ADDITIONAL NCLEX STRATEGIES

Additional NCLEX Strategies   ADDITIONAL NCLEX STRATEGIES STUCK IN A QUESTION? • Having problems answering a question? • The following strategies may help if you are having difficulty identifying the correct option. ADDITIONAL STRATEGIES • Eliminate options that contain closed-ended words • Eliminate options that contain medical rather than nursing interventions • Eliminate comparable or alike options • Ensure that all components of an option are correct • Select the umbrella option • Visualize the information • Look for comparable concepts in the question and one of the options • (Silvestri & Silvestri, 2016, p. 113) ELIMINATE OPTIONS THAT CONTAIN CLOSED-ENDED WORDS • Most options that contain closed-ended words are not correct • All Never • Always None • Cannot Not • Every Only • Must Will not • (Silvestri & Silvestri, 2016, p. 113) ELIMINATE OPTIONS THAT CONTAIN CLOSED-ENDED WORDS • Options that contain open-ended words may be correct. • Generally • May • Possibly • Usually • (Silvestri & Silvestri, 2016, p. 113) ELIMINATE OPTIONS THAT CONTAIN CLOSED-ENDED WORDS The nurse is providing dietary instructions to a client about a low-fat diet. The nurse should make which statement to the client? 1. “Never use butter for cooking.” 2. “Drink fluids only if they are fat free.” 3. “Eat foods that have less than 1% fat content only.” 4. “Read the labels on food items to determine the fat content.” • (Silvestri & Silvestri, 2016, p. 114) ELIMINATE OPTIONS THAT CONTAIN CLOSED-ENDED WORDS A client will undergo a barium swallow and the nurse provides pre-procedure instructions to the client. The nurse instructs the client to: 1. Avoid eating or drinking after midnight before the test. 2. Limit self to only two cigarettes on the morning of the test. 3. Have a clear liquid breakfast only on the morning of the test. 4. Take all routine medications with a glass of water on the morning of the test. • (Silvestri, 2012, p.28) ELIMINATE OPTIONS THAT CONTAIN CLOSED-ENDED WORDS A client is scheduled for a computerized tomography (CT) scan of the abdomen asks the nurse when the results of the test will be available. The nurse should make which response to the client? 1. “The results will not be available for at least 1 week.” 2. “You must ask the CT technician for that information.” 3. “Your health care provider (HCP) may have the results in about 3 days.” 4. “Every scan is read by a radiologist, and this process always takes 1 week.” • (Silvestri & Silvestri, 2016, p. 114) ELIMINATE OPTIONS THAT CONTAIN MEDICAL RATHER THAN NURSING INTERVENTIONS • NCLEX is a nursing exam. • Focus on nursing interventions rather than medical ones. • Only select a medical intervention if the question asks you to do so. • Example: Which intervention does the nurse anticipate to be prescribed? • (Silvestri & Silvestri, 2016, p. 115) ELIMINATE OPTIONS THAT CONTAIN MEDICAL RATHER THAN NURSING INTERVENTIONS The nurse is caring for a client with a diagnosis of heart failure who suddenly experiences severe dyspnea and suspects that pulmonary edema has developed. What is the immediate nursing action? 1. Insert a Foley catheter 2. Place the client in high-Fowler’s position. 3. Obtain a vial of furosemide and a syringe. 4. Obtain a dose of morphine sulfate from the medication drawer. • (Silvestri & Silvestri, 2016, p. 115) • Hint: Which action does not require a prescription? ELIMINATE OPTIONS THAT CONTAIN MEDICAL RATHER THAN NURSING INTERVENTIONS The nurse is admitting an infant to the pediatric unit with a diagnosis of respiratory syncytial virus (RSV). The nurse anticipates that the health care provider will prescribe which measure? 1. Ribavirin 2. A private room 3. Contact precautions 4. Strict handwashing procedure • (Silvestri & Silvestri, 2016, p. 115) • Hint: Which action requires a prescription? ELIMINATE OPTIONS THAT CONTAIN MEDICAL RATHER THAN NURSING INTERVENTIONS A nurse admits a client with myocardial infarction (MI) to the coronary care unit (CCU). The nurse plans to do which of the following in delivering care to the client? 1. Begin thrombolytic therapy. 2. Place the client on continuous cardiac monitoring. 3. Infuse intravenous (IV) fluid at a rate of 150 mL per hour. 4. Administer oxygen at a rate of 6 L per minute by nasal cannula. (Silvestri, 2012, p. 154) ELIMINATE COMPARABLE OR ALIKE OPTIONS • Eliminate options that are comparable or alike with regard to context. • The correct answer will be the option that is different. • (Silvestri & Silvestri, 2016, p. 116) • One of these things is not like the others. ELIMINATE COMPARABLE OR ALIKE OPTIONS The nurse is preparing a plan of care for a client who will be receiving a blood transfusion. The nurse should write which intervention in the plan that relates to monitoring for a transfusion reaction? 1. Weigh the client before and after the transfusion. 2. Check the client’s lung sounds hourly for crackles. 3. Monitor the client’s temperature during the transfusion. 4. Monitor the client’s intake and output during the transfusion. • (Silvestri & Silvestri, 2016, p. 116) ELIMINATE COMPARABLE OR ALIKE OPTIONS The nurse is assessing the leg pain of a client who has just undergone right femoral-popliteal artery bypass grafting. Which question would be most useful in determining whether the client is experiencing graft occlusion? 1. “Can you describe what the pain feels like?” 2. “Can you rate the pain on a scale of 1 to 10?” 3. “Did you get any relief from the last dose of pain medication?” 4. “Can you compare this pain to the pain you felt before surgery?” • (Silvestri, 2012, p. 27) ENSURE THAT ALL COMPONENTS OF AN OPTION ARE CORRECT • Options may contain two parts separated by the word and. • Read both parts of the option. • If one part of the option is incorrect, the entire option is incorrect. • (Silvestri & Silvestri, 2016, p. 117) ENSURE THAT ALL COMPONENTS OF AN OPTION ARE CORRECT The nurse is performing an assessment on a client diagnosed with a cataract of the right eye. The nurse should expect to obtain which data on assessment? 1. Reports of eye pain and a cloudy white pupil. 2. Reports of a frontal headache and photophobia. 3. Reports of gradual loss of vision and photophobia. 4. Reports of blurred vision and excessive tearing of the eye. • (Silvestri & Silvestri, 2016, p. 117) • Hint: Difference between manifestations of cataract and glaucoma. • Cataract: cloudy white pupil, photophobia • Glaucoma: eye pain, frontal headache, excessive tearing ENSURE THAT ALL COMPONENTS OF AN OPTION ARE CORRECT A client with a history of respiratory disease has experienced sudden onset of chest pain and dyspnea and is diagnosed with pulmonary embolism. The nurse immediately implements which expected prescription for this client? 1. Semi-Fowler’s position, oxygen, and morphine sulfate intravenously (IV). 2. Supine position, oxygen, and meperidine hydrochloride (Demerol) intramuscularly (IM). 3. High-Fowler’s position, oxygen, and meperidine hydrochloride (Demerol) intravenously (IV). 4. High-Fowler’s position, oxygen, and two tablets of acetaminophen with codeine (Tylenol #3) • (Silvestri, 2012, p. 100) SELECT THE UMBRELLA OPTION • Umbrella options are general statements that incorporate other options. • If more that one option appears correct, look for the umbrella option. • (Silvestri & Silvestri, 2016, p. 117) SELECT THE UMBRELLA OPTION In a telephone call from emergency medical services (EMS), the nurse in the emergency department is told that several victims who survived a plane crash and are suffering from cold exposure will be transported to the hospital. What is the initial nursing action by the nurse? 1. Call the nursing supervisor to activate the agency disaster plan. 2. Supply the trauma room with bottles of sterile water and normal saline. 3. Call the intensive care unit to request that nurses be sent to the ED. 4. Call the laundry department to request warm blankets. • (Silvestri & Silvestri, 2016, p. 118) SELECT THE UMBRELLA OPTION The home care nurse is caring for a client who has just been discharged from the hospital after implantation of a permanent pacemaker. A priority nursing action to maintain a safe environment for the client would be to assess the client’s home for the presence of: 1. Hair dryers. 2. Electric blankets. 3. Electric toothbrushes. 4. Items that have strong electric currents or magnetic fields. • (Silvestri, 2012, p.28) VISUALIZE THE INFORMATION • Form a mental image of the situation. • Place yourself as the nurse in the scenario. • May recall a similar situation and recall what was done. • (Silvestri & Silvestri, 2016, p. 121) • Be careful to not add details or ask “What if…”. Stay with the given scenario. VISUALIZE THE INFORMATION The nurse prepares to perform a sterile dressing change on an abdominal incision. The nurse explains the procedure to the client, washes her hands, and sets up the sterile field. The nurse should take which action next? 1. Don sterile gloves. 2. Assess the integrity of the abdominal incision. 3. Don clean gloves to remove the old dressing. 4. Clean the wound as prescribed. • (Silvestri & Silvestri, 2016, p. 121) VISUALIZE THE INFORMATION The nurse is caring for a client with a herniated lumbar intervertebral disk who is experiencing low back pain. The nurse plans to place the client in which position to minimize the pain? 1. Flat with the knees raised. 2. High Fowler’s position with the foot of the bed flat. 3. Semi-Fowler’s position with the foot of the bed flat. 4. Semi-Folwer’s position with the knees slightly raised. • (Silvesrtri, 2012, p.39) LOOK FOR COMPARABLE CONCEPTS IN THE QUESTION AND ONE OF THE OPTIONS • Read the question carefully. • Note the keywords including the subject of the question. • Look for the option that has comparable or alike concepts, with a relationship to those in the question. • This may be the correct option • (Silvestri & Silvestri, 2016, p. 122) LOOK FOR COMPARABLE CONCEPTS IN THE QUESTION AND ONE OF THE OPTIONS A client is admitted to the hospital with a diagnosis of pericarditis. The nurse assesses the client for which manifestation that differentiates pericarditis from other cardiopulmonary problems? 1. Anterior chest pain. 2. Pericardial friction rub. 3. Weakness and irritability. 4. Chest pain that worsens on inspiration. • (Silvestri & Silvestri, 2016, p. 122) LOOK FOR COMPARABLE CONCEPTS IN THE QUESTION AND ONE OF THE OPTIONS Both the client who had cardiac surgery and the client’s family express anxiety regarding how to cope with the recuperative process when they are home alone after discharge. The nurse plans to tell the client and family about which available resource? 1. The United Way 2. The local library 3. The American Cancer Society Reach for Recovery 4. The American Heart Association Mended Hearts Club • (Silverstri, 2012, p. 378) REFERENCES • Silvestri, L. A. (2012). Saunders Q&A review for the NCLEX-RN examination (5th ed. ). St. Louis: Elsevier • Silvestri, L. A. & Silvestri, A. (2016). Saunders strategies for test success: Passing nursing school and the NCLEX exam (4th ed. ). St. Louis: Elsevier