How to Answer NCLEX® Priority Questions

Order to prioritize ABCs PEF

*1) AIRWAY 2) BREATHING 3) CIRCULATION 4) Safety* 5) Pain 6) Education 7) Feelings Not only do you have to address these four things, but you have to do it in this exact order A before B, B before C, C before S . . . does that make sense?

When to Call the Doctor (or, "oh shit, I'm screwed")

You can answer this by asking yourself a very simple question: Does the patient have an immediate/significant need that I need to address before leaving the room? (airway issue, hemorrhaging, fallen)? 2) HAve all the necessary info and take all possible relevant nursing actions before calling the physician or hcp 3) Do not assume roles and responsibilities that are beyond the scope of nurising practice (3.a. dont give away roles and responsibilities of the nurse)

Recognizing Priority Style Questions The first thing we need to talk about it how to recognize these questions. Spotting them on the test allows you to know what you should be looking for and answer the question accordingly. Here are a few keywords you can expect to find in the stem of the question: KEYWORDS: Priority: Which patient is a priority? What is the nurses first priority? Emergency: A patient arrives in the emergency room. . . Ambulance: A patient arrives by ambulance. . . Returning to the Floor: A nurse is caring for a patient after returning to floor. . . Important: What's the most important intervention? See First: Which patient should the nurse see first?

*Priority:* Which patient is a priority? What is the nurses first priority? *Emergency:* A patient arrives in the emergency room. . . *Ambulance:* A patient arrives by ambulance. . . *Returning to the Floor:* A nurse is caring for a patient after returning to floor. . . (Important:* What's the most important intervention? *See First:* Which patient should the nurse see first?

Key words that are used to identify SAFETY (ABC*S*):

*physical* - rugs, - nightlight - phone - falls - walking after narcotic *infection* - assessing - temp - hand washing - cultures - antibiotics - wounds - drainage

Keywords that are used to identify BREATHING (A*B*CS)

- breath sounds *(vs Airway's "breathing") - o2 admin - o2 status pulse ox - raise head of bed (hob) - incentive spirometry

Keywords that are used to identify AIRWAY (*A*BCS)

- npo - gag reflex - breathing - water after surgery - dysphagia after stroke - airway

nursing scope of practice

1 Assessment: The registered nurse collects comprehensive data pertinent to the patient's health and/or the situation. 2 Diagnosis: The registered nurse analyzes the assessment data to determine the diagnoses or issues. 3 Outcomes Identification: The registered nurse identifies expected outcomes for a plan individualized to the patient or the situation. 4 Planning: The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes. 5 Implementation: The registered nurse implements the identified plan. 5a Coordination of Care: The registered nurse coordinates care delivery. 5b Health Teaching and Health Promotion: The registered nurse uses strategies to promote health and a safe environment. 5c Consultation: The graduate level-prepared specialty nurse or advanced practice registered nurse provides consultation to influence the identified plan, enhance the abilities of others, and effect change. 5d Prescriptive authority and treatment: The advanced practice registered nurse uses prescriptive authority, procedures, referrals, treatment, and therapies in accordance with state and federal laws and regulations. 6 Evaluation: The registered nurse evaluates progress toward attainment of outcomes.

Think through the nursing process

1) Asses before taking action; BUT 2) If you have all the assessment data you need *make a decision and take action* IF the test situation indicates that one step of the nursing process is completed look for an answer that uses the *very next * step.

Use your knowledge of the nursing scope of practice

1) Consider the necessary interventions that gall w/in the scope of *NURSING CARE* (ADPIE). -> 2) THEN determine the TOP PRIORITY interventions that can be carried out by the -> RN -> Practical nurse (PN) -> Unlicensed Assistive personnel (UAP)

the NCLEX® is structured around a framework called the "Bloom's Taxonomy". At it's core, Bloom's Taxonomy is a method for determining cognitive levels of conceptual understanding. Cognitive levels (RUA CEA) increase from the most basic (Remembering) understanding to in depth mastery of a concept (analyze) .

1) Remember 2) Understand 3) Apply 4) Create 5) Evaluate 6_ Analyze

Think about it this way . . . which question sounds more difficult? 1) What is the normal value for Sodium? 2) Your patient has voided 2 liters in the previous 24 hours. Which of the following lab values would you expect?

Both questions are essentially asking about normal Sodium levels (135-145) , however, question two requires the test taker to analyze assessment findings and apply knowledge about various disease processes to infer the need for checking sodium.

Keywords that are used to identify CIRCULATION (AB*C*S)

CIRCULATION: - hr - bp - cpr - fluid status (fluid deficit or overload) - diarrhea - pulses - iv fluids - Total Parenteral nutrition (tpn) - central lines - bleeding hemorrhage

Remember Hippocrates "Do no harm"

If more than one action can be taken to try to resolve a problem, begin with the least like to cause harm. "start with the least invasive interventions first"

When choosing between two good options

Make sure the clients *basic needs are addressed first*

When the question says: - First - Initial - Best - Priority - Most important *Remember:*

Maslow's Hierarchy of needs: *#1 = Physiological needs* #2) Safety*