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    17 views16 pages

    Critical Thinking Pyramid:NCLEX Test Strategy PDF

    Uploaded by

    Karen Hutchinson

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    of 16
    Critical Thinking Pyramid Comprehension of a Questio: 1. Separate the CASE SCENARIO from the STEM: | | . ‘a) CASE SCENARIO describes a clinical situation. The Client” ia, gene b) The STEM of a question asks you something or directs you. 2. Four Critical Elements: a) KEY WORDS - that are in a STEM and CASE SCENARIO. initial Irarnostace Most Likely Least Likely Early late First Post Op On Admission Best Most Appropriate Least Appropriate b) CLIENT — In general all clients/personnel are generic + Generic Client at Family Member a Child + Staff Member ¢) What's the Issue of the Question? + Medication ot Medication Response + Behavior Procedures 4) Type of Stem. (LEY At of the quashon' “TRUE RESPONSE STEM = 1 answer is correct and 3 are wrong! + FALSE RESPONSE STEM = 3 are correct and 1 answer is wrong!!! "ANSWER WILL BE THE RIGHT ANSWER) + COMPARISON STEM = sort of like a true response answer ++ PRIORITY STEM = all 4 answers are correct. You have to pick out the best. answer.*Remember if the question has APPROPRIATE in it, it is asking for only one answer. If you see INITIAL all answers are correct so pick the answer that is priority. eo (THE WRONG 3. GLOBAL RESPONSE ~ a general statement that may include ideas with other options init. All ‘answers may seem like they are saying the seme thing. Only one answer will encompass them all. That willbe the answer. 4, SIMILAR DISTRACTIONS - to say something or include the same ideas. They can NOT be the answer. Disregard answers like this, 5. Priority Key Words: Identifying priority questions 4 First + Initial + Next + Priority + Immediate 6. SIMILAR WORDS ~ generally if you see/ find a word in the case scenario or stem and you see It in the answers that generally is the answer. 7. ABSOLUTE WORDS ~ if you see these words in an answer that is NOT the answer. 1. Always 2. Never 3. Only 4 All 5. Every 6 None Post Op/ Emergency Med/ Trauma Questions = ABC's should be evaluated first. Airways 4 Breathing + Circulation Low Blood Pressure = Internal Hemorthage Patient could be bleeding out. Any Dressing/ Linen / Bandage that’s soiled gets double bagged. Be able to pick out key words to differentiate between two like terms. When eliminating answers use this method Plus (+) by the answer you are considering + Minus(-) by the answer you know for sure isn’t it £ Question Mark (?) by the answer you may be unsure of Fill in the blank questions are usually the math questions. Multiple Choice Strategies: “& Refer to above the above strategies. These steps will work for these types of questions as well. aL May have up to S or 6 answers When auscultating the lungs listen for: +L Rales~ Crackle (abnormal rattling) 4 Stridor Kids (Fluid build -up) a harsh or grating sound when breathing aL Wheezes ~ whistle or rattling sound ~ sibling ( high pitched, shrill sound) st Rhonchi ~ Course rattling repertory sounds- worse than snaring- snores- wheezing. Remember questions are written in the NCLEX hospital- so you will always have what you need. Answer all questions as if you were in the perfect facility with all the supplies and staff needed to complete the task at hand. Give by the book responses, Don’t defer an answer = don’t result to consult the physician answers. The questions are posed to see what you as the nurse would do, Pediatric doses will be a lot of converting kilograms to pounds to figure out medication dosage. Measurements: Ltsp =5ml ***iml=1ec 1 Tosp. = 15 mi 1 fluid 02. = 30 mi 1 cup = 240 ml or 8 FLoz. (nursing cup) 1 pint = 480 ml (in reality 1 pint equal 500 mt but it’s 480 ml in nursing cups) 1 quart (1000 mi/1 liter) = 960 mi 1 kilogram = 2.2 pounds ml & cc are the same thing ex: 10 ml = 10 ce 41 gram = 1,000 mg 1 mg = 1,000 mcg, 1 million micrograms = 1 gram 1.g=1,000,000 Kilogram = King of grams G=Queen ilo = Minion ‘Micro = Smallest 1.L = 1,000 milliliters inch = 2.54 centimeters (2%) Peee ree EEE ee EE EEE Divide 2.2 into 100 to get med dosage. If number (sum) is higher, then you multiplied instead of divided. The sum should always be lower. Grain 1 = grt = 60 or 65 mg ** generally if it’s below 60 or if it’s over 65. 4. Grains are generally in roman numerals Converting Temperatures: Fahrenheit = Celsius x 1.8 + 32 (converting Celsius into Fehrenheit) Celsius is smaller than Fahrenheit Celsius = Fahrenheit ~ 32 + 1.8 (converting Fahrenheit into Celsius) F=40°x1.8 +32 F = 104 (check your work) C= 104-32 + 1.8 = 104~32=72+ 1.8 = 40 (make sure to add the equal sign before dividing. EX: 104-32 =72, 72+1.8=40>F= 40x 1.8+32= 104 beer Practice Question: Avoiding the “What if ...2"" Syndrome and Reading Into the Question ‘Anu is changing the tapes on atracheostomy tube, The lent coughs, and the tube is dislodged. The initial nursing action & te: 1. Call the physidan to reinsert the tube, 2. Ventilate the cient using a manual resuscitation fbag and face mask. 3. Cover the tracheostomy site with a sterile dressing to prevent infection, 4. Call the respiratory therapy department to eeinsert the tracheostomy tube, Answer: 2 Test-Taking Strategy: Nowy, you may immediately think, “The tube is dislodged and I need a physician." Read the question carefull, and note the strategie word “inital” Focus on the subject of the tube being dislodged. Th question Is asking you for @ nursing action, 50 that is what you need to look for as you eliminate the incorrect options. Eliminate options 1 and 4, because they are com- parable or alike and delay the initial Intervention needed. Eliminate option 3, because this action will black the airway. If the tube is dislodged, the initial nursing action 's to ventilate the client using a manual resuscitation bag ‘and face mask. in addition, the use of the ABCS—airway, breathing, and circulation—will direct you to-the correct ‘option, Remember, avoid reading into the question! ‘Common Strategic Words = Early Immediately = Late = Most likely Best + Least likely «First * Most appropriate = Initial + Least appropriats 8. A charyfexhibit question will most likely con- tain options; read the question carefully and Jook at all of the information in the chart/exhi- Dit before selecting an answer Ill. THE STRATEGIC WORDS (Boxes 54 and 5-5) A, Strategic words focus your attention on a ctitical point to consider when answering the question and ‘will assist you with eliminating the incorrect options B. Some strategic words may indicate that all of the options are correct and that it wil be necessary to prioritize to select the corect option C. As you read the question, look for the strategic words; strategic words make a difference with regard to what the question is asking IV. THE SUBJECT OF THE QUESTION (Box 5.6) A. The subject of the question is the specific topic that the question is asking about B. Identifying the subject of the question will assist, with eliminating the incorrect options and direct you to the correct option CHAPTERS TestTaking strategies 23 ‘Multiple-Choice Question: Event, Event Query, and Options Event After thoracic surgery, a client has two chest tubes inserted into the right pleura space that are attached to hast. drainage syetems. vant Query: To promote optima respirtory functioning, the suse plan to implement which of the following? Option 1. Mik and strip the chest tubes once per shift 2. Postion the clanton the back and the ght side. 3. Encourage the client to cough and deep breathe every hour. 4 Maintain the lint on bedrest unti the chest tubes are removed, Ansier:3 Test-Taking Strategy: Focus on the subject af promot- ing optimal respiratory functioning. Option | iseliminated firs, because milking and stripping a chest tube is done only with a physician's order or when allowed by agency poly. Bedrest (option 4) does not promote respiratory function and is eliminated next. From the remaining tions, recalling that positioning is done acording to surgeon preference directs you to option 3. Practice Question: Strategic Words Aientwith a diagnosis of heart falure reports the occur- rence of sudden shortness of breath and dyspnea, the turse takes which immediate action? 4. cals the physcion 2 Adminiters oxygen 3: Elevates the heal of the bed 4, Prepares to administer furosemide (Lasix) Answer 3 TestTaking Strategy: Note the srategie word “immediate” Focutine on this strategic werd and the ci ‘rts symptoms (horiness of breath ad dyson) il ‘rect you tothe correct option. Note thet the questicn is asking for an immediate nursing scion 20 that whet The Subject of the Question ‘The nutse & planning to teach a client in skeletal leg traction about measures to increase bed mobility. Which item would be most helpful for ths client? 1. Television 2. Fracture bedpan 3. Overhead trapeze 4. Reading materials Answer: 3 Test-Taking Strategy: Focus on the subject of increasing bed mobility. Also note the strategic words “most helpful ‘The use of an overhead trapeze is extremely helpful for isting a client with moving about in bed and with get- ting on and off of the bedpan, Television and reading materials are helpful to reduce boredom and provide dis- traction. fracture bedpan is useful for reducing discom- fort with elimination. Remember to focus onthe subject! CHAPTERS TestTaking Strategies 25 [EOAEED] Practice Question: Use of the ABCs lent with a compound (open) fracture ofthe tadius hat 4 cast applied in the emergency department, The nurse A nurse is assigned to care fora dient experiencing dysto- provides home-care instructions and tells the client to cia, When assisting with planning cere, the nurse would | Practice Question: Maslow's | Hierarchy of Needs Theory seek medical attention if which of the following occurs? consider the highest priority to be frequent: 1. Numbness and tingling ate felt in the fingers 1. Position changes and providing comfort measures 2. The cast feats heavy and damp 24 hours after 2. Explanations to family members about what is application happening to the elient 3. The entire cast feels warm during the first 24 hours 3. Monitoring for changes in the physical condition of after application the mother and fetus A 4. Bloody drainage is noted on the cast during the 4, Reinforcement of breathing techniques learned in fist 6 hours after application, childbirth preparatory classes \ Answer: 1 Ansvrer:3 Test-Taking Strategy: Use the ABCE—aieway, breathing, Test-Taking Strategy: All of tions presented are and circulation—as a guide to direct you to the correct correct and would be implemented during the care of option. limbs encased in a cast is at risk for nerve this client, However, note the strategic words “highest emage and diminished circulation from Increased pres: priority," and use Maslow's Hierarchy of Needs theory to sure caused by edema, Signs of increased pressure and Prioritize, remembering that physiological needs come diminished circulation from the east include numbness, first. Using th’s guideline will direct you to option 3. In tingling, and increased pain. Remember to use the addition, note that option 3 i the only option that ABCs—airway’ breathing, and circulation—to prioritize. ad resses both the mother and the fetus, Nursing Prioiies from Mlastow’s Hierarchy felt-Actuallzation Hope. ‘Spiriual wet boing i FIG. 5-1 Using Maclow’s Hierarchy of Needs theory to establish priorities, (From Harlreader, H., Hogan, M. A, & Thobaben, M. [2007]. Fundamentals of nursing: Caring and clinical judgment (3rd ed). Philadelphia: Saunders) Eliminating Distractors Eo eeserenry 6. Eliminating Drill 6 Oistactars, “qaveic! Cite 4x sat is tn tho hospital with renal failure. The cleat is on uid Cen restrictions. Which ofthe following nursing actions would the nurse ‘ avoid? ie pens secormaiace , A .Provide w yaviety of fids in small containers. © tavorni the client and feily bout the restrictions C attow the tet to keep a record of oral intake. (Drevite qe prog a tines \0Omes of = Parse SKeinowiy ~ SEMEN cient Child Dee Mutt Seifert Fray Al Fett, wmbur male, Female exe) MAS Pena fea \ Os Restrict . Wow Stem - Fetlse Lesporse Sey Mwrestiney SoHo ty ae 7 | —Negpive Ragone Sen 3 are ci - NOC Weve \fug > 3 anus Covveck, one Wrong This e The Sao $Ste ny) ~Alaiwe “ G | right arewaee wg = Uribe AA conuck, pick. bak artwaey the Sem ig Slvaugs Ure Yast part of Phe gueshon! | @© iuny men eee Cou Ceetteaet at canta yates Seay ce Ee) ‘Multifactoriat Questions Orit 3 ‘The nurse is evaluating the morning laboratory reports forfour clients. Which value docs the nurse immediately report to the client's primary caro giver? a aay LLINR Ginteroationel normalized ratio) of 1 for a client receiving warfarin (Coumedin) for an artificial heart valve. Gar Questions 2. Platelet count of 6000 cells ul. for a elieat receiving marr raetbotsate (TA) for aut moyen, Pe {Fasting ucts of 122 mg/l. fora lea esvngpredaione (Deltasone) for a hypersensitivity reaction. Conn en ce 4, Hemoglobin of 10Ap/0L for a client recciving ferrous sulfate (Evosol) for acute anemia following surgical blood loss. Oita Fee a © Gere rece ore Ore : NEXT © : NurseLogic Dee eared ee) out Ceo 6. Muluplo Responsa Eaicnd Tet Gace ample Questi * i oi oa ample Questo! CS Senay a ae | Cope ‘The nurse is preparing to do an assessment of a toddler. Place the actions the nurse takes when assessing the client in the appropriate ‘order, Miows—o nance ie creed Opto ty uy Oued Regense pace eco a f Cot 2. Palpata the ents abdomen and |. b camer fe teen Pneews | ccnnatiacttesincoategant | f Y Sora ‘thine (pect a) @) euens Qroervar Gas F AILOYS IlSteq Gest betee fic MDA ges | Cc teats Cerne Welsomel Cari Tee circa a Global Response antag See Cont ey ers Mee) Por Acclient says, "Tam having areal problem geting preguant. What could Pato} bbe wroag?" The most appropriate nursing respanse i: boreal Infrtlity is: tomer oa Often caused by congenital anomlis of the reproductive Saree} ‘organs. AI Sometimes precipitated by the use of over-the-counter drugs. sono aT Cosy Decasionally caused by emotional problemsneluding stress. Ae] Orit 4 Frequently caused by multiple factors rather than a single factor. eS YFussime CL omvecooe 219 ——} Goran Qremrnew Quay Clwiocs\ bes PUSS - WILY Banned OMSNEES NV tre Yustiony @orck nexr@ NurseLogic Bie acai ee iJ Similar Words Enter rey PSRs Drill 3 pce Poconos An obese clsat sstaned a fracureof the tibia and fibula. Along tyzeast Sere has een appliedond the lent is admitted tothe ethopsdic un, Dares Inproviting nurdngearefor tbe cleat who hasa newly applied cat which af he Flowing is the moat vial consdsstion? COA Use ARCS , errr Comore Coad ey Elevation of the casted fog on a pillow swill minimize edema. - Healing ofa fracture requices an extended period of time, Hon - Along petiod of immobility may lead to atrophy of the muscle. Prone CT) 0 ira ; Bey «Analgesics may be needed for pain associated with the fracture, = wwe cous. 09:15) pear TWEE A Lee Wn ty Sees OMIURE Thos eye - MAUS SHEVA 4 AVR AMA | YL Wee hy We COREE CSN Ly much is vourcl\ Bin ia 2 dialect! Lew on the neves

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