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. f. or NCLEX-RN. ®. Success: . Strategies to . Correctly . Answer Questions. Developed by: Staja “STAR” Booker, MS, RN. Reviewed and . Approved . by: Alumni Webpage Committee. © 2011-14. Originally . ID: 491255 Download Presentation

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Slide1

Pearls

for NCLEX-RN® Success: Strategies to Correctly Answer Questions

Developed by: Staja “STAR” Booker, MS, RNReviewed and Approved by: Alumni Webpage Committee

© 2011-14

Originally

Developed for:

MACaN

@ Penn

State

Slide2

PEARLS for NCLEX Success

PEARLS

P

ractice questions and

P

ray often

E

xamine the

E

ntire question and all answers

A

void reading into the question and

A

pply your knowledge and skills

R

eview everyday and

R

est often

L

isten to your “first mind”

S

tudy difficult concepts and keep

S

tress to a minimum

Slide3

Outcomes

After completion of this presentation, learners will be able to:

--Appreciate and recognize importance of critical thinking, clinical judgment, clinical reasoning, and sound decision-making

--Identify the introductory statement, information distracters, and the stem of questions

--Identify the four elements in a question

--Demonstrate ways to isolate the correct answer(s)

--Gain confidence in answering NCLEX-style questions

--Recognize different types of

questions

Slide4

NCLEX Readiness Assessment

Complete the “Readiness for NCLEX Assessment” provided on this page webpage. This will help you identify areas that you need to spend additional time studying and practicing

Slide5

2013 NCLEX Content Areas

Slide6

NCLEX is a computer adapted test (CAT).

FYI

NCSBN

CAT video

:

https

://

www.ncsbn.org/3761.htm

Slide7

Computer Adaptive Testing (CAT)

You can’t skip or review NCLEX questions on the computer. Once you click Next, the questions are GONE!!

There is a tutorial at the beginning of the NCLEX to make sure your computer is working correctly and to ensure that you understand the directions. You will be given a couple of sample questions.

Your computer will automatically shut down after you have or have not demonstrated minimal competency.

Minimum questions – 75 Maximum questions – 265

15 items are “test” questions & are not scored

Slide8

Zerwehk, J., Claborn, J.C., & Miller, C.J. (2008). Memory notebook of nursing. (Volume 1, Ed. 4). Ingram, TX: Nursing Education Consultants.

Slide9

Review NCLEX test planPearson VUE NCLEX tutorial http://www.pearsonvue.com/nclex/#tutorial

Slide10

ˈTwas the night before NCLEX…

Do not study heavily. Use this day to relax, clear your mind, and reflect. If you must study, review core principles of nursing care.Gather the necessary materials you will need to take with youDo not drink alcohol or take mind-altering drugsSleep wellAvoid “negativity” and think positively. Decree and declare, “I will pass NCLEX the first time and become an excellent RN!”Dress comfortably

Slide11

Eat a light meal before the test to prevent your blood sugar from dropping.Arrive to the testing site 30min – 1 hour early.Have acceptable form of ID!! Don’t bring family, friends, or kids.You will 1) be photographed, 2) fingerprinted, 3) have your palm veins scanned, and 3) provide your digital signature.A plastic bag for storage or a locker will be assigned to you to secure all possessions. NOTHING goes into the computer room but your body, exceptions for those with cultural or religious needsYou will be given a dry erase board if you need to write information or do calculations– but no purging of knowledge.Time Allotted – 6 hours (you can take breaks but the clock doesn’t stop)

Slide12

Receive “unofficial” results 48 hours after the exam. This service is available for $7.95 on Pearson VUE website.PASS- YAY! get license number, a job, and begin practicingFAIL- Never give up. Can retake in 45 days. Will need to register, pay, etc. all over again.You'll receive an NCLEX Candidate Performance Report (CPR) which is an individualized document that shows how you performed in each of the test plan content areas.

Slide13

https://www.ncsbn.org/nclex.htmSee “The 8 Steps of the NCLEX” at https://www.ncsbn.org/2013_Eight_Steps_of_NCLEX.pdf

NCSBN Website

To learn more about NCLEX:

Slide14

KEEP THIS IN MIND

When answering NCLEX questions, keep these two statements in mind:

If I can only do one thing now….What will cause my patient least harm and most benefit?

Slide15

You betta check yo’ self!

Remember ABCs or CABs (appropriately)Know how to care for prevalent health conditionsKnow normal lab levelsKnow principles of infection prevention and control & various precautionsPrioritizationBetter safe than sorry!

Slide16

Misreading questions is a common reason why students answer question wrong.

TOPIC 1: Misreading Questions

Slide17

Misreading Questions

Do not misread questions. This can occur if you:

Read into the question: if it doesn’t say it, then don’t add it to the scenario.

Incorrectly analyze what the question is really asking you

Overlook key words

Misinterpret a disorder

Read question too fast

Slide18

Misreading Questions

The brain can read something that is not there, but it is important to take your time and analyze exactly what is presented.

If it doesn’t say it in the question, then don’t assume or add anything. Granted, there are things that you should know and/or gather from the situation presented.

For example

, if a question said that urine output per hour was below normal, then you can accurately conclude that output was less than 30ml/hr. But if it the question said that the urine was abnormally colored then you can’t assume that the urine was dark amber…it could be red, blue, orange, etc.

Slide19

Misreading Sentences

Look at this example…let’s read it aloud.

Paris in the

the spring time

Slide20

Misreading Sentences

Did

you catch that there are 2 “

the

s

” in the

phrase?

You most likely read the statement like this: “Paris in the spring time” when it really says “Paris in

the

the

spring time”

Slide21

Misreading Sentences

Here’s

another example…count the number of

F

s

below

.

Finished files are the result of years of scientific study combined with the experience of full years.

Slide22

Misreading Sentences

Did you count 7

F

s

?

F

inished

f

iles are the result o

f

years o

f

scienti

f

ic study combined with the experience o

f

f

ull years.

Slide23

Misreading Sentences

Read this sentence aloud.

Every 8 out of 10

hunans

report they are unhappy with their career choice.

Slide24

Misreading Sentences

Now how many of you read “

Every 8 out of 10

HU

M

ANS

report they are unhappy with their career choice.”

T

he word was

HU

N

AN

.

Slide25

Misreading Sentences

Misreading sentences can cause you to miss key information.

Take your time reading scenarios and understanding what the question is asking.

Slide26

RACE Model

Recognize

Ask

Critically analyze

Eliminate

Slide27

RACE Model

RECOGNIZE

what kind of information in the stem.

Recognize key words in the stem.

Recognize who the client is in the stem.

Recognize what the topic is about.

Slide28

RACE Model

ASK

what

is the question asking

?

Ask what are the key words in the stem that indicate the need for a response.

Ask what is the question is asking me to do

Slide29

RACE Model

CRITICALLY

analyze the options in relation to the question asked in the stem.

Critically examine each answer option in relation to the information in the stem

(

do the answers even match the information in the stem?

)

Critically identify a rationale and risk/benefit for each option

Critically compare and contrast the option in relation to the information in the stem and their relationships to one another

Slide30

RACE Model

ELIMINATE

as many answer options as possible

Eliminate one option at a time (determine if any answer options were in your “pool” of answers)

If any part of the answer is wrong, the entire answer is all wrong

Usually the answer that is most different from the other answer options is correct

Slide31

TOPIC 2: Parts of a Question

Slide32

Parts of a Question

Each question has 3-4 parts:

I

ntroductory statement

Clinical Information Distracters (

sometimes

)

Stem

Four answer options with 3 answers being distracters and 1 correct answer

(unless it is select all that apply/multiple select)

Slide33

Parts of a Question

ITEM

Slide34

Introductory Statement

The introductory statement tells you about the client’s situation, health problem, or clinical status that you should consider when answering the question.

The introductory statement sets up the scenario.

Slide35

Introductory Statement

Example:

Mr. Wilson is prescribed an iron supplement and an increased intake of Vitamin C in his diet.

The nurse understands that the best rationale for increasing Vitamin C in the diet is to:

Slide36

The Invisible Gorilla Challenge

http://www.theinvisiblegorilla.com/videos.html

Closely count the number of passes made by basketball players in white shirts.

Slide37

Distracters

1.

Did anyone see the gorilla that appeared halfway through the video?

Well that gorilla appeared to distract you, and sometimes information in questions and answers are simply there to distract you.

If you saw the gorilla and it threw you off from counting, you have to be careful about allowing distractor information in questions throw you off.

Slide38

Distracters

Distracter information in questions or answers is just that – it

distracts

,

detracts

, and

subtracts

from the main issue.

It is information that provides additional detail but does not necessarily help to answer the

question.

Slide39

Distracters

You must keep

your

mind

on

what the question is asking and what the answer is answering.

Likewise,

in practice, you

should avoid allowing

non-emergent issues distract you

from critical tasks…

(medication administration,

receiving or reporting critical labs, charting

,

report

, etc.)

because this increases

risk of nursing errors.

Slide40

Awareness of Distracters

On the flip side, failing to see the gorilla is reflective of inattentional blindness. Sometimes we overlook key points in the question (e.g. misread questions) and we read (or see) what we want to you read (see).

Slide41

Contributing Factors of Inattentional Blindness

Mental Capacity – how much your mind you “hold”; fatigue, stress, drugs and alcohol, sleep deprivation all decrease mental capacityConspicuity – physical properties of an image; we notice things that are bright, flicker, and move, italicized, bolded, all caps, etc.; NCLEX does not provide any of these sensory hints.Expectation – seeing what we believe or know; If something was correct the first three times you checked you may miss that it is incorrect the fourth timeMental Workload – how much is on your mind; although we are expected to multitask, if your mind is overloaded and attention is diverted there is increased risk for errors; Example: You are talking to a NP on the phone and fail to hear the ventilator alarm

Slide42

Distracters in Questions

Example:

Mrs. Jackson was admitted to the medical-surgical unit for a COPD exacerbation, but she is currently stable.

She is in normal sinus rhythm (NSR) and her blood glucose is 143.

Which rationale best explains why Mrs. Jackson is only prescribed 2L oxygen?

Slide43

Distracters in Answers

Mr. Ron is a

thirty five year old

male in the trauma ICU post MVA. A nasogastric tube has been inserted for feeding and medication delivery. Which part of the body requires special hygiene for a patient with a nasogastric tube?

Rectum

Abdomen

Oral cavity

Perineal

area

Slide44

Stem of a Question

The STEM is the portion of a question that “asks” the nurse to solve a specific problem by implementing a nursing action.

This is usually the actual “question.”

However, the stem may not be a separate sentence, but it may be a part of the introductory statement.

Slide45

Types of Stem

2 types of Stem:

--Appropriate action

(what the nurse should do, or did correct)

(what the patient should do or did correct)

(what

is true) –

Positive polarity

--Inappropriate action

(what the nurse

shouldn’t

do, or did

incorrect

)

(what the patient

shouldn’t

do or did

incorrect)

(what

is false) –

Negative polarity

Slide46

Stem of a Question

Example of STEM as a separate sentence:

During dinner, a client puts on her call light. When the RN enters the room, she notices that he is grabbing his chest and complaining of severe chest pain.

What action should the nurse take first?

Slide47

Stem of a Question

Example of STEM as part of the introductory statement:

After inserting a nasogastric (NG) tube in a patient for nutritional tube feedings, it is important to:

x

xxxxxxxxxxxxxxxxxxxxx

x

xxxxxxxxxxxxxxxxxxxxx

x

xxxxxxxxxxxxxxxxxxxxx

xxxxxxxxxxxxxxxxxxxxxxx

Slide48

TOPIC 3: Elements of a Question

Slide49

Elements of a Question

There are four elements in each test question:

S

ubject

I

ssue or problem

K

ey words

Appropriate or Inappropriate Action (i.e. answers)

Slide50

Step # 1

Identify the subject.

Slide51

The Subject

The subject is the focus of the question.The subject can be a patient (or client), nurse, family member(s), or colleagues.REMEMBER the answer choice you select must relate to the subject.

Slide52

The Subject

Example:A 23 year old female arrives at the ED after collapsing at home. She has no pulse or respirations. Which of the following accurately describes the cardio-pulmonary resuscitation process?So who is the subject? The 23 year old femaleIs she the patient, nurse, or family member? patient

Slide53

Step # 2

Identify the issue or the topic

THEN determine

Is further assessment needed?

Is it appropriate to apply ABCs or CABs?

Slide54

The Issue

The issue is the specific problem that the question is asking about.

Make sure you pay attention to what the question is

specifically

asking you about.

The issue is not necessarily the same as the patient’s admitting diagnosis. The question may tell you what the diagnosis is, but may not ask you anything about it.

Slide55

The Issue

An HIV + patient is admitted to the hospital with a tuberculosis (TB). Which of the following isolation categories should be implemented in order to prevent transmission of the HIV virus and tuberculosis? Select all that applyStrict isolationRespiratory precautionsUniversal precautionsEnteric precautionsWhat is the issue?Prevention of transmission of HIV and TB

Slide56

Step # 3

Identify Key Words

Slide57

Key Words

Key words are the important words in a question that should focus your attention on critical ideas in the stem and answers.

Key words can be positive, negative, urgent or absolute (i.e. definite).

Slide58

Key Words

CAN YOU THINK OF SOME KEY WORDS YOU HAVE SEEN ON YOUR EXAMS?

Slide59

Examples of Key Words

should domost likelyappropriateeffectivetrueinclude(d)indicatedconsistentrealisticcorrectnot neededsafebest

leastunlikelyexceptinconsistentinappropriatecontraindicatedfalsenotincorrect/wrongunrealisticneed…unsafeLate

Positive

Negative

Urgent

Priority (high or low)

first

initial(

ly

)

immediate(

ly

)

most important

STAT

now

early

prior

primary

q

uickly

Essential

mandatory

Slide60

Examples of Key Words

AlwaysNeverAllCompletelyOnlyThese terms usually make answers false!!

Absolute (Definite)

Inexact

Possible/y

UsuallyMaySomeOftenMost ManyMainlyThese terms often makes answers true.

Directionality

Maximum

Minimum

High

Low

Slide61

Examples of Key Wordsfor The Nursing Process

PlansGoalsDevelopsDetermine

Planning

Assessment

Assess

Ascertain

Gather

Collect

Determine

Identify

Monitor

Observe

Obtain (information)

Recognize

Find out

Check

Slide62

Examples of Key Wordsfor The Nursing Process

ExpectsDemonstratesDisplays understandingObservesAnticipatesEvaluateAchieveInterpret

Evaluation/Outcomes

Interventions

Intervenes

Apply(

ies

or

ication

)

Implements

Slide63

Key Words

Example:

When beginning an IV, the nurse

s

hould

first:

x

xxxxxxxxxxxxxxxxxxx

x

xxxxxxxxxxxxxxxxxxx

x

xxxxxxxxxxxxxxxxxxx

xxxxxxxxxxxxxxxxxxxx

Slide64

Step # 4

Identify

appropriate or inappropriate

nursing action

Slide65

Appropriate or Inappropriate Action

Mentally create a pool of answers

Then, examine each answer choice given and determine which outcome best answers the question

Your first answer may not be an option, so choose the 2

nd

best, safe answer.

Slide66

Make Mental Answers

An older adult with heart failure, Parkinson’s disease,

Lewy

body dementia, sleep apnea, and peripheral vascular disease is having trouble sleeping at night. He already takes many medications, and his wife does not want to add any additional ones. What non-pharmacological strategies may be safe to implement to aid in sleep?

Slide67

Answer Options

Give warm herbal tea 15 minutes before bed

Administer melatonin pills

Play soothing music on a low volume and dim lights

Talk to the older gentleman for an hour

Slide68

Make Mental Answers

What should the nurse do immediately before performing any procedure for a patient?

Slide69

Answer Options

Select all that apply

Shut the door

Wash hands

Close the curtain

Explain the procedure

Ask for patient’s permission

Slide70

Putting It All Together

An elderly confused man is on bed rest due to a DVT in his right leg. Which intervention will not effectively provide for this patient’s safety?Who is the subject?Elderly manWhat is the issue?SafetyWhat are the key words?Will not effectivelyWhat are the distracters?NoneWhat would you do? (your pool of answers)Let’s examine each answer and determine which will effectively provide safety.

Slide71

Putting It All Together

An elderly confused man is on bed rest due to a DVT in his right leg. Which intervention will not effectively provide for this patient’s safety

?

Provide regular toileting by bedpan

Explain to the man that he should use the call light if he needs to get up

Place 3 side rails in the up position and check on the client often

Initiate proper use of restraints

Place the bed in lowest position

Slide72

QUESTIONS?

Slide73

TOPIC 4: Answer Option Tips

Slide74

Answer Option Tips

After reading the question, develop a pool of answers in your mind before looking at the actual answers provided.

Answer the question, as if the situation is ideal or “textbook perfect.”

Your first choice may not be there, so choose the next best answer.

Three of the answer options are there to distract you, so make a decision on each before continuing.

Make a yes/no decision on each answer choice before moving to the next answer choice.

Slide75

Answer Option Tips

Look at how words or actions are grouped. Are all the answers physiological, intervention-centered, assessment, etc.?? There is only one best answer. No test question on NCLEX is keyed for two responses unless it is select all that apply.Go with your “first-mind”; never change your answer!!!If you do not know the answer, make your best educated guess and move on. Don’t spend more than 1-1.5 minutes/question.

Slide76

Answer Option Tips

Do not focus only on your experiences, which may be too narrow for a point of reference

FOCUS

ON WHAT YOU KNOW AND NOT ON WHAT YOU DON’T KNOW

!!!

Scope

of practice - Be able to differentiate the need for nursing judgment from the need for physician judgment

.

Watch out for

answer choices that are factually correct on their own, but fail to answer the question, and so are actually wrong.

Slide77

Answer Option Tips

Select

responses

that are:

Therapeutic and patient-centered

Show respect

Communicate

acceptance

Eliminate

responses that are:

Obviously wrong

Inappropriate and non-therapeutic

Partially true

In some instances, rule out an option if you know it is associated with something else. For example, you may not know about the laboratory values for warfarin therapy, but you do know the laboratory values for heparin and aspirin. Those values can be eliminated because you are “using what you know

.”

Slide78

TOPIC 5: NCLEX Question Formats

Slide79

NCLEX Question Formats

Multiple choice (one correct answer)

Alternate Item Formats

Multiple response (select all that apply)

Hot spots

Audio or Video

Drop-and-drag/ordered response

Chart exhibits

Fill-in-the

blank

(calculation

questions

)

Graphics (e.g. ECG rhythm)

Slide80

Slide81

Slide82

Slide83

Slide84

Slide85

Slide86

Slide87

NCLEX QUESTION

For a tutorial on alternate item NCLEX questions, click on the Alternate Test Item icon on the NCLEX resources webpage.

Slide88

The End

Star’s 106 year old granny

Slide89

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