aaanclexquestionanalysis

8/7/2019 aaaNCLEXQuestionAnalysis

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Prepare, Prepare, Prepare Get in a grove and this will enable you to feel physically, emotionally, and intellectuallyready NCLEX Questions are just 'common sense' practice... Remember... treat the underlyingcause (treat the

PATHOPHYSIOLOGY not just the symptoms).

FYI:

Get a couple of NCLEX books that is category specific and look at the Pathology/Conditions they talk about...

You'll find some common themes...

Confidence is KEY!!

Samuel Merritt Students and the NCLEX:

- Assessment: OK-Diagnosis: OK

- Planning: Noot so well

-Implementation: Not so well-Evaluation: Very Low

Critical Thinking: What does the term critical thinkingmean? Critical thinking is problem solving that involvesthinking creatively. It requires that the RN:

y Observe

y Decide what is important

y Look for Patterns and relationships

y Identify normal and abnormal

y Identify the problem

y Apply knowledge

y Transfer knowledge from one situation to another

y Evaluate according to established criteria


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Breaking Down the Question Types

Knowledge Questions

y AlphabetQues (e.g., ABCs)

y Acronyms (e.g., ABGs)

y Acrostics Phrase or motto or verse in which a letter of each word prompts the memory to retrieveinformation.

y Mneumonic a phrase, motto, or verse that jogs the memory. Differs from an acrostic in that no everyword is related to a specific piece of information.

Comprehension Questions:

y Explore Whys and Hows

y Study in Small Groups

Application Questions

y Relate New Information to Prior Learning

y Recognize Commonalities

Analysis Questions:

y Recognize Differences learn to discriminate among facts.

y Practice Test Taking Gradually increase test taking time until you become proficient in concentratingfor 2-3 hours. This will help you concentrate more effectively during a shorter test.

The RACE ApproachRegognize what information is in the stem

y Recognize they key words in the stem

y Recognize who the patient is in the stem

y Recognize what the topic is all about

Ask what is the question asking

y Ask what are they key words in the stem that indicate the need for a response

y Ask what the question is asking me to do.

Critically analyze the options in relation to the question asked in the stem

y Critically scrutinize each option in relation to the information in the stem

y Critically identify a rationale for each option

y Critically compare and contrast the options in relation to the information in the stem and theirrelationships to one another


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Eliminate as many options as possible.

y Eliminate one option at a time


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Multiple Choice Questions

y To answerstems with incomplete sentences read the answers before the question.

y When reading the stem:

o Underline the important wordso Do not add information from your own mind.o Do not make assumptions about the information presented in the stem

y When reading the options:

o Read all the options before choosing the correct answer

o Refer back only to the words that you underlined as being important in the stem

o Do not add information to an option

o Relate an option to just what is being asked in the response part of the stem.

o Focus on commonalities, principles and concepts associated with your level of learning that isbeing tested.

o Do not focus only on your experiences, which may be too narrow for a point of reference.

o Recognize that an option can contain correctinformation but it may or may not have anything todo with the information and response of the stem.

The Nursing Process(ADPIE)

Assessment Key Words: identify, verify, observe, determine, notify, check, inform, question, communicate, signs

and symptoms, stressors, adaptations, sources, perceptions and assess.

Diagnosis Key Words: valid, organize, categorize, cluster, reexamine, pattern, formulate, reflect, relate, problem,

interpret, decision, significant, deduction, statement and analysis.

Planning Key Words: achieve, desired, plan, effective, desired result, goal, priority, develop, formulate, establish,

design, prevent, strategy, select, anticipate, modify, arrange & coordinate.

- Set priorities based on Maslows needs.

Implementation Key Words: dependant, independent, change, assist, counsel, teach, give supervise, perform,

method, procedure, instruct, strategy, provide, inform, refer, technique, motivate, delegate and implement.

Evaluation Key Words: expected, met, desired, compared, succeeded, failed, modified, achieved, modified,

reassess, ineffective, response and evaluate.


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Setting Priorities

Priorities AreBased Upon:

y Physiologic needs generally need to be met before higher needs

y

D

isbelief and denial are generally a persons first response to news of a loss or anticipated loss.

y Meeting the needs of the patient come first over other tasks.

y Patient readiness to learn must be assessed first before designing a teaching program.

y A patients emotional status must be assessed as part of the first step in the nursing process.

y Nurses need to use interviewing techniques to effective communicate in a nonthreatening way withpatients.

y The RN must deliver care in a nonudgemental manner.

y Maintaining a patients airway is always a priority.

y The patients safety is always a priority.

y A thorough assessesment must be completed before other steps in the nursing process.

Thus: SettingPrioritiescan be based on:

-Maslows hierarchy of needs

-The Nursing Process

-Kubler-Rosss Theory ofDeath and Dying

-Patient-Centered Care

-Teaching/Learning Theory

-Emotional Support and Communication Theory

- ABCs.


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PATHOPHYSIOLOGY not just the symptoms).ApproachingMultiple Choice Questions

Identify Cluesin theStem

y A word or phrase in the stem may provide a hint for choosing the correct answer because of itsrelationship to another word or phrase in the stem.

y A clang association is when a word in the stem and prospective answer are the same and this is often thecorrect answer.

Identify the Central Personin the Questiony The pt. is almost always the center of the question when the stem is limited to just the pt and the RN.

y The central person is the one who receives the care.

Identify Patient-Centered Options

y Nursing involves both physical and emotional care

y Items include exploring patient feelings, identify patient preferences, empower the patient, afford thepatient choices, or in some other way place preference on the patient.

y Items that transfer patient-care responsibility can often be eliminated.

Identify Specific Determinersin Optionsy A word or statement that convetys a thought or concept that has no exceptions.

o Include: just, always, never, all, every, only and none.

y Frequently these options are incorrect and can be eliminated.

y Be discriminating.Identify Oppositesin Options

y Of the two choices, one will be the correct answer or both can be eliminated.

o When one is correct, you will be asked to differentiate between two extremes of a concept orprinciple.

y When options are opposites, more often than not one of them is the correct answer.

y Give serious consideration when opposites appear in the answer column.

y When the opposites are distractors, they are attempting to divert your attention away from the correctanswer.

Identify Equally Plausible or Unique Optionsy Sometimes items contain two or more options that are similar.

y One option appears no better or worse in relation to the statement presented in the stem.

y Usually equally plausible options are distractors and can be eliminated.

y This includes key words within the answers (i.e., each option deals with a similarconcept)


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Identify The Global Option

y Theglobal option is more comprehensie and general than the other options it is aimed at the applicationto allpatients.

o Look for the option that is more of a generalprinciple.

y Identifying the global option is similar to identifying the unique options.

y The global option is usually a broad, general statementwhereas the three distractors are specific

o You must pick out the option that is different.

y Umbrella Answer: One answer includes the others. There may be more than one correct answer.

o One answer is better than all the others because it includes them.

Identify Duplicate Facts Among the Options

y Usually identical or similar facts appear in at least two of the four options.

Identify Options that Deny Patient Feelings, Concerns,and Needs

y Options that imply everything will be alright dey patients feelings, change the subject raised by thepatient, encourage the patient to be cheerful, or transfer nursing responsibility to other members of thehealth team are usually distractors and can be eliminated.

UseMultiple Test-Taking Techniques

y As you becme better at applying test-taking techniques, you can further maximize success in choosing thecorrect option if you use more than one test-taking technique with a question.


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12 NCLEX Tips:

Strategy 1: Understand the IntimidationTest writers choose some material that is complely foreign. The questions themselves will contain the necessary

information to choose the correct answer.

Strategy 2: Finding Your Optimal PaceInitally conduct a flyover, looking for only a surface level of knowledge. Skim the question and read then readthe question slowly. Practice to learn an optimal rate.

Strategy 3: Don't bea PerfectionistDon't spend too much time on one question.

Strategy 4: Factually Correct,but Actually WrongSome items may be factually correct on their own, but fail to answer the question, and are thus actually wrong.

Watch out for answers that appear factually correct on their own.

Strategy 5: Extraneous InformationSome answer choices will seem to fit in and answer the question being asked. They might even be factuallycorrect.... Check and see if the answer choice actually matches the question, or is base on extraneous information

contained in the question.

Strategy 6: Avoiding DefinitesOften answer choices that contain a definite choice are wrong.

Strategy 7: Use CommonSenseThe questions on the test are not intended to be trick questions. Most choices have a sense of normalcy aboutthem that may be fairly obvious and could be answered simply by using common sense.

Strategy 8: Instinctsare RightWhen in doubt, go with your first instinct. Often when something feels right, it is right. Over analytical testtakers will often convince themselves otherwise. Don't fall into that trap and try not to get too nitpicky about ananswer choice. You shouldn't have to twist the facts and create hypothetical scenarios for an answer choice to be

correct.

Strategy 9: No FearDon't try to understand every facet of the nursing management provess. Don't memorize the minute details. Don't

get overwhelmed.

Strategy 10: Don't get Thrown Offby New InformationMake sure that you don't get distracted by answer choices containing new information that does not answer the

question.

Strategy 11: Narrowing theSearchWhenever two answer choices are direct opposites, the correct answer choice is usually one of the two. Often

these answers will differ by only one word. When answers are a mix of assessments and implementations, Doesthe situation require assessment?

Strategy 12: You'renot Expected to be EinsteinThe questions will contain the information that you need to know in order to answer them. Remember, some

questions contain obscure topics that you've never heard of. If you would need to know a lot of outside

knowledge about a topic in order to choose a certain answer, its usually wrong.


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Kaplan NursingStrategies

Maslow Strategy

Step 1: Look at your answer choices -- if answer choices are both physical and psychosocial, its time to "Maslow"

the answer choices.

Step 2: Eliminate all psychosocial answer choices. If an answer choice is psychiological don't eliminate it yet.Remember, Maslow states that psysiological needs must be met first. While pain certainly is has a physiological

component, reactions to pain are considered "psychosocial" on this exam and will become a lower priority.

Step 3: Ask yourself: Does this choice make sense?

Next, consider each of the remaining answer choices. Take the time to read each choice carefully and ask yourself"Does this answer make sense with regard to the disease or situation as described in the question?" If it makessense as an answer choice, keep it for consideration and go on to the next choice.

Step 4: Can you apply ABC's?Look at the remaining answer choices. Can you apply ABC's? If there is an answer that involves maintaining a

patent airway - it will be correct. If no, then is there a choice that involves breathing problems -- it will be correctIf no, then is there a choice pertaining to the cardiovascular system--it will be correct. If the ABC's don't apply

then compare the remaining answer choices and ask yourself, "What is the highest priority" -- this will be youranswer.


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Assessment vs. Implementation

A second strategy involves establishing priorities of assessment and implementation steps of the nursing process -- ADPIE. You will be given a clinical situation and asked to establish priorities. The possible answer choices

will include both the correct assessment and implementation for this clinical situation. How do you choose thecorrect answer? Think about these two steps in the nursing process --

Assessment

Assessment is the process of establishing a data profile about the client and his or her health problems. The RN

obtains subjective and objective data in a number of ways - evaluating lab results, collaborating w/others,interviews, etc

Once you collect the data you compare it to the client's baseline or normal values.

This is the first step in the nursing process and it takes priority over all other steps. It is essential that you

complete the assessment phase of the nursing process before you implement nursing activities--don't implement

before you assess.

Implementation:The care you provide to patients. Implementation includes: assisting with ADL's, counseling and educating,giving care, supervising and evaluating the work of others. Nursing actions maybe independent, dependent or

interdependent. Interdependant functions are shared w/other members of the health team (e.g., nutrition education

and chest physiotherapy). You should assume that you have an order for all dependent functions.

Reword the question...

Step 1: Read the answer choice to establish a pattern--are the answers a mix of assessments and implementations?

Step 2: Refer to the question to determine if you should be assessing or implementing... When a DX has been

made... It's time for implementation... Remember assessment comes before implementation.


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Establishinga Priority:

Step 1: Reword the question in your own words. This question is a priority question: What patient takes highest

priority? As with all priority questions, more than one question will seem correct.

Step 2: Eliminate answers using the Rules of Management -- Eliminate patients that can be delegated.

Step 3: Life Threatning, Health Threatning, Health promotion. Apply Maslow and ask yourself -- who requiresmy attentionfirst.

Strategy 3: Safety

Nurses have primary responsability to ensure the safety of their patients. this includes the patients at the

hospitals, home work, etc. Safety includes: metting basic needs (oxygen, food, fluids, etc.), reducing hazards thatcause injury to clients (accidents, obstacles in the home), and decreasing the transmission of pathogens

(immunizations, sanitation).

Always think safety when selecting the correct answers.

Reword the Question:

Step 1: Are all choices implementations? Yes.

Step 2: Can you answer the question based on your knowledge of the procedure? Yes/No

Step 3: Ask yourself "what will cause the patient the least amount of harm?"


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'Real World Experience'

Step 1: Avoid using personal experience for NCLEX questions NCLEX world, not the realworld.

Step 2:Do you have the time, staff, and equipment?

Step 3: Take Care of the patient first remember patient-centered care..Step 4: Make a judgment call

Equipment Malfunction/AdjustmentFirst take care of/evaluate the patient, then the equipment.

Notify the PhysicianUsually there is something you must do first before notifying the physician.

Therapeutic Communication:

The answer will more than likely contain a mix of correct information and be empathetic to the patients feelings.


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Strategiesfor Positioning:

Things to Remember

yEven if you didnt memorize that position to use before, during, and after a procedure, think about thequestionfor a moment. You can figure out what position is needed.

yYou cannot figure out the correct position if you do not know anatomy and physiology. If you think theliver is on the left side of the body, youre in trouble!

yYou cannot figure out a correct position if you do not know what youre trying to accomplish. If youcouldnt remember that a complication of liver biopsy is hemorrhage, your best hope of selecting the

correct answer would be to throw a dart.

yTo those students who think in images, you should form a mental image of each position. Picture yourselfplacing the client in each position, and then see if the position makes sense.


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Normal Lab Values:

K+ 3.5 5.0

Ca+ 4.5 5.0

Mg2+ 1.5 2.5

PO43-

1.8 2.6

Na+

135 145

Cl- 95 105

Crt. 0.5 1.2

BUN 10 20

PTT 60 70 -- (Heparin level) (1 times higher)

PT 10 12.5 sec (2.0 3.5 timesifon Coumadin)

INR ,1 -- (2.0 3.5 for Coumadin)

WBC 5 10

RBC 5

HCt 40

Hgb 15

pH 7.35 7.45

CO22- 35 45

Urine1.010 1.030

Therapeutic Ranges:

Digoxin = 0.5 2.0 ng/mLLithium = 0.5 1.5 mEq/LDilantin = 10-20 mcg/dL

Theophylline = 10-20 mcg/dLVanco = 10-20 mcg/dL

MgS

O4 = 4.0-7.0Acetaminophen: 1-30 mcg/ml

Alcohol: 100 mcg/ml

Diazepam (Valium): 100-1000 mcg/ml

Carbamazepine (Tegretol): 8-12 mcg/mlAmitriptyline (Elavil): 120-250 mcg/mlNormal - Troponin T < 0.1 ng/ml - 0.2 ng/ml


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Pharmacology - KnowIndication/Action/EffectPrefix/Suffix

-ase = thrombolytic

-azepam = benzodiazepine

-azine = antiemetic; phenothiazide

-azole = proton pump inhibitor, antifungal

-barbital = barbiturate

-coxib = cox 2 enzyme blockers

-cep/-cef = anti-infectives

-caine = anesthetics

-cillin = penicillin

-cycline = antibiotic

-dipine = calcium channel blocker

-floxacin = antibiotic

-ipramine = Tricyclic antidepressant

-ine = reverse transcriptase inhibitors,antihistamines

-kinase = thrombolytics

-lone, pred- = corticosteroid

-mab = monoclonal antibiotics

-micin = antibiotic, aminoglycoside

-navir= protease inhibitor

nitr-, -nitr- = nitrate/vasodilator

-olol = beta antagonist

-oxin = cardiac glycoside

-osin = Alpha blocker

-parin = anticoagulant

-prazole = PPIs

-phylline = bronchodilator

-pril = ACE inhibitor

-statin = cholesterol lowering agent

-sartan = angiotensin II blocker

-sone = glucocorticoid, corticosteroid

-stigmine = cholinergics

-terol = Beta 2 Agonist

-thiazide = diuretic

-tidine = antiulcer

-trophin = Pituitary Hormone

-vir= anti-viral, protease inhibitors

-zosin = Alpha 1 Antagonist

-zolam = benzo/sedative

-zine = antihistamine


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Pharm Facts

y Dont give non-selective beta-blockers to patients w/respiratory problems

y Vitamin C can cause false +ive occult blood

y Avoid the G herbs (ginsing, ginger, ginko, garlic) when on anti-clotting drugs (coumadin,ASA, Plavix, etc)

y ASA toxicity can cause ringing of the ears

y No narcotics to any head-injury victims

y Mg2+ toxicity is treated with Calcium Gluconate

y Do not give Calcium-Channel Blockers with Grapefruit Juice

y Oxytocin is never administered through the primary IV

y Lithium patients must consume extra sodium to prevent toxicity

y MAOI Patients should avoid tyramine:

o Aacados, bananas, beef/chicken liver, caffeine, red wine, beer, cheese (except cottagecheese), raisins, sausages, pepperoni, yogurt, sour cream.

y Dont give atropine for glaucoma it increases IOP

y Dont give ant-acids with food -- b/c it delays gastric emptying.

y Dont give Stadol to Methadone/Heroin Preggos -- cause instant withdrawal symptoms

y Insulin clearbefore cloudyy Dont give meperidine (Demerol) to pancreatitis patients

y Always verify bowel sounds when giving Kayexelate

y Hypercalcemia = hypophosphatemia (and vice versa)

y Radioactive Dye urine excretion

y Signs of toxic ammonia levels is asterixis (hands flapping)

y D10W can be substituted for TPN (temporary use)

y Dopamine and Lasix are incompatible

y Hypoglycemic shivers can be stopped by holding the limb, seizures cannot (infants)

y Common symptom of aluminum hydroxide constipation

y Thiazide diuretics may induce hyperglycemiay Take iron with Vit C it enhances absorbtion Do not take with milk

y B1 - For Alcoholic Patients (to prevent Wernickes encephalopathy & Korsakoffs synd)

y B6 - For TB Patients

y B9 - For Pregnant Patients

y B12 - Pernicious anemia, Vegetarians.


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y Complications of Coumadin - 3Hs - Hemorrhage, hematuria & hepatitis

y FFP is administered to DIC b/c of the clotting Fx

y Mannitol (osmtic diuretic [Head injury]) crystallizes at room temp use a filter needle

y Antianxiety medication is pharmacologically similar to alcohol used for weaning Tx

y Administrate Glucagon when pt is hypoglycemia and unresponsive

y Phenazopyridine ( Pyridium)--Urine will appear orange

y Rifampicin -- Red-urine, tears, sweat)

y Hot and Dry = sugar high (hyperglycemia)

y Cold and clammy = need some candy (hypoglycemia)

y Med of choice for V-tach is lidocaine

y Med of choice for SVT = adenosine or adenocard

y Med of choice for Asystole = atropine

y Med of choice for CHF is Ace inhibitor.

y Med of choice for anaphylactic shock is Epinephrine

y Med of choice for Status Epilepticus is Valium.

y Med of choice for bipolar is lithium.

y Give ACE inhibitors w/food to prevent stomach upset

y Administer diuretics in the morning

y Give Lipitor at 1700 since the enzymes work best during the evenin

y Common Tricyclic Meds - 3 syllabes (pamelor, elavil)

y Common MAOIs - 2 syllables (nardil, marplan)

y TPN has a dedicated line & cannot be mixed ahead of time

y RHoGAM -- Given at 28 weeks & 72 hrs postpartum

y Do not administer erythromycin to Multiple Sclerosis pt

y Benadryl and Xanax taken together will cause additive effects.

y Can't take Lasix if allergic to Sulfa drugs.

y Acetaminophen can be used for headache when the client is using nitroglycerin.

y Dilantin - can not give with dextrose. Only give with NS.

Addison is skinny ( hypoglycemic, you get weight loss, you got weakness, and you get postural hypotn)

Cushing is fat ( hyperglycemic, you get moon face big cheeks, and you retain a lot of Na and fluid)


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y Never Give via IVP:

o KCL

o Heparin

o Ibuprofen

o Insulin

o Dobutamine

o ASA

o Albumin

o Acetaminophen

y Insulin:

o Rapid: lispro onset 24hr

o V.Long: Lantus onset 1 hr. Peak: None. Duration: 24 hr continuous

y Anticholergic Side Effects:

o Cant See

o Cant Pee

o Cant Spit

o Cant Sh*t

y Hypocalcemia CATS

o Convulsions

o Arrythmias

o Tetany

o Spasms & Stridor

y Hyper Kalemia Causes: MACHINE

o Medicationa (ace inhibitors, NSAIDS)

o Acidosis (metabolic & repiratory)


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o Cellular destruction (burns, traumatic injuy)

o Hypoaldosteronism, Hemolysis

o Nephrons, renal failure

o Excretion (impaired)

y Signs of increased K Murder

o Muscle weaknes

o Urine olyguria, anuria

o Respiratory distress

o Decreaed cardiac contractility

o ECG Changes

o Reflexes hyperreflexia, or flaccid

y Substance Poisoning and Antidotes

o Methanol -- Ethanol

o CO2 -- Oxygen

o Dopamine -- Phentolamine

o Benzos (Versed) -- Flumazenil

o Lead -- Succimer, Calcium Disodium

o Iron -- Deferoxamine

o Coumadin -- Vitamin K

o Heparin -- Protamine Sulfate

o Thorazine -- Cogentine

o Wild Mushrooms - Atropine

o Rat Poison - Vit K

y Parkland Formula: 4cc * Kg * BSA Burned = Total Volume Necessary

o 1st 8hrs total volume

o 2nd

8hrs total volume

o 3rd

8 hrs total volumes

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