One of my classes is a review course for the NCLEX RN test I'll be taking after I graduate. We are learning how to answer questions and get the right answer (easier said than done) even when we aren't sure what the question is asking, or when we feel that every answer option is right! After each class, we all feel stupid.
More on what the NCLEX test is like later. First I want to show you what it takes to answer one question.
The Decision Tree:
Here's the best example I could find in my book to go through the Tree with. Try to go through the steps yourself and see if you can get the right answer!
Question:
A child has just returned to the pediatric unit following ventriculoperitoneal shunt placement for hydrocephalus. Which intervention should a nurse perform first?
(A VP shunt is put into the head to drain CSF fluid that the baby's body can't drain by itself; Hydrocephalus is a big word for fluid (CSF) on the brain).
1. Assess intake and output.
2. Place the child on the side opposite the shunt.
3. Offer fluids because the child has a dry mouth.
4. Administer pain medication by mouth as ordered.
The Decision Tree:
1) Can the topic of the question be identified?
Yes - Proceed to step 2
No - Read answer choices for clues. Identify the topic question. Proceed to step 2.
Topic of the question would be... PRIORITY intervention for VP shunt. On to step 2!
2) Are the answers assessments or implementations, or both?
- A mix of both? Read the step/topic of the question to determine if it is asking you to assess further or implement. Select correct answer.
- Are all answers assessments or implementation? Proceed to step 3.
With this question, answers are both assessment and implementation. 1= assess. 2= implement. 3=implement. 4= implement.
I think we need to go to step 3.
3)Maslow's Heirarchy of Needs - Physical or Psychosocial needs?
Does Maslow fit?
No - Are all answers physical? Proceed to step 4. Are all answers psychosocial? Proceed to step 5.
Yes - Eliminate psychosocial answers (they will never precede physical needs! Pain is considered a psychosocial need). Do physical needs make sense? ABC's (priorties of patient needs; Airway, Breathing, Circulation).
We can eliminate some!
4) All answers physical?
No - step 5
Yes - ABC's
There is nothing about the patient's airway or breathing...
5) What is the outcome of the remaining answer?
Is it desired? Select correct answer.
Desired outcome is correct functioning of the shunt and being sure it drains the CSF.
Whew. That's quite a lot of work for one answer! Which did you pick?
The correct answer is....
2! Placing the child on the side opposite the shunt prevents pressure on the shunt valve. Intake and output will also need to be assessed, but that isn't the nurse's priority. The child is usually on nothing-by-mouth status until bowel sounds return/able to eat. Pain medications should be administered by an I.V. route initially postoperatively.
Very rarely does it seem that there is a clear-cut answer, even when using the tree. I hear that some have felt that all they did during the NCLEX test was make educated guesses. I am sure that these test taking strategies help, even if only to make educated guesses!
1 comment:
If I was a cartoon, there would be smoke coming from my ears. You are amazing. I thought teaching a 2 year old how to sleep in a big boy bed was hard!
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