If you would like specific questions answered you may post them as a comment on this page. I will then reveiw them and see you in the live chat.
thank you!~
Friday, May 23, 2008
Live NCLEX Help Every Wednesday Night 7p EST with AnnelieseRN
Thursday, May 22, 2008
Sample NCLEX Questions
1. Your patient is considering participating in a multi-site trial of a new cancer medication. According to the " Patient's Bill of Rights," it is important for the patient to know that:
all costs of research are paid by the patient.
he has the right to refuse to participate in research without fear of loss of care.
the physicians will no longer be caring for him if he does not participate in the research.
the research study is his only hope of treatment.
2. At 8:30 a.m. on a Thursday morning, several small canisters exploded in a bus station. Later in the day, many of the people who were present at the time of the explosion developed shortness of breath and muscle and chest pain. The hazardous materials (Hazmat) team has determined the canisters contained Ricin. All of the following statements about Ricin are correct except:
inhaled Ricin attacks the respiratory system, causing pneumonia and pulmonary edema.
ingested Ricin causes gastrointestinal bleeding, which can lead to death.
Ricin can be produced in an aerosolized form and solid form.
symptoms of Ricin toxicity begin 48 to 72 hours after exposure.
3. While attending closed medical case rounds, you are giving as a part of the teaching-learning process a detailed written case that is to be further discussed. In the course of the discussion, the identity of the patient becomes known to the group. You should:
dispose of any class notes in the regular trash.
stop the discussion immediately after the identity of the patient is known.
participate in the discussion while in class, but dispose of the case information in the shredded trash after the presentation.
respect the patient's confidentiality by leaving the presentation at the point at which the identity of the patient becomes known.
4. Family members had a variety of negative reactions to the restraining of their relative in acute care settings. These reactions were:
"She didn't do anything and she's tied up."
"My mother was overjoyed over the restraint as it felt secure. "
"The restraints are a good thing for older people."
"Collaboration is always excellent here concerning restraints."
5. The goal of delegation is:
staff satisfaction.
workload distribution.
effective management.
prioritizing patient care needs.
6. Which activity is part of the termination phase of the therapeutic relationship?
Selecting behaviors that will terminate the relationship.
Discussing the expectations of the nurse and client.
Relating feelings generated by separation to former losses.
Selecting alternative responses to situations.
7. Priority setting occurs during which step of the nursing process ?
Assessment.
Planning.
Intervention.
Evaluation.
8. A client and nurse contracted to meet for 10 weeks. Beginning at the seventh week, the client starts arriving late to the meetings and engages mostly in superficial talk. The nurse recognizes this behavior is:
because the client has other responsibilities.
due to the client's anger over the upcoming termination.
the client oversleeping due to increased depression.
a relapse of the progress made earlier in the relationship.
9. The teaching plan for a comprehensive sex education program should include all of the following goals except:
teach appropriate values, beliefs, and attitudes about sexuality.
communicate accurate information about sexuality.
help students develop relationships and interpersonal skills.
encourage the exercise of responsibility in sexual relationships.
10. Potential quality indicators that may be the focus of unit-based quality improvement (CQI) activity on a med-surg unit are all of the following except:
medication errors.
incisional wound infections.
incidence of pneumonias post-operatively.
number of readmissions with primary diagnosis of CHF.
11. All of the following are true as a nurse designates a task as high priority except:
priorities are physiological.
priorities are psychological.
if untreated could result in harm to the client.
involve a quick response to needs as determined by the nurse independently from the client involved.
12. At 11:00 a.m., Mr. P. is brought to the unit from the emergency room for admission. Lying on the transport cart, he is complaining of severe nausea and is dry heaving into an emesis basin. His wife and son are with him. What would be the most appropriate action for the nurse to take at this time?
Help get Mr. P. into bed and orient him to the bed controls.
Help get Mr. P. into bed and begin to fill out the detailed admission assessment form.
Ask him whether he has valuables for the safe.
Help get Mr. P. into bed, properly positioned for comfort, and begin focused abdominal assessment targeting his nausea.
13. Which cranial nerve is responsible for chewing movement?
Facial.
Abducens.
Trigeminal.
Hypoglossal.
14. Which of the following signs or symptoms would alert a nurse to increasing intracranial pressure in a client with acute head trauma?
Widening pulse pressure.
Narrowing pulse pressure.
Tachycardia.
Regular respirations.
15. Which of the following terms describe a complication of rheumatoid arthritis where the fingers become bent outward?
Hallux valgus
Wwan-neck deformity.
Boutonniere deformity.
Ulnar drift.
16. Which of the following statements by a client indicates a need for further teaching by the nurse regarding prevention and treatment of Lyme disease?
"I will spray insect repellant on myself."
"I will tell my doctor about a bull's eye rash."
"If I see a tick, I will twist it out of my skin."
"I will avoid walking in tall grass."
17. A client who is an intravenous drug abuser had an appendectomy. He requests morphine sulfate for pain relief every hour, and it is only ordered every four hours. What is the appropriate response of the nurse?
Tell him it is only ordered every four hours.
Let him know his addiction may get worse.
Notify the physician of his request.
Instruct him on possible side effects.
18. Where should a nurse administer eye drops?
Inner corner of the eye.
Outer corner of the eye.
Directly over the cornea.
Center of conjunctival sac.
19. If a patient is deemed "incompetent," this means that:
he/she can't afford to pay the hospital bill.
he/she won't follow medical direction.
a court proceeding has declared him/her unable to make his/her own decisions.
as a nurse you have assessed that he/she is not making good choices or decisions.
20. A "DNRCC" code means that:
the patient should not have their symptoms actively treated.
the patient's care is less priority than another patient whose code status is full code.
therapies and treatments have been limited to those that promote comfort.
it's no longer necessary to take the patient's vital signs.
all costs of research are paid by the patient.
he has the right to refuse to participate in research without fear of loss of care.
the physicians will no longer be caring for him if he does not participate in the research.
the research study is his only hope of treatment.
2. At 8:30 a.m. on a Thursday morning, several small canisters exploded in a bus station. Later in the day, many of the people who were present at the time of the explosion developed shortness of breath and muscle and chest pain. The hazardous materials (Hazmat) team has determined the canisters contained Ricin. All of the following statements about Ricin are correct except:
inhaled Ricin attacks the respiratory system, causing pneumonia and pulmonary edema.
ingested Ricin causes gastrointestinal bleeding, which can lead to death.
Ricin can be produced in an aerosolized form and solid form.
symptoms of Ricin toxicity begin 48 to 72 hours after exposure.
3. While attending closed medical case rounds, you are giving as a part of the teaching-learning process a detailed written case that is to be further discussed. In the course of the discussion, the identity of the patient becomes known to the group. You should:
dispose of any class notes in the regular trash.
stop the discussion immediately after the identity of the patient is known.
participate in the discussion while in class, but dispose of the case information in the shredded trash after the presentation.
respect the patient's confidentiality by leaving the presentation at the point at which the identity of the patient becomes known.
4. Family members had a variety of negative reactions to the restraining of their relative in acute care settings. These reactions were:
"She didn't do anything and she's tied up."
"My mother was overjoyed over the restraint as it felt secure. "
"The restraints are a good thing for older people."
"Collaboration is always excellent here concerning restraints."
5. The goal of delegation is:
staff satisfaction.
workload distribution.
effective management.
prioritizing patient care needs.
6. Which activity is part of the termination phase of the therapeutic relationship?
Selecting behaviors that will terminate the relationship.
Discussing the expectations of the nurse and client.
Relating feelings generated by separation to former losses.
Selecting alternative responses to situations.
7. Priority setting occurs during which step of the nursing process ?
Assessment.
Planning.
Intervention.
Evaluation.
8. A client and nurse contracted to meet for 10 weeks. Beginning at the seventh week, the client starts arriving late to the meetings and engages mostly in superficial talk. The nurse recognizes this behavior is:
because the client has other responsibilities.
due to the client's anger over the upcoming termination.
the client oversleeping due to increased depression.
a relapse of the progress made earlier in the relationship.
9. The teaching plan for a comprehensive sex education program should include all of the following goals except:
teach appropriate values, beliefs, and attitudes about sexuality.
communicate accurate information about sexuality.
help students develop relationships and interpersonal skills.
encourage the exercise of responsibility in sexual relationships.
10. Potential quality indicators that may be the focus of unit-based quality improvement (CQI) activity on a med-surg unit are all of the following except:
medication errors.
incisional wound infections.
incidence of pneumonias post-operatively.
number of readmissions with primary diagnosis of CHF.
11. All of the following are true as a nurse designates a task as high priority except:
priorities are physiological.
priorities are psychological.
if untreated could result in harm to the client.
involve a quick response to needs as determined by the nurse independently from the client involved.
12. At 11:00 a.m., Mr. P. is brought to the unit from the emergency room for admission. Lying on the transport cart, he is complaining of severe nausea and is dry heaving into an emesis basin. His wife and son are with him. What would be the most appropriate action for the nurse to take at this time?
Help get Mr. P. into bed and orient him to the bed controls.
Help get Mr. P. into bed and begin to fill out the detailed admission assessment form.
Ask him whether he has valuables for the safe.
Help get Mr. P. into bed, properly positioned for comfort, and begin focused abdominal assessment targeting his nausea.
13. Which cranial nerve is responsible for chewing movement?
Facial.
Abducens.
Trigeminal.
Hypoglossal.
14. Which of the following signs or symptoms would alert a nurse to increasing intracranial pressure in a client with acute head trauma?
Widening pulse pressure.
Narrowing pulse pressure.
Tachycardia.
Regular respirations.
15. Which of the following terms describe a complication of rheumatoid arthritis where the fingers become bent outward?
Hallux valgus
Wwan-neck deformity.
Boutonniere deformity.
Ulnar drift.
16. Which of the following statements by a client indicates a need for further teaching by the nurse regarding prevention and treatment of Lyme disease?
"I will spray insect repellant on myself."
"I will tell my doctor about a bull's eye rash."
"If I see a tick, I will twist it out of my skin."
"I will avoid walking in tall grass."
17. A client who is an intravenous drug abuser had an appendectomy. He requests morphine sulfate for pain relief every hour, and it is only ordered every four hours. What is the appropriate response of the nurse?
Tell him it is only ordered every four hours.
Let him know his addiction may get worse.
Notify the physician of his request.
Instruct him on possible side effects.
18. Where should a nurse administer eye drops?
Inner corner of the eye.
Outer corner of the eye.
Directly over the cornea.
Center of conjunctival sac.
19. If a patient is deemed "incompetent," this means that:
he/she can't afford to pay the hospital bill.
he/she won't follow medical direction.
a court proceeding has declared him/her unable to make his/her own decisions.
as a nurse you have assessed that he/she is not making good choices or decisions.
20. A "DNRCC" code means that:
the patient should not have their symptoms actively treated.
the patient's care is less priority than another patient whose code status is full code.
therapies and treatments have been limited to those that promote comfort.
it's no longer necessary to take the patient's vital signs.
[ Click here for answers ]
PASSWORD: nclexhelpTuesday, May 20, 2008
New Changes - 2008 NCLEX-PN® Test Plan
This information is official and will be the new changes in the NCLEX-PN as pf April 2008
2008 NCLEX-PN® Test Plan
Test Plan for the National Council Licensure Examination for Practical/Vocational Nurses (NCLEX-PN® Examination)
Distribution of Content
The percentage of test items assigned to each Client Needs category and subcategory in the 2008 NCLEX-PN® Test Plan is based on the results of the study entitled Report of Findings from the 2006 LPN/VN Practice Analysis: Linking the NCLEX-PN® Examination to Practice (NCSBN, 2006), and expert judgment provided by members of the NCSBN Examination Committee.
Client Needs Percentage of Items from Each Category/Subcategory
Safe and Effective Care Environment
Coordinated Care 12-18%
Safety and Infection Control 8-14%
Health Promotion and Maintenance 7-13%
Psychosocial Integrity 8-14%
Physiological Integrity
Basic Care and Comfort 11-17%
Pharmacological Therapies 9-15%
Reduction of Risk Potential 10-16%
Physiological Adaptation 11-17%
2008 NCLEX-PN® Test Plan
Test Plan for the National Council Licensure Examination for Practical/Vocational Nurses (NCLEX-PN® Examination)
Distribution of Content
The percentage of test items assigned to each Client Needs category and subcategory in the 2008 NCLEX-PN® Test Plan is based on the results of the study entitled Report of Findings from the 2006 LPN/VN Practice Analysis: Linking the NCLEX-PN® Examination to Practice (NCSBN, 2006), and expert judgment provided by members of the NCSBN Examination Committee.
Client Needs Percentage of Items from Each Category/Subcategory
Safe and Effective Care Environment
Coordinated Care 12-18%
Safety and Infection Control 8-14%
Health Promotion and Maintenance 7-13%
Psychosocial Integrity 8-14%
Physiological Integrity
Basic Care and Comfort 11-17%
Pharmacological Therapies 9-15%
Reduction of Risk Potential 10-16%
Physiological Adaptation 11-17%
NCLEX Changes and updates
The NCSBN Board of Directors Voted to Raise the Passing Standard for the NCLEX-PN Examination
12/7/2007
The NCSBN Board of Directors voted to raise the passing standard for the NCLEX-PN examination at its meeting on Dec. 5-7, 2007.
Contact: Dawn M. Kappel
Director, Marketing and Communications
312.525.3667 direct
312.279.1034 fax
dkappel@ncsbn.org
FOR IMMEDIATE RELEASE
CHICAGO - The National Council of State Boards of Nursing, Inc. (NCSBN) voted at its Dec. 5-7, 2007, meeting to raise the passing standard for the NCLEX-PN examination (the National Council Licensure Examination for Practical Nurses). The new passing standard is -0.37 logits on the NCLEX-PN logistic scale, 0.05 logits higher than the previous standard of -0.42. The new passing standard will take effect on April 1, 2008, in conjunction with the 2008 NCLEX-PN Test Plan.
After consideration of all available information, the NCSBN Board of Directors determined that safe and effective entry-level LPN/VN practice requires a greater level of knowledge, skills, and abilities than was required in 2005, when NCSBN established the current standard. The passing standard was increased in response to changes in U.S. health care delivery and nursing practice that have resulted in entry-level LPN/VNs caring for clients with multiple, complex health problems.
The Board of Directors used various sources of information to guide its evaluation and discussion regarding the change in passing standard. As part of this process, NCSBN convened an expert panel of 10 nurses to perform a criterion-referenced standard setting procedure. The panel's findings supported the creation of a higher passing standard. NCSBN also considered the results of a national survey of nursing professionals including nursing educators, directors of nursing in acute care settings and administrators of long-term care facilities.
In accordance with a motion adopted by the 1989 NCSBN Delegate Assembly, the NCSBN Board of Directors evaluates the passing standard for the NCLEX-PN examination every three years to protect the public by ensuring minimal competence for entry-level LPN/VNs. NCSBN coordinates the passing standard analysis with the three-year cycle of test plan evaluation. This three-year cycle was developed to keep the test plan and passing standard current. A PDF of the 2008 NCLEX-PN Test Plan is available free of charge from the NCSBN Web site https://www.ncsbn.org/1287.htm.
The National Council of State Boards of Nursing, Inc. (NCSBN) is a not-for-profit organization whose membership comprises the boards of nursing in the 50 states, the District of Columbia and four U.S. territories.
Mission: The National Council of State Boards of Nursing (NCSBN), composed of Member Boards, provides leadership to advance regulatory excellence for public protection.
Media inquiries may be directed to the contact listed above. Technical inquiries about the NCLEX examination may be directed to the NCLEX information line at 1.866.293.9600 or nclexinfo@ncsbn.org.
The definition of a logit may be found on NCSBN’s Web site at https://www.ncsbn.org/02_18_05_brief.pdf.
12/7/2007
The NCSBN Board of Directors voted to raise the passing standard for the NCLEX-PN examination at its meeting on Dec. 5-7, 2007.
Contact: Dawn M. Kappel
Director, Marketing and Communications
312.525.3667 direct
312.279.1034 fax
dkappel@ncsbn.org
FOR IMMEDIATE RELEASE
CHICAGO - The National Council of State Boards of Nursing, Inc. (NCSBN) voted at its Dec. 5-7, 2007, meeting to raise the passing standard for the NCLEX-PN examination (the National Council Licensure Examination for Practical Nurses). The new passing standard is -0.37 logits on the NCLEX-PN logistic scale, 0.05 logits higher than the previous standard of -0.42. The new passing standard will take effect on April 1, 2008, in conjunction with the 2008 NCLEX-PN Test Plan.
After consideration of all available information, the NCSBN Board of Directors determined that safe and effective entry-level LPN/VN practice requires a greater level of knowledge, skills, and abilities than was required in 2005, when NCSBN established the current standard. The passing standard was increased in response to changes in U.S. health care delivery and nursing practice that have resulted in entry-level LPN/VNs caring for clients with multiple, complex health problems.
The Board of Directors used various sources of information to guide its evaluation and discussion regarding the change in passing standard. As part of this process, NCSBN convened an expert panel of 10 nurses to perform a criterion-referenced standard setting procedure. The panel's findings supported the creation of a higher passing standard. NCSBN also considered the results of a national survey of nursing professionals including nursing educators, directors of nursing in acute care settings and administrators of long-term care facilities.
In accordance with a motion adopted by the 1989 NCSBN Delegate Assembly, the NCSBN Board of Directors evaluates the passing standard for the NCLEX-PN examination every three years to protect the public by ensuring minimal competence for entry-level LPN/VNs. NCSBN coordinates the passing standard analysis with the three-year cycle of test plan evaluation. This three-year cycle was developed to keep the test plan and passing standard current. A PDF of the 2008 NCLEX-PN Test Plan is available free of charge from the NCSBN Web site https://www.ncsbn.org/1287.htm.
The National Council of State Boards of Nursing, Inc. (NCSBN) is a not-for-profit organization whose membership comprises the boards of nursing in the 50 states, the District of Columbia and four U.S. territories.
Mission: The National Council of State Boards of Nursing (NCSBN), composed of Member Boards, provides leadership to advance regulatory excellence for public protection.
Media inquiries may be directed to the contact listed above. Technical inquiries about the NCLEX examination may be directed to the NCLEX information line at 1.866.293.9600 or nclexinfo@ncsbn.org.
The definition of a logit may be found on NCSBN’s Web site at https://www.ncsbn.org/02_18_05_brief.pdf.
Monday, May 19, 2008
Thought For The Day
What is Life? by Anneliese Garrison, RN
© written 10/22/00
Alone in a crowd
qiuet in the mist of commotion
I watch life pass by....
What is Life?
As the people pass hurriedly by
No one stops to talk
As if they were shy--
I catch a glimpse of someone starring
He turns away as if I was darring....
What is Life?
Out the window I gaze
I watch life
But what do I see
through life's hurriedly haze?
I see a couple hug
Showing obvious signs of love....
A child crys for a mother
A hug a kiss and then another....
In a dark alley corner
a tear is wiped away.
A homeless shelter...
a blanket for warmth
food for their hunger.
This is life....
As the people pass hurriedly by.....
© written 10/22/00
Alone in a crowd
qiuet in the mist of commotion
I watch life pass by....
What is Life?
As the people pass hurriedly by
No one stops to talk
As if they were shy--
I catch a glimpse of someone starring
He turns away as if I was darring....
What is Life?
Out the window I gaze
I watch life
But what do I see
through life's hurriedly haze?
I see a couple hug
Showing obvious signs of love....
A child crys for a mother
A hug a kiss and then another....
In a dark alley corner
a tear is wiped away.
A homeless shelter...
a blanket for warmth
food for their hunger.
This is life....
As the people pass hurriedly by.....
States That Do Not Require the CGFNS
I received this information from a good friend of mine. I always get asked this question in my emails. “Do you have to take the CGFNS in ________ (Name of State)?” This a the best way to explain it.
Each state has unique laws and regulations for Registered Nurses (RNs). Differences are apparent between states in requirements for foreign educated nurses.
Connecticut: an applicant for RN licensure educated in a foreign country must successfully complete the CGFNS exam prior to being accepted for examination and licensure in the state.
Arizona: As of August 1, 2002, The Arizona Board of Nursing will accept applications from foreign educated nurses who have not completed the CGFNS exam. These nurses will only need the TOEFL or similar English exam, if their nursing education was not in English. Additionally, nurses must have their nursing program transcripts evaluated for equivalency to U. S. nursing educational standards and validation of unrestricted licensure in their country of origin.
California: does not require CGFNS certification or require the foreign educated nurse applicant to pass the CGFNS qualifying exam. It does require that the nurse undergo a credentials review by specialists within the state licensing agency, not through CGFNS. California will review a copy of a credential certificate from another source, but the state must complete its own review of the transcript.
Maryland: has relatively flexible requirements relative to CGFNS certification. A course-by-course evaluation from CGFNS for foreign educated nurses is required. A CGFNS exam may be required after the Maryland Board of Nursing evaluates the applicant's credentials.
New Mexico: does not require CGFNS certification. It does require evaluation of nursing education credentials sent to the state board of nursing directly from a board-recognized credentialing agency or CGFNS.
New York: does not require CGFNS certification. It does require a credentials verification process by an independent organization such as CGFNS. (CGFNS certification is required for RN limited permit applicants; a limited permit authorizes the practice of registered nursing under the immediate and direct supervision of a licensed, currently registered RN, with the endorsement of the employer.)
Ohio: does not require CGFNS certification, but does require a credentials evaluation.
Oregon: does not require CGFNS certification, but applicants must have their credentials evaluated and prove proficiency in English.
Utah: requires applicants to undergo only the CGFNS credentials evaluation. That evaluation, in turn, will determine if the nurse applicant must obtain CGFNS certification before taking the NCLEX.
Michigan: As of June 2007, Governor Jennifer Ganholm has signed into law House Bill 4207, allowing Filipino and other foreign nursing graduates who wish to work in the state to apply to take the National Council Licensing Exam (NCLEX) without the need to pass the Commission on Graduates of Foreign Nursing Schools (CGFNS) qualifying tests.
Unless otherwise mention above, all other States require the CGFNS exam.
Each state has unique laws and regulations for Registered Nurses (RNs). Differences are apparent between states in requirements for foreign educated nurses.
Connecticut: an applicant for RN licensure educated in a foreign country must successfully complete the CGFNS exam prior to being accepted for examination and licensure in the state.
Arizona: As of August 1, 2002, The Arizona Board of Nursing will accept applications from foreign educated nurses who have not completed the CGFNS exam. These nurses will only need the TOEFL or similar English exam, if their nursing education was not in English. Additionally, nurses must have their nursing program transcripts evaluated for equivalency to U. S. nursing educational standards and validation of unrestricted licensure in their country of origin.
California: does not require CGFNS certification or require the foreign educated nurse applicant to pass the CGFNS qualifying exam. It does require that the nurse undergo a credentials review by specialists within the state licensing agency, not through CGFNS. California will review a copy of a credential certificate from another source, but the state must complete its own review of the transcript.
Maryland: has relatively flexible requirements relative to CGFNS certification. A course-by-course evaluation from CGFNS for foreign educated nurses is required. A CGFNS exam may be required after the Maryland Board of Nursing evaluates the applicant's credentials.
New Mexico: does not require CGFNS certification. It does require evaluation of nursing education credentials sent to the state board of nursing directly from a board-recognized credentialing agency or CGFNS.
New York: does not require CGFNS certification. It does require a credentials verification process by an independent organization such as CGFNS. (CGFNS certification is required for RN limited permit applicants; a limited permit authorizes the practice of registered nursing under the immediate and direct supervision of a licensed, currently registered RN, with the endorsement of the employer.)
Ohio: does not require CGFNS certification, but does require a credentials evaluation.
Oregon: does not require CGFNS certification, but applicants must have their credentials evaluated and prove proficiency in English.
Utah: requires applicants to undergo only the CGFNS credentials evaluation. That evaluation, in turn, will determine if the nurse applicant must obtain CGFNS certification before taking the NCLEX.
Michigan: As of June 2007, Governor Jennifer Ganholm has signed into law House Bill 4207, allowing Filipino and other foreign nursing graduates who wish to work in the state to apply to take the National Council Licensing Exam (NCLEX) without the need to pass the Commission on Graduates of Foreign Nursing Schools (CGFNS) qualifying tests.
Unless otherwise mention above, all other States require the CGFNS exam.
Sunday, May 18, 2008
Delegating and Prioritizing In A Disaster
[Copywrite 2008 - ] do not republuish without permission
Okay, this is a much needed informational blog that I put together to explain the difference between internal, natural and external disasters. The NCLEX is focusing a lot on this due to the advent of 9/11/2001 and the changing times we live in.
What is meant by Internal Disaster was when the buildings actually started emploding [collapsing upon themselves] killing and/or trapping thousands of people inside. This is your INTERNAL DISASTER. You know more than you can handle will be hurt and or dead. What do you do? You are the head of the INTERNAL DISASTER MANAGEMENT TEAM. When a disaster happens INSIDE and enclosed place with lots of people, you help the people that are least hurt first. The reason being, so that they can possible help you, with the other survivors or you have very little time and you know you can move the victim and they have a chance to survive. In an INTERNAL DISASTER help and survival are KEY.
How does this differ from a disaster from which they are now coming to your hospital? Now, we take all the people from the World Trade Center and now, they are start coming to your hospital. Of course, now you are over loaded. It is up to you as the triage nurse NOW to see the most traumatized person FIRST. The rest can wait. Once they are at their destination of medical care, the gear shifts, you help the more tramatized patient first to ensure their chances of survival.
An EXTERNAL DISASTER can also be known as a NATURAL DISASTER in some cases. This involves a disaster that occurs outside the hospital as well such as a plane crash, or a train wreck ect. To summarize the three types of disasters: an INTERNAL DISASTER is a large number of people wounded/hurt/dead in an enclosed place be it inside or outside. [ie: 9/11 with the explosion of the twin towers in New York or the Pentagon in Washington]. An EXTERNAL DISASTER is a disaster away from a medical center and it is "man made". [ie: Plan crash, train wreck or casualties of war].
In a NATURAL DISASTER, say the San Diago Bridge collapses or there is a giant volcano ect. Still use the same rule as in the 2001 ect above. Help the people off the bridge [the least wounded] before the bridge collapses. The goal here is to save lives. You can not do anything about the people whose cars have already fallen into the ocean or for the people to whom the fire has already engulfed. Once, you get the people into a save distance, then you do the whole triage thing helping the most wounded.
Does that make it any clearer? Please continue to ask your questions. This is an important area of discussion. My goal personally, is not to answer the actual questions. You will never pass the nclex memorizing questions. We must understand CONCEPTS to pass the NCLEX.
Now, let us move on to delegating in terms of triage:
How do you prioritize in a disaster? Remember the word T-R-I-A-G-E. Trauma, R=respiratory, Intracranial pressure & mental status, An infection, GI-upper, Elimination-lower. In that order. Prioritizing, starting with trauma first and lower GI injuries last. You will not need to know how to tag for the nclex but I place this here so that you can understand the concept.
Triage is a French verb that means "to sort". The goal of triage is
to do the greatest good for the greatest numbers of individuals. This
is accomplished by having a system to quickly assess each patient,
categorize and prioritize them according to their needs. Be sure to
evaluate the hazards before entering an area to perform triage.
Triage should be initiated whenever there are more injured persons
than rescuers.
The four (4) triage categories and a description of their meanings
are:
• Green is the lowest priority and is used for walking wounded or
patients who may not need to go to the hospital. Patients in this
category may have minor musculoskeletal or soft tissue injures. They
can wait for treatment and/or transport until all other patients have
been removed from the scene.
• Moving up the tag, yellow is the next category and is used for
patients who definitely need to go to a hospital, but not
immediately. These patients have injuries that are serious but not
life-threatening, such as burns without airway problems, major or
multiple bone or joint injuries, and back injuries without spinal
cord damage. These patients will be treated and transported after the
critical (or red-tagged) patients have been taken to trauma centers
or hospitals.
• The highest priority is red, and it is used for critically-injured patients with treatable life-threatening injuries or illnesses. This
might include airway and breathing difficulties, decreased mental
status, and uncontrolled bleeding. These patients will be treated and
transported from the scene first.
• The final category is black and it is used for dead and
unsalvageable patients such as someone in cardiac arrest. These
victims will be removed from the scene, but only after all of the
living/salvageable patients.
START Now
METTAGs in hand, you now begin the tremendous responsibility of
organizing the chaos. Simple Triage And Rapid Treatment, or START, is
a triage system that was developed in California in the early 1980s. It is simple and fast, requiring less than sixty seconds for each patient. It does not require any special assessment or diagnostic tools. EMTs do not need a blood pressure cuff, a stethoscope or even a penlight. The system provides for rapid life saving stabilization such as airway control and bleeding control, but excludes CPR.
A word here about cardiopulmonary resuscitation: CPR is not performed
in these situations because two or three rescuers would be required
to treat a single patient whose probability of survival (in the
chaos) is zero-to-none. On the other hand, those same two or three
rescuers could play an important role in treating five, ten, or maybe
even more patients.
How to Start
The first (and easiest) thing you must do is separate the walking
wounded from the other victims with more severe injuries. This can be
done by shouting slowly and clearly or using a bullhorn. Designate an
area for walking wounded and instruct anyone who can walk to get up
and move to that area. (Note: Some victims may be unwilling to leave
their friends or family members who are ill or injured; permit them
to stay as they can help you with managing the patient.) The theory
here is that if a person can walk, he does not need immediate medical
care. Green-tagged patients will not be ignored. Rather, they will be
further assessed and treated when all of the red and yellow patients
have been treated and/or transported and resources become available
to take care of them.
All of the patients in this area are considered to be "green tags."
Later you will return to the "green" area and "officially" tag them
but only after you have triaged the red and yellow victims. With this
green group in a separate (safe) location, you are well on the way to
being organized.
Evaluating the Remaining Victims
The next step is to triage the remaining victims. By evaluating
respiration, perfusion and mental status, you sort and separate them
into three categories which give the greatest priority to those
victims who are most critically injured, and have the greatest chance
of survival. Let's quickly review our color-coded tags:
• Red Tag: those victims whose injuries are life-threatening and
must be immediately treated and transported.
• Yellow Tag: those whose injuries will allow for delayed
treatment and transport.
• Black Tag: those who are dead or unsalvageable.
How do we make that determination? RPM.
R = Respirations
The first assessment is for presence and rate of respiration (RPM).
Is the victim breathing? If there is no respiratory effort,
reposition his head and reassess. If there is still no respiratory
effort, the victim is considered "dead/non-salvageable." Apply a
black tag and move on to the next victim.
What if he is breathing? Assess the rate. If the rate is above 30
breaths-per-minute, the patient is critical and requires immediate
care. (Remember from your EMT-B class that a respiratory rate above
30 and below eight breaths-per-minute (BPM) is not adequate to meet
the body's needs and may quickly progress to cellular death.) As
triage officer, however, you do not stop to ventilate this patient!
He is given a red tag and you move on to the next victim. You do not
need to complete any other components of the START assessment on this
patient.
If the patient requires simple airway maintenance (e.g. manual head
positioning), you will need to assign someone to this task. If no
emergency service personnel are available, remember that you have a
pool of human resources in the green tag area. If no one there is
available, you will need to improvise by placing something under the
patient's head/neck to keep the airway open. It should also be
noted here that airway maintenance might need to be done without standard
cervical spine precautions.
If the respiratory rate is less than 30 breaths-per-minute, move on
to the next part of the assessment process.
P = Perfusion
The next step is to assess for Perfusion (RPM). As you may remember
from your EMT-B course or core refresher, perfusion is the
circulation of blood within an organ or tissue in adequate amounts to
meet the cells' current needs. If the body lacks adequate
perfusion
or circulation, cells, tissues, and organs will die.
How do we assess perfusion in victims at an MCS? Check for the
presence of radial pulses. However, note that we are not concerned
with a pulse rate at this time. If the patient has no radial pulses,
he is critical and in immediate need of care. You apply a red tag to
the patient and move on to the next patient.
If there are no radial pulses, there is no need to check for carotid
pulses. Why not? If the patient does not have a carotid pulse, then
he will also have no respiratory effort, and therefore, would have
been triaged as dead/non-salvageable in the previous step. Recall
also that the presence of a radial pulse correlates to a systolic
blood pressure of at least 80 to 90 mmHg. If radial pulses are
present, move onto the next assessment.
There is one other assessment-finding related to perfusion status
which must be mentioned here: severe bleeding. Uncontrolled bleeding
is potentially life threatening and must be treated when found.
Again, you may have to improvise by using the cleanest piece of cloth
around which may not be sterile.
Do not forget your human resources available in the green area.
Delegate someone to maintain direct pressure on the wound and move on
to the next victim. Your job remains triage.
M = Mentation
The third and final assessment is for Mentation (RPM) or mental
status. A patient who is either unconscious, or conscious but unable
to follow directions, is critical and requires immediate care. You
will apply a red tag to this patient and move on to the next victim.
If the patient has a normal level of consciousness and can follow
directions, he is not in immediate need of care and is triaged as
yellow.
As soon as a patient meets any one of the criteria for triage as
critical/immediate, you should apply a red tag, delegate someone to
provide rapid treatment (e.g. maintain an airway or control
bleeding), stop any further assessment and move on to the next
victim.
Any patient who makes it through all three assessments, without any
findings that would result in triaging as critical/immediate, is
given a yellow tag. No triage system is 100% fail safe. It is,
however, reasonable to assume, that a patient who cannot walk, but is
maintaining his own airway, breathing at a rate less than 30 breaths-
per-minute, perfusing radial pulses, has no sign of uncontrolled
bleeding and follows commands, is in need of medical attention at the
hospital, but can wait until all of the critical/immediate (red tags)
are removed from the scene.
Secondary Triage
Let's quickly review how START integrates with the METTAG system.
• Anyone who gets up and walks to the designated area is given a
green tag (may not even require hospital care).
• Anyone who is not breathing is given a black tag (dead/non-
salvageable).
• Anyone who fails one of the RPM assessments is given a red tag
(critical/immediate).
• Anyone who cannot walk but passes all of the assessments is
given a yellow tag (delayed).
Okay, this is a much needed informational blog that I put together to explain the difference between internal, natural and external disasters. The NCLEX is focusing a lot on this due to the advent of 9/11/2001 and the changing times we live in.
What is meant by Internal Disaster was when the buildings actually started emploding [collapsing upon themselves] killing and/or trapping thousands of people inside. This is your INTERNAL DISASTER. You know more than you can handle will be hurt and or dead. What do you do? You are the head of the INTERNAL DISASTER MANAGEMENT TEAM. When a disaster happens INSIDE and enclosed place with lots of people, you help the people that are least hurt first. The reason being, so that they can possible help you, with the other survivors or you have very little time and you know you can move the victim and they have a chance to survive. In an INTERNAL DISASTER help and survival are KEY.
How does this differ from a disaster from which they are now coming to your hospital? Now, we take all the people from the World Trade Center and now, they are start coming to your hospital. Of course, now you are over loaded. It is up to you as the triage nurse NOW to see the most traumatized person FIRST. The rest can wait. Once they are at their destination of medical care, the gear shifts, you help the more tramatized patient first to ensure their chances of survival.
An EXTERNAL DISASTER can also be known as a NATURAL DISASTER in some cases. This involves a disaster that occurs outside the hospital as well such as a plane crash, or a train wreck ect. To summarize the three types of disasters: an INTERNAL DISASTER is a large number of people wounded/hurt/dead in an enclosed place be it inside or outside. [ie: 9/11 with the explosion of the twin towers in New York or the Pentagon in Washington]. An EXTERNAL DISASTER is a disaster away from a medical center and it is "man made". [ie: Plan crash, train wreck or casualties of war].
In a NATURAL DISASTER, say the San Diago Bridge collapses or there is a giant volcano ect. Still use the same rule as in the 2001 ect above. Help the people off the bridge [the least wounded] before the bridge collapses. The goal here is to save lives. You can not do anything about the people whose cars have already fallen into the ocean or for the people to whom the fire has already engulfed. Once, you get the people into a save distance, then you do the whole triage thing helping the most wounded.
Does that make it any clearer? Please continue to ask your questions. This is an important area of discussion. My goal personally, is not to answer the actual questions. You will never pass the nclex memorizing questions. We must understand CONCEPTS to pass the NCLEX.
Now, let us move on to delegating in terms of triage:
How do you prioritize in a disaster? Remember the word T-R-I-A-G-E. Trauma, R=respiratory, Intracranial pressure & mental status, An infection, GI-upper, Elimination-lower. In that order. Prioritizing, starting with trauma first and lower GI injuries last. You will not need to know how to tag for the nclex but I place this here so that you can understand the concept.
Triage is a French verb that means "to sort". The goal of triage is
to do the greatest good for the greatest numbers of individuals. This
is accomplished by having a system to quickly assess each patient,
categorize and prioritize them according to their needs. Be sure to
evaluate the hazards before entering an area to perform triage.
Triage should be initiated whenever there are more injured persons
than rescuers.
The four (4) triage categories and a description of their meanings
are:
• Green is the lowest priority and is used for walking wounded or
patients who may not need to go to the hospital. Patients in this
category may have minor musculoskeletal or soft tissue injures. They
can wait for treatment and/or transport until all other patients have
been removed from the scene.
• Moving up the tag, yellow is the next category and is used for
patients who definitely need to go to a hospital, but not
immediately. These patients have injuries that are serious but not
life-threatening, such as burns without airway problems, major or
multiple bone or joint injuries, and back injuries without spinal
cord damage. These patients will be treated and transported after the
critical (or red-tagged) patients have been taken to trauma centers
or hospitals.
• The highest priority is red, and it is used for critically-injured patients with treatable life-threatening injuries or illnesses. This
might include airway and breathing difficulties, decreased mental
status, and uncontrolled bleeding. These patients will be treated and
transported from the scene first.
• The final category is black and it is used for dead and
unsalvageable patients such as someone in cardiac arrest. These
victims will be removed from the scene, but only after all of the
living/salvageable patients.
START Now
METTAGs in hand, you now begin the tremendous responsibility of
organizing the chaos. Simple Triage And Rapid Treatment, or START, is
a triage system that was developed in California in the early 1980s. It is simple and fast, requiring less than sixty seconds for each patient. It does not require any special assessment or diagnostic tools. EMTs do not need a blood pressure cuff, a stethoscope or even a penlight. The system provides for rapid life saving stabilization such as airway control and bleeding control, but excludes CPR.
A word here about cardiopulmonary resuscitation: CPR is not performed
in these situations because two or three rescuers would be required
to treat a single patient whose probability of survival (in the
chaos) is zero-to-none. On the other hand, those same two or three
rescuers could play an important role in treating five, ten, or maybe
even more patients.
How to Start
The first (and easiest) thing you must do is separate the walking
wounded from the other victims with more severe injuries. This can be
done by shouting slowly and clearly or using a bullhorn. Designate an
area for walking wounded and instruct anyone who can walk to get up
and move to that area. (Note: Some victims may be unwilling to leave
their friends or family members who are ill or injured; permit them
to stay as they can help you with managing the patient.) The theory
here is that if a person can walk, he does not need immediate medical
care. Green-tagged patients will not be ignored. Rather, they will be
further assessed and treated when all of the red and yellow patients
have been treated and/or transported and resources become available
to take care of them.
All of the patients in this area are considered to be "green tags."
Later you will return to the "green" area and "officially" tag them
but only after you have triaged the red and yellow victims. With this
green group in a separate (safe) location, you are well on the way to
being organized.
Evaluating the Remaining Victims
The next step is to triage the remaining victims. By evaluating
respiration, perfusion and mental status, you sort and separate them
into three categories which give the greatest priority to those
victims who are most critically injured, and have the greatest chance
of survival. Let's quickly review our color-coded tags:
• Red Tag: those victims whose injuries are life-threatening and
must be immediately treated and transported.
• Yellow Tag: those whose injuries will allow for delayed
treatment and transport.
• Black Tag: those who are dead or unsalvageable.
How do we make that determination? RPM.
R = Respirations
The first assessment is for presence and rate of respiration (RPM).
Is the victim breathing? If there is no respiratory effort,
reposition his head and reassess. If there is still no respiratory
effort, the victim is considered "dead/non-salvageable." Apply a
black tag and move on to the next victim.
What if he is breathing? Assess the rate. If the rate is above 30
breaths-per-minute, the patient is critical and requires immediate
care. (Remember from your EMT-B class that a respiratory rate above
30 and below eight breaths-per-minute (BPM) is not adequate to meet
the body's needs and may quickly progress to cellular death.) As
triage officer, however, you do not stop to ventilate this patient!
He is given a red tag and you move on to the next victim. You do not
need to complete any other components of the START assessment on this
patient.
If the patient requires simple airway maintenance (e.g. manual head
positioning), you will need to assign someone to this task. If no
emergency service personnel are available, remember that you have a
pool of human resources in the green tag area. If no one there is
available, you will need to improvise by placing something under the
patient's head/neck to keep the airway open. It should also be
noted here that airway maintenance might need to be done without standard
cervical spine precautions.
If the respiratory rate is less than 30 breaths-per-minute, move on
to the next part of the assessment process.
P = Perfusion
The next step is to assess for Perfusion (RPM). As you may remember
from your EMT-B course or core refresher, perfusion is the
circulation of blood within an organ or tissue in adequate amounts to
meet the cells' current needs. If the body lacks adequate
perfusion
or circulation, cells, tissues, and organs will die.
How do we assess perfusion in victims at an MCS? Check for the
presence of radial pulses. However, note that we are not concerned
with a pulse rate at this time. If the patient has no radial pulses,
he is critical and in immediate need of care. You apply a red tag to
the patient and move on to the next patient.
If there are no radial pulses, there is no need to check for carotid
pulses. Why not? If the patient does not have a carotid pulse, then
he will also have no respiratory effort, and therefore, would have
been triaged as dead/non-salvageable in the previous step. Recall
also that the presence of a radial pulse correlates to a systolic
blood pressure of at least 80 to 90 mmHg. If radial pulses are
present, move onto the next assessment.
There is one other assessment-finding related to perfusion status
which must be mentioned here: severe bleeding. Uncontrolled bleeding
is potentially life threatening and must be treated when found.
Again, you may have to improvise by using the cleanest piece of cloth
around which may not be sterile.
Do not forget your human resources available in the green area.
Delegate someone to maintain direct pressure on the wound and move on
to the next victim. Your job remains triage.
M = Mentation
The third and final assessment is for Mentation (RPM) or mental
status. A patient who is either unconscious, or conscious but unable
to follow directions, is critical and requires immediate care. You
will apply a red tag to this patient and move on to the next victim.
If the patient has a normal level of consciousness and can follow
directions, he is not in immediate need of care and is triaged as
yellow.
As soon as a patient meets any one of the criteria for triage as
critical/immediate, you should apply a red tag, delegate someone to
provide rapid treatment (e.g. maintain an airway or control
bleeding), stop any further assessment and move on to the next
victim.
Any patient who makes it through all three assessments, without any
findings that would result in triaging as critical/immediate, is
given a yellow tag. No triage system is 100% fail safe. It is,
however, reasonable to assume, that a patient who cannot walk, but is
maintaining his own airway, breathing at a rate less than 30 breaths-
per-minute, perfusing radial pulses, has no sign of uncontrolled
bleeding and follows commands, is in need of medical attention at the
hospital, but can wait until all of the critical/immediate (red tags)
are removed from the scene.
Secondary Triage
Let's quickly review how START integrates with the METTAG system.
• Anyone who gets up and walks to the designated area is given a
green tag (may not even require hospital care).
• Anyone who is not breathing is given a black tag (dead/non-
salvageable).
• Anyone who fails one of the RPM assessments is given a red tag
(critical/immediate).
• Anyone who cannot walk but passes all of the assessments is
given a yellow tag (delayed).
You Are A Nursing Student
You Are A Nursing Student by Anneliese Garrison, RN
© written 12/20/95
You will be mentally stressed.
You will be emotionally challenged.
You will learn how to work together.
You will learn to work alone.
You will learn when to speak.
You will learn when to be silent.
You will learn when to lead.
You will learn when to follow.
You will be constructively criticized.
You will be praised.
You will shed a few tears.
You will share in each other's laughter.
You will learn the need to help eachother.
You will learn to help yourself.
You will learn to be part of a group.
You will learn to be yourself--an individual.
You will learn responsibility.
You will learn disipline.
You will learn these things because
someday someone's life will depend
on you.
You are a nursing student
you will graduate------
You will be,
in all it's wonder and glory,
a Nurse.
© written 12/20/95
You will be mentally stressed.
You will be emotionally challenged.
You will learn how to work together.
You will learn to work alone.
You will learn when to speak.
You will learn when to be silent.
You will learn when to lead.
You will learn when to follow.
You will be constructively criticized.
You will be praised.
You will shed a few tears.
You will share in each other's laughter.
You will learn the need to help eachother.
You will learn to help yourself.
You will learn to be part of a group.
You will learn to be yourself--an individual.
You will learn responsibility.
You will learn disipline.
You will learn these things because
someday someone's life will depend
on you.
You are a nursing student
you will graduate------
You will be,
in all it's wonder and glory,
a Nurse.
Saturday, May 17, 2008
HELP!~ Managing Stress and The NCLEX
STRESS AND WAYS TO HANDLE IT
[ http://www.thebody.com ] PLAIN TALK ABOUT STRESS
[http://mentalhelp.net ] WAYS OF HANDLING STRESS AND ANXIETY
[ http://www.mouthshut.com ] DON'T WORRY BE HAPPY: WAYS TO HANDLE STRESS
[ http://www.mouthshut.com ] STRESS: ACCEPT, UNDERSTAND AND FACE IT
RELAXATION TECHNIQUES TO FREE YOURSELF FROM STRESS
[ http://www.toolsforwellness.com ] RELIEVE STRESS: A TOOL FOR WELLNESS
[ http://www.clevelandclinic.org ] STRESS: HOW CAN I COPE?
[ http://www.cdc.gov ] DEALING WITH STRESS
[ http://www.ncfh.org ] TIPS TO REDUCE STRESS [easy read]
[http://www.learningmeditation.com ] LEARNING TO RELAX [this has text and real audio]
WHEN FEAR GRIPS YOU SUDDENLY
Dealing with stress to avoid anxiety through relaxation techniques is a good preventative measure but how do you handle it when fear grips you suddenly? Ex. You are walking into the test center to take your exam, and suddenly you turn white as a ghost, fear paralyzes you in your tracks and people asking if you are alright just makes it worse! What do you do? "Please help, get a grip!" You may say to yourself.
[ http://www.mindpub.com ] WAYS TO HANDLE ANXIETY AND PANIC ATTACKS
[ http://www.associatedcontent.com ] Simple Cognitive Tools to Control Your Anxiety and Eliminate Panic Attacks
[ http://www.panic-attacks.co.uk FREE PANIC ATTACKS PREVENTION PROGRAM
[ http://www.thebody.com ] PLAIN TALK ABOUT STRESS
[http://mentalhelp.net ] WAYS OF HANDLING STRESS AND ANXIETY
[ http://www.mouthshut.com ] DON'T WORRY BE HAPPY: WAYS TO HANDLE STRESS
[ http://www.mouthshut.com ] STRESS: ACCEPT, UNDERSTAND AND FACE IT
RELAXATION TECHNIQUES TO FREE YOURSELF FROM STRESS
[ http://www.toolsforwellness.com ] RELIEVE STRESS: A TOOL FOR WELLNESS
[ http://www.clevelandclinic.org ] STRESS: HOW CAN I COPE?
[ http://www.cdc.gov ] DEALING WITH STRESS
[ http://www.ncfh.org ] TIPS TO REDUCE STRESS [easy read]
[http://www.learningmeditation.com ] LEARNING TO RELAX [this has text and real audio]
WHEN FEAR GRIPS YOU SUDDENLY
Dealing with stress to avoid anxiety through relaxation techniques is a good preventative measure but how do you handle it when fear grips you suddenly? Ex. You are walking into the test center to take your exam, and suddenly you turn white as a ghost, fear paralyzes you in your tracks and people asking if you are alright just makes it worse! What do you do? "Please help, get a grip!" You may say to yourself.
[ http://www.mindpub.com ] WAYS TO HANDLE ANXIETY AND PANIC ATTACKS
[ http://www.associatedcontent.com ] Simple Cognitive Tools to Control Your Anxiety and Eliminate Panic Attacks
[ http://www.panic-attacks.co.uk FREE PANIC ATTACKS PREVENTION PROGRAM
NCLEX Test Tips
1. Know yourself. Identify your usual testing behaviors. Do you get anxious? Is time a problem? Do you do better on a certain type of test?
2. Know the test plan. What kind of questions are going to be used. You know that we use multiple choice questions. Some cover basic knowledge, for example the signs and symptoms are. But more and more the questions wants to know what action is required based on those signs and symptoms, what do you do? This requires higher level thinking, or application of the knowledge. NCLEX is written in this format which is why we do also. This is why memorization alone does not guarantee success on nursing exams. Practice answering this type of question.
3. Start with the "I can do this, I just need to figure out how." Be positive, you came this far, you CAN do it.
4. Get organized and plan ahead. Start your success notebook. Plan you study times or study groups.
5. Learn how to read questions. Identify the background statement, the stem and the key words. This will help you choose the best response when given similar responses and will help you make an educated guess if you are unsure.
6. Practice, practice, practice, answer many questions. Practice 100 to 150 questions a day. This is what you will be able to do comfortable or do 3000 to 7000 practice questions before you take the NCLEX. We have included some here but there are many resources available, NCLEX review books, online resources, your text books, study guides, etc. I strongly urge and recommend that you get First Aide For NCLEX by Anderson and Lippincott's RN Review. This book iis also available for Practical Nurses taking the NCLEX.
7. Arrive early for warm up. Give yourself enough time to calm down and get focused and mentally review. But this is NOT the time to try and learn new information or listen to you classmates.
8. You will not be able skim the whole test first. But you will get 3 warm up questions at the beginning. These also get your brain in gear. The worse approach is to stress out because you can't think of the answer to the first question.
9. Focus on what you know. Don't spend time for example, knowing the actual medciation but rather, know the class and action of a medication. Time is still an issue and you will have 5 hours to complete 265 questions if necessary. This works out to be 1 minute and 13 seconds per question should you have to go all the way to the end. However, most of the time you do not go to the end so take the time to read the questions at least twice. If you get up to 200 questions, this would be a que to pick up the pace if needed.
10. When in doubt do NOT change answers. Studies have shown that your first response is most likely correct. Do not talk yourself out of the answer. Do not read information into the question that is not there. The NCLEX means what itasks, not something else.
11. List lab values, draw pictures. Write on the paper and pencil that is provided to you at the testing center, use key words or diagrams that will jog your memory.
12. While studying at home, write any information that you have missed during your studies down. Then, take your notes and record them to a tape. Listen to yourself and your notes every chance you get: driving, cleaning and even when going to bed. This will help the information stay with you and it is a good use of study time.
13. Do not forget to eat a good breakfast the morning of your test. I personally would stay away from caffeine or nicotine. This is easier said then done coming from a non smoker but the key here is to RELAX and be sharp.
14. I do not recommend this often, but if you are one of the many masses that have taken the NCLEX more than 2 times, perhaps, you need to see a doctor about taking some medication to calm your nerves. If you do decide to go this route, please take one prescribed dose a couple days before your actual test day. You want to see how your body responds. You don't want to be sleepy just calm. If you find that you get sleepy, than take less of the medication or none at all.
15. Lastly, I would recommend a dry run to the testing center. Find out where to park and where the actual room is for the NCLEX exam. A lot of times it is in a big city in a big building. It is easy to get lost and although you are not really late, time does not start until you sit in front of computer, you do not want to add more stress to yourself on your important day.
2. Know the test plan. What kind of questions are going to be used. You know that we use multiple choice questions. Some cover basic knowledge, for example the signs and symptoms are. But more and more the questions wants to know what action is required based on those signs and symptoms, what do you do? This requires higher level thinking, or application of the knowledge. NCLEX is written in this format which is why we do also. This is why memorization alone does not guarantee success on nursing exams. Practice answering this type of question.
3. Start with the "I can do this, I just need to figure out how." Be positive, you came this far, you CAN do it.
4. Get organized and plan ahead. Start your success notebook. Plan you study times or study groups.
5. Learn how to read questions. Identify the background statement, the stem and the key words. This will help you choose the best response when given similar responses and will help you make an educated guess if you are unsure.
6. Practice, practice, practice, answer many questions. Practice 100 to 150 questions a day. This is what you will be able to do comfortable or do 3000 to 7000 practice questions before you take the NCLEX. We have included some here but there are many resources available, NCLEX review books, online resources, your text books, study guides, etc. I strongly urge and recommend that you get First Aide For NCLEX by Anderson and Lippincott's RN Review. This book iis also available for Practical Nurses taking the NCLEX.
7. Arrive early for warm up. Give yourself enough time to calm down and get focused and mentally review. But this is NOT the time to try and learn new information or listen to you classmates.
8. You will not be able skim the whole test first. But you will get 3 warm up questions at the beginning. These also get your brain in gear. The worse approach is to stress out because you can't think of the answer to the first question.
9. Focus on what you know. Don't spend time for example, knowing the actual medciation but rather, know the class and action of a medication. Time is still an issue and you will have 5 hours to complete 265 questions if necessary. This works out to be 1 minute and 13 seconds per question should you have to go all the way to the end. However, most of the time you do not go to the end so take the time to read the questions at least twice. If you get up to 200 questions, this would be a que to pick up the pace if needed.
10. When in doubt do NOT change answers. Studies have shown that your first response is most likely correct. Do not talk yourself out of the answer. Do not read information into the question that is not there. The NCLEX means what itasks, not something else.
11. List lab values, draw pictures. Write on the paper and pencil that is provided to you at the testing center, use key words or diagrams that will jog your memory.
12. While studying at home, write any information that you have missed during your studies down. Then, take your notes and record them to a tape. Listen to yourself and your notes every chance you get: driving, cleaning and even when going to bed. This will help the information stay with you and it is a good use of study time.
13. Do not forget to eat a good breakfast the morning of your test. I personally would stay away from caffeine or nicotine. This is easier said then done coming from a non smoker but the key here is to RELAX and be sharp.
14. I do not recommend this often, but if you are one of the many masses that have taken the NCLEX more than 2 times, perhaps, you need to see a doctor about taking some medication to calm your nerves. If you do decide to go this route, please take one prescribed dose a couple days before your actual test day. You want to see how your body responds. You don't want to be sleepy just calm. If you find that you get sleepy, than take less of the medication or none at all.
15. Lastly, I would recommend a dry run to the testing center. Find out where to park and where the actual room is for the NCLEX exam. A lot of times it is in a big city in a big building. It is easy to get lost and although you are not really late, time does not start until you sit in front of computer, you do not want to add more stress to yourself on your important day.
How To Choose The Right Answer
So you are ready to take your State Boards, congratulations!~ You sit down to study and you start doing question 1 of the thousands of questions you have to answer. The problem is that you can always narrow it down to two answers! You take your best shot and "darn it!", you still get it wrong? You muddle through anyway and you find that you are only getting in the 60th percentile on the practice exams. Is this normal? Yes, it is but here at caring4you.net, I have come up with a way that helps you to choose the right answer on your NCLEX:
Decide What the Question is Dealing With:
Which part of the Nursing Process: Assessment; Analysis; Planning; Implementation or Evaluation?
Next, Decide the Order of Priority:
First you must decide what part of the nursing process the question is connected with:
ANALYSIS--is the process of identifying potential and actual health problems. Most identify pertinent assessment information and assimilate it into the nursing diagnosis. Prioritize the needs that have been identified during analysis.
Some common words that are associated with ANALYSIS questions:
diagnose; contrast; compare; analyze; order; prioritize; define; classify; catagorize; synthesize; sort; arrange;
ASSESSMENT--consists of a collection of data. Baseline information for pre and post procedures is included. Also included the recognition of pertinent signs and symptoms of health problems both present and potential. Verification of data and confirmation of findings are also included. Assess a situation before doing an intervention.
Some common words that are associated with ASSESSMENT questions:
observe; gather; collect; differentiate; assess; recognize; detect; distinguish; identify; display; indicate; describe;
PLANNING--Involves formulating goals and outcomes. It also involves various members of the health care team and the patient's family. All outcome criteria must be able to be evaluated with a specific time frame. Be sure to establish priorities and modify according to question.
Some common words that are associated with PLANNING questions:
rearrange; reconstruct; determine; outcomes; formulate; include; expected; designate; plan; generate; short/long term goal; develop;
IMPLEMENTATION--Addresses the actual/direct care of a patient. Direct care entails pre, intra and postoperative management, preforming procedures, treatments, activities of daily living. Also includes the coordination of care and referral on discharge. It involves documentation and therapeutic response to intervention and patient teaching for health promotion and helping the patient maintain proper health.
Some common words that are associated with IMPLEMENTATION questions:
document; explain; give; inform; administer; implement; encourage; advise; provide; perform;
EVALUATION--Determines if the interventions were effective. Were goals met? Was the care delivered properly? Are modification plans needed. Addresses the effectiveness of patient teaching and understands and determines in proper care was offered. Evaluation can involve documentation, reporting issues, evaluates care given and determine the appropriateness of delegating to others. Most significantly, it finds out the response of the patient to care and the extent to which the goals we met.
Some common words that are associated with EVALUATION questions:
monitor; expand; evaluate; synthesize; determine; consider; question; repeat; outcomes; demonstrate; reestablish;
After determining what part of the nursing process the question is concerned with, next focus your attention on determining the category of priority:
Safe and effective care environment is always first. Patient safety is related to the proper preparation and delivery of nursing techniques and procedures as part of the nursing practice. It relates to every aspect of the delivery of care.
Physiologic integrity is the ability to provide competent care Information that may be described as traditionally medical- surgical and pediatric nursing falls into this category. Specific questions in this area can be related to many direct-care aspects of nursing practice. The importance of this area is highlighted because it is one in which planning, implementation and evaluation of care needs can easily be identified and tested. Physiologic integrity is always a slight lower priority than safety unless it involves airway, breathing and circulation. "ABC's" always comes first!
Psychosocial integrity tests the knowledge about a patients response to a disease or disorder. An understanding of stress, anxiety and ways to cope are essential. This is a lower priority the physiological integrity.
Health maintenance deals with health promotion, health teaching, disease prevention and assessment of risk factors for health problems. Normal growth and development is a major theme in this category. This however, is a low priority.
In Summary, when choosing the right answer for you NCLEX exam question 1) ask yourself, "what part of the nursing process is this question dealing with: analysis, assessment, planning, implantation or evaluation? and 2) Remember to prioritize your choices: safety always being first, 2)physiological integrity, 3)psychosocial integrity and health maintenance always has the lowest priority when choosing an answer.
Other tidbits:
avoid choices with the answers "all" "always" "never" or "none". Nothing is ever a definite in Science.
look for answers that are different. If three answers say the same thing but in different words, choose the answer that is different.
when given choices that are pharmacologically based or non pharmacologically based, choose the non pharmacological intervention. It is more often then not, the correct answer.
Video Related Link:
[ PROFESSOR NIGHTEMGALE'S TEST TAKING TIPS ]
Decide What the Question is Dealing With:
Which part of the Nursing Process: Assessment; Analysis; Planning; Implementation or Evaluation?
Next, Decide the Order of Priority:
First you must decide what part of the nursing process the question is connected with:
ANALYSIS--is the process of identifying potential and actual health problems. Most identify pertinent assessment information and assimilate it into the nursing diagnosis. Prioritize the needs that have been identified during analysis.
Some common words that are associated with ANALYSIS questions:
diagnose; contrast; compare; analyze; order; prioritize; define; classify; catagorize; synthesize; sort; arrange;
ASSESSMENT--consists of a collection of data. Baseline information for pre and post procedures is included. Also included the recognition of pertinent signs and symptoms of health problems both present and potential. Verification of data and confirmation of findings are also included. Assess a situation before doing an intervention.
Some common words that are associated with ASSESSMENT questions:
observe; gather; collect; differentiate; assess; recognize; detect; distinguish; identify; display; indicate; describe;
PLANNING--Involves formulating goals and outcomes. It also involves various members of the health care team and the patient's family. All outcome criteria must be able to be evaluated with a specific time frame. Be sure to establish priorities and modify according to question.
Some common words that are associated with PLANNING questions:
rearrange; reconstruct; determine; outcomes; formulate; include; expected; designate; plan; generate; short/long term goal; develop;
IMPLEMENTATION--Addresses the actual/direct care of a patient. Direct care entails pre, intra and postoperative management, preforming procedures, treatments, activities of daily living. Also includes the coordination of care and referral on discharge. It involves documentation and therapeutic response to intervention and patient teaching for health promotion and helping the patient maintain proper health.
Some common words that are associated with IMPLEMENTATION questions:
document; explain; give; inform; administer; implement; encourage; advise; provide; perform;
EVALUATION--Determines if the interventions were effective. Were goals met? Was the care delivered properly? Are modification plans needed. Addresses the effectiveness of patient teaching and understands and determines in proper care was offered. Evaluation can involve documentation, reporting issues, evaluates care given and determine the appropriateness of delegating to others. Most significantly, it finds out the response of the patient to care and the extent to which the goals we met.
Some common words that are associated with EVALUATION questions:
monitor; expand; evaluate; synthesize; determine; consider; question; repeat; outcomes; demonstrate; reestablish;
After determining what part of the nursing process the question is concerned with, next focus your attention on determining the category of priority:
Safe and effective care environment is always first. Patient safety is related to the proper preparation and delivery of nursing techniques and procedures as part of the nursing practice. It relates to every aspect of the delivery of care.
Physiologic integrity is the ability to provide competent care Information that may be described as traditionally medical- surgical and pediatric nursing falls into this category. Specific questions in this area can be related to many direct-care aspects of nursing practice. The importance of this area is highlighted because it is one in which planning, implementation and evaluation of care needs can easily be identified and tested. Physiologic integrity is always a slight lower priority than safety unless it involves airway, breathing and circulation. "ABC's" always comes first!
Psychosocial integrity tests the knowledge about a patients response to a disease or disorder. An understanding of stress, anxiety and ways to cope are essential. This is a lower priority the physiological integrity.
Health maintenance deals with health promotion, health teaching, disease prevention and assessment of risk factors for health problems. Normal growth and development is a major theme in this category. This however, is a low priority.
In Summary, when choosing the right answer for you NCLEX exam question 1) ask yourself, "what part of the nursing process is this question dealing with: analysis, assessment, planning, implantation or evaluation? and 2) Remember to prioritize your choices: safety always being first, 2)physiological integrity, 3)psychosocial integrity and health maintenance always has the lowest priority when choosing an answer.
Other tidbits:
avoid choices with the answers "all" "always" "never" or "none". Nothing is ever a definite in Science.
look for answers that are different. If three answers say the same thing but in different words, choose the answer that is different.
when given choices that are pharmacologically based or non pharmacologically based, choose the non pharmacological intervention. It is more often then not, the correct answer.
Video Related Link:
[ PROFESSOR NIGHTEMGALE'S TEST TAKING TIPS ]
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