTION – ABC’S The pt with a diagnosis of cancer is

receiving morphine sulfate for pain. When preparing the plan of care for the pt, the nurse includes which priority action?Monitor stoolsEncourage fluid intakeMonitor the urine outputEncourage the pt to cough and deep

breathe.

RATIONALE Use the ABC’s as a guide to direct you. Recall that morphine sulfate suppresses

the cough reflex and the respiratory reflex.

Although the first 3 options are components of the care plan, the correct option addresses airway. (encourage coughing and deep-breathing)

SAMPLE QUESTION – UMBRELLA OPTION A nurse is developing a plan of care for

a pt with Meniere’s disease. The priority nursing interventions should focus on which of the following?Safety measuresDietary measuresActivity limitationsKnowledge about medication therapy

RATIONALE Focus on the pts disorder, meniere’s

disease and recall the pathophysiology associated with the disease.

All the options identify a component of the care plan, but remember safety is a priority.

Also note that the option of safety is the umbrella option in that it is a broad statement of intervention.

SAMPLE QUESTION-ELIMINATING CLOSE-ENDED WORDS A pt will undergo a barium swallow and

the nurse provides instructions to the pt. The nurse instructs the pt to:Avoid eating or drinking after midnight

before the testLimit self to only two cigarettes on the

morning of the testHave a clear liquid breakfast only on the

morning of the testTake all routine medications with a glass of

water on the morning of the test

RATIONALE Note the close-ended words ‘only’ and

‘all’ in the last 3 choices. Also the last 3 can be eliminated

because they are comparative…they all involve taking in something on the morning of the test.

SAMPLE QUESTION – GUIDELINES OF DELEGATION A nurse is planning the pt assignments

for the day and has an LPN and a nursing assistant on their team. Which pt would the nurse most appropriately assign to the LPN?A pt who is scheduled for and ECG and CXRA pt with stable CHF who has early-stages

of AlzheimersA pt who was treated for dehydration and is

weak and needs assistance with bathingA pt with emphysema who is receiving

O22L/NC and becomes dyspneic on exertion

RATIONALE The nurse would most appropriately

assign the pt with emphysema to the LPN

This pt has an airway problem and has the highest priority needs of the pts described

The other pts can be cared for appropriately by the nursing assistant

Remember, match the pts needs with the scope of practice of the healthcare provider

SAMPLE QUESTION-PHARMACOLOGY Quinapril hydrochloride (acupril) is

prescribed as an adjunctive therapy in the treatment of heart failure. After administering the first dose, the nurse monitors which of the following most closely?RespirationsUrine outputLund soundsBlood pressure

RATIONALE Focus on the name of the medication Note the strategic wording ‘most

closely’, this tells you that all of the choices may be correct and you will have to prioritize

Medication ending in –pril are ACE inhibitors, and treat HTN. Excessive hypotension (first dose syncope) can occur in pts with heart failure or in pts volume/sodium depleted.

Although respirations, urine output, and lung sounds would be monitored, the nurse would ‘most closely’ monitor blood pressure