nle prioritization
TRANSCRIPT
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Dwindling success rates
Mismatched of the nursing curriculum and
the current PNLE test plan PNLE evolves and demands critical
thinking and decision making skills
Real life situation Measures the ability of the nurse-examinee
to respond appropriately by choosing an
answer among possible choices provided.
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Decision depends on critical thinking
skills in prioritizing nursing actions
Prioritization questions take the bulk ofthe questions of the current PNLE.
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After the end of the seminar, the NCM
105 students of the College of Nursing of
Medina College, Ipil Campus for theSchool Year 2010-11 will know the
Philippine Nursing Licensure
Examination Test Plan and able to buildtheir confidence in successfully passing
it.
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Within the two and a-half hour of lecture-
presentation and interactive discussion,
the participants will be able to: Understand current situation of the PNLE especially
the discrepancy of the nursing curriculum and the
current test plan.
Demonstrate an appreciation of the current test plan.
Apply critical thinking and decision making skills in
prioritizing nursing action called for in each real life
situation presented in the PNLE.
Respond accurately and speed in a given simulated
situation.
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The CompetencyBased BSN
Program
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ETHICO- LEGAL BASIS
R.A. 9173 Nursing Act of 2002
CHED Memo No. 14, 2009
PRC Modernization Act 8981
E.O. 220 Good Governance
Code of Ethics for Nurse
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The Features of theCompetency Based Approach
It will always be relevant.
It is learner- centered not teacher centered
It is outcome-focused
Evaluation focused on performance ofcompetencies, criterion-referenced and
summative
Over laps will be controlled
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Patient CareCompetencies
Safe and quality nursing care
Communication
Collaboration and teamwork
Health Education
Empowering Legal responsibility
Ethico-moral responsibility
Personal and professional development
Enhancing Record management
Management of resources and environment
Enabling Quality Improvement
Research
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NURSING PROCESS
NP I NP II NP III NP IV NP V
Basic
Foundation ofNursing andProfessional
Practice
Community
Health
Nursing and
Care of
Healthy/At
Risk
Mother and
Child
Care ofClients with
Physiologicand
PsychosocialAlterations
[A]
Care ofClients with
Physiologicand Psycho-
socialAlterations
[B]
Care ofClients withPhysiologic
andPsycho-social
Alterations
[C]
ACROSS THE LIFESPAN
INDIVIDUALS, FAMILIES, GROUPS, COMMUNITY
IN VARIED SETTINGS
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PREVENTIVE
REHABILITATIVE
PROM
OTIVE
CURAT
IVE
NURSING PROCESS
NP I NP II NP III NP IV NP V
SAFE AND QUALITY NURSING CARE
COMUNICATION
COLLABORATION AND TEAMWORK
HEALTH EDUCATION
RESEARCH
QUALITY IMPROVEMENT
ETHICO
MORAL RESPONSIBILITY
LEGAL RESPONSIBILITY
PERSONAL AND PROFESSIONAL DEVELOPMENT
RECORDS MANAGEMENT
MANAGEMENT OF RESOURCES AND ENVIRONMENT
BasicFoundation of
Nursing and
Professional
Practice
CHN & Care ofNormal Mother &
Child
Care of Clients w/Physiologic &
Psychosocial
Alterations
Part A
Care of Clients w/Physiologic &
Psychosocial
Alterations
Part B
Care of Clientsw/ Physiologic &
Psychosocial
Alterations
Part C
ACROSS THE LIFESPAN
CUR
ATIV
E
PATIENTCARE
COMPETENCIES
ENHANCING
EMPOWERING
ENABLING
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SQC, Comm,Collaboration
& HE (70)
Empowering (10)
Management ofresources andenvironment
Record
management
Research
Qualityimprovement
Legal responsibilities
Ethico-moral responsibilities
Pesonal and professional development
Competency-Based Test Framework
Patient Care Competencies
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First day of duty
Equipped with nursing school knowledge
Decision making:
What would you doin particular situation?
In what sequence?
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OUTCOME:
SAFE ANDQUALITY
NURSING CARE
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PATIENT THEMSELVES
SIGNIFICANT OTHERS/FAMILYHEALTH TEAM/DOCTORS
ORDER
NURSING JUDGMENT
PROTOCOLS
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Adult
Well
Hospital-setting
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Identify the topic of the question.
Select an answer by eliminatingchoices. Do not use background information
unless absolutely necessary. Do not read into the question.
Think about what the answer choices
REALLY mean.
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REWORD
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TRUE STATEMENT Most or most
appropriate
Most likely
Best
Best judgment
Initial
First
Chief
Immediate
FALSE STATEMENT Except, not, or but
Least likely
Need further
instructions or
education
Lowest priority
Incorrect
Unsafe
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SKIMMING-TO CREATE STRATEGY
SCANNING-TO ELIMINATE CHOICES
READING INTELLIGENTLY
PICTURE OUT SITUATION
CONSIDER ALL DETAILS AND DATA
REMEMBER THAT ALL ELEMENTS OF
AN ANSWER MUST BE CORRECT FOR
THE ANSWER TO BE CORRECT
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The nurse describes the procedure for collecting a
clean-catch urine for culture and sensitivity to a male
patient. Which of the following explanations, ifmade by the nurse, would be most accurate?
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(1) The urinary meatus is cleansed with an iodine
solution and then a urinary drainage catheter is insert
ed to obtain urine.
(2) You will be asked to empty your bladder one
half hour before the test; you will then be asked to
void into a container.
(3)Before voiding, the urinary meatus is cleansedwith an iodine solution and urine is voided into a
sterile container; the container must not touch the
penis.(4) You must void a few drips of urine, then stop;
then void the remaining urine into a clean container,
which should be immediately covered.
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REPHRASE THE QUESTION
AND REREAD IT WITH THEANSWER ASK:
WHERE IS THE IMPORTANT INFO.? LOOK FOR KEY WORDS IN THE STEM
SKIM FOR PIECES OF INFO
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A 12-year-old boywas riding his biketo school when he
hit the curb. He felland hurt his leg.The school nursewas called and
found him alert,conscious but insevere pain with apossible fracture of
the right femur.What is the firstaction that thenurse should take?
(1)Immobilize theaffected limb with asplint and ask him
not to move.(2) Make a thorough
assessment of thecircumstancessurrounding theaccident.
(3)Put him in semi-Fowlers position forcomfort.
(4) Check the pedalpulse and blanchingsign in both legs.
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A 12-year-old sixthgrade boy was
riding his bike toschool when he hitthe curb. The boytells the school
nurse, I think myleg is broken.What is the firstaction the nurseshould take?
(1)Immobilize the affectedlimb with a splint andask the client not to
move.
(2)Ask the client to explainwhat happened.
(3) Put the client in semi-Fowlers position tofacilitate breathing.
(4)Check the appearanceof the clients leg.
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A woman is admittedto the hospital with a
ruptured ectopicpregnancy. Alaparatomy is
scheduled.Preoperatively, whichof the following goals
is most important forthe nurse to includeon the patients plan
of care?
1) Fluidreplacement
2) Pain relief3) Emotional
support
4) Respiratorytherapy
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The nurse plans care for
a 14-year- old girl
admitted with an eatingdisorder. On
admission, the girl
weighs 82 lbs. and is
54 tall. Lab testindicate severe
hypokalemia, anemia,
and dehydration. The
nurse should givewhich of the following
nursing diagnoses the
highest priority?
Body imagedisturbance related toweight loss.
(2) Self-esteemdisturbance related tofeelings of inadequacy
(3)Altered nutrition:less than bodyrequirements related todecreased intake.
(4)Decreased cardiacoutput related to thepotential fordysrhythmias.
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Prioritization
Initial
Essential
Vital
Immediate
Highest
Best
Most
Priority
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INITIAL OR FIRST-USE NURSINGPROCESS-ASSESSMENT FIRST
BEST- ONE MORE ESSENTIAL ANDINCLUSIVE OF OTHERS
PRIORITY- SAFETY AND ABCS
MOST IMPORTANT- MASLOWS
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a) Has a respiratory infection
b) Is intubated and on a ventilator
c) Has pleural chest tubesd) Post-op client with a high abdominal
incision.
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The nurse cares for a 72-year-old man with a
diagnosis of cerebral vascular accident (CVA). The
nurse is feeding the patient in a chair when he
suddenly begins to choke. Which of the followingactions should the nurse take FIRST?
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(1)Check for breathlessness by placing an ear over
the patients mouth and observing the chest.
(2) Leave the patient in the chair and apply vigorous
abdominal or chest thrusts from behind the
patient.
(3)Ask the patient, Are you choking?
(4) Return the patient to the bed and apply vigorous
abdominal or chest thrusts while straddling the
patients thighs.
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A 35-year-old woman with a history of bipolar
disorder is admitted to the psychiatric hospital. Shewas found by the police attempting to climb onto the
wing of a plane at the airport. Her husband reports
that she has not eaten or slept in two days, and he
suspects she has stopped taking lithium. On
admission, the nurse should place the highest
priority on which of the following patient care
needs?
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(1) Teaching the patient about the importance of
taking lithium as prescribed.
(2)Providing the patient with a safe environment
with few distractions.
(3)Arranging for food and rest for the patient.
(4) Setting limits on the patients behavior.
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a) None, it was discussed by
healthcare workers in a secludedarea
b) They can be charged with slander
c) They can be charged with libel
d) None ,unless it has caused harm to
the patient.
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The nurse caresfor a 30 year oldpt on peritoneal
dialysis. Theinfusate amountsto 2L. Later 1L isreturned. The
nurse should:
1. Turn the patientside to side
2. Push thecatheter infurther
3. Milk the catheter
4. Press on theabdomen
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The physician order a nasogastric tube inserted andconnected to low intermittent suction for a patient
with an intestinal obstruction. Two hours after the
insertion of the nasogastric tube, the patient vomits200 cc. While irrigating the nasogastric tube, the
nurse notes resistance. The nurse should
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(1) replace the nasogastric tube with a larger one.
(2)turn the client on his left side.
(3) change the suction from intermittent tocontinuous.
(4) continue the irrigation.
NLE I t th
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NLE Isnt the
Real World
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The nurse is
unable to
identify a patient
who is confused
because his
armband is
missing. Which
of the following
actions by the
nurse is best?
1) Have the patients
roommate identifyhim.
2) Ask the patient to
state his full name.
3)Ask one of the other
nurses to identify the
patient.4) Look in the chart at the
picture of the patient.
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Always take care of the patient
first
before the equipment.
A 36 ld 1) Determine all weights
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A 36-year-old
woman with a
fractured left femur
is placed on a
Thomas splint and
Pearson
attachment. Thepatient tells the
nurse she has
terrible pain inher left thigh.
Initially, the nurse
should:
1) Determine all weights
and ropes from traction
are in line and hanging
freely.2) Ask the patient for more
information about locationand characteristics of her
pain.3) Check traction apparatus
to make sure they are
appropriately positioned.
4) Explain to the patient that
pain on the affected leg is
a common occurrence.
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Memorize normal lab
values and be able to
interpret them.
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The physician orders furosemide (Lasix) and
spironolactone (Aldactone) for a patient. Prior to
administering the medication, the nurse determines
that the patients potassium is 3.2 mEq/L. In addition
to notifying the physician, the nurse should
anticipate taking which of the following actions?
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(1) Do not administer the Lasix or Aldactone.
(2)Administer the Aldactone only.
(3) Administer the Lasix only.
(4) Administer the Lasix and Aldactone.
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Dont pass the
buck.
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Think.the NLE wants toknow what you would DO!
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A 53-year-old man
is receiving packed
RBCs. Severalminutes after the
infusion is started,
he complains of
itching anddevelops hives on
his chest and
abdomen. Which ofthe following
actions should the
nurse take first?
1) Slow down the rate
of the transfusion.
2) Call the physician for
an order for an
antihistamine.
3) Mix IV fluid with
blood to dilute it.
4) Stop the transfusion.
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RELATE AND APPLY
PRINCIPLES CONCEPTS
AND PROTOCOLS
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1 Do not delegate assessment,
teaching, or evaluation2 Delegate care for stable patientswith expected outcomes
3 Delegate tasks that involvestandard, unchanging procedures
4 Stable vs. unstable
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Which of the following tasks is appropriate for the
nurse to delegate to an experienced nursing
assistant?
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(1) Obtain a 24-hour diet recall from a patient recently
admitted with anorexia nervosa.
(2)Obtain a clean catch urine specimen from a patient
suspected of having a urinary tract infection.
(3) Observe the amount and characteristics of the
returns from a continuous bladder irrigation for a
patient after a transuretheral resection.
(4) Observe a patient newly diagnosed with diabetes
mellitus practice injection techniques using an
orange.
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After receiving a report from the night nurse,which of the following patients should the nurse
see first?
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(1) A 31-year-old woman refusing Carafate before
breakfast.
(2) A 40-year-old man with left-sided weakness
asking for assistance to the bedside commode.
(3)A 52-year-old woman complaining of chills who
is scheduled for a cholecystectomy.
(4) A 65-year-old man with a nasogastric tube who
had a bowel resection yesterday.
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Feelings reflected.
Encourage verbalization.
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Remember, dont ask why
!
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Eliminate Dont worry
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Focus on the client, not on
the nurse.
A 35 year old man
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A 35-year-old man
has been
hospitalized for
treatment of
hepatitis. When the
nurse enters the
room, he asks thenurse to leave him
alone and stop
bothering him.
Which of the
following responses
by the nurse is
appropriate?
1) I understand and
will leave you alone
for now.
2) Why are you
angry with me?3) Are you upset
because you do not
feel better?4) You seem upset
this morning.
A patient in the 1) This is a hospital and
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A patient in thepsychiatric unitasks the nurse,Am I in a specialradioactiveshelter? Which
of the followingresponses madeby the nursewould be the
mostappropriate?
1) This is a hospital, andwe do not have a nuclearmedicine department
here.2) Dont worry, you are
safe. There is noradioactivity here.
3) Im sure your safety is ofconcern to you, but this isa hospital.
4) Please share with mewhat makes you thinkthere is a radioactivityhere.
A 8 ld
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A 58-year-old
woman states
she is afraid tohave her cast
removed from
her fracturedarm. Which of
the following is
the most
appropriateresponse by the
nurse?
1) I know it is unpleasant.
Try not to be afraid. I will
help you.2) You seem very anxious.
I will stay with you while
the cast is removed.3) I dont blame you. Id
be afraid also.
4) My aunt just had a castremoved and shes just
fine.
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1 Are you trying to prevent orpromote?
2 What are you trying to preventor promote?
3 Think A & P
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(1)Supine
(2)Right side-lying
(3)Left side lying(4)Semi-Fowlers
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CALCULATEDINTELLIGENT
DECISION MAKING
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You have a body ofknowledge use it!
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Think positively!
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