strategies & techniques in taking the exam

STRATEGIES & TECHNIQUESIN TAKING THE EXAMIrene M. Magbanua, RN

Professional Review Specialist

St. Paul University Manila

FIRST- FIRST IN THE TEST QUESTION: F I R S T Sample Question: The nurse is caring for a patient in the emergency

department with a gunshot wound to the chest. The nurse observes carefully for signs and symptoms of tension pneumothorax. Which of the following will be seen FIRST:

A. PallorB. Crackles sound audible on inspectionC. Restlessness, sudden onset of persistent chest pain and tracheal deviationD. Hypertension

MOST IMPORTANT- IN THE TEST QUESTION P S L S S Sample Question: A client diagnosed with Bipolar disorder exhibits square

dancing, unkempt appearance and have not slept for 36 hours. The MOST IMPORTANT nursing care appropriate for this client during manic episodes will be:

A. Confront the client’s inappropriate dancing and bad body odor

B. Send client to chestboard game to divert client’s energyC. Let the client lad a singing groupD. Provide the client high caloric finger foods

INITIAL- IN THE TEST QUESTION A A O P I E Sample Question: A child with Insulin Dependent Diabetes Mellitus (IDDM) develops weakness and cold clammy skin. Which of the following should the nurse do initially?

A. Give subcutaneous glucagonsB. Administer the prescribed insulinC. Increase recommended carbohydrate in the dietD. Check capillary blood glucose and give a glass of orange

juice

BEST- IN THE TEST QUESTION M M T Sample Question: A client with admitting symptoms of occipital headache in

the morning, palpitations and epistaxis has been diagnosed with HYPERTENSION. Medical and nursing management will be based on:

A. DietB. Diet and regular exerciseC. Diet, regular exercise and antihypertensive medicationsD. Diet, regular exercise, antihypertensive medications and avoidance of alcohol

MEMORIZATION-MNEMONICS Assessment of pain/ABC’s P Q R S T Sample Question: Interventions for COPD (Chronic Obstructive Pulmonary Disease) are the following:

A. Propranolol, 6L oxygen and restB. Aminophylline, Bronchodilators, Chest physiotherapy,

Deliver O2 2L, Expectorants and Force fluidsC. Bronchodilators, Betablockers and BusparD. Increase fluids, increase oxygen and decrease chest

physiotherapy

RULE OF 2’S- AS A WAY TO REMEMBER TOXICITY LEVEL Acetaminophen - Dilantin - Aminophylline - Lithium - Digitalis - Sample Question: A client’s digoxin blood level is 2.2 ng/dL. The MOST

APPROPRIATE nursing actions:

A. withdraw blood and check electrolyte levelB. withhold digoxin, assess for toxicity and notify the provider immediately C. give client citrus juice to replace the lost of potassiumD. increase the IV, client will manifest diuresis

NEGATIVE MODIFIERS- word or words that would make the option incorrect

Sample Question: The nurse is counseling a parent about the management of her 6-

year-old child who has chickenpox. Which statement by the parent indicates that the teaching by the nurse has NOT BEEN EFFECTIVE?

A. “I will keep my child’s fingernails cut short.”B. “I will never send my child in school again.”C. “If one of the chickenpox becomes swollen and ooze yellow drainage, I will call the doctor.”D. “I will give my child diphenhydramine (Benadryl) if the itching

becomes severe.

POSITIVE MODIDIFIERS- Words that would make the option correct

Sample Question:

A client who have undergone episiotomy asked the nurse when she can resume sexual intercourse. The appropriate response of the nurse would be:

A. “It is impossible for you to indulge in sex since it will cause injury to the wound.”

B. “Why don’t you ask the doctor for this?”

C. Usually, it will take about 4 to 6 weeks and until

lochia ceases.”

D. “Anytime you are ready.”

COMMONALITY Sample Question:

A client has undergone

thyroidectomy. Which of the following

symptom is considered the

HALLMARK SIGN of THYROID STORM

A. hypotension

B. hypothermia

C. hypoglycemia

D. uncontrolled fever, 100 to 106 degree F

PRIORITY- use ABC Sample Question: Which assessment area would the nurse give the highest PRIORITY when admitting a client to the emergency department?

A. nutritional statusB. airway statusC. elimination statusD. psychotic status

Sample Question: A client with a spinal cord injury at

the level of C4 has a weakened respiratory effort, ineffective cough, and is using accessory muscles in breathing. The nurse carefully monitors of the following nursing diagnoses?

A. Ineffective breathing pattern B. Risk for impaired skin integrity C. Risk for injuryD. Risk for infection

Sample Question: A client for whom NARDIL was prescribed for

depression is brought to the ER with severe occipital headaches for eating pepperoni pizza for lunch. Which of the following interpretation is it important for the nurse to make regarding these findings?

A. Allergic reaction related to ingestion of processed food

B. Hypertensive crisis related to drug and food reaction

C. Panic anxiety related to unresolved issues, uncontrolled anxiety

D. Ineffective individual coping related to MAOI treatment

THERAPEUTIC COMMUNICATIONS:

- Silence- Stay with the patient- Listening- Broad openings- Open-ended questions- Clarifying- Focusing on the client’s feeling- Explore the client’s feeling- Validate the client’s feeling- Orientation to reality

Sample Question: A nurse finds a newly admitted patient to the

psychiatric unit in her room clutching her knees close to her and staring

blankly ahead. When the nurse greets the patient, she responds in

incomprehensible words. What would be the nurse’s INITIAL

intervention?

A. Ask the client, “Why you were brought here?”B. Provide information regarding the whole activities of

the hospital.C. Tell the patient, “I will stay with you until you calm

down.”D. Begin the saying, “I will now take your history.”

Process of Elimination (POE) Criteria for eliminating the remaining

incorrect answer choice:

1. Choices that contain absolutes (i.e., always, all) are more likely to be incorrect

2. Choices with qualifiers in them (i.e., commonly, possibly) are more likely to be correct

3. Information repeated from the question may be repeated in the correct response

Use Common Sense This requires understanding concepts, not

memorizing diseases. Sample Question: A client is admitted to the emergency room in a

HONKC. After ascertaining that her airway is patent and her heart rhythm is sinus, the nurse should assess:

A. Neurological statusB. Urine outputC. Family’s coping mechanism D. Skin integrity

Use of Prefixes and Suffixes Example:

If a question contains the word hemopoiesis, you do not need to memorize what it means. Just think about it.

Hemo = blood

-poiesis = making,forming

Prioritization Priority questions may take a few

forms on the exam. They might ask you:

1. What is the most important?2. What is the initial (first) action of the

nurse?3. What is the best nursing action?4. Which client would the nurse care for

first?

Here are a few hints that can help you find the

correct answers to priority questions.

1. Use Maslow’s Hierarchy of Needs. The hierarchy includes (in

descending order) 1)physiological needs (survival); 2) safety needs (both physical and psychological); 3) a priority question, you need to choose the response that ranks the highest in the hierarchy.

2. Use the Nursing Process (APIE) to establish priorities. You must first assess, then plan, then implement, and finally evaluate. Select responses in which you assess the client before you implement the care.

3. Use ABC’s. When you encounter a question that requires you to establish priorities, think airway, breathing, and then circulation. Your first priority in an emergency situation would be to establish a patient airway.

4. Use RACE. When you see priority questions that deal with fires, think: remove the clients, the sound the alarm, call the fire department, and finally extinguish the fire. The safety of the clients is the first priority.