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Kaplan Online Review NCLEX -- Strategies and Information

front 1

Therapeutic Communication

back 1

1. Respond with feeling tone

2. Provide information

3. Do not ask "why"

4. No yes/no questions

5. Do not focus on the nurse

6. Do not explore

7. Never say "dont worry"

front 2

Therapeutic Communication

back 2

We communicate therapeutically with everyone in NCLEX land-> think "listen, reflect, provide info or ask open ended questions" listen to your client=what is the topic? (what do they want to talk about) and reflect on that topic

front 3

Who do you see FIRST

back 3

-The most unstable

(Who is going to die first)

-Compare each patient to the next; eliminate the more stable of the patients

-Consider:

ABC

Acute vs Chronic

Expected vs Unexpected

Actual vs Potential

-Eliminate each stable patient until you have most unstable

front 4

Assignment Strategy

back 4

RN: assessment, teaching, evalution

i.e. admit, discharge, change in condition, etc

LPN: stable patients with predictable outcomes

i.e. gather data, recognize norms, know sterile procedures

NAP: standard unchanging procedures

i.e VS, o2 sats, ADLs, blood glucose, etc (remember, if you would allow the patient to do it at home safety, most likely it would be safe for the NAP to do)

Think: it is a risk for aspiration? is it safe?

front 5

Decision Tree

back 5

Step 1: Topic

Step 2: Gathering Data vs Implementation

Step 3: Physical vs Psychosocial

Step 4: ABCs

Step 5: Outcome

-All outcomes must be safe and effective

front 6

ABC

back 6

Airway

Breathing

Circulation

front 7

Triage

back 7

Actual vs Potential

Acute vs Chronic

Expected vs Unexpected

ABCs

front 8

Decide if a question is...

back 8

Priority or Evaluation

front 9

Priority Questions

back 9

BEST, MOST, FIRST

-Use all 5 steps of the tree

-If it is a statement, even if is has priority words in it, it could still be an evaluation, but if it is an action, it is a priority

front 10

When gathering data

back 10

Decide if it is NEED to know or GOOD to know

front 11

If unsure if it is a priority or evaluation question...

back 11

Just go down the decision tree anyway

front 12

When a patient is using crutches..

back 12

they should come to about 1-2 in below axillary

front 13

5 Ps

back 13

Perastesia (no feeling)

Pulselessness (no pulse)

Pallor (pale)

Paralysis (cant move)

-Added by kaplan instructor

Poikilothermia (feels cool to touch)

front 14

Mantoux test

back 14

TB skin test

front 15

People before..

back 15

Paperwork

front 16

Dialysis

back 16

Feel the thrill

front 17

Hypercalcemia

back 17

Can damage CNS

(8.5-10.5)

front 18

Contraindications for birth control

back 18

Circulatory issues

front 19

Pay attention to extreme words

back 19

ALL, NEVER, ALWAYS, INSISTS, IMMEDIATELY, SUDDEN, REQUIRED, NONE, MOST, ONLY, etc

front 20

Mongolian spots

back 20

Bluish-black pigmented skin on an african american infant

front 21

Always chart...

back 21

detailed observations (paint the oncoming nurse a vivid picture)

front 22

What happens when a pregnant female lays on her back?

back 22

It compresses the vena cava flat and can cause her to faint (feel dizzy and nauseous at first)

front 23

Should a pregnant women receive live virus injections?

back 23

No, it should be done after baby is born and the women should not get pregnant for atleast 4 weeks after

front 24

Elderly+Antibiotics+Foul smelling stools=?

back 24

C. Diff= highly contagious Gi infection.

Elderly clients are at a greater risk for C. Diff related to atrophy (shrinks) of thier GI cells. Antibiotics destroy normal flora = C. Diff has a party and grows in the elderly population

front 25

Fires

back 25

RACE: Rescue, Alarm, Contain, Extinguish

front 26

Environmental temp..

back 26

can change skin color

front 27

When using crutches

back 27

Think up with the bad and down with the good

When going up the stairs, advance the good leg first.

When going down the stairs, advance the bad leg first

front 28

Conpartment Syndrome

back 28

Think 5 Ps

front 29

When in doubt, ask yourself...

back 29

Is this the safest option

front 30

When Studying Pharmocology

back 30

Study the classifications of meds (Antihypertensives) and each family in that classification (ACE inhibitors/Beta blockers/Calcium Channel blockers/Diurectics). The classification tells you what the meds action is (antihypertensives- decrease BP). The family generally will all act the same, have similar side effects, nursing considerations (ACE inhibitors – dry cough is an adverse reaction). Understand the action and effects on the body. Pay attention to nursing consideration.

front 31

Strategy for answering questions

back 31

If your topic includes something you "suspect" is happening -> a data answer that "validates/confirms" (gives you concrete evidence of what you thought was happening) = an appropriate priority answer option. You want to confirm what you suspect before you implement thus that data answer helps you help the client/situation.

front 32

Decision Tree

To help you remember, and so you can take with you during your NCLEX exam -
Use Your Hand! Raise it high and wave it--You have the answer!

back 32

-First finger - index finger = Step 1 Identify your topic *points you in the right direction.
Read the stem only (question not the answers)
rephrase into 2-3 of your own words
not sure - take a look at your answer options for clues

-2nd Finger - Middle finger = Step 2 Data vs Implementation
*this is usually the most difficulty step to understand--that is why it is the middle finger ;-) *(Do you need more date before you flip the person off or are you going to go ahead and implement it?) Determine if you need more data or validate (confirm) what you are thinking with more data or you need to “do” something about the problem (implementation).
An "action" that gives you data about the client or situation is a “data” answer option (VS, physical assessment findings, asking questions, Lab values/results, etc)
An "action" that does something for your problem/situation and does not give you data = implementation (sitting patient up, turning patient, give O2, give meds, etc)
The NCLEX tests your thinking on "do you know when you need more information (data) or do you know when you have enough information and you need to "do" something for a problem/situation (implementation)
If you have a mix (data and implementations)--then you have the ability to prioritize and eliminate answer options. The NCLEX is testing your thinking!
Start with looking at the assessment answers first and determine if you need more "data" in this situation, if it makes sense for the topic, and if it may confirm "validates" what you were thinking. Then the assessment is appropriate -- hold on to it.

**Validation = "confirms" what you were thinking. An example is you have a client that is diabetic and jittery -- you think (“suspect”) possible "hypoglycemia". A data answer that "validates" what you were thinking would be "getting the blood sugar". The blood sugar gives you concrete evidence -**validation** of what you thought was going on. A data answer that “validates” is an appropriate priority answer option.

-3rd Finger -Ring Finger = Step 3 Maslow - Physical vs Psychosocial
*ring finger signifies marriage - thoughts/feelings, social activities, emotions, love, belonging
Physical answer options are needed to survive = air, water, food, shelter, safety, etc.
Psychosocial answer options are not needed to survive = emotions, thoughts/feelings, love/belonging, social activities, emotional support, teaching for later use, expected pain,etc.
Physical answer options take priority over psychosocial answer options = Eliminate psychosocial answer options if they do not make sense -> think "what will kill them first"
*** Expected pain is considered psychosocial but think better -> if pain is indicative of being severe/sudden and/or a physical problem (loss of life/limb/organ) then consider it physical. Severe pain can cause “shock” which is a threat of loss of life.

4th Finger -pinky-Step 4 ABC's
*pinky = prioritize - Use the ABC's, *pinky promise to prioritize
Airway, Breathing and Circulation answer options take priority over other answer options.
When you have all Physical answer left, use the ABC's to prioritize your answer options.
** Your correct answer will address the topic -> Think Better -- remember that if you have a circulation problem, you need a circulation answer. If you have a breathing problem, you need a breathing answer. Do NOT just go for the breathing answers.

5th Thumb = Step 5 Evaluation
*it is your THUMBS UP--as long as you think about what the outcome is and that it makes sense --you are OKAY
What is the outcome, if I do this what will be the outcome?
Does this make sense for my topic? Does it help me here and now?
Is this safe and effective?
If I can do 1 thing and walk away, will this help me help my client?

***Now, you can't raise that hand unless you have your arm--**remember your arm is your content review
-for your hand to work, you must have your arm--you must review content.
Use the Decision Tree with every question. Questions can either be Evaluation questions and/or Priority questions. With Evaluation questions – use the shortcut Step 1 and Step 5 (know your topic and evaluate whether it is a true/false statement). With Priority questions use all the steps within the Decision Tree to find the priority answer. Steps 2 through 4 help you to prioritize and Eliminate answer options that are not priority to find the best answer option. Also remember to think about priority questions as “If I can do 1 thing and go home”.

You CAN do it –the Decision Tree will help you think better and get you were you need to be. Stay in control of every question and be confident with the strategies you have learned and practiced. Remember –as long as you are getting question = you are still in the game –don’t give up.

front 33

Think before you answer...

back 33

Is your topic a physical or psychosocial topic? your answer should match

i.e You want to know if your client is in pain.. Topic: pain (psychosocial) Answer: Ask you client to rate the pain (psychosocial)

A wrong answer would be.. Observe your clients urinary cath.. It didnt say your client was unconscious so you would ask first.

front 34

RICE

back 34

Rest Ice Compression Elevation

(moderate ankle sprain)

front 35

Balanced suspension traction

back 35

Weights should be hanging freely

front 36

DASH Diet

back 36

Dietary Approaches to Stop Hypertension

-fruits, veggies, potassium, decreased salt, etc

front 37

PEG Tube

back 37

Percutaneous Gastrostomy Tube

-sewn in

-you want to compare tube length to the measurement recorded after insertion to verify placement

-want in high fowlers

-warm feeding to room temp

front 38

Tubes

back 38

Remember, tubes are just an extension of your patient, observe before reporting, unless life threatening

ie Patient with a urinary cath complains of having the need to urinate... You will want to observe for kinks, etc

*Never secure tubing to bed linens or rail but upper abdomen is okay

front 39

Isometric

back 39

Same length

-So if your patient was preforming isometric exercises you would want the muscle to stay the same length, no stretching, so i.e placing the foot on the ground and pushing down, it is cramping the calf muscle but it is not stretching it

front 40

COAL

back 40

Cane Opposite Affected Leg

-Remember up with good, down with bad

-Cane should be at the level of the greater trochanter

front 41

If a patient has had a long leg fracture...

back 41

Shortness of breath is indicator of fat embolism

-24-72 hours post fracture is highest risk

If high respiratory rate with some apnea is a answer, it is not right. Even though apnea may be more severe than shortness of breath, you have to read the whole answer. The high respiratory rate is compensating for the apnea. So, in this case, shortness of breath is more extreme

front 42

"Do not explore" Therapeutic Communication.

What does it mean?

back 42

It mean exploring the patients delusions or hallucinations

front 43

Depression-- aceSS

back 43

Lower case-- decreased

-appetite

-concentration

-energy

Upper Case-- Increased

-Social Isolation

-Sleep

front 44

Withdrawal Tip

back 44

No matter the substance, withdrawal is the opposite of the effect of the substance

i.e Alcohol is a depressant, so therefor, the withdrawal effects will be stimulation.. cant sleep, diarrhea, shaky hands, tremors, etc

front 45

Alcohol Withdrawal

back 45

CNS stimulation-- excitability-- mild symptoms occur 6-12 hours after last drink

front 46

Tip on Cocaine

back 46

Stimulant will effect the heart-- tachycardia

front 47

Stages of Grief-- SAR

back 47

Shock and disbelief

Awareness of the pain (loved one was experiencing)

Restitution/Resolutions

front 48

TIP

back 48

If the face is red, raise the bed

If the face is pale, raise the tail

(trouble breathing--face will be read-- raise the HOB)

(If in shock--face is pale--trendelenburg--feet up head down)

front 49

When positioning.. think..

back 49

What are you trying to prevent?

What are you trying to promote?

front 50

Urine specific gravity

back 50

1.002 and 1.030

The higher the # the less fluid--dehydration-- urine is more concentrated therefor weights more

The lower the # the more fluid--more diluted--fluid overload--weights less

front 51

Urine output

back 51

Minimum- 30ml/hr (not normal but stable)

Normal: 1500mL/day (about 62.5ml/hr)

front 52

Heart Failure

back 52

Left--Lungs

Right--Rest of body

front 53

Erbs Point

back 53

Left sternal border, 3rd intercostal space

--Think.. E backwards is 3 (and it rhymes)= 3rd intercostal space

front 54

Valve sounds

back 54

All People Eat Taco Meat

Aortic

Pulmonic

Erbs point

Tricuspid

Mitral (bicuspid or apical)

front 55

Homonymous Hemianopsia

back 55

Can happen with a stroke

-Loss of half of the vision in both eyes and is common with Unilateral Neglect

-patient may turn head side to side when eating

front 56

Herbals

back 56

If its got a G it'll make 'em bleed

-Ginko, Garlic, Ginseng, etc

front 57

St johns wart

back 57

Contraindication for blood thinners because it can act like vit K

front 58

MRI concerns

back 58

Metal in the body (M&Ms) (MRI & Metal)

-Pearcings, Intra-uterine implant, pacemaker, etc

front 59

For a Fem-pop bypass..

back 59

You never want to remove the dressing just reinforce (you cant see insertion site)

-If you believe the patient may be bleeding internally, check BP

front 60

Side Effects vs Adverse Effects

back 60

SE- more common, less severe

AE- more intense, more life-threatening

front 61

Cephalosporins and Penicillin

back 61

Are cousins, share some of the same reaction

Patient that is allergic to one may be allergic to the other

front 62

What lab to look at with Warfarin?

back 62

INR

front 63

What lab to look at with Heprin?

back 63

PTT

Think--Ptt--squish the 2 Ts together (tt) and you have an H (heprin)

front 64

Ace Inhibitors

back 64

Give them Ace they will cough in you face

-Common adverse reaction is dry cough

front 65

Stupor

back 65

Not responsive

front 66

Albuterol

back 66

Stimulates lungs--stimulates side effects--tachycardia

Think--did we stimulate TOO MUCH? Is patient stable?

front 67

Nitropatch

back 67

Should be removed at night to reduce the chance of tolerance build up

front 68

NCLEX land

back 68

Is a perfect world, you have everything you would ever need

-keep personal experience out!

-You only have 1 patient unless otherwise stated

front 69

When answering

back 69

Eliminate wrong answer first

-Answer must relate to topic

-If one part of the answer is wrong, The WHOLE thing is wrong

-Is this the safest answer?

-no "What-ifs"

-If question says left or right side, take your hand and place it on that side so that you dont forget

front 70

Vertical Chain of command

back 70

When supervisor is notified

front 71

Strategy for answering Risk factor questions

Who is at high risk?

back 71

Go through each answer and make a tally for each risk in that answer and at the end put the number of tallys in order and boom you have your answer

front 72

Peripheral vs Central Cyanosis

back 72

Understand that "core measure" (inside the body) gives us the best info on client status. Environmental temp can change skin color. note the pattern--ear, hands, and lips are on the periphery/Conjuctivae is encased in the body (core)