1. Decision Tree

2. Requires the nurse to:  validate and organize data.  look for patterns and relationships.  transfer knowledge from one situation to another.  evaluate according to established criteria.

3.  Student assumes expert has all the right answers  Student believes there is a right answer that is always correct in every situation

4.  Student analyzes the situation described in the question  Student determines what the question is asking  Student selects the answer that represents the safest nursing judgment  Student accepts that a correct nursing action on one question may not be correct on another question

5.  Identify the topic of the question.  Select an answer by eliminating choices.  Do not use background information unless absolutely necessary.  Do not “read into” the question.  Think about what the answer choices really mean.

7.  Cover all the answer choices.  Read only the stem of the question.  Identify what the question is asking by rewording the question in your own words. Your rephrased question should be 2 to 3 words. For example: “Priority, toxic shock.”  If you can identify topic of question, proceed to Step 2.

8.  Uncover the answer choices.  Read the answer choices for clues about the topic of the question. Don’t try to answer the question at this point because you don’t know the topic!  After you identify the topic of the question from clues contained in the answer, rephrase the question in your own words and proceed to Step 2.

9.  Read each answer choice to determine if it is an assessment or implementation.  If answers are a mix of assessment and implementation, go back to stem to determine if assessment or validation is required.  If answers are all assessment or all implementation, proceed to Step 3.

10.  If there is no nursing assessment in the question stem, does the situation required assessment?  If nursing assessment is included in stem, determine if validation required. If so, continue the assessment process.  If the nurse determines assessment or validation is required but there is no correct assessment, evaluate the implementation answers.

12.  Determine if answers are a mix of physical and psychosocial.  If answers are all physical, proceed to Step 4.  If answers are all psychosocial, proceed to Step 5.

13.  Answers are a mix of physical and psychosocial.  Eliminate answer choices that are psychosocial.  For the licensure exam, consider pain a psychosocial need.

14.  Look at the remaining answer choices and ask yourself, “Does this make sense?”  If more than one answer remains, use the ABCs.

17.  Answers all assessment:  Identify why each assessment is performed.  Determine the outcome of each assessment.  Is it desired for the situation?  Answers all implementation:  Identify why each implementation is performed.  Determine the outcome of each answer.  Is it desired?

18. Let us now Practice these strategies ! Created by Nirvanni Chatoori NU105 Pharmacology

19.  You are always taking care of the patient and are present  You always have an order  Do not pass the buck. Do it yourself!  Client 1 st then equipment  Communicate therapeutically  Do not delegate assessment, teaching, nor evaluation  First, Best, Initial – establishes priority  Comma, Comma rule – all parts have to be correct  Do not use background info unless necessary  Do not read too much into the question  Know lab values, expected outcomes, & various positioning for optimal well being

21.  A patient suffering from COPD is admitted in the hospital for respiratory distress. He is on 2L O2 via NC with a saturation of 92%. The nurse practitioner has ordered Albuterol treatments Q4 hours. The nurse recognizes that the patient has a clear understanding of the medication when he states  A. “It is okay to feel tired and drowsy”  B. “My heart may begin pounding”  C. “I am not excited about the nausea”  D. “My chest will begin to tighten”

22.  Step #1: What is the topic of the question?  YES? then to  Step#2: Are answers assessments OR Interventions?  Step#3: Does Maslow fit?  YES? Eliminate psychosocial answers and ask yourself do physical needs make sense? If so which one?  NO? Proceed to  Step#5: What is the outcome of remaining answers? It is desired? A patient suffering from COPD is admitted in the hospital for respiratory distress. He is on 2L O2 via NC with a saturation of 92%. The nurse practitioner has ordered Albuterol treatments Q4 hours. The nurse recognizes that the patient has a clear understanding of the medication when he states A. “It is okay to feel tired and drowsy” B. “My heart may begin pounding” C. “I am not excited about the nausea” D. “My chest will begin to tighten”

23.  A graduate nurse is instructing a patient with asthma about the use of bronchodilators. The preceptor would need to intervene after which of the following statements made by the graduate nurse?  A. “Take only the specific drug prescribed”  B. “Abuterol is a very short acting drug”  C. “This medication works best for acute bronchospasm”  D. “Take it four hours before exercise to prevent an attack”

24.  A student nurse is completing a care plan for a patient diagnosed with an acute respiratory disorder. The student knows that a priority nursing action is to assess?  A. respiratory rate Q4 hour  B. blood pressure Q4 hours  C. lung sounds 12 hours  D. psychosocial status Q shift

25.  A nurse is providing education to the community about systemic and topical decongestants. It is understood that these medications are used to treat swollen nasal membranes resulting from: (Choose ALL that apply)  A. Hay fever  B. Common cold  C. Sinusitis  D. Allergy

26.  Standardized communication between members of the health care team about a patient's condition SBAR is used when:  A nurse is calling a physician  Nurses are handing off patients to one another  Nurses are transferring patients to other facilities or to other levels of care

27.  The safe and effective care of patients depends on consistent communication between caregivers.  Hand-offs or the process of passing on specific information about patients from one caregiver or one team to another, is an area where the breakdown of communication often leads to episodes of avoidable harm to patients.  The Joint Commission on Accreditation of Hospitals has added "standardized communication" to the Patient Safety Goals and recommends SBAR as a best practice. (Safer Healthcare, 2012)

28.  Introduction  Dr. Jones, this is Deb McDonald RN, I am calling from ABC Hospital about your patient Jane Smith.  Situation  Here's the situation: Mrs. Smith is having increasing dyspnea and is complaining of chest pain.  Background  The supporting background information is that she had a total knee replacement two days ago. About two hours ago she began complaining of chest pain. Her pulse is 120 and her blood pressure is 128/54. She is restless and short of breath.  Assessment  My assessment of the situation is that she may be having a cardiac event or a pulmonary embolism.  Recommendation  I recommend that you see her immediately and that we start her on 02 stat. Do you agree? (Safer Healthcare, 2012)

30.  Drugs that Affect the Cardiovascular System  Discussion board assignment  Weekly Quiz  Complete the KTP Focused Review test for Pharmacological/Parenteral Therapy 1, located on the KTP site by end of unit #7 Tues, 5/8 th 2359  Complete the KTP Focused Review test for Pharmacological/Parenteral Therapy 2, located on the KTP site by end of unit #8. Tues 5/15 th 2359

31. Drugs to manage: Cholesterol, Hypertension & Angina Diuretics Anticoagulants Thrombolytic Pay attention to nursing process, actions, side effects, lab values, therapeutic monitoring, toxicity, antidotes, & herbal interactions.