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NCLEX PREPARATION PROGRAM

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Presentation on theme: "NCLEX PREPARATION PROGRAM"— Presentation transcript:

1 NCLEX PREPARATION PROGRAM
MODULE 1 Overview, Assessment Testing Preparing to be Successful on the NCLEX-RN

2 Philosophy of Learning
Adult Learner Individual Responsibility Collaboration Adult learner – self paced assertive wide range of experiences Individual respon. confidentiality what part are you resp for Collaboration don’t grade on the curve develop group process

3 The Adult Learner is Unique!
1. Like to determine their own learning experiences 2. Enjoy small group interactions 3. Learn from others’ experiences as well as their own 4. Hate to have their time wasted

4 The Adult Learner is Unique!
5. Some adults will like some lectures but all lectures won't be liked by all adults 6. Are motivated to learn when they identify they have a need to learn 7. Are motivated to learn when societal or professional pressures require a particular learning need

5 The Adult Learner is Unique!
8. Are motivated to learn when “others” arrange a learning package in such a manner that the attraction to learning overcomes the resistance 9. Draw their knowledge from years of experience and don’t change readily 10. Want practical answers for today’s problems

6 The Adult Learner is Unique!
11. Like physical comfort 12. Enjoy practical problem solving 13. Like tangible rewards 14. Refreshments and breaks establish a relaxed atmosphere and convey respect to the learner

7 Values If you have identified values and designated adequate time and support, you are likely to be successful at attaining your goal

8 Skills the Successful RN Candidate Will Need:
Comfort with mathematics: Math Tutorial CD Critical thinking skills and some memorization: Critical Thinking Exam Reading and reviewing many pages of nursing content almost daily in preparation for class and the NCLEX exam Time and stress management Self-confidence in one’s ability to be successful: positive self talk

9 Computer Skills Basic computer literacy and comfort are very important! Competent working knowledge of Windows programs.

10 Study Time Required 8-12 hours per week classroom
5 hours/week computerized testing practice 2 or more hours/week for classroom preparation & homework assignments Working more than 32 hours/week is not recommended *Commuters add 4-6 hours/week for travel

11 We Want You to Be Successful
One day at a time! Know your learning style Organize and plan ahead Assume responsibility for your learning Practice first party communication Be empowered Strengthen skills Practice balance Practice “stress busters”!

12 What is Your Learning Style?
Each of us has a unique way in which we process information and learn the best. Knowing your learning style preference allows you to choose learning strategies that are most effective for you. Learning Style assessment results indicate learning preferences rather than strengths. Done right, learning can be fun!

13 draw, diagram, outline, color
Major Learning Styles Visual draw, diagram, outline, color To learn more effectively remember to use: Flow charts, graphs, labeled diagrams Visual imagination Written words Pictures Graphs Timeline Highlight text

14 Major Learning Styles Aural /Auditory Lectures in the classroom
To learn more effectively focus on: Lectures in the classroom Tape recording the lectures Group discussions Web chat; talk things through Sort things out by speaking out loud (to yourself and to others)

15 Major Learning Styles Read/Write
To learn most effectively remember to: Read and reread Write and rewrite (take notes and use them for study outside the classroom) Organize Use outlines Change graphs, etc. into statements or words

16 Major Learning Styles Kinesthetic/tactile
Related to the use of experience and practice (simulated or real) To learn most effectively, remember to: Be actively involved Touch, act Type notes Make flash cards, Use mind mapping (more information to follow) Watch videos depicting real-life scenarios

17 Major Learning Styles Multimodal (a mix of learning styles)
50 to 70% of the population Choose among your preferences to suit the occasion or situation -or- Use strategies from each preference to learn

18 Mind Mapping What is it? How does it work?
Mind mapping is a technique for taking notes in such as way that it produces strong visuals How does it work? To make a mind map, one starts in the center of the page with the main idea, and works outward in all directions, producing a growing and organized structure composed of key words and key images.

19 Case Study – Mind Mapping Sample

20 Mind Mapping Why does it work?
Mind maps help organize information using the same structure that our brain uses for making memories By presenting your thoughts and perceptions in a spatial manner and by using color and pictures, a better overview is gained and new connections can be made visible. Mind maps allow you to use both sides of your brain

21 Struggling Student vs. Successful Student
Denial Avoids problems Blames others Avoids Faculty Disorganized Tries Hard Lucky SUCCESSFUL: Realistic Addresses problems Accountable Works with Faculty Organized & Manages Time Tries Hard and Produces Works Hard & is Prepared

22 At Risk Students: Board of Registered Nursing (BRN) Task Force defines “at risk” students as follows: English as a second language Works >20 hours / week Family responsibilities If you fit any of these criteria: DEVELOP A PLAN

23 Seven Steps to Reach Your Goals
1. Write them down. 2. Be specific, measurable. 3. Be certain they are YOUR goals 4. Be positive. 5. Establish a time frame. 6. Do goals conflict with goals in other areas of your life? 7. Keep score!

24 To Enhance Your Success:
Utilize faculty Plan ahead Complete and turn assignments in on time Read study guides prior to lecture

25 Study Skills Inventory
Complete the study skills inventory tool located on page 13 of Module 1; Study Guide #3

26 S.M.A.R.T. Outcomes Specific Measurable Attainable Realistic
Time-targeted 26

27 Plan and Prepare! Organize now
Enlist help from family (i.e. helping w/ meals) Assess finances Reduce work hours Schedule fun What works best for you is unique

28 Student/Family Prep Activity
Complete the Student/Family Prep Activity tool located on page 16 of Module 1; Study Guide #3

29 Support is Available: Instructors Peers/Study Groups Counseling
Family and Friends Employer/Supervisor “Return on Investment”

30 Return on Investment Why it’s OK to ask your employer for 4-8 hours per week of paid time-off: Your success at becoming a RN is of benefit to your employer! Providing support to you during your NCLEX review is a less expensive way for your employer to gain a new RN than recruiting a new RN!

31 Preparation for classroom lecture discussions
A successful participant is a prepared participant. Read ahead. Come to class with questions if portions of the study guides were unclear. Your questions in class will help someone else understand the concept better as well.

32 Preparation for classroom lecture discussions
When completing your weekly NCLEX-RN computerized testing practice, focus on the same subject matter being covered in class that week. Prior to class, brush up on physiology, terminology and the lab values one can expect while caring for patients with the diseases being discussed.

33 Preparation for classroom lecture discussions
Create flashcards of material that requires memorization and that is new to you. Write down your questions to ask in class. Also take the opportunity to learn from your workplace if working in the healthcare field. Tying together what you observe in action and what you learn in the classroom is a great learning strategy.

34 Maslow’s Hierarchy of Needs Theory
What is Maslow’s Hierarchy of Needs Theory? How will understanding the needs theory help with prioritizing nursing interventions? How does the hierarchy apply to a NCLEX candidate's life? Most questions are written at the application or higher levels of cognitive ability.

35 Maslow’s Hierarchy of Needs in Descending Order
5th. Self-Actualization 4th. Self-Esteem 3rd. Love & Belonging 2nd Safety & Security 1st. Physiological Needs Most questions are written at the application or higher levels of cognitive ability.

36 Maslow's Hierarchy of Needs

37 Physiological Needs According to Maslow, physiologic needs are the highest priority and must be met first. Physiologic needs are necessary for survival. Oxygen Elimination Fluid Shelter Nutrition Rest Temperature Sex Most questions are written at the application or higher levels of cognitive ability.

38 Safety and Security Physical and Psychosocial
Physical safety includes decreasing what is threatening to the patient. The threat could be an illness, accidents, or environmental threats. Psychological safety states that the client must have adequate knowledge and an understanding about what to expect from others in his environment. Most questions are written at the application or higher levels of cognitive ability.

39 Love & Belonging Client needs to feel loved by family and accepted by others. When a client feels self-confident and useful, he will achieve the need of esteem as described by Maslow. Most questions are written at the application or higher levels of cognitive ability.

40 Self Esteem How one feels about himself/herself
Feelings of adequacy or inadequacy

41 Self-Actualization This is the highest level of Maslow’s hierarchy of needs. To achieve this level, the client must experience fulfilment and recognize his or her potential. In order for self-actualization to occur, all of the lower level needs starting with physiologic must first be met. Most questions are written at the application or higher levels of cognitive ability.

42 How to Apply Maslow’s Needs to Establish Priorities of Care
First recognize that answer options include both physical and psychosocial needs. Next eliminate the psychosocial answer. Ask yourself “Does this make sense in this case?” Finally apply the “ABCs” of care. Airway, Breathing, Circulation Answer

43 Application of Maslow's Hierarchy
A woman is admitted to the hospital with a ruptured ectopic pregnancy. A laparotomy is scheduled. Which preoperative nursing intervention is most important for the nurse to consider in this patient’s plan of care? a. Fluid Replacement b. Pain Relief c. Emotional Support d. Respiratory Therapy Most questions are written at the application or higher levels of cognitive ability.

44 Physical Needs First The nurse obtains a diet history from a pregnant 16-year-old girl. The girl tells the nurse that her typical daily diet includes cereal and milk for breakfast, pizza and soda for lunch, and cheeseburger, milkshake, fries and salad for dinner. Which of the following is the most accurate nursing diagnosis based on this data provided?

45 Highest Priority Need 1. Altered nutrition: more than body requirements related to high-fat intake. 2. Knowledge deficit: nutrition in pregnancy. 3. Altered nutrition: less than body requirements related to increased nutritional demands of pregnancy. 4. Risk for injury: fetal malnutrition related to poor maternal diet.

46 Prioritizing Care The nurse plans care for a 14-year-old girl
admitted with an 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?

47 Physiological needs are most important. Remember the “ABCs”!
1. Body image disturbance related to weight loss. 2. Self-esteem disturbance related to feelings of inadequacy. 3. Altered nutrition: less than body requirements related to decreased intake. 4. Decreased cardiac output related to the potential for dysrhythmias.

48 Computerized Adaptive Testing (CAT)
CAT is a method whereby the examination is created as you answer each question. If you select the correct answer, the computer selects a more difficult question for your next question. If you selected an incorrect answer, the computer will then select an easier question. This process continues until the computer has established with 95% confidence that you have been successful or unsuccessful. Knowing what you will encounter during the process of testing will assist in alleviating your fear and anxiety. CAT stands for “computerized adaptive testing.”

49 Computerized Adaptive Testing
When a test question is presented, it must be answered in order; move to the next question. There is no penalty for guessing. A computer keyboard tutorial is offered at the beginning of the examination in order to orient you to the use of the keys, etc. A proctor always is present to assist in explaining the use of the computer to ensure your full understanding of how to proceed.

50 Computerized Adaptive Testing
Time Considerations The maximum testing time is 6 hours. This time period includes: The computer tutorial The sample items All breaks (restroom, stretching, etc.) The examination All breaks are optional! The first preprogrammed optional break takes place after 2 hours of testing; the second preprogrammed optional break is after 3.5 hours of testing. The computer screen will notify you of the time for these breaks. You must leave the testing room during breaks;

51 Computerized Adaptive Testing
The minimum number of questions that you will need to answer is 75. The maximum number of questions in the test is 265. Each exam has 15 “pilot testing” questions that will not be added to your score. Fifteen of the total number of questions that you need to answer will be pretest (unscored) questions. The pretest questions are questions that may be presented as scored questions on future examinations. These pretest questions are not identified as such; that is, you will not know which questions are the pretest (unscored) questions. Therefore, it is important to answer every question as if it were being scored.

52 Computerized Adaptive Testing (CAT)
Each candidate’s exam is unique because it is created interactively as the exam proceeds. Computer technology selects items to administer that match the candidate’s ability level. All test items are stored in a large item pool. Items have been classified by test plan area being evaluated and level of difficulty. Most questions are written at the application or higher levels of cognitive ability.

53 Scoring the Computerized Adaptive Test
After the candidate answers an item, the computer calculates an ability estimate based on all of the previous answers the candidate selected. An item determined to measure the candidate’s ability is selected and this process is repeated for each item, creating an exam tailored to the candidate’s knowledge and skills while fulfilling all NCLEX-RN Test Plan requirements. The exam continues with items selected being administered in this way until a pass or fail decision is made. Most questions are written at the application or higher levels of cognitive ability.

54 Computerized Adaptive Testing: Pass or Fail?
After 75 questions are answered the computer compares the test-taker’s ability level to the standard required for passing. If the test-taker is above the passing standard, then the test-taker has passed. If the test-taker is below the passing standard, then the test-taker fails. The standard required for passing is set based on the expert judgment of several individuals appointed by the National Council of State Boards of Nursing. Do not get anxious if your computer does not stop at 75 questions!

55 Computerized Adaptive Testing: Pass or Fail? …cont
If the computer is not able to determine whether the test-taker has passed or failed, then the computer continues asking questions. The computer must be 95% certain before it stops testing.

56 How is the NCLEX-RN Exam Written?
First data is collected to reflect the current practice of the entry-level nurse. Data analyzed regarding frequency of performance, impact on maintaining client safety and client care settings where activities performed. This guides the selection of content and behaviors to be tested. Question writers voluntarily submit an application to become a writer and must meet specific established criteria designated by the NCSBN. However, a nurse currently employed in clinical nursing practice and working directly with nurses who have entered practice within the last 12 months may be selected to participate

57 NCLEX Definition of RN Provides a unique comprehensive assessment of the health status of the client (individual, family or group). Develops, then implements an explicit plan of care. Assists clients in the promotion of health, in adapting to and/or recovering from the effects of disease or injury and in supporting the right to a dignified death. Accountable for abiding by all applicable federal, state and territorial statutes related to nursing practice.

58 NCLEX-RN Detailed Test Plan
Reviewed and approved by National Council of State Boards of Nursing (NCSBN) every three years. Expert resources support changes that reflect practice trends. Comprehensive listing of content for each client need category and sub category.

59 Test Plan Components Questions are written to address:
Bloom’s Taxonomy Levels of cognitive ability Client Needs Integrated Processes Item writers are master’s-prepared nursing educators. The content of NCLEX-RN reflects the activities that a newly licensed, entry- level, registered nurse must be able to perform to provide clients with safe and effective nursing care.

60 NCLEX Test Plan Framework
Bloom’s taxonomy ranks levels of learning from simple to complex, it is used as a basis for writing and coding test items. Nursing practice requires the application of knowledge, skills and abilities. The majority of items are written at the application or higher levels of cognitive ability. This requires more complex thought processing.

61 Blooms Taxonomy and Test Question Construction
Levels of Cognitive Ability Knowledge Comprehension Application Analysis Most questions are written at the application or higher levels of cognitive ability.

62 Analysis Application Bloom's Taxonomy of Questions with
Increasing Difficulty and Sophistication Analysis Application In nursing school, you are also given test questions written at the comprehension level. These questions require you to understand the meaning of the material. Let’s look at this same question written at the comprehension level. Comprehension Recall/Recognition 62

63 Application Questions
Which of the following symptoms, if observed by the nurse during the first 24 hours after a percutaneous liver biopsy, would indicate a complication from the procedure? 1. Anorexia, nausea and vomiting 2. Abdominal distension and discomfort 3. Pulse 112, BP - 100/60, R - 20 4. Pain at the biopsy site Can you select an answer based on recall or recognition? No. Let’s analyze the question and answer choices. The question is: What is a complication of a liver biopsy? In order to begin to analyze this question, you must know that hemorrhage is the major complication. But it’s not listed as an answer. Can you find hemorrhage in one of the answer choices? 1. Anorexia, nausea…. Does this indicate that the patient is hemorrhaging? No, these are not symptoms of hemorrhage Abdominal … Does this indicate that the patient is bleeding? Perhaps. Abdominal distention could indicate internal bleeding. 3. Pulse: 112… does this indicate that the patient is bleeding? Yes. And increased pulse, a decreased BP, and increased respiratory rate indicate shock. Shock is a result of hemorrhage. 4. Pain at the biopsy…. Does this indicate the patient is bleeding? No. Pain at the biopsy site is expected due to the procedure. This question tests you at the paplication level. 63

64 Application Questions
It’s the principle of the thing! Application involves the utilization of basic facts and principle to make nursing judgements. The NCLEX exam tests your ability to apply nursing knowledge and principles in a variety of clinical situations across the life span.

65 Application Questions
One’s ability to solve problems, prioritize care, draw conclusions, perform assessments and synthesize information is not directly tested with recall, recognition or comprehension level questions. You must be able to answer questions at the application level in order to prove your competence on the NCLEX.

66 Analysis Type Question
A man is brought to the emergency room complaining of chest pain. The nurse performs an assessment of the patient. Which of the following symptoms would be MOST characteristic of an acute myocardial infarction? 1. Colic-like epigastric pain. 2. Sharp, well localized unilateral chest pain. 3. Severe substernal pain radiating down the left arm. 4. Sharp, burning chest pain moving from place to place. Many students panic when they read this question because they can’t immediately recall any diet restriction by a patient taking Haldol. Analysis questions are many times written so that a familiar piece of information is put in an unfamiliar setting. Let’s think about this question. Choosing the menu that best represents a balanced diet is not a difficult question to answer. The challenge lies in determining that a balanced diet is the topic of the question.Note that answer choices (1) and (2) are very similar. Because NCLEX is testing your discretion, you will be making decisions between answer choices that are ver close in meaning. Don’t expect obvious answer choices. These questions highlight the difference between the knowledge/comprehension=based questions that you may have seen in nursing school, and the application/analysis-based questions that you will see on the NCLEX. What type of diet do you choose for a patient receiving Haldol? In order to begin analyzing this question, you must first recall that Haldol is an antipsychotic medication used to treat psychotic disorders. There are no diet restrictions for clients taking Haldol. Since there are not diet restrictions, you must problem-solve to determine what this question is really asking. Based on the answer choices, it is obviously a diet question. What kind of diet should you choose for this patient/ Since you have been given no other information, there is only one type of diet that can be considered: a regular balanced diet. This is an example of taking the familiar (a regular balanced diet) and putting into the unfamiliar (a patient receiving Haldol). In this question, the critical thinking is deciding what this question is really asking. QUESTION: “What is the most balanced regular diet?” 66

67 Comprehension Question
The nurse understands that hemorrhage is a complication of a liver biopsy because: There are several large blood vessels near the liver. The liver cells are bathed with a mixture of venous arterial blood. The test is performed on patients with elevated enzymes. The procedure requires a large piece of tissue to be removed. The questions restated is, “Why does hemorrhage occur after a liver biopsy?” In order to answer this question, the nurse must understand that the liver is a highly vascular organ. The portal vein and the hepatic artery join in the liver to form the sinusoids that bathe the liver in a mixture of venous and arterial blood. NCLEX asks few minimum competency questions at the comprehension level. It assumes you know and understand the facts you learned in nursing school. 67

68 The NCLEX Test Plan The content of the NCLEX-RN test plan is organized into four major Client Needs categories. Two of the four categories are further divided into subcategories. All content categories and subcategories reflect client needs across the life span in a variety of settings.

69 NCLEX Test Plan Framework
Client Needs categories include the following: Safe and Effective Care Environment Health Promotion and Maintenance Psychosocial Integrity Physiological Integrity. In the Test Plan implemented in April 2004, the National Council of State Boards of Nursing (NCSBN) has identified a test plan framework on Client Needs.

70 Client Needs Sample Question
The nurse is delivering external cardiac compressions to a 63 year old woman while performing cardiopulmonary resuscitation (CPR). It is most important for the nurse to: Maintain a position close to the client’s side with the nurse’s knees apart. Maintain vertical pressure on the client’s chest through the heel of the nurse’s hand. Recheck the nurse’s hand position after every 10 chest compressions. Check for a return of the client’s pulse after every 8 breaths by the nurse. The correct answer is (2). The nurse’s elbows should be locked, arms straight, with shoulders directly over hands. Incorrect pressure or improperly placed hands could cause injury to the client. 70

71 Sample Recall and Recognition Knowledge-based Question
Which of the following is a complication that occurs during the first 24 hours after a percutaneous liver biopsy? a. Nausea and vomiting b. Constipation c. Hemorrhage d. Pain at the biopsy site. The question restated is, “What is a common complication of a liver biopsy?” You may or may not remember the answer. So, as you look at the answer choices, you hope to seen an item that looks familiar. You do see something that looks familiar: “Hemorrhage.” You selected the correct answer based on recall or recognition. NCLEX rarely asks passing questions at the recall/recognition level. 71

72 NCLEX Test Plan Framework
Woven within the client needs categories are four Integrated Processes. Nursing process Caring Communication and Documentation Teaching and Learning

73 A Closer Examination Let’s examine each component in greater detail including sample questions that will emphasize key concepts. First Client Needs categories Next Bloom’s Taxonomy Cognitive Domain Finally Integrated Processes

74 Client Need #1 Safe and Effective Care Environment Subcategory: Management of Care: 13-19%
Advance Directive Advocacy Case Management Client rights Collaboration with Interdisciplinary team Concept of Management Confidentiality/Information Security Consultation Continuity of Care Delegation

75 Client Need #1 Safe and Effective Care Environment Subcategory: Management of Care: 13-19%
Establishing Priorities Ethical Practice Informed Consent Legal Rights and Responsibilities Performance Improvement (Quality Assurance) Referrals Resource management Staff Education Supervision

76 Client Needs Sample Question
A client scheduled for surgery tells the nurse that she signed an informed consent but was never told about the risks of the surgery. The nurse serves as the client’s advocate by performing which of the following actions?

77 Client Needs (cont’d) a. Writing a note on the front of the client’s record so that the surgeon will see it when the client arrives in the operating room. b. Documenting in the client’s record that the client was not told about the risks of the surgery. c. Contacting the surgeon and asking the surgeon to explain the surgical risks to the client. d. Reassuring the client that the risks are minimal and unlikely to occur. Answer: c

78 Client Need #1 Safe and Effective Care Environment Subcategory: Safety and Infection Control: 8 –14%
Accident prevention Disaster planning Emergency Response Plan Ergonomic Principles Error prevention Handling hazardous and infectious materials Home Safety Injury Prevention

79 Medical and Surgical Asepsis
Client Need #1 Safe and Effective Care Environment Subcategory: Safety and Infection Control: 8 –14% Medical and Surgical Asepsis Reporting of Incident/Event/Irregular Occurrence/Variance Safe Use of Equipment Security Plan Standard/Transmission-Based/Other Precautions Use of Restraints/Safety Devices

80 Safety and Infection Control Sample Question
The physician orders tobramycin sulfate (Nebcin) 3mg/kg IV every 8 hours for a 3-year-old boy. The nurse enters the patient’s room to administer the medication and discovers that the boy does not have an identification bracelet. What should the nurse do? Ask the parents at the child’s bedside to state their child’s name. Ask the child to say his first and last name. Have a co-worker identify the child before giving the medication. Hold the medication until an identification bracelet can be obtained.

81 Client Need #2: Health Promotion and Maintenance: 6 – 12%
The Aging Process Ante/Intra/Postpartum and Newborn Care Developmental Stages and Transitions Disease Prevention Expected Body Image Changes Family Planning Family Systems Growth and Development It is important to understand that not everyone described in the question will be sick or hospitalized. Some clients may be in a clinic or home-care setting. Some clients may not be sick at all. Wellness is an important concept on the NCLEX. It is necessary for a safe and effective nurse to know how to promote health and prevent disease. 81

82 Client Need #2: Health Promotion and Maintenance: 6 – 12%
Health and Wellness Health Promotion Programs Health Screening High Risk Behaviors Human Sexuality Immunizations Life Style Choices Principles of Teaching and Learning Self-Care Techniques of Physical Assessment

83 Client Needs Sample Question
A nurse is preparing to care for a hospitalized female teenager in skeletal traction. The nurse plans patient care, knowing that the most likely primary concern of the teenager is: a. Body image b. Keeping up with school work c. Obtaining adequate nutrition d. Obtaining adequate rest and sleep

84 Client Need #3 Psychosocial Integrity: 6-12%
Abuse/Neglect Behavioral Interventions Chemical Dependency Coping Mechanisms Crisis Intervention Cultural Diversity End of Life Family Dynamics Grief and Loss Mental Health Concepts

85 Client Need #3 Psychosocial Integrity: 6-12%
Psychopathology Religious and Spiritual Influences on Health Sensory/Perceptual Alterations Situational Role Changes Stress management Support Systems Therapeutic Communication Therapeutic Environment Unexpected body image

86 Client Needs Sample Question
A boy is brought to the school nurse’s office with reports of abdominal pain. On assessment, the nurse notes the presence of several bruises on the child’s abdomen and back and several cigarette burn marks. The nurse suspects child abuse and plans for which priority action? a. Documents the bruises noted on the child’s body. b. Calls the parents to ask them how the child’s bruises and burn marks occurred. c. Notifys Child Protective Services to facilitate the removal of the child from the abusive situation in order to prevent further injury. d. Asks the child how long his parents have been abusing him.

87 Client Needs Sample Question
A 50-year-old male patient comes to the nurses’ station and asks the nurse if he could go to the cafeteria to get something to eat. When told that his privileges do not include visiting the cafeteria, the patient became verbally abusive. Which of the following approaches by the nurse would be most effective? a. Tell the patient to lower his voice because he is disturbing the other patients. b. Ask the patient what he wants from the cafeteria and have it delivered to his room. c. Calmly but firmly escort the patient back to his room. d. Assign a nursing assistant to accompany the patient to the cafeteria. The correct answer is (3). The nurse should not reinforce abusive behavior. Patients need consistent and clearly defined expectations and limits. 87

88 Client Need #4 Physiological Integrity Basic Care and Comfort: 6-12%
Alternative and Complementary Therapies Assistive Devices Elimination Mobility and Immobility Non-Pharmacological Comfort Interventions Nutrition and Oral Hydration Palliative and Comfort Care Personal Hygiene Rest and Sleep Keep on moving. Hazards of immobility are frequently tested. 88

89 Client Needs Sample Question
A nurse has provided information to a client about measures that will promote normal urination patterns and prevent urinary tract infections. Which statement by the client indicates a need for further information? a. “I should take my furosemide (Lasix) in the morning.” b. “I should drink plenty of fluids during the day.” c. “I should try and hold my urine as long as I can rather than expelling it when I feel the urge.” d. “I should eat foods that will make my urine acidic.”

90 Client Need #4 Physiological Integrity Pharmacological and Parenteral Therapies: 13 – 19%
Adverse effects/Contraindications Blood and Blood Products Central Venous Access Devices Dosage Calculations Expected Outcomes/Effects Intravenous Therapy Medication Administration Parenteral Fluids Pharmacological Agents/Actions Pharmacological Interactions Pharmacological Pain Management Total Parenteral Nutrition Know your medications. Actions, indications, side effects and nursing considerations. 90

91 Client Needs Sample Question
Cyclosporine (Sandimmune) oral solution is prescribed for a patient who had a kidney transplant. The nurse provides information to the patient about the medication and tells the patient that which of the following is most important to monitor? a. Temperature b. Peripheral pulses c. Platelet count d. Apical heart rate

92 Client Need #4 Physiological Integrity Reduction of Risk Potential: 13 –19%
Diagnostic Tests Laboratory Values Monitoring Conscious Sedation Potential for Alterations in Body Systems Potential Complications of Diagnostic Tests/ Treatments/Procedures Potential for Complications from Surgical Procedures and Health Alterations System Specific Assessments Therapeutic Procedures Vital Signs

93 Client Needs Sample Question
A 7-year-old girl with type I insulin dependent diabetes mellitus (IDDM) has been home sick for several days and is brought to the ER by her parents. If the child is experiencing ketoacidosis, the nurse would expect to see which of the following lab results? a. Serum glucose 140 mg./dl b. Serum creatine 5.2 mg./dl c. Blood pH 7.28 d. Hematocrit 38% The correct answer is (3) Normal pH is 7.35 – 7>45. This indicates DKA. 93

94 Client Need #4 Physiological Integrity Physiological Adaptation: 11 – 17%
Alteration in Body Systems Fluid and Electrolyte Imbalances Hemodynamics Illness Management Infectious Diseases Medical Emergencies Pathophysiology Radiation Therapy Respiratory Care Unexpected Response to Therapies Think ER. Know what to do in an emergency. 94

95 Integrated Processes These “threads” of knowledge are fundamental to the practice of nursing and are integrated throughout the Patient Needs categories and subcategories.

96 Four Integrated Processes Categories
1. Nursing Process is a scientific problem solving approach to client care that includes assessment, analysis, planning, implementation and evaluation.

97 Four Integrated Processes Categories
2. Caring is the interaction of the nurse and patient in an atmosphere of mutual respect and trust. In this collaborative environment, the nurse provides encouragement, hope, support and compassion to help achieve desired outcomes.

98 Four Integrated Processes Categories
3. Communication/Documentation Communication is the verbal and nonverbal interaction between the nurse and the client, the client's significant others and the other members of the health care team. Documentation relates to events and activities associated with client care which are validated in written and/or electronic records that reflect standards of practice and accountability in the provision of care. Communication-type test questions are integrated throughout the NCLEX-RN Test Plan and may address a situation in any health care setting.

99 Four Integrated Processes Categories
4. Teaching/Learning is the facilitation of the acquisition of knowledge, skills and attitudes promoting a change in behavior. It is the distribution of content.

100 6 Types of Questions on the NCLEX Exam
Multiple choice - one correct answer Fill-in-the-Blank - type in the answer Hot Spot - select a specific area on a diagram or illustration Exhibit - information needed for the answer is in the form of an exhibit or spreadsheet. Ordered response - select choice in the proper sequence (prioritize) Multiple response - more than one answer is correct; select all that apply Some questions, such as those that present a figure or illustration, may require you to use the mouse component of the computer system; you may be asked to “point and click”.

101 Multiple Choice Questions
Most of the questions that you will be asked to answer will be in the multiple choice format. These questions will provide you with data about a particular client situation, together with four answers or options.

102 Fill-in-the Blank Questions
Follow the directions for each question. Use the on-screen calculator and verify calculations a second time. Type in only the numeric component of the answer as directed. Round the answer to the nearest whole number if directed to do so. Do not use abbreviations if directions indicate that they are not acceptable.

103 Hot Spot Questions This type of question allows you to use the mouse or arrow keys to identify a figure, illustration or other item designated in the stem of the question.

104 Exhibit Questions In order to answer exhibit questions you will need to click on the button that says, “Exhibit.” This opens up a new smaller window with either a list or a spreadsheet. There may be more than one page to the exhibit. If this is the case, there will be tabs at the top of the exhibit. Be sure to look at all of the tabs provided.

105 Multiple Response Questions
You must select all of the options that relate to the information being asked in the question. There is no partial credit given for correct selections you have chosen. You must select ALL that apply in order for the question to be counted as correct.

106 Ordered Response Questions
Prioritizing questions ask you to select options in the correct sequence or use the computer mouse to drag and drop your nursing actions in order of priority. Information will be presented and based on the data you have been provided. You will need to determine what you would do first, second, third and so forth.

107 Golden Rules for NCLEX Success
Be prepared Avoid negative people Do not discuss the exam Avoid distractions Think positively

108 Golden Rules for NCLEX Success
Eat well Exercise Sleep well Eliminate alcohol and other mind-altering drugs Schedule study time

109 Tutorial Prior to NCLEX Exam
Each NCLEX candidate is given a tutorial at the beginning of the exam in order to become familiar with how to answer each question using a mouse, arrow keys, and a calculator. There is no partial credit given for an answer that is only partially correct. Updated information on the administration of the test plan can be found at NCSBN web site:

110 Test Taking Strategies
If an option contains an absolute word, it is usually an incorrect choice and can safely be eliminated as an option. If a tentative word is used in an option, then it is more likely to be the correct answer. Absolute Words :All, always, can’t, never, must, only, won’t none Tentative words: generally, most often, may, possibly, usually

111 Examples of Absolute Words
Always advise clients to eat low sodium foods. Drink fluids only if they are fat-free. Eat only foods that have less than 1% fat content Never use butter for cooking.

112 Examples of Tentative Words
Nursing actions are usually in the clients’ best interest. It is sometimes necessary to call for an emergency support team. Hot liquids may cause skin damage if spilled. Often times clients who break their legs need instruction in crutch walking.

113 Questions Containing Laboratory Values
Laboratory values questions will first require you identify whether the results are normal or abnormal. You will need to memorize common laboratory values. Next you will be asked to analyze the laboratory value as it relates to the client situation being presented. Finally you may be asked to make the appropriate assessment, judgement and/or nursing action. When a question is presented on the NCLEX-RN regarding a specific laboratory value, note the disorder presented in the question and the associated body organ that is affected as a result of the disorder.

114 Laboratory Values Sample Question
A client with a diagnosis of sepsis is receiving antibiotics by the intravenous route. The nurse assesses for nephrotoxicity by closely monitoring which of the following laboratory values?

115 Laboratory Values Sample Question Possible Answers
a. Lipase level b. Platelet count c. White blood cell count d. Blood urea nitrogen Answer d. – Note that the issue is nephrotoxicity. Read each option carefully and note that option d is the only option that relates to kidney function.

116 Nursing Interventions
Although sometimes appropriate, avoid jumping immediately to an answer that recommends immediate referral to the patient’s M.D. NCLEX is examining your abilities as a nurse and doesn’t usually want immediate referral to other members of the health care team.

117 Key Words Key words in NCLEX-RN test questions are critical in defining the correct answer. Examples of how key words are used include: …is an early sign of…? …is the most important…? Identify the ___ with the highest priority… Which ____ would the nurse do initially?

118 Sample Question – Key Word in Stem
A nurse is caring for a patient with a diagnosis of congestive heart failure who suddenly experiences severe dyspnea. The nurse suspects that pulmonary edema has developed. The immediate nursing action is:

119 Sample Question Answer Options
a. Place the client in high-Fowler’s position. b. Insert a Foley catheter STAT. c. Obtain a dose of morphine sulfate from the narcotic medication drawer. d. Begin oxygen at 2 liters per minute. Answer: Note keyword immediately and note the issue of the question: a nursing action. Option A is a nursing action that does not require a medical order. Remember the NCLEX is a nursing examination, not a medical examination.

120 Sample Question – Key Word in Stem
A nurse in the emergency department receives a call from emergency medical services and is told that several victims who survived a plane crash and are suffering from cold exposure will be transported to the hospital. The initial nursing action for the emergency department nurse is which of the following?

121 Sample Question Answer Options
a. Call the laundry department and ask the department to send as many warm blankets as possible to the emergency room. b. Call the intensive care unit to request that nurses be sent to the emergency room. c. Call the nursing supervisor to activate the agency disaster plan. d. Supply the trauma rooms with bottles of sterile water and normal saline. Answer: Note the keyword initial and focus on the issue: the nursing action in the event of a disaster. As you read each option, you will note that all of the options are correct. In this type of question, look for the umbrella option. Option c is the umbrella option.

122 Visualization as a Test-Taking Strategy
Visualize the specific information in the case situation in order to answer the question. See yourself performing the procedure, assessing the client, delegating the care, etc. Remember that clinical practice can vary depending upon where it is practiced and who is performing the care. Be certain that you draw upon knowledge and skills which come from nursing textbooks. Forming a mental image of the situation places you as the nurse into the scenario. In addition, visualize each option as you read it.

123 Visualization Sample Test Question
A nurse prepares to perform a sterile dressing change on an abdominal incision. The nurse explains the procedure to the patient, washes her hands and sets up the sterile field. The nurse takes which action next?

124 Visualization Sample - Answer Options
a. Assesses the integrity of the abdominal incision. b. Cleans the wound with Betadine solution as prescribed. c. Dons clean gloves and removes the old dressing. d. Dons sterile gloves and begins the procedure. Answer: Note the word next. Form an image of this procedure and visualize the steps that you would take in this procedure. You cannot clean the wound or assess the wound unless you remove the old dressing; therefore, option c is correct.

125 Response Options “Odd man out” Eliminate obvious wrong answers.
If two answers are opposites, chances are one of them is the correct answer. “Wordy” answers tend to be the correct answer (only use this if two answers look correct but one is more wordy than the other).

126 Additional Strategies
Read each question carefully and avoid reading more into the question than is there. Try not to answer a question based on what you’ve seen in a clinical setting. Reinforce your learning by: testing your knowledge using NCLEX-RN review resources

127 Additional Strategies
Reinforce your learning by: Using NCLEX-RN review videos and computer programs Frequently asking yourself questions that reinforce your learning such as, “If I had to do that procedure, what would I need to know?” –or– “If I had to teach a client about that particular diagnosis, how would I explain it?”

128 Pacing Strategies When Testing
Once you’re allowed to begin, check the time. Try to spend no more than 1 minute per test question Don’t allow difficult questions to immobilize you. Make your best selection and then move on. While completing the NCLEX-RN computerized practice testing during this course, aim to answer one answer correctly per minute.

129 Strategies – Day of Testing
Eat breakfast. Brains function optimally if blood sugar levels are even. Use scratch paper as a tool for helping to answer future questions based on information in older questions. Remember you can’t go back to previous questions so this may be useful. Don’t panic if someone finishes before you.

130 Anxiety Anxiety is an individual’s negative response to the stressor being confronted. Anxiety is defined as a state of varying degrees of uneasiness or discomfort resulting in energy that can be constructive or destructive. Learning how to prevent stress from becoming anxiety is an important skill for everyone to learn.

131 Tips to Reduce Test Anxiety
Sufficient preparation helps candidates feel confident and that they can be successful. Make a study schedule; cramming isn’t associated with success and therefore doesn’t work!

132 Tips to Reduce Test Anxiety
Decide what and when to study (study plan). Use a study system or technique that works best for you (study groups, flash cards, diagrams, etc.) Take a second look at your study environment. Have you provided for your physiological needs?

133 Tips to Reduce Test Anxiety
Rethink your attitude about test taking. Read all test directions carefully. Remember to breathe and relax your body. Move along at a steady pace without getting hung up on any one question.

134 Techniques for Reducing Stress and Anxiety
Reward yourself regularly for your efforts. Spend more time on your “weak” areas or on those that create the most anxiety. Know that test anxiety is very common. Get help from classmates, faculty, counsellors and family. It is a sign of strength to admit that you could use some help. Stay focused on the tasks at hand.

135 Reducing Stress and Anxiety
Turn to a comforting person Rely on self-discipline Talk it out Think it through - introspection Work it off - physical activity Use symbolic substitutes Religion and spirituality - prayer, meditation, being with nature.

136 Stress Stress can be a good thing or a bad thing!
Stress is defined as a broad class of experiences which are demanding and tax an individual’s resources and coping abilities. The way a stressor is viewed by an individual plays a big role in helping one cope, work effectively for a solution and organize resources in a productive way.

137 Stress Stage 1: Alarm Reaction
Sympathetic nervous system initiates “fight or flight” Adrenaline (AKA epinephrine) surges! Hypothalamic-pituitary-adrenal axis releases cortisol, norepinephrine & epinephrine Heart pounds, breathing rapid, BP increases, mouth dry, sweaty, pupils dilate, digestion slows, muscles tense, hyper-alert Cannot stay in alarm stage long During the alarm stage, the sympathetic nervous system initiates the “fight or flight response and activates defense mechanisms. Adrenaline surges, the heart speeds and the body prepares for fighting or running away. This fight or flight response is sustained by the hypothalamic-pituitary-adrenal axis, which releases cortisone, norepinephrine and epinephrine into the blood. Body responses in the alarm reaction stage include: rapid, pounding heart, rapid breathing, increased BP, dry mouth, sweating & dilated pupils. Digestion slows, (nausea, anorexia) and muscles are tense & poised for action, awareness is hyper-alert The alarm reaction is self-limited; living in a continuous state of alarm would result in death, so the person moves into the second stage, resistance 137

138 Stress Stage 2: Resistance
Quickly follows alarm reaction Body attempts to adapt to stressor Parasympathetic nervous system opposes action of sympathetic nervous system. Cortisol levels still increased. If adaptation occurs, individual will reestablish homeostasis If not, will enter exhaustion stage During the alarm stage, the sympathetic nervous system initiates the “fight or flight response and activates defense mechanisms. Adrenaline surges, the heart speeds and the body prepares for fighting or running away. This fight or flight response is sustained by the hypothalamic-pituitary-adrenal axis, which releases cortisone, norepinephrine and epinephrine into the blood. Body responses in the alarm reaction stage include: rapid, pounding heart, rapid breathing, increased BP, dry mouth, sweating & dilated pupils. Digestion slows, (nausea, anorexia) and muscles are tense & poised for action, awareness is hyper-alert The alarm reaction is self-limited; living in a continuous state of alarm would result in death, so the person moves into the second stage, resistance 138

139 Stress Stage 3: Exhaustion
All energy for adaptation expended Body cannot defend against stressor Illness and/or death will occur if stress continues and appropriate outside assistance is not given Candidates perform at their highest level when stress is at a minimal level During the alarm stage, the sympathetic nervous system initiates the “fight or flight response and activates defense mechanisms. Adrenaline surges, the heart speeds and the body prepares for fighting or running away. This fight or flight response is sustained by the hypothalamic-pituitary-adrenal axis, which releases cortisone, norepinephrine and epinephrine into the blood. Body responses in the alarm reaction stage include: rapid, pounding heart, rapid breathing, increased BP, dry mouth, sweating & dilated pupils. Digestion slows, (nausea, anorexia) and muscles are tense & poised for action, awareness is hyper-alert The alarm reaction is self-limited; living in a continuous state of alarm would result in death, so the person moves into the second stage, resistance 139

140 Final Tips for Passing NCLEX
Set goals and manage your time to accomplish these goals. Face the challenges by taking small steps! Think about your past accomplishments!

141 Final Tips for Passing NCLEX
Think positive thoughts and use positive self talk! Maintain your self-confidence and control anxiety! Visualize yourself as an RN!

142 Positives that Perfect Your Performance!
Familiarity and repetition can help with retention. You have assessed your strengths and weaknesses. You have completed hundreds of similar test questions.

143 Positives that Perfect Your Performance!
You know what factors were considered when the test was constructed. You are familiar with the use of the computer. You are familiar with the testing procedures. You have studied English and medical terminology.

144 Positives that Perfect Your Performance!
You are aware of the content areas where you believe little fine-tuning is necessary. You have reviewed several areas of nursing content you believe are in need of more in- depth concentrated study.

145 Positives that Perfect Your Performance!
You have reviewed test taking techniques and learned how to more carefully examine each test question so that it is more easily understood.

146 Visualize! Your Name

147 Photo Acknowledgement: Unless noted otherwise, all photos and clip art contained in this module were obtained from the 2003 Microsoft Office Clip Art Gallery.


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