Test T aking Skills

1. Test Taking Skills Rita Carey-Nita

2. Avoid asking What If? • Focus on the information in the question • Do not add information or read into the question • Rule out definite incorrect options first • Then re-read the question and make choice based on remaining options • Trust yourself

3. Example of What If ? A nurse is changing the tapes on a tracheostomy tube. The client cough, and the tube is dislodge. The initial nursing action is to: • Call the physician to reinsert the tube. • Ventilate the client using a manual resuscitation bag and face mask. • Cover the tracheostomy site with a sterile dressing to prevent infection • Call the respiratory therapy department to reinsert the tracheostomy tube.

4. What If A nurse is changing the tapes on a tracheostomy tube. The client cough, and the tube is dislodge. The initial nursing action is to: • Call the physician to reinsert the tube. • Ventilate the client using a manual resuscitation bag and face mask. • Cover the tracheostomy site with a sterile dressing to prevent infection • Call the respiratory therapy department to reinsert the tracheostomy tube.

5. Strategic Words • Makes difference with regard to what question is asking • Helps to focus your attention on a critical point to consider when answering the question • All options may be correct but one is priority or most essential

6. Strategic Words • Best • First • Immediately • Initial • Most likely • Least likely • Most appropriate • Least appropriate • Early • Late

7. Example of Strategic Word ? • A client with a diagnosis of heart failure reports the occurrence of sudden shortness of breath and dyspnea. The nurse takes which immediate action: • Calls the physician • Administers oxygen • Elevates the head of the bed • Prepares to administer furosemide (Lasix)

8. Answer for Strategic Word ? • A client with a diagnosis of heart failure reports the occurrence of sudden shortness of breath and dyspnea. The nurse takes which immediate action: • Calls the physician • Administers oxygen • Elevates the head of the bed • Prepares to administer furosemide (Lasix)

9. Prioritizing Questions • What is the first priority in regards to scenario? • Think about the question • Apply nursing knowledge • Apply clinical experience • For listing answers according to priority you must list what is first then next & so on…

10. Prioritizing Strategic Words • Best • Essential • First • Highest priority • Immediate • Initial • Most important • Primary • Vital • Next

11. Prioritization Question • The nurse is assigned to care for four clients. When planning client rounds, which client should the nurse check first ? • A client on a ventilator • A client in skeletal traction • A postoperative client preparing for discharge • A client admitted on the previous shift who has a diagnosis of gastroenteritis

12. Prioritization Question • The nurse is assigned to care for four clients. When planning client rounds, which client should the nurse check first ? • A client on a ventilator • A client in skeletal traction • A postoperative client preparing for discharge • A client admitted on the previous shift who has a diagnosis of gastroenteritis

13. Ingredients of Question • See Box 5.3

14. Subject of Question • What is the subject or focus of the question? • Focus on the subject to help eliminate incorrect options • If the option does not fit the subject, you know to rule it out.

15. Example of Subject of the Question The nurse is planning to teach a client in skeletal leg traction about measures to increase bed mobility. Which item would be most helpful for this client? • Television • Fracture bedpan • Overhead trapeze • Prepares to administer furosemide (Lasix)

16. Subject of Question The nurse is planning to teach a client in skeletal leg traction about measures to increase bed mobility. Which item would be most helpful for this client? • Television • Fracture bedpan • Overhead trapeze • Prepares to administer furosemide (Lasix)

17. Positive Versus Negative Query • Pay attention….Is the question asking you for a positive or a negative answer • Example of Positive Query • The patient shows an understanding of the goal of treatment when….. • Looking for a positive response by patient • Example of Negative Query • The patient requires further patient teaching when stating…. • Looking for an incorrect response by the patient

18. Positive Query The nurse has provided discharge instructions regarding nitroglycerin therapy to the client with angina. Which statement by the client indicates an understanding of the home use of the nitroglycerin? • “If I use the nitroglycerin and the pain does not subside in 15 minutes, I should go to the hospital.” • “When I have pain, I should lie down and place a tablet under my tongue. If unrelieved in 5 minutes, I should take another tablet.” • “When I have pain, I should put a tablet under my tongue. If I have a burning sensation, I should call the doctor immediately.” • When I experience chest pain, I can continue what I’m doing. If it doesn’t go away in 10 minutes, I should use a nitroglycerin tablet.”

19. Positive Query The nurse has provided discharge instructions regarding nitroglycerin therapy to the client with angina. Which statement by the client indicates an understanding of the home use of the nitroglycerin? • “If I use the nitroglycerin and the pain does not subside in 15 minutes, I should go to the hospital.” • “When I have pain, I should lie down and place a tablet under my tongue. If unrelieved in 5 minutes, I should take another tablet.” • “When I have pain, I should put a tablet under my tongue. If I have a burning sensation, I should call the doctor immediately.” • When I experience chest pain, I can continue what I’m doing. If it doesn’t go away in 10 minutes, I should use a nitroglycerin tablet.”

20. Negative Query A nurse has provided medication instructions to a client who will be taking warfarin sodium (Coumadin) indefinitely. Which statement by the client indicates a need for further teaching? • “I need to use a soft toothbrush.” • “I need to use a straight razor for shaving.” • “I need to avoid drinking alcohol while taking this medication.” • “I need to carry identification about the medication being taken.”

21. Negative Query A nurse has provided medication instructions to a client who will be taking warfarin sodium (Coumadin) indefinitely. Which statement by the client indicates a need for further teaching? • “I need to use a soft toothbrush.” • “I need to use a straight razor for shaving.” • “I need to avoid drinking alcohol while taking this medication.” • “I need to carry identification about the medication being taken.”

22. Focus on ABC’s • Think ABC’s • Airway • Breathing • Circulation • If you don’t have an airway…you have nothing • With physiological questions focus on first airway, then breathing & move on to circulation

23. ABC Question A client with a compound (open) fracture of the radius has a cast applied in the emergency department. The nurse provides home-care instructions and tells the client to seek medical attention if which of the following occurs? • Numbness and tingling are felt in the fingers • The cast feels heavy and damp 24 hours after application • The entire cast feels warm during the first 24 hours after application • Bloody drainage is noted is noted on the cast during the first 6 hours after application.

24. ABC Question A client with a compound (open) fracture of the radius has a cast applied in the emergency department. The nurse provides home-care instructions and tells the client to seek medical attention if which of the following occurs? • Numbness and tingling are felt in the fingers • The cast feels heavy and damp 24 hours after application • The entire cast feels warm during the first 24 hours after application • Bloody drainage is noted is noted on the cast during the first 6 hours after application.

25. Maslow’s Hierarchy • Physiological are first priority • Airway~Respirations~HeartRate~Nutrition~Elimination • Safety & Security 2. Protection from injury~sense of security • Love & Belonging 3. Having support system~not isolated • Self-Esteem 4. control~competence~positiveregard~acceptance~worthiness • Self-Actualization 5. hope~spiritual well-being~enhanced growth

26. Maslow Hierarchy A nurse is assigned to care for a client experiencing difficult labor. When assisting with planning care, the nurse would consider the highest priority to be frequent: • Position changes and providing comfort measures • Explanations to family members about what is happening to the client • Monitoring for changes in the physical condition of the mother and fetus • Reinforcement of breathing techniques learned in childbirth preparatory classes

27. Maslow’s Hierarchy A nurse is assigned to care for a client experiencing difficult labor. When assisting with planning care, the nurse would consider the highest priority to be frequent: • Position changes and providing comfort measures • Explanations to family members about what is happening to the client • Monitoring for changes in the physical condition of the mother and fetus • Reinforcement of breathing techniques learned in childbirth preparatory classes

28. Question focusing on the Nursing Process • Think about the steps of the nursing process • Data Collection (Assess) • Diagnose • Plan • Implement • Evaluate • If it is a question involving the nursing process determine which step the question is focused on • Then choose the option that addresses that step

29. Nursing Process • If it is a data collection (AKA: Assessment) step look for options that have terms such as: • Check • Collect • Determine • Find out • Gather • Identify • Monitor • Observe • Obtain information • Recognize

30. Nursing Process • Planning phase: • The planning of care • Focuses on setting goals • Organizing or managing care • Implementation phase: • The action of providing care • Managing care • Providing care • Communicating • Documenting

31. Nursing Process • Evaluation phase • Evaluates the success or failure of the plan of care • Focus on comparing the actual outcome with the planned or expected outcome • Focus on possible factors the cause interference of accomplishment of goals • May use a negative query for this type of question

32. Nursing Process Question • The nurse develops a plan of care for an older client with diabetes mellitus. The nurse plans to first: 1. Structure menus for the diet 2. Teach about insulin administration using videotapes 3. Encourage dependence on others to prepare the client for this chronic disease 4. Determine the clients ability to read label markings on syringes and blood glucose monitoring equipment

33. Nursing Process Question: Assessment • The nurse develops a plan of care for an older client with diabetes mellitus. The nurse first must: 1. Structure menus for the diet (plan) 2. Teach about insulin administration using videotapes (implementation) 3. Encourage dependence on others to prepare the client for this chronic disease (implementation) 4. Determine the clients ability to read label markings on syringes and blood glucose monitoring equipment(assessment)

34. Client Needs • Remember the importance of safety measures • Call bell~siderails~bed in low position~handwashing • Psychosocial Integrity • Questions regarding emotional, mental & social well-being • Use of therapeutic communication as correct option • Select options that focus on the feeling of patient, caregiver, significant others.

35. Client Needs • Health Promotion • Questions focus on promotion of patient health or maintenance of health • May focus on normal growth and development • Early detection or screening for illness • May focus on patients willingness & readiness to change health habits • These questions are often set up as negative query

36. Certain options to watch for • Eliminate comparable or alike options • If only one answer is correct, you know these can be eliminated narrowing your choices • Eliminate options with close-ended words • Options with the following words are usually wrong; too extreme • All~Always~Every~Must~None~Never~Only • Look for umbrella options • This option contains the concepts of the other options as well • This is usual a correct option

37. Comparable or Alike Question • A nurse instructs an adolescent with iron-deficiency anemia about the administration of oral iron preparations. The nurse tell the adolescent that it is best to take iron with: • Cola • Soda • Ginger ale • Tomato juice

38. Comparable or Alike Question • A nurse instructs an adolescent with iron-deficiency anemia about the administration of oral iron preparations. The nurse tell the adolescent that it is best to take iron with: • Cola • Soda • Ginger ale • Tomato juice

39. Delegating • There may be question regarding delegation • Key Principles: • Know your scope of practice as well as the CNA & RN • Which tasks can be delegated to the CNA? • What are the skill and duties you can perform? • What is strictly the role of the RN? • Keep in mind..Depending on the setting…you may be the one delegating or in charge.

40. Delegating Question A nurse is planning the client assignment for the day and most appropriately assigns which client to the nursing assistant? • A client on strict bedrest • A client with dyspnea who is receiving oxygen therapy • A client scheduled for transfer to the hospital for surgery • A client with a gastrostomy tube who requires feedings every 4 hours

41. Delegation Question A nurse is planning the client assignment for the day and most appropriately assigns which client to the nursing assistant? • A client on strict bedrest • A client with dyspnea who is receiving oxygen therapy • A client scheduled for transfer to the hospital for surgery • A client with a gastrostomy tube who requires feedings every 4 hours

42. Pharmacology Questions • If familiar with medication, use your nursing knowledge • Will include generic and trade name • Break down the medication • What class is it? • Is there a specific disease process it is used for? • What are some common side-effects? • Think about the common endings to medications • olol-beta-blocker

43. Pyramid Points • No antacid with meds • Don’t not crush enteric coated & sustained release tablets or open capsules • Patients should never adjust doses or abruptly stop medications • Use caution with over the counter and herbal supplements • Use caution with alcohol and smoking • Never administer a medication that is questionable or illegible

44. Calculations Calculations • If there is a question requiring calculations always recheck your math • Review and understand your formulas for dosage calculations or for IV therapy • Unfortunately this is a point of memorizing the formula • Need to know it to apply it

45. Some key study skills • Be sure not to cram • Find a study method that works best for you • Determine best time for you to study • Know what type of learner you are and utilize methods that work best for you • Sometimes study groups are good and sometimes bad • You need to know material before you can work in group setting • Choose study partner carefully • Don’t take someone’s word for it • Be sure they know what they are talking about

46. Wrap Up • Some general principles for test day: • BREATHE • RELAX • Dress comfortable • Give yourself enough time to arrive for test • On the day of a test just have confidence that you know the material • Trust yourself