Kaplan-decision-tree guide to answering questions PDF

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kaplan decision tree - guide to answering nclex style questions...

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KAPLAN DECISION TREE FOR ANSWERING QUESTIONS STEP ONE: Can you identify the topic of the question?

NO

YES

Trap: NCLEX hides the topic of the question

Read answer choices for clues Identify the topic of the question Proceed to Step2

Proceed to Step2

STEP TWO: Are the answers assessments or implementations?

Trap: Is validation required?

A mix of assessments and Implementations?

Are answers all Assessment or Implementation?

Read stem of question to Determine if you should Assess or implement

Proceed to Step3

Select correct answer. STEP THREE: Does Maslow fit?

NO

Are all answers physical? Proceed to Step4

Are all answers psychosocial? Step5

YES

Eliminate Psychosocial answers Trap: Physical needs take priority over psychosocial needs. Eliminate pain, it’s considered as psychosocial need.

Do the physical needs make Proceed to sense?

Apply ABCs.

STEP FOUR: Are all answers physical?

NO

Trap: Don’t automatically select respiratory answers.

Proceed to Step5

YES

Apply ABCs

STEP FIVE: What is the outcome of each of the remaining answers? Trap: Don’t select answers that “sound” right. Do evaluation, ask yourself, “If I do this, what will the outcome be?” Determine outcome of each answer. Is it desired?

Select correct answer

ANSWERING STRATEGIES 1. Read word for word. 2. Determine what the question is asking…>FIGURE IT OUT, ANALYZE, THINK! 3. Look for “danger” words: FIRST, INITIALLY, HIGHEST PRIORITY, MOST IMPORTANT, BEST, MOST CONCERNED 4. Picture the question, use imagery 5. Clang Association- sometimes a word/phrase in the question comes out exactly at the correct answer 6. Hold the phone- if the doctor is on the phone, you should not answer it, care for the PATIENT FIRST 7. Think before calling physician- do independent nursing actions first then assess outcome then report to physician. Ie: If px has fracture on upper and lower extremity, assess first for neurologic/circulatory defects. If px complains(subjective assessment), do an objective assessment (vital signs) THEN call doctor. Tip: get complete assessment, subjective and objective…if subjective only, it’s unreliable. 8. Know what’s normal, know lab values 9. Look for clues, DO EVERYTHING BY THE BOOK! 10. Reword/rephrase the question

11. 2 choices of same content, ELIMINATE! 12. Umbrella answer is the right answer 13. Choose HERE and NOW answer 14. Use nsg process 15. Use Maslow 16. Real prob is a priority vs. potential prob 17. Predict outcomes 18. Ask yourself, “does this answer make sense? Does it answer the question?” 19. Don’t choose answers with absolutes: ALL, ABSOLUTELY, ENTIRE, ONLY, ALWAYS, TOTAL, EVERY, EACH, MUST etc.

NCLEX TOPICS I.

Chain of Command- probs associated with co-workers>inform to YOUR NSG SUPERVISOR BUT if the outcome of the action of the co-worker is harmful to the patient’s rights in the HERE and NOW, you can call their attention. Ie. If you hear two nurses talking about a patient in the elevator, mentioned the name and case, you call their attention then report to nsg supervisor.

II.

Rule of Cohorting- patient with infection put in a room with another patient with the same infection.

III.

Rules of Delegation 1. RNs: a. don’t delegate assessment, teaching, evaluation to LPN, UAP (unlicensed assistive personnel), Nsg aide b. delegate STABLE patient with EXPECTED outcomes TIP: 24hr post-op patient is considered stable c. delegate tasks that involve STANDARD UNCHANGING tasks ie. Bed bath, feeding, bed making 2. RNs communicate to health team about changes in patients condition 3. LPNs CAN: a. perform STERILE dressing changes, sterile technique b. give SQ, IM, PO meds but NOT IV, NEBU & TOPICAL c. give supplementary health teachings d. do suctioning, catheterization

IV.

Pleur-Evac Dislodgment 1. If you’re asked what to do when it’s dislodged FROM THE PATIENT: Question asks What to do: a. FIRST: choose Cover opening on patient’s chest with any CLEAN Material possible. b. BEST: choose Cover opening on patient’s chest with STERILE VASELINIZED GAUZE GOAL: prevent air from entering 2. If you’re asked what to do when it’s dislodged FROM THE CHAMBER: Question asks What to do: a. FIRST: choose Insert/Submerge tube tip in a container with STERILE NSS b. BEST: choose CLAMP tube farthest from the patient. V. Fetal Heart Rate

1. Early deceleration- normal finding; due to head compression - FHR decelerates at the BEGINNING of contraction then return to baseline AFTER Contraction 2. Variable deceleration- due to cord compression - FHR decelerates without regard with the contraction -Intervention: decrease perineum; knee-chest position, elevate foot of bed 3. Late deceleration- due to utero-placental insufficiency - FHR decelerates at the PEAK or AFTER peak of contraction then returns to baseline after contraction - Intervention: turn mom to left side VI. AV Fistula Assessment for: a. Thrill- put finger over fistula and feel b. Bruit- auscultate VII. Immunization Birth- Hep B 1 mo- Hep B 4mos- IPV, Dtap, Hib 6mos- IPV, Dtap, Hib, HepB 12-18mos-Dtap, Varicella Zoster 4-6yrs-IPV, Dtap, Hib 11-16yrs- Td Legend: IPV-Inactivate Polio Virus (via IM) Hib- Hemophilus Influenza B

2 mos- IPV, Dtap , Hib 12-15mos- Hib, MMR 11-12yrs- MMR(if not given at 4-6yrs)

Dtap-Diptheria, tetanus, pertussis Td- Tetanus toxoid

Types of Vaccines: a. Component Vaccines- Hib, Pneumococcal, Hep A/B b. Live Vaccines- MMR, OPV, Chicken Pox/Varicella *can’t be given to immunocompromised patients c. Killed/Inactivated Vaccines- Inactivated influenza vax, IPV(Salk Vaccine) d. Toxoid Vaccine- DPT, Td VIII. Cultural Differences A. Chinese Amer – may nod head to indicate yes or shake head to mean no - Excessive eye contact means rudeness - Excessive touching is offensive - Nsg implications: ask questions carefully and clarify responses - YIN- cold/ negative force - YANG- hot/positive force B. Islam- no pork and alcoholic beverages allowed - prefer foods with HALAL seal - prior to death, family members are asked to be present so they can read the Koran and Pray with the client. - must face Mecca(where the sun rises) and confess sins, beg for forgiveness in the presence of the family - burial is done ASAP before sundown -donation of organs is prohibited C. Amer Indian/ Native Amer - prone to accidents, alcohol abuse, TB, arthritis -lactose intolerant -does yoga (mind body therapy) D. Jehovah’s Witness - blood transfusions violate God’s law, prefer to die than transfuse blood

-food with blood is prohibited -can consume animal meat that has been drained from blood -give plasma expander instead of blood transfusion E. Orthodox Jews Kosher Diet- prohibit mixing of meat and milk in one meal -if both meat and milk eaten at the same meal, body should not be touched for 48hours . -utensils used for meat can’t be used for milk or non-kosher food -fish, eggs, fruits, vegetables and grains can be eaten with either meat or dairy -meats allowed: animals that’re vegetable eaters, cloven-hoofed animals, animals that’re ritually slaughtered (sheep, cattle, goats, dear) -fish with scales are allowed -During Yom Kippur-24 hour fasting - Passover week, only unleavened bread is eaten F. Russian Orthodox -abstain from meat and dairy products on Wed, Fri and Lent -during Lent, all animal products, including dairy are prohibited -fasting during Advent, exception are illness and pregnancy -can transplant organs except HEART...