TEST-TAKING TIPS (Part 2)
sent by Mrs.
Sheila Marie Subong-Gernade
USE MASLOW’S NEEDS TO ESTABLISH PRIORITIES
Because physiological needs are necessary for
survival, they have highest priority and must be met first. If you
don’t have oxygen to breathe or food to eat, you really don’t care if
you have stable psychosocial relationships!!!
The nurse plans care for a 14
year old girl admitted with eating disorder. On admission, the girl
weighs 82 lbs. And is 5’4" tall. Lab test indicate severe hypokalemia,
anemia and dehydration. The nurse should give which of the following
nursing diagnoses the highest priority?
A. Body image disturbance related
to weight loss
B. Self-esteem disturbance related to feelings of inadequacy
C. Altered nutrition: less than body requirements related to
D. Decreased cardiac output related to the potential for
1. Look at the answer choices. If
the answer choices are both physical and psychosocial, eliminate all
psychosocial answer choices. (physiological needs must be met first) …
meaning, eliminate choice A and B.
2. Consider the remaining answer
choices (C and D). Does the choice make sense with regard to the
disease or situation as described in the question?
3. Can you apply ABC’s (airway,
breathing, circulation)? If ABC does not apply, what is the highest
Letter C makes sense since the patient is
anorexic and is 5’4" tall and weighs 82 lbs.
Letter D makes sense since dysrhythmias are a concern for a patient
with severe hypokalemia, which often occurs with anorexia.
Correct answer: Letter D
– decreased cardiac output is higher priority than altered nutrition.
A woman is admitted to the
hospital with a ruptured ectopic pregnancy. A laparotomy is scheduled.
Preoperatively, which of the following goals is most important
for the nurse to include on the patient’s plan of care?
A. fluid replacement
B. pain relief
C. emotional support
D. respiratory therapy
Correct answer : letter A
Options B and C are eliminated because they
are psychosocial in nature (in the NCLEX, pain is considered a
Letter A – fluid replacement makes sense
since a ruptured fallopian tube causes extensive bleeding in the
Letter D – does not make sense;
an obstetrical patient is not likely to need respiratory care prior to
WHAT WILL CAUSE THE
LEAST AMOUNT OF
A 4 year old child undergoes a tonsillectomy
for treatment of chronic tonsillitis unresponsive to antibiotic
therapy. After surgery, the child is brought tot he recovery room.
Which of the following actions should the nurse include in his plan of
institute measures to minimize crying
B. perform postural drainage every two hours
C. cough and deep breathe every hour
D. give ice cream as tolerated
Reworded question: What should you do after tonsillectomy?
2. Are all answer choices implementations?…..yes.
3. If you are still not sure of your answer, ask yourself: "What
will cause my patient the least amount of harm?"
will help prevent bleeding….consider this
B. may cause bleeding….eliminate
C. may cause bleeding…eliminate
D. may cause child to clear his throat causing
Correct Answer: letter A
are important in deciding which nursing care to give. To help select
correct answers, think:
EVERYTHING BY THE BOOK – use your real world
help you visualize the patient described in the question, BUT
SELECT YOUR ANSWERS BASED ON WHAT IS FOUND IN THE TEXTBOOKS.
Assessment is the first step in the nursing
process and take 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!!!
A 10 year old boy was riding
his bike to school when he hit the curb. The boy tells the school
nurse, "I think my leg is broken." What is the first action the nurse
A. Immobilize the affected limb
with a splint and ask patient not to move
B. Ask the client to explain what happened
C. Put the client in semi-Fowler’s position to facilitate
D. Check the appearance of the client’s leg
Determine whether you should assess or
implement. The client has stated "my leg is broken" but this is NOT the
nurse’s assessment. Eliminate options A and C because they are
Correct answer: Letter D
– assessment of the leg takes priority over an assessment of what
happened to cause the accident.
A 12 year old boy was riding
his bike to school when he hit the curb. He fell and hurt his leg. The
school nurse was called and found him alert, conscious but in severe
pain with a possible fracture of the right femur. What is the first
action that the nurse should take?
A. immobilize the affected limb
with a splint and ask him not to move
B. make a thorough assessment of the circumstances
surrounding the accident
C. put him in semi-fowler’s position to facilitate breathing
D. check the pedal pulse and blanching sign in both legs
Determine whether you should be assessing or
implementing. According to the question, the nurse has determined that
the boy has a possible fracture. This implies that assessment has been
done and it is time to implement. Eliminate options B and D because
they are assessments.
Correct answer: Letter A
– the situation does not indicate any respiratory distress, so letter C
is eliminated. Use the ABC’s if they are appropriate
to the situation.
– includes meeting basic
(oxygen, food, fluids, etc.), reducing hazards that cause injury to
obstacles in the home), and decreasing thetransmission of pathogens
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Parvae Lucies Domini (http://www.ann2.net/pld)
Thanks to Mrs. Sheila Subong-Gernade for sending these tips