Transcript cornerstones

Session One (8am – 3pm)
1. Course Introduction
2. Content Review (8 taxonomies)
Session Two (8am – 3pm)
1. Test Taking Skills
2. Critical Thinking Skills
Session Three (8am-3pm)
1. Practice Questions
Session Four (8am-3pm)
1. Practice Questions
 Course
Introduction
 Content Review
 The
Cornerstones Course will provide the
nursing student sufficient content, test
taking skills, and critical thinking skills
needed to successfully pass the NCLEX-PN
exam.
 The student will need to practice from 2000
to 3000 questions after this course is
completed, and before the NCLEX exam.
 The integration of the Cornerstones’ skills
and recommended practice builds the
confidence needed to successfully pass the
NCLEX.
The purpose of the NCLEX exam is to verify
the ability to be an entry level, generalist,
minimally safe, and therapeutically effective
nurse. It is a function of each States’ Nurse
Practice Act. The outcome is “licensure”.
Basically, it means the new nurse can take
care of anybody, anywhere, any age and
gender, with any wellness or illness issue.
The NCLEX is about fundamental nursing
science and nursing art, and basic skills.
1.


CONTENT
Memorize and recall 60-80% of what was
learned.
Covers 8 taxonomies
a)
b)
c)
d)
e)
f)
g)
h)
Coordination of Care
Safety & Infection Control
Health Promotion & Maintenance
Basic Care & Comfort
Psychosocial Integrity
Physiological Adaptation
Pharmacology
Reduction of Risk Potential
2. TEST TAKING TOOLS
 NCLEX is a “standardized: exam and
requires special skill set.
3. CRITICAL THINKING TOOLS
 Definition: gathering data to make a
decision.
 Similar to the Nursing Process, these
strategies represent a “new” process you
must learn.
4. CONFIDENCE
NURSING SCHOOL
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Uses rote memorization
to answer questions.
Topic (stem word, key
word, subject) is included
by name.
Very little use of
“distraction” in question
or “traps” in answers.
NCLEX
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Uses application of
knowledge to answer
questions.
Topic is usually “hidden”.
Uses much more
“distraction” in question,
and more “traps” in
answers.
NURSING SCHOOL
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Limited use of “basic
critical thinking” in
answering questions.
Goal is to pass using one
raw score.
An “A” is typically 90-100;
a “D” or “F” is failing,
usually <70.
NCLEX
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Uses three levels of
“complex critical
thinking” in answering
questions.
Goal is to pass each of
the 8 taxonomies, using 8
scores.
An “A” is 65, and must be
achieved on each of the 8
taxonomies.
NURSING SCHOOL
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Time allotment: 1 question
per minute.
Read question, identify
topic, answer question.
Does not require answer
validation.
NCLEX
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Time allotment:
approximately 1 question
per 1.5 minutes (5 hours
maximum).
Read question, read
answers, identify topic,
apply critical thinking tools,
choose answer.
Validate answer.

a)
b)
c)
85 minimum questions; 205 maximum
questions.
If the computer cuts off at 85 questions,
outcome is usually “pass”, though it is also
possible to “fail” or “nearly pass” in 85
questions.
If all 205 questions must be used, outcome
is usually “fail” or “nearly pass”, though it
is also possible to “pass” in 205 questions.
It is possible to “pass” 7 taxonomies, but
“fail the 8th, thus failing the entire NCLEX.
To construct a question/answer set, the
item writer uses three boxes:
a) Taxonomy (8 categories)
b) Critical thinking levels (Bloom’s
Taxonomy)
c) Topical/Strategic/Both (3 possibilities)
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Bloom’s Taxonomy (Recognition/Recall – Understanding –
Application – Analysis)
 Based
on eight different scores (8
taxonomies), not just one raw score.
 Must show competence in all eight
taxonomies.
 Categories: Passing, Nearly Passing, Did
Not Pass. (only “passing” passes).
 Minimum 85 questions
 8 taxonomies (approximately
10
questions/taxonomy)
 3 levels of critical thinking (3 questions for
each level within each taxonomy)
 65 indicates “passing” score (must correctly
answer 6-7 questions out of the 10
questions, and at all three levels of critical
thinking).
 Questions 86 – 205 focus on getting up the
“stairs” at least twice out of multiple
attempts.
1. Coordination of Care:
a)
Advanced directives/DPOA/MDPOA/living will
b)
Chain of command
c)
Nurse Practice Act (scope of practice)
d)
Assault and Battery
e)
Restraints
f)
Multidisciplinary team
g)
Negligence
h)
Impaired nurses
i)
False Imprisonment
j)
Patient privacy/confidentiality/HIPPA
k)
Basic rules of therapeutic communication
l)
Patient Advocacy
m)
Patient Rights
n)
Information technology
2. Safety & Infection Control:
a.
Personal protective equipment
b.
Isolation precautions
c.
Hand washing
d.
Infection control
e.
Use of antimicrobial therapy
f.
Radioactivity
g.
Hazardous material contamination
h.
Emergency preparedness
i.
Accident/injury prevention
j.
Ergonomics
k.
Home safety
l.
Medical/surgical asepsis
m.
Incident reporting
n.
Safe use of equipment
o.
Security plan
p.
Standard precautions
3. Health Promotion & Maintenance:
a. Growth and development (physical and psychosocial)
b. Immunizations
c. Ante/intra/post partum care
d. Newborn care
e. Data collection
f. Disease prevention
g. Lifestyle choices
h. Human sexuality
i. Family planning
j. Expected body changes
k. Screening programs
l. High risk behavior
m. Self care
4. Basic Care & Comfort:
a. Range-of-motion
b. Postoperative leg exercises
c. Positions
d. Assistive devices
e. Elimination
f. Rest/sleep
g. Comfort measures
h. Mobility/immobility
i. Palliative care
j. Personal hygiene
k. Nutrition/oral hydration
5. Psychosocial Integrity:
a. Therapeutic communication in the psych millieu
b. Abuse/neglect
c. Behavior management
d. Sensory/perceptual alterations
e. Situational role changes
f. Coping mechanisms
g. Crisis intervention
h. Cultural awareness
i. Unexpected body changes
j. End-of-life care
k. Grief and loss
l. Religious/spiritual influences
m. Stress management
n. Substance abuse
o. Emotional support systems
p. Suicide/violence precautions
6. Physiological Adaptation
a.
Alterations in body systems
b.
Basic pathophysiology
c.
Fluid/electrolytes
d.
Acid/Base
e.
Medical emergencies
f.
Radiation therapy
g.
Unexpected responses to therapies
7. Pharmacology:
a.
IV fluids
b.
Starting IV’s
c.
Dosage calculations
d.
Adverse side effects and side effects
e.
Contraindications and compatibilities
f.
Expected outcomes
g.
Medication administration
h.
Drug mechanisms of action
8. Reduction of Risk Potential
a. Preventing future complications
b. Diagnostic tests
c. Lab values
d. Therapeutic procedures
e. Vital signs
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2.
3.
4.
5.
CRAM List:
Everybody crams before any big exam, but there is an easy
way to do it.
As you begin to study, including completing practice questions
(recommendation is 1500 questions), start keeping an
“inventory”.
This inventory should include five primary categories of topics:
pathophysiologies, drugs, medical procedures, labs, and the
topics of Coordination of Care.
When “cram” time arrives, there will exist a “short list” of
relevant NCLEX topics.
Resources include ATI, Kaplan-PN, studyguidezone.com
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1.
Pharmacology rules:
Upper/Downer Rule & Overdose-to-Withdrawal Continuum
EXAMPLE: A young adult brings his friend into the emergency room and states
that his friend has been using heroin. The nurse would be MOST concerned if
which of the following was observed?
a. dilated pupils, irritability, tremors
b. pinpoint pupils, respiratory depression, hypotension
c. restlessness, diaphoresis, nausea/vomiting
d. dilated pupils, euphoria, diaphoresis
Pharmacology rules
2. Hypersensitivity-to-Allergic Reaction-to-Anaphylaxis Continuum
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EXAMPLE: The school nurse attends a picnic for elementary students. A 10
year-old child begins screaming, “I’ve been stung by a bee”. The nurse notes the
child has a large welt at the site of the bite and a raised red rash on the extremity. As
the nurse examines the child, the states, “ I am feeling really hot.” Which of the
following actions should the
nurse take FIRST?
a. remove the stinger and apply ice to the site
b. assess the rate and quality of respirations
c. administer 0.3mg of epinephrine subcutaneously
d. ask the child about previous reactions to bee stings
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3.
Pharmacology rules
Drug-Drug Interaction, Drug-Food Interaction, Drug-Body Interaction
EXAMPLE: The nurse admits a patient with a history of breast cancer and type 1
diabetes. The nurse is aware that careful monitoring of the patient’s blood sugar
is necessary if the patient receives which of the following medications?
a. prednisone
b. captopril
c. nifedipine
d. amoxicillin
EXAMPLE: The nurse is teaching a patient about phenelzine(Nardil). The nurse
should instruct the patient to avoid which of the following medications?
a. ibuprofen
b. pseudoephedrine
c. acetaminophen
d. aspirin
Pharmacology rules
4. Central nervous system v/s Peripheral nervous system drugs
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EXAMPLE: The nurse cares for a client receiving carbidopa/levidopa
(Sinemet). The nurse is MOST concerned if the client states which of the following?
a. “ I take a daily multivitamin,”
b. “ I exercise daily.”
c. “ I take kava for insomnia.”
d. “ I eat several small meals a day.”
Pharmacology rules
5. Cross Sensitivity
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EXAMPLE: A 65 year-old man has an allergy to penicillin and sulfa. Which of the
following medications, if ordered by the physician, should the nurse question?
a. tetracycline
b. sulfisoxazole
c. azithromycin
d. ciprofloxacin
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1.
Psychosocial rules:
Identify whether question is about safety, setting boundaries, or reality testing.
EXAMPLE: A patient with chronic schizophrenia tells the nurse, “ The voice is
telling me that I’m a bad person. I can’t get it to stop talking!”. Which of the following
responses by the nurse is BEST?
a. : Does the voice tell you why you are such a bad person?”
b. “ You hear a voice. I don’t hear anything. We have other
things to talk about.”
c. “ It is important for you to let these voices go so that you can
get well.”
d. “ That’s not what the voice is saying. It is saying you are a
good person.”
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2.
Psychosocial rules:
Effective therapeutic communication (in the psych millieu) requires that the
nurse not confront, nor enable a patient.
EXAMPLE: The nurse is caring for a patient with a diagnosis of schizophrenia.
The patient points to another patient and says to the nurse, “ Do you see that
person over there who is shaking and pointing? She is possessed by the devil and
is trying to get my soul”. Which of the following responses by the nurse is BEST?
a. “Is there something about her that makes you feel bad about
yourself?”
b. “That sounds like a scary thought. She is shaking because of her
illness.”
c. “ Something about her seems to frighten you. Try to ignore her.”
d. “ No, I don’t see it that way. What makes you think that?”
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3.
Psychosocial rules:
Never leave any patient “alone”. For all psychiatric diagnosis, except
Depression, do not try to involve the symptomatic patient with other patients, or
in busy activities.
EXAMPLE: Several days after being admitted for Depression, a patient is
observed sitting alone in the dining room, and the nurse notes the patient has
not finished his meal. Which of the following actions is MOST appropriate?
a. sit with the patient during meals.
b. ask the family to bring in favorite foods.
c. permit the patient to eat alone until the patient
becomes more comfortable.
d. allow the patient to determine if and when he will
eat.
Psychosocial rules
4. Decrease sensorium for all neurological and neuropsych patients.
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EXAMPLE: As the nurse admits a patient to the psychiatric unit, the patient
becomes agitated and belligerent. The nurse should take which of the following
actions?
a. obtain order for a antipsychotic drug
b. place the patient in a dimly lit room with the door ajar
c. ask the patient to calm down
d. explain the unit rules
 Test Taking
Skills
 Critical Thinking Skills
A
typical test question requiring critical
thinking has three parts:
1. Introduction
2. Important Data
3. Actual Question
Example:
The nurse in the outpatient clinic receives a phone call from a mother of a 4
year-old. She tells the nurse her child has a dry, “barking” cough, a
temperature of 101.0F, is very irritable, and has very little appetite.Which of
the following indicates the nurse’s BEST response?
 Remember, there
are many item writers
and styles of questions.
 Process of elimination – must use. Just as
important to know why the wrong
answers are wrong as it is to know why
the correct answer is correct.
 Benchmark answer – what your “gut” tells
you is correct.
 Beware of “all” or “nothing” answers.
 Comma, comma, comma.
 Note
use of negative words and odd
numbers.
 Identify distraction in questions, and traps in
answers.
 Identify “buzz words” (i.e. should intervene,
discharge teaching is effective, further
teaching is necessary).
 Do not read into the question. Can be
creative with the answers.
 There will be 10 “alternate” questions on
the NCLEX.
 There
will be alternative style questions on
the NCLEX: fill in the blank, select all that
apply, hotspots, ranking, chart, auditory)
 Old v/s New.
 The “repeat” question.
 Know that all correct answers have
textbook rationale
 “Guessing” v/s “Educated Guessing”.
 Can’t change, can’t go back, can’t skip.
 Drop down calculator; dry board/paper.
 Questions of High Anxiety ( #1 and #86).
 Time allocation: questions 1-85 (150
seconds); questions 86-205 (70 seconds).
Take a timepiece and keep up with your
time.
 Recommendation: practice 2000-3000
questions (content and critical thinking).
 Visit test center prior to test date.
 Say to yourself repeatedly, “ It’s just a test of
minimal competency; I know I am more than
minimally competent .”
 Every
20 questions, take 3 deep breaths
as you close your eyes.
 If you get frustrated or anxious, say to
yourself, “ It’s normal to feel this way, but
I am not going to let that defeat me.”
 If video camera security makes you
nervous, either smile at the camera or act
like you are a spy.
 If it helps to answer a question, “act out”
the answers (i.e. crutch walking).
 Do
NOT cram at least 24 hours prior to
the test date/time. It wastes 60% of the
energy you will need on test day.
 Don’t drink any diuretic beverages on
test day; eat only minimal simple sugars;
get the RDA of B-complex vitamins.
 No one expects to “fail”. But, be realistic,
even if failure of the NCLEX happened,
one can always take it again.
Content questions = 75%
Critical Thinking questions = 25%
 Tool One: Identify topic (also called stem,
key word, subject).
 Tool Two: Assessments v/s Interventions
 Tool Three: Physical v/s Psychosocial
(Maslow).
 Tool Four: ABC’s
 Tool Five: Validation
 Tools, 2, 3, &
4 are “big” tools and are
optional.
 Tool 5 are “little” tools and must be used.
 NCLEX questions may use big tools, little
tools, or both to determine correct answers.
 Possible combinations: (1,2,3,4,5), (1,2,3,5),
(1,2,4,5), (1,2,5), (1,3,4,5), (1,3,5), (1,4,5),
(1,5).
 Some questions require more critical
thinking in the question (topical), or some
require more critical thinking in the answers
(strategic).
 Topic
is usually “hidden”.
 Read entire question/answer set once or
twice before deciding upon topic.
 Clues to the topic are often found in the
answers.
 Identify distraction.
 Identify traps (looks, feels, or sounds good).
 Look for “specific signs/symptoms in
question as probable topic.
 Locations (i.e. Med/Surge) don’t matter.
 Times
and dates in the question are
important.
 Ages or reference to age (i.e. older) in
the question are important.
 Ages in the answers are traps, except for
questions about risk factors.
 Identify “priority words” (i.e. MOST,
FIRST, BEST, INITIAL, HIGHEST).
 Don’t
read into the question. Don’t play
“what if” with the data in the question.
 Main types of questions:
1. Content (no real need for critical thinking;
you know this or you don’t).
2. Priority Action (uses a priority word in the
question and usually has word “actions”);
clue to use Tool Two next.
3. Patient Priority (use Tools 3, 4,
abnormal/normal: expected/unexpected).
 Are
answers assessments or
interventions.
 Nursing Process indicates assessments
come before interventions, so analyze
assessment answers first.
 Definition of assessment: an action done
to gather data in order to devise an
intervention.
 Note “medical” interventions
v/s
“nursing” interventions.
 Note “subjective” assessment v/s “
objective” assessment.
 Determine
if answers are physical or
psychosocial.
 Physical answers always win over
psychosocial answers.
 Note if pain is topic, only two physical
pain conditions: cardiac, sickle cell crisis.
 Airway, breathing, circulation.
 Answers
aren’t always so obvious.
 For example, “facial edema” infers
airway.
 For example, “restlessness” infers
hypoxia, indicating a breathing issue.
NCLEX is NOT the REAL
WORLD!!!!!
 Does
the answer make sense?
 Does the answer relate to the topic?
 Make sure answers are “patient focused”.
Patients are more important than
documentation, paperwork,
administrative items, and equipment.
 Always have an order for a medical
intervention.
 Know when to “pass the buck”.
 The
nurse has plenty of time, staff, and
resources.
 T.E.A (teaching, evaluation, assessment).
 Erickson (psychosocial growth and
development).
 Nursing interventions v/s medical
interventions (i.e. fluff a pillow or
oxygen?)
 Ask , “ what if I do this, what if I don’t?”
 Positioning.
 Ask, “
Have I done all that I can do?”
 General Therapeutic Communication
rules:
1. Do not ask “why”.
2. Address “feeling tone” (i.e. anger,
tearful, etc.)
3. Open v/s Closed-Ended.
4. Do not provide “false reassurance”
5. Stay patient focused.
6. Use “projection” thoughtfully.
 NCLEX
test-takers are presumed to know
about all medical equipment.
 C.A.R.D (confusion, agitation,
restlessness, disorientation).
 Safety valve = safest answer.
 Abnormal v/s normal; expected v/s
unexpected; complicated v/s
uncomplicated; acute v/s chronic.
 Priority word (here and now).
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penicillin, ampicillin, amoxicillin
Cephalosporins (ke, ce, kef, cef, ceph)
tetracycline, doxycycline
clindamycin, erythromycin, vancomycin, neomycin, azithromycin
ciprofloxacin
sulfisoxasole, trimethoprim/sulfamethoxazole
neosporin, bacitracin, betadine, silvadene, nystatin
nitrofurantoin
darifenacin, oxybutynin, solifenacin
finasteride
sildenafil
norepinephrine, dopamine, epinephrine, phenylephrine
nitroglycerin
chlordiazepoxide, diazepam, alprazolam, lorazepam, midazalam
buspirone, hydroxyzine, diphenhydramine
kava, melatonin, ginger, ginkgo, garlic, St. John’s wart
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aluminum hydroxide, calcium carbonate, magnesium hydroxide
procainamide, lidocaine, amiodarone
atropine, scopolamine, iprotropium
benztropine, carbidopa/levodopa, pergolide, amantadine, trihexyphenidyl
heparin, enoxaparin, warfarin
phenytoin, phenobarbital, valproic acid, carbamazepine, gabapentin
Nardil, Marplan, Parnate
Prozac, Paxil, Zoloft, Celexa, Effexor, Lexapro
amitriptyline, doxepin
bupropion, trazadone
insulin- rapid (lispro)
insulin – short (humulin r, regular)
insulin – intermediate (nph, lente)
insulin – long (ultralente)
insulin – very long (lantus)
glipizide, glyburide, metformin, acarbose, repaglinide, rosiglitazone
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glucagon
Pepto-Bismol, Kaopectate, Lomotil, Imodium
prochloroperazine, ondansetron, metoclopramide, meclizine, promethazine
diphenhydrinate, droperidol
amphotericin b, nystatin, flucanozole
colchicine, allopurinol
diphenhydramine, loratidine, certirizine, chlorpheniramine
cholestyramine, folic acid, simvastatin, atorvastatin, rosuvastatin, genfibrozil
captorpil, enalapril, lisinopril
atenolol, propranolol, metoprolol
nifedipine, verapamil, diltiazem, amlodipine
losartan, valsartan
prazosin, doxazosin
clonidine, methyldopa
hydralazine, minoxidil
ma-huang, ephedra, black cohosh, goldenseal
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lithium, divalproex
Chemotherapy: cisplatin, chlorambucil, fluroracil, methotrexate, doxorubicin
Chemotherapy (cont.): tamoxifen, testolactone, vincristin, topotecan
Chemotherapy (cont.): cyclophosphamide, cytarabine, hydroxyurea
clopidogrel, ticlodipine, dipyridamole, abciximab
haloperidol, fluphenazine, chlorpromazine, risperidone, quetiapine, ziprasidone,
aripiprazole, clozapine, olanzepine
acetaminophen, aspirin, ibuprofen, naproxen, ketoralac
propylthiouracil, Lugol’s solution
levothyroxine, liothyronine
isoniazid/INH, ethambutol, rifampin, streptomycin, pyrazinamide
dextromethophan, guaifenesin
acyclovir, ribavarin, zidovudine, didanosine, ganciclovir, oseltamivir, zanamivir
methylphenidate, dextroamphetamine
alendronate, ibandronate
digoxin, Digibind
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aminiphylline, caffeine, theophylline, salmeterol, albuterol, montelukast, cromolyn
sodium, acetylcysteine, tiotropium, terbutaline
acetazolamide
sucralfate
hydrochlorothiazide, furosemide, bumetamide, Mannitol
spironlactone
calcium chloride, potassium chloride, magnesium chloride, sodium chloride
ferrous sulfate, iron dextran
methylcellulose, tetrahydrozoline, timolol maleate, tetracaine, pilocarpine,
latanoprost
cortisone, hydrocortisone, prednisone methylprednisolone, prednisolone,
deltasone, dexamethasone, beclomethasone, budesonide
fludrocortisone
edetate calcium, deferoxamine
cyclosporine
cascara, bisacodyl, mineral oil, docusate, Milk of Magnesia, psyllium, polyethylene
glycol
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edrophonium, neostigmine, pyridosygmine, glucosamine
morphine, codeine, methadone, meperidine, hydrocodone, hydromorphone,
oxycodone, fentanyl, propoxyphene, Roxanol
indomethacin, celecoxib
calcitonin
streptokinase, tissue plasminogen activator, reteplase
cimetadine, ranitidine, famotidine
omeprazole, lansoprazole, rabeprazole, esomeprazole
misoprostol
cyanocobalamin (b12), vitamins A,D,E,K, vitamin C, thiamine, niacin
estradiol, levonorgestrel, conjugated estrogen, medroxyprogestrone
tamsulosin, dutasteride, saw palmetto, terazosin
other herbals: echinacea, evening primrose oil, chondroitin, capsicum, feverfew,
flaxseed, licorice, chamomile, velarian, hawthorn, eucalyptus
isotonic iv solutions: NS, D5W, LR, hetastarch (colloidal)