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NCLEX PREPARATION PROGRAM

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NCLEX PREPARATION PROGRAM MODULE 1 Overview, Assessment Testing Preparing to be Successful on the NCLEX-RN Philosophy of Learning The Adult Learner is Unique! – PowerPoint PPT presentation

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Title: NCLEX PREPARATION PROGRAM


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

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 dont change readily
  • 10. Want practical answers for todays
  • 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
If you have identified values and designated
adequate time and support, you are likely to be
successful at attaining your goal
Values
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 ones 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
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
  • 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?
  • 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
  • STRUGGLING
  • 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 gt20 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

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 its 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
Maslows Hierarchy of Needs Theory
  • What is Maslows 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?

35
Maslows Hierarchy of Needs in Descending Order
5th. Self-Actualization 4th. Self-Esteem 3rd.
Love Belonging 2nd Safety Security 1st.
Physiological Needs
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

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.

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.

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

41
Self-Actualization
  • This is the highest level of Maslows 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.

42
How to Apply Maslows Needs to Establish
Priorities of Care
Maslows
  • 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 patients plan of care?
  • a. Fluid Replacement
  • b. Pain Relief
  • c. Emotional Support
  • d. Respiratory Therapy

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 54 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.

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.

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!

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.

52

Computerized Adaptive Testing (CAT)
  • Each candidates exam is unique because it is
    created interactively as the exam proceeds.
  • Computer technology selects items to administer
    that match the candidates 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.

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 candidates
    ability is selected and this process is repeated
    for each item, creating an exam tailored to the
    candidates 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.

54
Computerized Adaptive Testing Pass or Fail?
  • After 75 questions are answered the computer
    compares the test-takers 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.

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.

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
  • Blooms Taxonomy Levels of cognitive ability
  • Client Needs
  • Integrated Processes
  • Item writers are masters-prepared nursing
    educators.

60
NCLEX Test Plan Framework
  • Blooms 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

62
Bloom's Taxonomy of Questions with Increasing
Difficulty and Sophistication
Analysis
Application
Comprehension
Recall/Recognition
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
64
Application Questions
  • Its 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
  • Ones 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.
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.

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.

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 clients side
    with the nurses knees
  • apart.
  • Maintain vertical pressure on the clients chest
    through the heel of
  • the nurses hand.
  • Recheck the nurses hand position after every 10
    chest
  • compressions.
  • Check for a return of the clients pulse after
    every 8 breaths by the
  • nurse.

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.

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
  • Lets examine each component in greater detail
    including sample questions that will emphasize
    key concepts.
  • First Client Needs categories
  • Next Blooms 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 clients advocate by
    performing which of the following actions?

77
Client Needs (contd)
  • a. Writing a note on the front of the clients
    record so that the surgeon will see it when the
    client arrives in the operating room.
  • b. Documenting in the clients 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.

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
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 patients 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 childs bedside to state
    their childs 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

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 nurses office
    with reports of abdominal pain. On assessment,
    the nurse notes the presence of several bruises
    on the childs 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 childs
    body.
  • b. Calls the parents to ask them how the childs
    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.

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

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

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

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

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.

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

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
  • www.ncsbn.org

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.

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.

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

116
Nursing Interventions
  • Although sometimes appropriate, avoid jumping
    immediately to an answer that recommends
    immediate referral to the patients M.D.
  • NCLEX is examining your abilities as a nurse and
    doesnt 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-Fowlers 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.

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.

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.

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.

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 youve
    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 youre allowed to begin, check the time.
  • Try to spend no more than 1 minute per test
    question
  • Dont 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 cant go back to previous
    questions so this may be useful.
  • Dont panic if someone finishes before you.

130
Anxiety
  • Anxiety is an individuals 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 isnt
  • associated with success and therefore
  • doesnt 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 individuals
    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

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

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

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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