STUDY SKILLS EXTRA STUDY SKILLS EXTRA HELP SESSIONHELP SESSION

Test Taking Strategies For Test Taking Strategies For SuccessSuccess

Critical Thinking Applied to Test TakingCritical Thinking Applied to Test Taking

Educational DomainsEducational Domains

Components of Multiple choice questionsComponents of Multiple choice questions

Cognitive level of Nursing questionsCognitive level of Nursing questions

Educational DomainsEducational DomainsNursing as a discipline includes three domainsNursing as a discipline includes three domains

Affective Domain:Affective Domain: concerned with attitude, values concerned with attitude, values and development of appreciation. Ex. The nurse and development of appreciation. Ex. The nurse quietly accepting a patients statement that there is quietly accepting a patients statement that there is no God without imposing personal feelings.no God without imposing personal feelings.

Psychomotor Domain:Psychomotor Domain: concerned with manipulative concerned with manipulative or motor skills Ex. Is the nurse administering an IM.or motor skills Ex. Is the nurse administering an IM.

Cognitive Domain:Cognitive Domain: concerned with the recall, concerned with the recall, comprehension, development and application of comprehension, development and application of knowledge and skills. Ex. The nurse clustering knowledge and skills. Ex. The nurse clustering collected data, and determining its significance.collected data, and determining its significance.

Components of a Multiple Choice Components of a Multiple Choice QuestionQuestion

Each item (multiple choice question) has two Each item (multiple choice question) has two parts:parts:

Stem:Stem: part that contains the information part that contains the information topic, parameters, asks the topic, parameters, asks the questionquestion

Option:Option: one or more possible responses one or more possible responses

Cognitive Levels of Nursing Cognitive Levels of Nursing QuestionsQuestions

Four typesFour types

Knowledge:Knowledge: - recall - recall

Comprehensive:Comprehensive: - understanding the meaning and - understanding the meaning and intent of remembered informationintent of remembered information

Application:Application: emphasis is on remembering emphasis is on remembering understood information and utilizing it in new understood information and utilizing it in new situationssituations

Analysis:Analysis: emphasis is on comparing and contrasting emphasis is on comparing and contrasting a variety of elements of informationa variety of elements of information

The Race Model : The Application of Critical The Race Model : The Application of Critical Thinking to Multiple Choice QuestionsThinking to Multiple Choice Questions

R:R: Recognize the key words in the stemRecognize the key words in the stemRecognize what information is in the stemRecognize what information is in the stemRecognize who the client is in the stemRecognize who the client is in the stemRecognize what the topic is aboutRecognize what the topic is about

A:A: Ask what is the question asking?Ask what is the question asking?Ask what are the key words, that indicate a responseAsk what are the key words, that indicate a responseAsk what the question is asking me to doAsk what the question is asking me to do

C:C: Critically analyze the options in relation to what Critically analyze the options in relation to what is is asked in the stemasked in the stem

Critically scrutinize each option in relation to what is asked Critically scrutinize each option in relation to what is asked Critically identify a rationale for each optionCritically identify a rationale for each optionCritically compare and contrast the optionsCritically compare and contrast the options

E:E: Eliminate as many options as possibleEliminate as many options as possibleEliminate one option at a timeEliminate one option at a time

Critical Elements of a test questionCritical Elements of a test question

A.A. Key words (early-late, immediately, Key words (early-late, immediately, postoperative period)postoperative period)

B.B. The client (the client in the question)The client (the client in the question)

C.C. The issue (Problem or subject the The issue (Problem or subject the question is asking)question is asking)

D.D. The type of stem (positive or negative)The type of stem (positive or negative)

Eliminate incorrect options Eliminate incorrect options (1-5)(1-5)

A.A. DistractersDistractersB.B. Avoid misreading test questionsAvoid misreading test questions

1.1. Separate the case scenario and stem, Separate the case scenario and stem, identify the client, the issue and type of stemidentify the client, the issue and type of stem

2.2. Identify Key words Identify Key words3.3. Avoid reading into the questions Avoid reading into the questions

a.a. Restate question in own wordsRestate question in own wordsb.b. Eliminate any option which include “new” Eliminate any option which include “new”

information that was not give in the case information that was not give in the case scenarioscenario

c.c. Avoid misinterpreting disorders (review Avoid misinterpreting disorders (review carefully; focus on areas of difficulty)carefully; focus on areas of difficulty)

In preparing to give a client a bed In preparing to give a client a bed bath, the nurse would:bath, the nurse would:A.A. Place the bed in the lowest positionPlace the bed in the lowest positionB.B. Expose the top side of the body, washing Expose the top side of the body, washing

and drying quickly, then doing the same on and drying quickly, then doing the same on the posterior sidethe posterior side

C.C. Gather all articles necessary for the bed Gather all articles necessary for the bed bath and place them where they will be bath and place them where they will be within easy reach of the nurse during the within easy reach of the nurse during the bathbath

D.D. Use firm, scrubbing strokes to remove dirt Use firm, scrubbing strokes to remove dirt and bacteriaand bacteria

Answer: CAnswer: C

The nurse is preparing to give a morning The nurse is preparing to give a morning medication. The first nursing action in this medication. The first nursing action in this activity is to:activity is to:

A.A. Read the labelRead the label

B.B. Check for the right doseCheck for the right dose

C.C. Wash the nurse’s handsWash the nurse’s hands

D.D. Check for the right timeCheck for the right time

Answer: CAnswer: C

A client who has right sided weakness needs to be A client who has right sided weakness needs to be transferred from his bed to a wheelchair. In transferred from his bed to a wheelchair. In transferring the client, the nurse must remember to:transferring the client, the nurse must remember to:

A.A. Keep the client at arm’s length while Keep the client at arm’s length while transferring himtransferring him

B.B. Bend at the waist to get down to his levelBend at the waist to get down to his level

C.C. Maintain a straight back and bend at the Maintain a straight back and bend at the knees.knees.

D.D. Try to transfer the client alone, before Try to transfer the client alone, before determining the help is neededdetermining the help is needed

Answer: CAnswer: C

4. Client A and Client B are sitting in the day lounge. 4. Client A and Client B are sitting in the day lounge. The nurse has medication to administer to client A. The nurse has medication to administer to client A. When the nurse enters the lounge, Client B says to the When the nurse enters the lounge, Client B says to the nurse “I see you found me to give me my pills” The nurse “I see you found me to give me my pills” The best nursing response would be: best nursing response would be:

A.A. ““I don’t have any pills for you, Client B”I don’t have any pills for you, Client B”B.B. ““Let me check your identification armband, Let me check your identification armband,

and I will check to see if you are supposed and I will check to see if you are supposed to receive any pillsto receive any pills

C.C. ““Client A, I have pills for you to take, but Client A, I have pills for you to take, but none for Client B”none for Client B”

D.D. ““Client A, would you please take these pills”Client A, would you please take these pills”

Answer: BAnswer: B

5.5. The nurse must lift a heavy object which is found The nurse must lift a heavy object which is found in the hallway. Which is the best approach when in the hallway. Which is the best approach when the nurse must lift a heavy object?the nurse must lift a heavy object?

A.A. Lift the object at arm’s length so all of the arm Lift the object at arm’s length so all of the arm muscles are being used.muscles are being used.

B.B. Bend from the waist, using a wide stance, so Bend from the waist, using a wide stance, so that the leg muscles of the body are usedthat the leg muscles of the body are used

C.C. Maintain good body alignment and use the large Maintain good body alignment and use the large muscles of the bodymuscles of the body

D.D. Bend at the knees and use the large leg Bend at the knees and use the large leg muscles when lifting the objectmuscles when lifting the object

Answer: CAnswer: C

Choosing between the two best Choosing between the two best optionsoptions

Identify the global responseIdentify the global response1.1. Global response: is a general statement which Global response: is a general statement which

includes correct idea form other optionsincludes correct idea form other options2.2. Practice steps: (6-8)Practice steps: (6-8)

a. Identify critical elementsa. Identify critical elementsb. Evaluate stem: Positive or negativeb. Evaluate stem: Positive or negativec. Eliminate options that do not match the c. Eliminate options that do not match the stem stemd. Compare remaining options- look for global d. Compare remaining options- look for global

response option response option

6.6. A client returns with a foley catheter after A client returns with a foley catheter after surgery. In providing catheter care, which is surgery. In providing catheter care, which is the best nursing approach?the best nursing approach?

A.A. Preventing infection and maintaining a Preventing infection and maintaining a patient catheter and drainage systempatient catheter and drainage system

B.B. Keeping the collection bag above the level Keeping the collection bag above the level of the bladderof the bladder

C.C. Using soap and water to clean the perineal Using soap and water to clean the perineal areaarea

D.D. Maintaining a closed system without any Maintaining a closed system without any kinks in the tubingkinks in the tubing

Answer: AAnswer: A

7.7. While getting a elderly client who is very While getting a elderly client who is very weak out of bed and into a wheelchair, the weak out of bed and into a wheelchair, the best nursing approach initially is to:best nursing approach initially is to:

A.A. Lock the wheels of the bedLock the wheels of the bedB.B. Position the equipment to provide the Position the equipment to provide the

safest transfer that is possible for the safest transfer that is possible for the clientclient

C.C. Align the wheelchair as close to the bed Align the wheelchair as close to the bed as possible, to prevent the client from as possible, to prevent the client from falling to the floorfalling to the floor

D.D. Remove the leg support on the Remove the leg support on the wheelchair on the side closest to the bedwheelchair on the side closest to the bed

Answer: BAnswer: B

8.8. In a long-term care facility, the nurse finds an In a long-term care facility, the nurse finds an elderly client on the floor. After having the elderly client on the floor. After having the client examined by the physician, the most client examined by the physician, the most important nursing action is to:important nursing action is to:

A.A. Call the family and ask them to stay with Call the family and ask them to stay with the clientthe client

B.B. Provide for the safety and protection of Provide for the safety and protection of the clientthe client

C.C. Apply wrist and leg restraints to prevent Apply wrist and leg restraints to prevent the client from falling from the bedthe client from falling from the bed

D.D. Obtain an order for medication to sedate Obtain an order for medication to sedate the clientthe client

Answer: BAnswer: B

Choosing between the two best Choosing between the two best options cont.options cont.

Eliminate similar distractersEliminate similar distracters1.1. There is only one correct answer. If two There is only one correct answer. If two

options say the same thing or include the options say the same thing or include the same idea, neither can be correctsame idea, neither can be correct

2.2. Practice steps: (9-13)Practice steps: (9-13)A.A. Review the questions: identify the critical Review the questions: identify the critical

elements elementsB.B. Narrow your choices Narrow your choices C.C. Use the similar distracter strategy and look for Use the similar distracter strategy and look for

the option that is different the option that is different

9.9. One of the most important nursing actions in One of the most important nursing actions in the care of the elderly is to:the care of the elderly is to:

A.A. Avoid drying agents when providing skin Avoid drying agents when providing skin carecare

B.B. Encourage the client to perform as many Encourage the client to perform as many activities of daily living as possibleactivities of daily living as possible

C.C. Gently apply moisturizing lotions to Gently apply moisturizing lotions to pressure areaspressure areas

D.D. Apply powder to moist folds in the skinApply powder to moist folds in the skin

Answer: BAnswer: B

10.10. A newly diagnosed adult diabetic is doing a return A newly diagnosed adult diabetic is doing a return demonstration of the proper technique for insulin demonstration of the proper technique for insulin injection. He draws up the correct dose of insulin using injection. He draws up the correct dose of insulin using the proper technique, but when he is ready to inject the the proper technique, but when he is ready to inject the needle, he hesitates and says, “I’m not sure I can do needle, he hesitates and says, “I’m not sure I can do this.” Which response by the nurse would be best this.” Which response by the nurse would be best initially?initially?

A.A. ““I’ll show you again how to inject the I’ll show you again how to inject the needle.”needle.”

B.B. ““I’ll inject the needle for you this time.”I’ll inject the needle for you this time.”C.C. ““You’re doing fine so far. Give it a try”You’re doing fine so far. Give it a try”D.D. ““Why are you so nervous? Do you need Why are you so nervous? Do you need

help?”help?”

Answer: CAnswer: C

11.11. An obese client had been placed on a high-An obese client had been placed on a high-protein, low-calorie diet by his physician. protein, low-calorie diet by his physician. Which nursing action is most appropriate?Which nursing action is most appropriate?

A.A. Explain to the client the he will have to Explain to the client the he will have to change his eating habitschange his eating habits

B.B. Explain the importance of exercise when Explain the importance of exercise when dietingdieting

C.C. Explain to the client what types of foods Explain to the client what types of foods are permitted on a low calorie, high are permitted on a low calorie, high protein dietprotein diet

D.D. Tell the client that if he doesn’t stay on Tell the client that if he doesn’t stay on this diet he will continue to gain weightthis diet he will continue to gain weight

Answer: CAnswer: C

12.12. A client tells the nurse that his last name is A client tells the nurse that his last name is not spelled right on his identification bracelet. not spelled right on his identification bracelet. The appropriate nursing action is to: The appropriate nursing action is to:

A.A. Tell the client that as long as his Tell the client that as long as his medical record numbers are correct, medical record numbers are correct, the mistake is not a problemthe mistake is not a problem

B.B. Ask the client for the correct spelling, Ask the client for the correct spelling, and change his name in his chart.and change his name in his chart.

C.C. Notify the admitting office of the error Notify the admitting office of the error and obtain correct identification and obtain correct identification bracelet for the clientbracelet for the client

D.D. Notify the physician of the errorNotify the physician of the errorAnswer: CAnswer: C

13.13. A client is admitted to the hospital for evaluation A client is admitted to the hospital for evaluation of inadequate circulation to her lower of inadequate circulation to her lower extremities. The doctor orders a tub bath at the extremities. The doctor orders a tub bath at the clients request. In assisting the client with her clients request. In assisting the client with her bath, which nursing action would be unsafe?bath, which nursing action would be unsafe?

A.A. Place a rubber mat on the bottom of the Place a rubber mat on the bottom of the tubtub

B.B. Fill the tub approximately half fullFill the tub approximately half full

C.C. When the client steps into the bath, ask When the client steps into the bath, ask her if the water is the right temperature for her if the water is the right temperature for herher

D.D. Obtain all the necessary supplies and Obtain all the necessary supplies and place them within easy reach of the client.place them within easy reach of the client.

Answer: CAnswer: C

Answering Communication QuestionsAnswering Communication QuestionsA.A. Use test question logicUse test question logic

a.a. Identify the client Identify the clientb. Identify the issue/problem/feelingb. Identify the issue/problem/feelingc. Identify the type of stemc. Identify the type of stem

B.B. Eliminate distracters (14-21)Eliminate distracters (14-21)1.1. Correct answers have a therapeutic response Correct answers have a therapeutic response

a. Therapeutic communication tools: being silent, a. Therapeutic communication tools: being silent, offering self, showing empathy, focusing, offering self, showing empathy, focusing,

restatement, validation/clarification, giving restatement, validation/clarification, giving information, dealing with the here and now information, dealing with the here and now

2. Communication blocks are the distracters. 2. Communication blocks are the distracters. Communication blocks prevent therapeutic Communication blocks prevent therapeutic communicationcommunication

a. Communication blocks: giving advice, showing a. Communication blocks: giving advice, showing approval/ approval/ disapproval, using cliché and false disapproval, using cliché and false reassurance, reassurance, requesting an explanation, requesting an explanation, devaluing clients feelings, devaluing clients feelings, being defensive, focusing on being defensive, focusing on inappropriate issues or inappropriate issues or persons, places clients issues persons, places clients issues on holdon hold

Answering Communication Questions cont.Answering Communication Questions cont.

C.C. Using communicationUsing communication

a. Address the clients feelingsa. Address the clients feelingsClient- centered response’sClient- centered response’s

b. Analyze the introductory statementb. Analyze the introductory statement

1. 1. Physical problems are addressed Physical problems are addressed firstfirst

2. 2. Use the nursing process: is more Use the nursing process: is more information needed?information needed?

3.3. If the client is upset, feelings must If the client is upset, feelings must be be address firstaddress first

14.14. An elderly male client is admitted to the An elderly male client is admitted to the hospital. His son asks the nurse what he hospital. His son asks the nurse what he should do concerning his father’s hearing should do concerning his father’s hearing problem. The nurse’s best response to the son problem. The nurse’s best response to the son is:is:

A.A. ““As people get older, they tend to have As people get older, they tend to have hearing problems”hearing problems”

B.B. ““Your father will need to be seen by a Your father will need to be seen by a specialist”specialist”

C.C. ““I would ask your father how he feels I would ask your father how he feels about his hearing loss”about his hearing loss”

D.D. ““What kind of hearing problem does What kind of hearing problem does you father have?”you father have?”

Answer: DAnswer: D

15.15. A client is in hospital because of severe weight loss A client is in hospital because of severe weight loss and refusal to eat. The physician orders the and refusal to eat. The physician orders the insertion of a NG tube for feeding. The nurse find insertion of a NG tube for feeding. The nurse find the client with the tube removed. The client tells the client with the tube removed. The client tells the nurse the he “doesn’t need that thing”. The the nurse the he “doesn’t need that thing”. The most appropriate nursing response is:most appropriate nursing response is:

A.A. ““You shouldn’t have done that! Now I have to You shouldn’t have done that! Now I have to put it down again.”put it down again.”

B.B. ““Why did you pull that tube out? Do you want Why did you pull that tube out? Do you want to die?”to die?”

C.C. ““Tell me what you don’t like about the tube”Tell me what you don’t like about the tube”

D.D. ““Your doctor is going to be really upset with Your doctor is going to be really upset with you for doing this”you for doing this”

Answer: CAnswer: C

16.16. A female client is schedule for cardiac bypass A female client is schedule for cardiac bypass surgery in the morning. She says to the nurse, “I surgery in the morning. She says to the nurse, “I don’t think I’m going to have the surgery. don’t think I’m going to have the surgery. Everybody had to die sooner or later” The most Everybody had to die sooner or later” The most therapeutic nursing response is:therapeutic nursing response is:

A.A. ““if you don’t have the surgery, you will most if you don’t have the surgery, you will most likely die sooner.”likely die sooner.”

B.B. ““There are always risk involved with surgery. There are always risk involved with surgery. Why have you changed you mind about the Why have you changed you mind about the operation?”operation?”

C.C. ““Cardiac bypass surgery must be very Cardiac bypass surgery must be very frightening for you. Tell me how you feel frightening for you. Tell me how you feel about the surgery”about the surgery”

D.D. ““I will call you doctor and have him come in I will call you doctor and have him come in and talk to youand talk to you

Answer: CAnswer: C

17.17. A male nurse has received a doctor’s order to A male nurse has received a doctor’s order to catheterize one of his female clients. The client catheterize one of his female clients. The client says, “I’m not going to allow a male nurse to says, “I’m not going to allow a male nurse to catheterize me.” The nurse’s best response is:catheterize me.” The nurse’s best response is:

A.A. ““Your doctor is a male. Would you let him Your doctor is a male. Would you let him catheterize you?”catheterize you?”

B.B. ““I’ve done this many times with no I’ve done this many times with no problems.”problems.”

C.C. ““You can explain to your doctor why the You can explain to your doctor why the catheter wasn’t inserted.”catheter wasn’t inserted.”

D.D. ““You appear to be upset. Let me find a You appear to be upset. Let me find a female nurse to help with this procedure.”female nurse to help with this procedure.”

Answer: DAnswer: D

18.18. A male client is admitted to the hospital for surgery A male client is admitted to the hospital for surgery after finding a lump in his right testicle. He asks after finding a lump in his right testicle. He asks the nurse, “Do you think that the doctor will find the nurse, “Do you think that the doctor will find cancer?” The most appropriate nursing response cancer?” The most appropriate nursing response is:is:

A.A. “ “ Most lumps found in the testicle are Most lumps found in the testicle are benign.”benign.”

B.B. ““It must be difficult for you not to know It must be difficult for you not to know what the doctor will find.”what the doctor will find.”

C.C. ““I think that you should discuss this I think that you should discuss this with your doctor.”with your doctor.”

D.D. ““It might be, but the doctor won’t know It might be, but the doctor won’t know until the surgery is performed.”until the surgery is performed.”

Answer: BAnswer: B

19.19. A client is admitted to the hospital with abdominal A client is admitted to the hospital with abdominal pain. She overhears her doctor and her nurse pain. She overhears her doctor and her nurse discussing cancer of the liver. Later, she says to discussing cancer of the liver. Later, she says to the nurse, “Having cancer of the liver must be a the nurse, “Having cancer of the liver must be a terrible thing.” Which is the best nursing response?terrible thing.” Which is the best nursing response?

A.A. ““Yes, it is a terrible disease.”Yes, it is a terrible disease.”B.B. ““What made you think about cancer of What made you think about cancer of

the liver?”the liver?”C.C. ““Any kind of cancer is terrible, but you Any kind of cancer is terrible, but you

can’t live without a liver.”can’t live without a liver.”D.D. ““Yes. A client on this floor has it and it Yes. A client on this floor has it and it

is very said for everyone.”is very said for everyone.”Answer: BAnswer: B

20.20. The nurse is teaching a female client about self The nurse is teaching a female client about self breast exam. The client tells the nurse that she breast exam. The client tells the nurse that she doesn’t understand why she is being taught this, doesn’t understand why she is being taught this, since she doesn’t plan on doing it anyway. The since she doesn’t plan on doing it anyway. The best response by the nurse isbest response by the nurse is::

A.A. ““Self breast exam is taught to women in order to Self breast exam is taught to women in order to detect any lumps or changes in the breast which detect any lumps or changes in the breast which can be an early sign of cancer, because early can be an early sign of cancer, because early treatment had a higher rate or cure”treatment had a higher rate or cure”

B.B. ““You’re right. If you don’t plan on doing the exams, You’re right. If you don’t plan on doing the exams, then I don’t need to show you how to do it.”then I don’t need to show you how to do it.”

C.C. ““If you don’t plan on doing the exam yourself, then If you don’t plan on doing the exam yourself, then you should have your doctor do it at your annual you should have your doctor do it at your annual check up.”check up.”

D.D. ““You have the right to do whatever you choose. It is You have the right to do whatever you choose. It is your body.”your body.”

Answer: AAnswer: A

21.21. A confused elderly female client has wet herself and is A confused elderly female client has wet herself and is standing in the hospital corridor in a puddle of urine. standing in the hospital corridor in a puddle of urine. She has trouble getting to the bathroom in time. She She has trouble getting to the bathroom in time. She looks ashamed. She says to the nurse, “I want to go looks ashamed. She says to the nurse, “I want to go outside for a walk now.” What is the most appropriate outside for a walk now.” What is the most appropriate response by the nurse at this time?response by the nurse at this time?

A.A. ““Before we go for a walk, perhaps we can make Before we go for a walk, perhaps we can make a list that will help you make your bathroom a list that will help you make your bathroom trips easier.”trips easier.”

B.B. ““Right now, let me wipe up the urine on the Right now, let me wipe up the urine on the floor, and let’s get a change of clothing. I am floor, and let’s get a change of clothing. I am sure that this problem is upsetting for you.”sure that this problem is upsetting for you.”

C.C. ““This had been a problem for you. Let’s see if This had been a problem for you. Let’s see if we can find a solution together.”we can find a solution together.”

D.D. ““Wetting yourself is very upsetting, Yes, let’s Wetting yourself is very upsetting, Yes, let’s take a walk.”take a walk.”

Answer: BAnswer: B

Priority setting questions (22-27)Priority setting questions (22-27)

A.A. Decision making questions involving setting Decision making questions involving setting priorities. Common words used in priority priorities. Common words used in priority setting test question are:setting test question are:

1. Initial response1. Initial response

2.2. Essential nursing action Essential nursing action

3.3. Vital considerations Vital considerations

4. Immediate attention4. Immediate attention

5. Priority nursing action5. Priority nursing action

6.6. Best Nursing judgment Best Nursing judgment

7.7. Most important Most important

Priority setting questions cont. (22-27)Priority setting questions cont. (22-27)

B.B. Priority-setting guidelinesPriority-setting guidelines

a.a. Nursing processNursing process

Assessment received priorityAssessment received priority

b. Maslow’s Hierarchy of needsb. Maslow’s Hierarchy of needs

ABC’sABC’s

c. Communication theoryc. Communication theory

Tools and feelingsTools and feelings

d. Teaching/Learning theoryd. Teaching/Learning theory

Motivation is keyMotivation is key

22.22. A client, 21 years old, is admitted to the hospital A client, 21 years old, is admitted to the hospital because of extreme weight loss. It is noted on the because of extreme weight loss. It is noted on the admission assessment that the client believes that admission assessment that the client believes that she is overweight at 88 pounds. What aspect of she is overweight at 88 pounds. What aspect of care should the nurse consider her first priority?care should the nurse consider her first priority?

A.A. Assessing the client’s nutritional status.Assessing the client’s nutritional status.

B.B. Obtaining a psychiatric consultObtaining a psychiatric consult

C.C. Planning a therapeutic diet for the clientPlanning a therapeutic diet for the client

D.D. Talking to the family members to find Talking to the family members to find out more about the client self conceptout more about the client self concept

Answer: AAnswer: A

23.23. An elderly male client with COPD is receiving O2 per nasal An elderly male client with COPD is receiving O2 per nasal cannula at 2 liters per minute. At 3:30pm. The nurse cannula at 2 liters per minute. At 3:30pm. The nurse assesses that the client appears to have made a good assesses that the client appears to have made a good adjustment to hospitalization. At 5pm the nurse finds the adjustment to hospitalization. At 5pm the nurse finds the oxygen cannula on the floor. The client is angry and says, oxygen cannula on the floor. The client is angry and says, “It’s about time you got here. Where am I? Where is my “It’s about time you got here. Where am I? Where is my breakfast?” Which consideration would receive the nurse’s breakfast?” Which consideration would receive the nurse’s immediate consideration?immediate consideration?

A.A. Has the O2 cannula been off long enough to cause Has the O2 cannula been off long enough to cause hypoxia?hypoxia?

B.B. Is the client’s anger related to being hospitalized?Is the client’s anger related to being hospitalized?C.C. Does the client need a clock in the room to keep track Does the client need a clock in the room to keep track

of time?of time?D.D. Is the client accustomed to eating dinner very early in Is the client accustomed to eating dinner very early in

the day?the day?

Answer: AAnswer: A

24.24. A hospitalized elderly female client is to receive A hospitalized elderly female client is to receive an x-ray. The nurse enters the client’s room, an x-ray. The nurse enters the client’s room, and ask if the client is ready to go to x-ray. She and ask if the client is ready to go to x-ray. She nods her head “yes” the next priority nursing nods her head “yes” the next priority nursing action is to:action is to:

A.A. Explain the x-ray procedure to the Explain the x-ray procedure to the client.client.

B.B. Help the client into a wheelchair, so Help the client into a wheelchair, so that when the transporter arrives the that when the transporter arrives the client will be readyclient will be ready

C.C. Ask if the client has any questionsAsk if the client has any questions

D.D. Look at the clients ID braceletLook at the clients ID bracelet

Answer: DAnswer: D

25.25. A 15-year old female client is being seen in the A 15-year old female client is being seen in the family planning clinic. She says to the nurse family planning clinic. She says to the nurse that she is nervous and has never had a pelvic that she is nervous and has never had a pelvic exam before. The best response by the nurse exam before. The best response by the nurse initially is:initially is:

A.A. ““All you have to do is relax”All you have to do is relax”

B.B. ““It is only slightly uncomfortable”It is only slightly uncomfortable”

C.C. ““What part of the exam makes you What part of the exam makes you nervous?nervous?

D.D. If you want birth control pills, then a If you want birth control pills, then a pelvic exam is requiredpelvic exam is required

Answer: CAnswer: C

26.26. The nurse caring for a postoperative client. The nurse caring for a postoperative client. The nurse is informed during report that the The nurse is informed during report that the client had not voided for 8 hours. The initial client had not voided for 8 hours. The initial nursing action would be to:nursing action would be to:

A.A. Assist the client to the bathroomAssist the client to the bathroom

B.B. Place the client on a bed pan and pour Place the client on a bed pan and pour warm water over her perineumwarm water over her perineum

C.C. Palpate and percuss the client’s bladderPalpate and percuss the client’s bladder

D.D. Catheterize the clientCatheterize the client

Answer BAnswer B

27.27. The nurse had completed pre-discharge teaching for an The nurse had completed pre-discharge teaching for an elderly female client who is being discharged from the elderly female client who is being discharged from the hospital after treatment for poor circulation to her lower hospital after treatment for poor circulation to her lower extremities. Which action by the client would the nurse extremities. Which action by the client would the nurse identify as the most important indication of the success for identify as the most important indication of the success for failure of the pre-discharge teaching?failure of the pre-discharge teaching?

A.A. The client puts on stockings with elastic tops and The client puts on stockings with elastic tops and tells the nurse that she does not like other kinds of tells the nurse that she does not like other kinds of hosieryhosiery

B.B. The client tells the nurse that she will get a The client tells the nurse that she will get a thermometer to measure the temperature of the thermometer to measure the temperature of the bath waterbath water

C.C. The client asks her husband to take her sandals The client asks her husband to take her sandals home and bring a pair of shoes to the hospital for home and bring a pair of shoes to the hospital for her to wear homeher to wear home

D.D. The client tells the nurse that she is going to have a The client tells the nurse that she is going to have a hard time remembering to keep her legs uncrossed.hard time remembering to keep her legs uncrossed.

Answer AAnswer A

Answering questions using the Nursing ProcessAnswering questions using the Nursing Process

A.A. Test questions will associate with nursing Test questions will associate with nursing behavior when using the nursing processbehavior when using the nursing process

1. Assessment questions (28-30)1. Assessment questions (28-30)

A. Tips for assessment questionsA. Tips for assessment questionsa. Terms used: observe, monitor, check,

obtain information, and find out

b. Remember: assess first

c. Know your vital signs and lab values

d. Focus on the issue

B. Eliminate optionsEliminate options

28.28. A male client returns from the recovery room A male client returns from the recovery room to the surgical unit following surgery. Upon to the surgical unit following surgery. Upon his arrival in the client care unit, what is the his arrival in the client care unit, what is the initial focus of the nurse’s assessmentinitial focus of the nurse’s assessment

A.A. Urine outputUrine output

B.B. Vital signsVital signs

C.C. Pain in the incisionPain in the incision

D.D. Status of the dressingStatus of the dressing

Answer: BAnswer: B

29.29. The nurse is monitoring a client who is The nurse is monitoring a client who is receiving IV infusion for the signs of receiving IV infusion for the signs of infiltration. In assessing an IV site which has infiltration. In assessing an IV site which has become infiltrated, the nurse knows that become infiltrated, the nurse knows that which finding is unexpected?which finding is unexpected?

A.A. The infusion rate slows or stops while the The infusion rate slows or stops while the tubing in not kinkedtubing in not kinked

B.B. The area around the injection site feels warm The area around the injection site feels warm to the touchto the touch

C.C. Swelling, hardness, or pain is found around Swelling, hardness, or pain is found around the needle sitethe needle site

D.D. Blood fails to return in the tubing when the Blood fails to return in the tubing when the bottle is loweredbottle is lowered

Answer: BAnswer: B

30.30. A client puts her call light on and tells the nurse A client puts her call light on and tells the nurse that she had to urinate. The client had had a foley that she had to urinate. The client had had a foley catheter in place since her surgery two days ago. catheter in place since her surgery two days ago. The appropriate nursing action is to:The appropriate nursing action is to:

A.A. Remind the client that she had a foley Remind the client that she had a foley catheter in place and does not need to go to catheter in place and does not need to go to the bathroomthe bathroom

B.B. Replace the foley catheter with a new Replace the foley catheter with a new cathetercatheter

C.C. Explain to the client that the urge to void is a Explain to the client that the urge to void is a common occurrence for clients who have common occurrence for clients who have urinary cathetersurinary catheters

D.D. Check the catheter and tubing for kinks and Check the catheter and tubing for kinks and note the urine output in the drainage bagnote the urine output in the drainage bag

Answer DAnswer D

Answering questions using the Nursing ProcessAnswering questions using the Nursing ProcessA.A. Test questions will associate with nursing behavior when Test questions will associate with nursing behavior when

using the nursing processusing the nursing processA.A. Analysis question: most difficult (32)Analysis question: most difficult (32)

A.A. Nursing behaviors associated with analysisNursing behaviors associated with analysisA.A. Interpreting dataInterpreting dataB.B. Validating dataValidating dataC.C. Organizing related dataOrganizing related dataD.D. Recording dataRecording dataE.E. Identify a nursing diagnosisIdentify a nursing diagnosis

B.B. Be sure to identify the issue and focus on the Be sure to identify the issue and focus on the nursing rationalenursing rationale

C.C. Tips for Analysis questionsTips for Analysis questionsA.A. Identify the issueIdentify the issueB.B. Do not read into the questionDo not read into the questionC.C. Focus on the nursing rationaleFocus on the nursing rationale

32.32. In preparing a preoperative teaching plan, In preparing a preoperative teaching plan, the nurse would give top priority to:the nurse would give top priority to:

A.A. Active range of motion exerciseActive range of motion exercise

B.B. A rationale for various tubes, IV’s, etcA rationale for various tubes, IV’s, etc

C.C. The need to record vital sign frequentlyThe need to record vital sign frequently

D.D. Coughing and deep breathing exerciseCoughing and deep breathing exercise

Answer: DAnswer: D

Answering questions using the Nursing ProcessAnswering questions using the Nursing Process

A.A. Test questions will associate with nursing behavior when Test questions will associate with nursing behavior when using the nursing processusing the nursing process

A.A. Planning questions (33-35)Planning questions (33-35)

A.A. Nursing behaviors associated with planningNursing behaviors associated with planning

A.A. Starting goals and priorities for an NCPStarting goals and priorities for an NCP

B.B. Selecting intervention for an NCPSelecting intervention for an NCP

C.C. Stating outcomesStating outcomes

D.D. Modifying NCP’sModifying NCP’s

E.E. Cooperating with others form delivery of careCooperating with others form delivery of care

F.F. Documentation pertinent informationDocumentation pertinent information

B.B. Warning! Many planning questions have negative Warning! Many planning questions have negative stemstem

Answering questions using the nursing Answering questions using the nursing

process contprocess cont..

Tips for planning questions:Tips for planning questions:– Answer involves something in the NCP Answer involves something in the NCP

verses the medical plan. The exam is on verses the medical plan. The exam is on nursing action not medical actionnursing action not medical action

– Highlight the issue of the questionHighlight the issue of the question– Do not read into the questionsDo not read into the questions– When the question asks you to select When the question asks you to select

priorities- use Maslow’s Hierarchy of needspriorities- use Maslow’s Hierarchy of needs

33.33. An elderly, confused client is on bed rest. In An elderly, confused client is on bed rest. In planning nursing care for this client, which planning nursing care for this client, which nursing intervention will not effectively nursing intervention will not effectively provide for this client’s safety?provide for this client’s safety?

A.A. Provide regular toiletingProvide regular toileting

B.B. Explain to the client that she should use the Explain to the client that she should use the call light if she needs to get upcall light if she needs to get up

C.C. Place the side rails in the up position and Place the side rails in the up position and check on client oftencheck on client often

D.D. Initiate the proper use of restraintsInitiate the proper use of restraints

Answer: BAnswer: B

35.35. An elderly client is in a nursing home and An elderly client is in a nursing home and confined to bed. In planning care for this confined to bed. In planning care for this client, the nurse knows that the most client, the nurse knows that the most essential nursing intervention to prevent skin essential nursing intervention to prevent skin breakdown and decubitus ulcers is to: breakdown and decubitus ulcers is to:

A.A. Massage all bony prominences with Massage all bony prominences with lotionlotion

B.B. Keep the skin clean and dryKeep the skin clean and dry

C.C. Turn the client at least every two hoursTurn the client at least every two hours

D.D. Place and egg crate mattress on the Place and egg crate mattress on the bedbed

Answer: CAnswer: C

When caring for a patient in pain, the most When caring for a patient in pain, the most important thing the nurse must recognize is that:important thing the nurse must recognize is that:

A.A. The extent of pain is directly related to the The extent of pain is directly related to the amount of tissue damageamount of tissue damage

B.B. Administering analgesics for pain will eventually Administering analgesics for pain will eventually lead to addictionlead to addiction

C.C. Behavioral adaptation are congruent with Behavioral adaptation are congruent with statements about painstatements about pain

D.D. The person experiencing pain is the authority The person experiencing pain is the authority about the painabout the pain

Answer: DAnswer: D

Which most accurately implies physical rest?Which most accurately implies physical rest?

A.A. Peace of mindPeace of mind

B.B. Increased sleepIncreased sleep

C.C. Decreased movementDecreased movement

D.D. Freedom from anxietyFreedom from anxiety

Answer: CAnswer: C

Which is the most important thing the nurse can Which is the most important thing the nurse can do to support a patient’s ability to sleep in the do to support a patient’s ability to sleep in the hospital settinghospital setting

A.A. Provide a extra blanketProvide a extra blanketB.B. Limit unnecessary noise on the unitLimit unnecessary noise on the unitC.C. Shut off all lights in the patient’s roomShut off all lights in the patient’s roomD.D. Pull curtain around the bed at nightPull curtain around the bed at night

Answer: BAnswer: B

When assessing a patient in pain, which defining When assessing a patient in pain, which defining characteristic is more common in acute pain than characteristic is more common in acute pain than in chronic pain?in chronic pain?

A.A. Self-focusingSelf-focusing

B.B. Sleep disturbancesSleep disturbances

C.C. Guarding behaviorsGuarding behaviors

D.D. Variation of vital signsVariation of vital signs

Answer: DAnswer: D

Thank you!Thank you!Fundamentals Success, FA DavisFundamentals Success, FA Davis

Good Luck Everyone on Good Luck Everyone on Future Exams!Future Exams!