STUDY SKILLS EXTRA HELP SESSION

1. STUDY SKILLS EXTRA HELP SESSION Test Taking Strategies For Success

2. Critical Thinking Applied to Test Taking • Educational Domains • Components of Multiple choice questions • Cognitive level of Nursing questions

3. Educational Domains Nursing as a discipline includes three domains • Affective Domain: concerned with attitude, values and development of appreciation. Ex. The nurse quietly accepting a patients statement that there is no God without imposing personal feelings. • Psychomotor Domain: concerned with manipulative or motor skills Ex. Is the nurse administering an IM. • Cognitive Domain: concerned with the recall, comprehension, development and application of knowledge and skills. Ex. The nurse clustering collected data, and determining its significance.

4. Components of a Multiple Choice Question • Each item (multiple choice question) has two parts: • Stem: part that contains the information topic, parameters, asks the question • Option: one or more possible responses

5. Cognitive Levels of Nursing Questions Four types • Knowledge: - recall • Comprehensive: - understanding the meaning and intent of remembered information • Application: emphasis is on remembering understood information and utilizing it in new situations • Analysis: emphasis is on comparing and contrasting a variety of elements of information

6. The Race Model : The Application of Critical Thinking to Multiple Choice Questions • R: Recognize the key words in the stem • Recognize what information is in the stem • Recognize who the client is in the stem • Recognize what the topic is about • A: Ask what is the question asking? • Ask what are the key words, that indicate a response • Ask what the question is asking me to do • C: Critically analyze the options in relation to what is asked in the stem • Critically scrutinize each option in relation to what is asked • Critically identify a rationale for each option • Critically compare and contrast the options • E: Eliminate as many options as possible • Eliminate one option at a time

7. Critical Elements of a test question • Key words (early-late, immediately, postoperative period) • The client (the client in the question) • The issue (Problem or subject the question is asking) • The type of stem (positive or negative)

8. Eliminate incorrect options (1-5) • Distracters • Avoid misreading test questions 1. Separate the case scenario and stem, identify the client, the issue and type of stem 2. Identify Key words 3. Avoid reading into the questions a. Restate question in own words b. Eliminate any option which include “new” information that was not give in the case scenario c. Avoid misinterpreting disorders (review carefully; focus on areas of difficulty)

9. In preparing to give a client a bed bath, the nurse would: A. Place the bed in the lowest position B. Expose the top side of the body, washing and drying quickly, then doing the same on the posterior side C. Gather all articles necessary for the bed bath and place them where they will be within easy reach of the nurse during the bath D. Use firm, scrubbing strokes to remove dirt and bacteria Answer: C

10. The nurse is preparing to give a morning medication. The first nursing action in this activity is to: A. Read the label B. Check for the right dose C. Wash the nurse’s hands • Check for the right time Answer: C

11. A client who has right sided weakness needs to be transferred from his bed to a wheelchair. In transferring the client, the nurse must remember to: • Keep the client at arm’s length while transferring him • Bend at the waist to get down to his level • Maintain a straight back and bend at the knees. • Try to transfer the client alone, before determining the help is needed Answer: C

12. 4. Client A and Client B are sitting in the day lounge. The nurse has medication to administer to client A. When the nurse enters the lounge, Client B says to the nurse “I see you found me to give me my pills” The best nursing response would be: • “I don’t have any pills for you, Client B” • “Let me check your identification armband, and I will check to see if you are supposed to receive any pills • “Client A, I have pills for you to take, but none for Client B” • “Client A, would you please take these pills” Answer: B

13. The nurse must lift a heavy object which is found in the hallway. Which is the best approach when the nurse must lift a heavy object? A. Lift the object at arm’s length so all of the arm muscles are being used. B. Bend from the waist, using a wide stance, so that the leg muscles of the body are used C. Maintain good body alignment and use the large muscles of the body D. Bend at the knees and use the large leg muscles when lifting the object Answer: C

14. Choosing between the two best options Identify the global response 1. Global response: is a general statement which includes correct idea form other options • Practice steps: (6-8) a. Identify critical elements b. Evaluate stem: Positive or negative c. Eliminate options that do not match the stem d. Compare remaining options- look for global response option

15. A client returns with a foley catheter after surgery. In providing catheter care, which is the best nursing approach? • Preventing infection and maintaining a patient catheter and drainage system • Keeping the collection bag above the level of the bladder • Using soap and water to clean the perineal area • Maintaining a closed system without any kinks in the tubing Answer: A

16. While getting a elderly client who is very weak out of bed and into a wheelchair, the best nursing approach initially is to: • Lock the wheels of the bed • Position the equipment to provide the safest transfer that is possible for the client • Align the wheelchair as close to the bed as possible, to prevent the client from falling to the floor • Remove the leg support on the wheelchair on the side closest to the bed Answer: B

17. In a long-term care facility, the nurse finds an elderly client on the floor. After having the client examined by the physician, the most important nursing action is to: • Call the family and ask them to stay with the client • Provide for the safety and protection of the client • Apply wrist and leg restraints to prevent the client from falling from the bed • Obtain an order for medication to sedate the client Answer: B

18. Choosing between the two best options cont. Eliminate similar distracters 1. There is only one correct answer. If two options say the same thing or include the same idea, neither can be correct • Practice steps: (9-13) A. Review the questions: identify the critical elements B. Narrow your choices C. Use the similar distracter strategy and look for the option that is different

19. One of the most important nursing actions in the care of the elderly is to: • Avoid drying agents when providing skin care • Encourage the client to perform as many activities of daily living as possible • Gently apply moisturizing lotions to pressure areas • Apply powder to moist folds in the skin Answer: B

20. A newly diagnosed adult diabetic is doing a return demonstration of the proper technique for insulin injection. He draws up the correct dose of insulin using the proper technique, but when he is ready to inject the needle, he hesitates and says, “I’m not sure I can do this.” Which response by the nurse would be best initially? • “I’ll show you again how to inject the needle.” • “I’ll inject the needle for you this time.” • “You’re doing fine so far. Give it a try” • “Why are you so nervous? Do you need help?” Answer: C

21. An obese client had been placed on a high-protein, low-calorie diet by his physician. Which nursing action is most appropriate? • Explain to the client the he will have to change his eating habits • Explain the importance of exercise when dieting • Explain to the client what types of foods are permitted on a low calorie, high protein diet • Tell the client that if he doesn’t stay on this diet he will continue to gain weight Answer: C

22. A client tells the nurse that his last name is not spelled right on his identification bracelet. The appropriate nursing action is to: • Tell the client that as long as his medical record numbers are correct, the mistake is not a problem • Ask the client for the correct spelling, and change his name in his chart. • Notify the admitting office of the error and obtain correct identification bracelet for the client • Notify the physician of the error Answer: C

23. A client is admitted to the hospital for evaluation of inadequate circulation to her lower extremities. The doctor orders a tub bath at the clients request. In assisting the client with her bath, which nursing action would be unsafe? • Place a rubber mat on the bottom of the tub • Fill the tub approximately half full • When the client steps into the bath, ask her if the water is the right temperature for her • Obtain all the necessary supplies and place them within easy reach of the client. Answer: C

24. Answering Communication Questions • Use test question logic a. Identify the client b. Identify the issue/problem/feeling c. Identify the type of stem B.Eliminate distracters (14-21) 1. Correct answers have a therapeutic response a. Therapeutic communication tools: being silent, offering self, showing empathy, focusing, restatement, validation/clarification, giving information, dealing with the here and now 2. Communication blocks are the distracters. Communication blocks prevent therapeutic communication a. Communication blocks: giving advice, showing approval/ disapproval, using cliché and false reassurance, requesting an explanation, devaluing clients feelings, being defensive, focusing on inappropriate issues or persons, places clients issues on hold

25. Answering Communication Questions cont. • Using communication a. Address the clients feelings Client- centered response’s b. Analyze the introductory statement 1. Physical problems are addressed first 2. Use the nursing process: is more information needed? 3. If the client is upset, feelings must be address first

26. An elderly male client is admitted to the hospital. His son asks the nurse what he should do concerning his father’s hearing problem. The nurse’s best response to the son is: • “As people get older, they tend to have hearing problems” • “Your father will need to be seen by a specialist” • “I would ask your father how he feels about his hearing loss” • “What kind of hearing problem does you father have?” Answer: D

27. A client is in hospital because of severe weight loss and refusal to eat. The physician orders the insertion of a NG tube for feeding. The nurse find the client with the tube removed. The client tells the nurse the he “doesn’t need that thing”. The most appropriate nursing response is: • “You shouldn’t have done that! Now I have to put it down again.” • “Why did you pull that tube out? Do you want to die?” • “Tell me what you don’t like about the tube” • “Your doctor is going to be really upset with you for doing this” Answer: C

28. A female client is schedule for cardiac bypass surgery in the morning. She says to the nurse, “I don’t think I’m going to have the surgery. Everybody had to die sooner or later” The most therapeutic nursing response is: • “if you don’t have the surgery, you will most likely die sooner.” • “There are always risk involved with surgery. Why have you changed you mind about the operation?” • “Cardiac bypass surgery must be very frightening for you. Tell me how you feel about the surgery” • “I will call you doctor and have him come in and talk to you Answer: C

29. A male nurse has received a doctor’s order to catheterize one of his female clients. The client says, “I’m not going to allow a male nurse to catheterize me.” The nurse’s best response is: • “Your doctor is a male. Would you let him catheterize you?” • “I’ve done this many times with no problems.” • “You can explain to your doctor why the catheter wasn’t inserted.” • “You appear to be upset. Let me find a female nurse to help with this procedure.” Answer: D

30. A male client is admitted to the hospital for surgery after finding a lump in his right testicle. He asks the nurse, “Do you think that the doctor will find cancer?” The most appropriate nursing response is: • “ Most lumps found in the testicle are benign.” • “It must be difficult for you not to know what the doctor will find.” • “I think that you should discuss this with your doctor.” • “It might be, but the doctor won’t know until the surgery is performed.” Answer: B

31. A client is admitted to the hospital with abdominal pain. She overhears her doctor and her nurse discussing cancer of the liver. Later, she says to the nurse, “Having cancer of the liver must be a terrible thing.” Which is the best nursing response? • “Yes, it is a terrible disease.” • “What made you think about cancer of the liver?” • “Any kind of cancer is terrible, but you can’t live without a liver.” • “Yes. A client on this floor has it and it is very said for everyone.” Answer: B

32. The nurse is teaching a female client about self breast exam. The client tells the nurse that she doesn’t understand why she is being taught this, since she doesn’t plan on doing it anyway. The best response by the nurse is: • “Self breast exam is taught to women in order to detect any lumps or changes in the breast which can be an early sign of cancer, because early treatment had a higher rate or cure” • “You’re right. If you don’t plan on doing the exams, then I don’t need to show you how to do it.” • “If you don’t plan on doing the exam yourself, then you should have your doctor do it at your annual check up.” • “You have the right to do whatever you choose. It is your body.” Answer: A

33. A confused elderly female client has wet herself and is standing in the hospital corridor in a puddle of urine. She has trouble getting to the bathroom in time. She looks ashamed. She says to the nurse, “I want to go outside for a walk now.” What is the most appropriate response by the nurse at this time? • “Before we go for a walk, perhaps we can make a list that will help you make your bathroom trips easier.” • “Right now, let me wipe up the urine on the floor, and let’s get a change of clothing. I am sure that this problem is upsetting for you.” • “This had been a problem for you. Let’s see if we can find a solution together.” • “Wetting yourself is very upsetting, Yes, let’s take a walk.” Answer: B

34. Priority setting questions (22-27) • Decision making questions involving setting priorities. Common words used in priority setting test question are: 1. Initial response 2. Essential nursing action 3. Vital considerations 4. Immediate attention 5. Priority nursing action 6. Best Nursing judgment 7. Most important

35. Priority setting questions cont. (22-27) • Priority-setting guidelines a.Nursing process  Assessment received priority b. Maslow’s Hierarchy of needs  ABC’s c. Communication theory  Tools and feelings d. Teaching/Learning theory  Motivation is key

36. A client, 21 years old, is admitted to the hospital because of extreme weight loss. It is noted on the admission assessment that the client believes that she is overweight at 88 pounds. What aspect of care should the nurse consider her first priority? • Assessing the client’s nutritional status. • Obtaining a psychiatric consult • Planning a therapeutic diet for the client • Talking to the family members to find out more about the client self concept Answer: A

37. An elderly male client with COPD is receiving O2 per nasal cannula at 2 liters per minute. At 3:30pm. The nurse assesses that the client appears to have made a good adjustment to hospitalization. At 5pm the nurse finds the oxygen cannula on the floor. The client is angry and says, “It’s about time you got here. Where am I? Where is my breakfast?” Which consideration would receive the nurse’s immediate consideration? • Has the O2 cannula been off long enough to cause hypoxia? • Is the client’s anger related to being hospitalized? • Does the client need a clock in the room to keep track of time? • Is the client accustomed to eating dinner very early in the day? Answer: A

38. A hospitalized elderly female client is to receive an x-ray. The nurse enters the client’s room, and ask if the client is ready to go to x-ray. She nods her head “yes” the next priority nursing action is to: • Explain the x-ray procedure to the client. • Help the client into a wheelchair, so that when the transporter arrives the client will be ready • Ask if the client has any questions • Look at the clients ID bracelet Answer: D

39. A 15-year old female client is being seen in the family planning clinic. She says to the nurse that she is nervous and has never had a pelvic exam before. The best response by the nurse initially is: • “All you have to do is relax” • “It is only slightly uncomfortable” • “What part of the exam makes you nervous? • If you want birth control pills, then a pelvic exam is required Answer: C

40. The nurse caring for a postoperative client. The nurse is informed during report that the client had not voided for 8 hours. The initial nursing action would be to: • Assist the client to the bathroom • Place the client on a bed pan and pour warm water over her perineum • Palpate and percuss the client’s bladder • Catheterize the client Answer B

41. The nurse had completed pre-discharge teaching for an elderly female client who is being discharged from the hospital after treatment for poor circulation to her lower extremities. Which action by the client would the nurse identify as the most important indication of the success for failure of the pre-discharge teaching? • The client puts on stockings with elastic tops and tells the nurse that she does not like other kinds of hosiery • The client tells the nurse that she will get a thermometer to measure the temperature of the bath water • The client asks her husband to take her sandals home and bring a pair of shoes to the hospital for her to wear home • The client tells the nurse that she is going to have a hard time remembering to keep her legs uncrossed. Answer A

42. Answering questions using the Nursing Process • Test questions will associate with nursing behavior when using the nursing process 1. Assessment questions (28-30) A. Tips for assessment questions a. Terms used: observe, monitor, check, obtain information, and find out b. Remember: assess first c. Know your vital signs and lab values d. Focus on the issue B. Eliminate options

43. A male client returns from the recovery room to the surgical unit following surgery. Upon his arrival in the client care unit, what is the initial focus of the nurse’s assessment • Urine output • Vital signs • Pain in the incision • Status of the dressing Answer: B

44. The nurse is monitoring a client who is receiving IV infusion for the signs of infiltration. In assessing an IV site which has become infiltrated, the nurse knows that which finding is unexpected? • The infusion rate slows or stops while the tubing in not kinked • The area around the injection site feels warm to the touch • Swelling, hardness, or pain is found around the needle site • Blood fails to return in the tubing when the bottle is lowered Answer: B

45. A client puts her call light on and tells the nurse that she had to urinate. The client had had a foley catheter in place since her surgery two days ago. The appropriate nursing action is to: • Remind the client that she had a foley catheter in place and does not need to go to the bathroom • Replace the foley catheter with a new catheter • Explain to the client that the urge to void is a common occurrence for clients who have urinary catheters • Check the catheter and tubing for kinks and note the urine output in the drainage bag Answer D

46. Answering questions using the Nursing Process • Test questions will associate with nursing behavior when using the nursing process • Analysis question: most difficult (32) • Nursing behaviors associated with analysis • Interpreting data • Validating data • Organizing related data • Recording data • Identify a nursing diagnosis • Be sure to identify the issue and focus on the nursing rationale • Tips for Analysis questions • Identify the issue • Do not read into the question • Focus on the nursing rationale

47. In preparing a preoperative teaching plan, the nurse would give top priority to: • Active range of motion exercise • A rationale for various tubes, IV’s, etc • The need to record vital sign frequently • Coughing and deep breathing exercise Answer: D

48. Answering questions using the Nursing Process • Test questions will associate with nursing behavior when using the nursing process • Planning questions (33-35) • Nursing behaviors associated with planning • Starting goals and priorities for an NCP • Selecting intervention for an NCP • Stating outcomes • Modifying NCP’s • Cooperating with others form delivery of care • Documentation pertinent information • Warning! Many planning questions have negative stem

49. Answering questions using the nursing process cont. • Tips for planning questions: • Answer involves something in the NCP verses the medical plan. The exam is on nursing action not medical action • Highlight the issue of the question • Do not read into the questions • When the question asks you to select priorities- use Maslow’s Hierarchy of needs

50. An elderly, confused client is on bed rest. In planning nursing care for this client, which nursing intervention will not effectively provide for this client’s safety? • Provide regular toileting • Explain to the client that she should use the call light if she needs to get up • Place the side rails in the up position and check on client often • Initiate the proper use of restraints Answer: B