Strategy 4 An educated guess is better than no answer at all
Strategy 5 Use the process of elimination in selecting the correct answer
Strategy 6 Look for the answer that has the broader focus (Umbrella options)
Example Umbrella Type Questions The nurse suspects that a client is having an anaphylactic-type allergic reaction to an IV antibiotic just received. Which symptoms, manifested by the client, would most likely lead the nurse to this conclusions? A. Nausea and vomiting B. Itchy rash and hives C. Hypertension and tachycardia D. Sudden wheezing and urticaria
Strategy 8 Look for qualifying words in the question stem – FIRST – BEST – MOST – INITIAL – BETTER – HIGHEST PRIORITY
Example Priority-Type Question A 62 year-old client has a history of coronary heart disease and is brought into the ER complaining of chest pain. What initial action should be taken by the nurse? a. Give the client NTG gr 1/150 SL now b. Call the client’s cardiologist about admission c. Place the client in a high-Fowler’s position after loosening the shirt d. Check BP and note the location and degree of the chest pain.
Strategy 9 Look for negatives in the question stem NOT LEAST UNLIKELY INAPPROPRIATE UNREALISTIC LOWEST PRIORITY CONTRAINDICATED FALSE EXCEPT INCONSISTENT UNTOWARD ALL BUT ATYPICAL INCORRECT
Example Negative Question A client, after being admitted to the Medical Unit, is still having some mild chest pain. Select the medication that is inappropriate for the relief of chest pain. a. Diltiazem (Cardizem) b. Propranolol (Inderal) c. Digoxin (Lanoxin) d. Meperidine (Demerol)
Strategy 10 Avoid selecting answers that have absolutes in them ALWAYS EVERY ONLY ALL NEVER NONE
Example Absolute Question When assessing the chest pain of a client with cardiovascular disease, what may be considered? a.This pain is always caused by constriction or blockage of the coronary arteries by fat plaques or blood clots b.True cardiac pain is never relieved without treatment c.This type of pain is only relieved by NTG d.Clients often attribute the pain to indigestion
Strategy 11 The answer that is presented differently is usually the incorrect answer
Example Differently Presented Question A client has developed heart failure. Identify the correct dosage for a loading dose of digoxin (Lanoxin) for an adult client. a.0.75 mg divided into three doses q 8 hours b.0.75 Gm divided into four doses q 8 hours c.10 mg – the client is a very large person with a Native American backgroud which causes slow absorption of the medication d.0.25 mg
Strategy 12 Avoid selecting answers that pass the decision to the physician
Strategy 13 Avoid looking for a pattern in the selection of answers
Strategy 14 DO NOT PANIC if a totally unfamiliar question is encountered
Example Totally Unfamiliar Question A 33-year-old client has been diagnosed as having a pheochromocytoma. Select the appropriate initial nursing activity. a.Administering large doses of xylometazoline (Otrivin) to help control the symptoms of the disease. b.Monitoring the client’s vital signs closely, particularly the blood pressure. c.Preparing the client and family for imminent death. d.Having the family discuss the condition with the physician before informing the client about the disease because of the protracted recovery period after treatment.
Strategy 15 Do not choose answers that make the client seem unworthy or ignorant
Strategy 16 Look for the proper sequence of actions
Strategy 17 If there is a lengthy nursing situation or case study, read the stem of the question first.
Strategy 18 Choose answers that acknowledge the client, communicate acceptance, are open- ended and encourage discussion and expression of feelings.
Other study suggestions Prepare “If I don’t know it by now, I never will” Directed study and preparation
Review books should cover Names of Common Medications Lethal and Therapeutic Doses and Antidotes Common Adverse Effects of Medications Lab Values and Implications Growth and Development Diet Therapy Basic Anatomy and Physiology The Stages of the Nursing Process
Group Study Rules Be very selective of the members of the study group Have each individual prepare a particular section for each group study session Limit the length of the study session
Individual Study Review Book Practice answering questions
Steps to Take night prior to test Plan to arrive on time Review information (formulas, names of common medications, etc.) Go to bed at a reasonable hour Use a relaxation exercise Look forward to the test
Day of Examination Avoid excessive oral intake of diuretics: coffee, tea, soft drinks, etc. Support your usual habit, but do not overdo it. Wear comfortable clothing Relaxation techniques –Posture –Breathing –Picture (visualization) –Relaxation word (Key word) –Breathing
Evaluation 1. What should the nurse do immediately before performing any procedure? 1. Shut the door B. Wash the hands C. Close the curtain D. Drape the patient
2. When providing care to a patient with a nasogastric tube, the nurse recognizes that the tube goes into the: A. Stomach B. Bronchi C. Trachea D. Duodenum
3. What should be the first action of the nurse when a fire alarm rings in a health- care facility? A. Close all doors on the unit. B. Take an extinguisher to the fire scene. C. Move patients laterally toward the stairs. D. Determine if it is a fire drill or a real fire.
4. What is the most common reason why older adults become incontinent of urine? A. The muscles that control urination become weak. B. Their increase in weight places pressure on the bladder. C. They use incontinence to manipulate and control others D. Older adults tend to drink less fluid than younger patients.
5. To best understand what a patient is saying, the nurse should: A. Demonstrate interest B. Listen carefully C. Remain silent D. Employ touch
6. When assisting a female patient with dementia to groom her hair, the nurse should: A. Offer constant support and encouragement B. Set time aside for a long teaching session C. Alternate using a brush and a comb D. Teach her how to braid her hair
7. An older adult who is dying starts to cry and says, “I was always concerned about myself first and I hurt many people during my life.” What is the underlying feeling being expressed by the patient? A. Ambivalence B. Sadness C. Anger D. Guilt
8. Range-of-motion (ROM) exercises should NOT be done: A. For comatose patients B. On limbs that are paralyzed C. Beyond the point of resistance D. For patients with chronic joint disease
9. On what part of the body should the nurse avoid using sop when bathing a patient? A. Eyes B. Back C. Under the breasts D. Glans of the penis
10. What position would be contraindicated for the patient who has dyspnea? A. Supine B. Contour C. Fowler’s D. Orthopneic