1. 5/2011

2.  Avoid asking yourself, “well, what if….?”  Focus only on the information in the question, read every word, and make a decision regarding what the question is asking.  Look for strategic words in the question.

3.  Always use process of elimination when choices or options are presented; once you have eliminated options, reread the question before selecting your final choice or choices.  Determine if the question is a positive or negative event query.  Use all your nursing knowledge, your clinical expertise, and your test-taking skills and strategies to answer the question.

4.  Best  Early  Late  First  Immediately  Initial  Most  Least  Vital  Next  Primary  Highest priority  Essential

5.  ABC’s  Airway, breathing, circulation  Maslow’s hierarchy  Basic physiological needs, safety/security, love/belonging, self-esteem, self-actualization  Nursing process  Assessment, analysis, planning, implementation

6.  When reading the options, look for options that are comparative or alike; these options will include a similar concept or nursing action.  Comparative or alike options can be eliminated as possible answers.

7.  The umbrella is one that is a broad or universal statement and that usually contains the concepts of the other options within it.  The umbrella option will be the correct answer.

8.  All  Always  Every  Must  None  Never  Only  These words infer a fixed or extreme meaning; these types of options are usually incorrect.  One exception is when the question refers to safety…”patients in the PACU should never be left alone”

9.  Focus on the information in the question and what task or assignment is to be delegated  Match the client’s needs with the scope of practice of the health care providers indentified in the question  Generally non-invasive interventions such as skin care, range-of-motion exercises, ambulation, grooming, and hygiene measures can be assigned to a nursing assistant

10.  A licensed practical nurse can perform all of the tasks of a nursing assistant and can also usually perform certain invasive tasks such as dressings, suctioning, urinary catheterization, PO/SC/IM meds  The RN is responsible for assessment, planning care, analyzing client care, supervising care, initiating teaching, IV meds

11.  Try to determine the classification to assist in determining the action and/or side effects  Generalities to remember  The pt should not take an antacid with medication because the antacid will affect the absorption of the medication  Enteric-coated and sustained-release tablets should not be crushed

12.  Capsules should not be opened  The pt should never adjust or change a medication dose or abruptly stop taking a medication

13.  The nurse never adjusts or changes the pts medication dosage and never discontinues a medication  The client needs to avoid taking any over-the- counter medications/any other medications such as herbals unless they are approved by the health care provider  Medications are never administered if the order is difficult to read, is unclear, or identifies a medication dose that is not a normal one

14.  Don’t answer questions based upon what you may have seen in a clinical setting. Base your answer on what you have learned from class/lecture/text books.

15.  A nurse is caring for a hospitalized pt with a diagnosis of CHF who suddenly complains of shortness of breath and dyspnea. The nurse takes which immediate action?  Calls the physician  Administers oxygen to the pt  Elevates the HOB  Prepares to administer furosemide (lasix)

16.  Your initial thought may go to pulmonary edema and administering a diuretic, but nothing in the question mentions pulmonary edema.  Not the strategic word ‘immediate’ an focus on the subject  Although the physician may need notification, that is not an immediate need  A physician order is needed for oxygen.  The question is asking for a nursing action  Answer is to elevate the HOB

17.  A nurse is caring for a group of pts. On review of the pts medical records, the nurse determines that which of the pts is at risk for fluid volume excess?  Pt on diuretics  Pt with renal failure  Pt with an ileostomy  Pt with gastrointestinal suctioning

18.  Based on pathophysiology, you would look at the fact that all but the pt with renal failure are alike in that they have disease processes that lose fluid. This would point you to the answer of renal failure and fluid retention

19.  A nurse is caring for a pt who just returned from the recovery room after undergoing abdominal surgery. The nurse monitors the pt for which early sign of hypovolemic shock?  Lethargy  Increased pulse rate  Increased depth of respiration  Decreased deep tendon reflexes

20.  Note the strategic word ‘early’.  Focusing on this strategic word and recalling that the earliest clinical signs of hypovolemic shock are cardiovascular changes will direct you to the correct option.  Although lethargy, increased depth of respirations, and decreased or absent deep tendon reflexes occur in hypovolemic shock, these are not early signs.

21.  The pt with a diagnosis of cancer is receiving morphine sulfate for pain. When preparing the plan of care for the pt, the nurse includes which priority action?  Monitor stools  Encourage fluid intake  Monitor the urine output  Encourage the pt to cough and deep breathe.

22.  Use the ABC’s as a guide to direct you.  Recall that morphine sulfate suppresses the cough reflex and the respiratory reflex.  Although the first 3 options are components of the care plan, the correct option addresses airway. (encourage coughing and deep-breathing)

23.  A nurse is developing a plan of care for a pt with Meniere’s disease. The priority nursing interventions should focus on which of the following?  Safety measures  Dietary measures  Activity limitations  Knowledge about medication therapy

24.  Focus on the pts disorder, meniere’s disease and recall the pathophysiology associated with the disease.  All the options identify a component of the care plan, but remember safety is a priority.  Also note that the option of safety is the umbrella option in that it is a broad statement of intervention.

25.  A pt will undergo a barium swallow and the nurse provides instructions to the pt. The nurse instructs the pt to:  Avoid eating or drinking after midnight before the test  Limit self to only two cigarettes on the morning of the test  Have a clear liquid breakfast only on the morning of the test  Take all routine medications with a glass of water on the morning of the test

26.  Note the close-ended words ‘only’ and ‘all’ in the last 3 choices.  Also the last 3 can be eliminated because they are comparative…they all involve taking in something on the morning of the test.

27.  A nurse is planning the pt assignments for the day and has an LPN and a nursing assistant on their team. Which pt would the nurse most appropriately assign to the LPN?  A pt who is scheduled for and ECG and CXR  A pt with stable CHF who has early-stages of Alzheimers  A pt who was treated for dehydration and is weak and needs assistance with bathing  A pt with emphysema who is receiving O 2 2L/NC and becomes dyspneic on exertion

28.  The nurse would most appropriately assign the pt with emphysema to the LPN  This pt has an airway problem and has the highest priority needs of the pts described  The other pts can be cared for appropriately by the nursing assistant  Remember, match the pts needs with the scope of practice of the healthcare provider

29.  Quinapril hydrochloride (acupril) is prescribed as an adjunctive therapy in the treatment of heart failure. After administering the first dose, the nurse monitors which of the following most closely?  Respirations  Urine output  Lund sounds  Blood pressure

30.  Focus on the name of the medication  Note the strategic wording ‘most closely’, this tells you that all of the choices may be correct and you will have to prioritize  Medication ending in –pril are ACE inhibitors, and treat HTN. Excessive hypotension (first dose syncope) can occur in pts with heart failure or in pts volume/sodium depleted.  Although respirations, urine output, and lung sounds would be monitored, the nurse would ‘most closely’ monitor blood pressure