5 Nursing Care Plans and Test Taking Skills

5 Nursing Care Plans + Test Taking Skills 2009 http://1nurses.com

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CHOLECYSTECTOMY
One of the most common reasons for cholecystectomy is
cholecystitis caused by gallstones or cholelithiasis.
In order to understand and create a nursing care plan for
Cholecystectomy we should understand cholelithiasis first.

So what is Cholelithiasis?
• Formation of GALLSTONES in the biliary apparatus

** Obesity increases the risk for cholelithiasis.
Note the mix gallstones with a prominent component of
yellowish cholesterol seen here in an opened gallbladder
removed at surgery.



So what are the Predisposing factors?
4F’s
“F”
• Female
• Fat
• Forty
• Fertile

Check 1nurses.com for more Nursing Resources
And the Pathophysiology?



Gross appearance of gallbladder after sectioning longitudinally. Notice thickness
of gallbladder wall, abundant stones




 Which symptom best describes murphy’s sign =
 On deep inspiration, pain is elicited and breathing stops

Ok, so what’s our Assessment findings?
• 1. Indigestion, belching and flatulence
• 2. Fatty food intolerance
• 3. Epigastric pain that radiates to the scapula or localized
at the RUQ
• 4. Mass at the RUQ
• 5. Murphy’s sign
• 6. Jaundice
• 7. CHARCOT TRIAD


And what are the Diagnostic procedures we can take?
• 1. Ultrasonography- can detect the stones
• 2. Abdominal X-ray
• 3. Cholecystography
• 4. WBC count increased
• 5. ERCP: reveals inflamed gallbladder with gallstone



What’s ERCP?
 Endoscopic Retrograde Cholangiopancreatography?
 Examination where a flexible endoscope is inserted
into the mouth and via the common bile duct and
pancreatic duct to visualize the structures

ERCP

So what’s our Nursing Interventions?
 1. Maintain NPO in the active phase
 2. Maintain NGT decompression
 3. Administer prescribed medications to relieve pain.
Codeine and Morphine may cause spasm of the Sphincter
 increased pain.
 4. Instruct patient to AVOID HIGH- fat diet


 5. Assist in surgical and non-surgical measures
 6. Surgical procedures = CHOLECYSTECTOMY!

And the Pharmacologic Therapy…
1. Analgesic
2. Ursodiol **
3. ESWL

 Ursodiol is a bile acid available as 300 mg capsules
suitable for oral administration.
** Ursodiol, USP (ursodeoxycholic acid) is a naturally
occurring bile acid found in small quantities in normal
human bile and in the biles of certain other mammals.
 to dissolve the gallstones


Ok, why is the stool foul smelling?
Greasy Stool = Steatorrhea



Obstruction (Cholelithiasis)
Bile Stasis
Decreased Bile  Duodenum
Decreased digestion of fats
Undigested Fats
Excrete: STEATORRHEA (greasy, foul smelling)
How about Surgical Interventions?
• Cholecystectomy  removal of the gall bladder
• Choledocotomy  opening of the gallbladder to remove
stones
• Choledocostomy  CBD exploration
• Laparoscopic Cholecystectomy

•



•

•
What’s Choledochostomy?
If with CBD exploration: T – tube
• Purpose: to drain the bile
• Drainage:
Brownish red for the first 24 hours (combination of
bile and blood)


300 – 500 mL of bile drainage for the first 24 hours
Drainage bottle should be placed in bed at the level
of incision; this is to drain the excess bile, not all the bile

Here’s some Post-OP Nursing Interventions…
• 1. Monitor for surgical complications
• 2. Post-operative position after recovery from
anesthesia- LOW / SEMI FOWLER’s
• 3. Encourage early ambulation



• 4. Administer medication before coughing and deep
breathing exercises
• 5. Advise client to splint the abdomen to prevent
discomfort during coughing
• 6. Administer analgesics, antiemetics, antacids
• 7. Care of the biliary drainage or T-tube drainage
• 8. Fat restriction is only limited to 4-6 weeks. Normal diet
is resumed
Now let’s go to the Nursing Care Plan Commonly
associated with Cholecystectomy…
 Click Here To Get NCP for Cholecystectomy

Check 1nurses.com for more Free Nursing Care Plans



APPENDECTOMY
Appendectomy is commonly done because of Appendicitis.
Let’s talk about Appendicitis first!

So what is Appendicitis?
Infectious and inflammatory process of the appendix
creating acute abdominal pain and nausea.

And what are the Signs and Symptoms?
 Vague epigastric or peri-umbilical pain which progress to
right lower quadrant pain
 Low-grade fever
 Nausea
 Vomiting
 Loss of appetite
 Local tenderness when pressure is applied
 Pain gradually becomes localized in RLQ / Mc Burney’s
point



 Pain is initially intermittent then become steady and
severe over a short period.
 Rebound tenderness
 Psoas sign
 Rovsing’s sign
 Obturator sign
 Jarr sign
McBurney's point is located one third of the distance along
a line from the front of the right pelvic bone and the belly
button.
JARR SIGN  plantar flex of RIGHT foot  pain
ILOPSOAS SIGN  supine L side lying flex backward of R
foot  PAIN
 Rebound tenderness (Blumberg sign)

 Psoas sign (lateral position with right hip flexion)

 Rovsing’s sign (right quadrant pain when the left is
palpated)

 Obturator sign (pain on external rotation of the right
thigh)




This is the normal appearance of the appendix against the
background of the cecum.



Seen here is acute appendicitis with yellow to tan exudate and
hyperemia, including the periappendiceal fat superiorly,
rather than a smooth, glistening pale tan serosal surface.
So what’s the pathophysiology?



So What’s the treatment?
1. Antibiotics
2. Appendectomy
3. General or spinal anesthetic with a low abdominal
incision or by laparoscopy
And your Goals for Management?
NPO
Bed rest
Relieve pain
Avoid factors that increase peristalsis, thereby
rupture:
 Heat application over the abdomen
 Laxative
 Enema
Here’s a nursing care plan for Appendectomy
 Click here to get the NCP for Appendectomy



GASTRECTOMY
Removal of the stomach can be temporary or permanent. One
of the primary causes for Gastrectomy is the presence of
Gastric cancer caused by PUD or Peptic Ulcer Disease.
So let’s learn more about Peptic Ulcer Disease, what is PUD?
Commonly referred with respect to the location  if in
the stomach, gastric ulcer and if in the duodenum,
duodenal ulcer
The precise cause is not known
Now let’s compare Duodenal Ulcer VS Gastric Ulcer



 Pain from a gastric ulcer often occurs when food is still in
the stomach, shortly after eating.
 Pain from a duodenal ulcer often occurs when the stomach
is empty, several hours after eating, and may improve after
eating. Pain also may wake you frequently in the middle of
the night.

And Here’s the Pathophysiology of PUD



So what are Gastric Ulcers?
Gastric secretions and stomach emptying rate are usually
normal
Occurs more often in men, in unskilled laborers, and in
lower socioeconomic groups; peak age 40 – 55 years
(older age group)
Caused by smoking, alcohol abuse, emotional tension,
and drugs (salicylates, steroids)

Now let’s check our Assessment findings :
1. The pain is NOT relived by eating.
* Pain located in the upper left epigastrium,
usually occurs 1 – 2 hours after meals, rarely at night.
 A chronic complication seen in gastric ulcer is gastric
cancer.

2. Weight loss, vomiting, bleeding episodes, epigastric
tenderness, and pyrosis.



3. Complications associate with peptic ulcer: Bleeding,
Perforation, Pyloric obstruction and intractable pain.

Here’s the Lab Findings…
Endoscopy reveals ulceration; BIOPSY is usually done to
detect H. pylori infection and to rule out MALIGNANCY!
Gastric analysis: normal gastric acidity in gastric ulcer
(increased in duodenal ulcer)
Upper GI series
And our Nursing Interventions…
1. Administer medications as ordered.
2. Provide nursing care for the client with ulcer surgery.
3. Prepare the client for diagnostic procedure (barium swallow
and EGD)
4. Provide client teaching and discharge planning concerning
Checklists for Medication regimen
 Take medications at prescribed times. Antacids are
taken ONE hour AFTER meals.
 Have antacids available at all times.



 Recognize situations that would increase the need
for antacids.
 Avoid ulcerogenic drugs (salicylates, steroids).
 Know proper dosage, action, and side effects.
Checklists for Proper Diet
 1) Bland diet consisting of six small meals/ day.
 2) Eat meals slowly.
 3) Avoid acid-producing substances (caffeine, alcohol,
highly seasoned foods, milk and creams).
 4) Avoid stressful situations at mealtime.
 5) Plan for rest periods after meals.
 6) Avoid late bedtime snacks.
Other things to consider:
C. Avoidance of stress-producing situations
D. Development of stress-reduction methods (relaxation
techniques, exercises, biofeedback).



How about Duodenal Ulcers?
 Characterized by gastric hyperacidity and a significant
increased rate of gastric emptying
 Occur more often in younger men; more women
affected after menopause; peak age: 35 – 45 years
(younger than gastric ulcer group)
 Caused by smoking, alcohol abuse, psychologic stress

An acute duodenal ulcer is seen in two views on upper
endoscopy in the panels below.
Our Assessment findings:
Relieved by food.
Usually not accompanied by nausea and vomiting
Diagnostic tests: same as for gastric ulcer.



Nursing interventions: same as for gastric ulcers.
Medical management: same as for gastric ulcers
So what’s our Surgical Interventions?
 Vagotomy
 Antrectomy
 Pyloroplasly
 Vagotomy
 Antrectomy
 Pyloroplasly
Removal of the antrum (distal half) of the stomach; often
combined with bilateral excision of portions of vagus
nerve trunks (vagectomy) in treatment of peptic ulcer.
Vagotomy: severing of part of the vagus nerve
innervating the stomach to decrease gastric acid
secretion
Antrectomy: removal of the antrum of the stomach to
eliminate the gastric phase of digestion (contains the
cells that secrete gastrin)
Pyloroplaslty: enlargement of the pyloric sphincter with
acceleration of gastric emptying




Gastroduodenostomy (Billroth I)
Gastrojejunostomy (Billroth II)




Gastrectomy:
Removal of 60% - 80% of the stomach
Esophagojejunostomy (total gastrectomy):
Removal of the entire stomach with a loop of
jejunum anastomosed to the esophagus




So here’s a summary of how to manage the patient in
Surgery:
 Pre – op Care
Teach deep breathing exercises
Provide nutritional support  TPN
Inform about post-op measures and tubes to
anticipate
Nasogastric tube
TPN until peristalsis returns



 Post-op Care
Promote patent airway and ventilation
Semi-Fowler’s position
Reinforce Deep Breathing and Coughing
exercise, incentive spirometry
Administer analgesic before activities
Splint incision before patient coughs
Encourage early ambulation
Promote adequate nutrition
NPO until peristalsis returns
Measure NG drainage accurately
Monitor for sign of leakage of anastomosis
Small, frequent feedings
Monitor for early satiety and regurgitation
Eat less food at a slower pace
Monitor weight regularly



Prevent potential complications
 Bleeding – first 24 hours, 4th to 7th day post-op due to
non-healing
BLEEDING
Monitor NG drainage for blood
Avoid unnecessary irrigation or repositioning of
the NGT
Monitor for signs of peritonitis: severe
abdominal pain, rigidity fever
 Dumping Syndrome
 A group of unpleasant vasomotor and G.I. symptoms
caused by rapid emptying of gastric content into the
jejunum.
 Abrupt emptying of stomach contents into the
intestine



What’s the Pathophysiology of Dumping Syndrome?

Here’s our Nursing Interventions for Dumping Syndrome
Eat in a recumbent or semi  recumbent position
Lie down after a meal
Small, frequent feedings



Moderate fat, high protein diet.
Limit carbohydrates, no simple sugars
Give fluids few hours after meals
Avoid very hot and cold foods and beverages

Now let’s check a Nursing Care Plan on Gastrectomy
 CLICK HERE TO GO TO THE NCP for GASTRECTOMY



THYROIDECTOMY
Another Topic that we would like to discuss for this report is
Hyperthyroidism, One of the possible reasons for
Thyroidectomy.
Let’s Start…
What is Hyperthyroidism?
EXCESSIVE THYROID HORMONE SECRETIONS LEADING TO
THYROTOXICOSIS
And it can result to:
HYPERMETABOLISM
INCREASED SYMPATHETIC ACTIVITY
What are the causes of Hyperthyroidism?
GRAVE’S DISEASE
TOXIC MULTINODULAR GOITER
THYROID ADENOMA
THYROIDITIS
T3 THYROTOXICOSIS
THYROID CARCINOMA



And what are the Clinical Manifestations of the patient?
HALLMARK IS HEAT INTOLERANCE
VISUAL CHANGES
FATIGUE
WEAKNESS
PALPITATION
CHEST PAIN




What are the Lab and Diagnostic Tests for Hyperthyroidism?
T3,T4,TSH,T3 RESIN UPTAKE
THYROID SCAN
POSITION, SIZE AND FUNCTIONING OF THE GLAND



ULTRASOUND
ECG
Here are some possible Nursing Diagnosis for Hyperthyroidism
IMBALANCED NUTRITION: LESS THAN BODY
REQUIREMENTS RELATED TO INADEQUATE INTAKE
IN RELATION TO METABOLIC NEEDS
HYPERTHERMIA RELATED TO INCREASED
METABOLIC NEEDS
POTENTIAL FOR HYPERTENSION AND CARDIAC
FAILURE
Nursing Management
VITAL SIGNS, REST, QUIET AND COOL ENVIRONMENT
And the Pharmacological therapy
PTU
METHIMAZOLE
CARBIMAZOLE
IODINE PREPARATIONS
BETA BLOCKERS
RADIOACTIVE IODINE


And the Surgical Intervention
Partial or Total Thyroidectomy !
Watch out for these complications!
HEMORRHAGE
RESPIRATORY DISTRESS
HYPOCALCEMIA & TETANY
If Parathyroid glands are affected…
Chvostek’s Sign
Trosseau Sign
LARYNGEAL NERVE DAMAGE
And Our NCP for Thyroidectomy
 CLICK HERE TO CHECK the NCP for Thyroidectomy

Check 1nurses.com for more Free Nursing Care Plans



CESAREAN OPERATION
CS Operation are done as an elective or as an optional
operation, but most of the time it is required for a patient
with Gestational Diabetes, Abruptio Placenta, Preeclampsia,
and other High Risk Pregnancies.
Let’s talk about Gestational Diabetes first before we go to the
NCP for CS operations…
So what is Gestational Diabetes?
It is Diabetes Mellitus that begins during pregnancy as a result
of changes in glucose metabolism and insulin resistance.
And what are the data that are collected?
- Glucose Challenge Test (GCT) at 24-48 hours,if GCT
>140 mg/dl proceed to 3 hour oral glucose tolerance
test (GTT)
- If GTT positive, dietary controls initiated
- If dietary controls fail to keep FBS <105 mg/dl,
insulin therapy is initiated
- Observe for
glycosuria,ketonuria,polydipsia,polyphagia and
polyuria.



- Monitor for excessive weight gain or excessive
weight loss
- Fetal growth is estimated serially with sonograms
- Antepartum visits biweekly until 34 weeks, then
weekly
- Biophysical profile (BPP) at 34 weeks, then weekly
- Daily fetal movement counts
- Client’s understanding of findings of hyperinsulinism
and ketoacidosis
So What’s our Management?
- Maintain euglycemia throughout pregnancy
- Mother proceeds to term (>37 weeks) with
reassuring fetal condition
- Delivery of infant without morbidity or mortality
And our Nursing Interventions should include…
- Monitor Blood Sugar and Report Abnormalities
- Reinforce Education of client regarding:
Increased risk for genitourinary
infections,dystocia,hydramnios, Cesarean birth



Diet, glucose screening and insulin
administration
Treatment for hyperglycemia,hyperinsulinemia
and recognize signs of ketoacidosis.
- Most clients with GDM will return to normal glucose
levels after childbirth
- Clients with GDM are at greater risk for GDM in
future pregnancies
What’s our Evaluation Findings?
- Client verbalizes understanding of treatment regime
- Client verbalizes understanding of Potential
Complications
- Client is hospitalized if complications arise
- Maternal/fetal morbidity and mortality are
minimized
For more information about GDM check http://www.diabetes.org
And now here’s our Nursing Care Plan on CS
Operations
 Click Here to Check the NCP for CS operations



Ultimate Test Taking Skills v.1.0
For Student Nurses, Registered Nurses, and other Professionals

Do you know any of these Test Taking Skills?

Conquer your exams, Period.



INTRODUCTION

Have you ever wanted to successfully pass your Nursing exams?
Do you spend lots of time studying and yet you still get failing grades or
low marks? Are you having a hard time analyzing and answering
Nursing exams?

If you answered Yes in any of these questions, you are in luck.
This Report is for you.

Taking Exams is stressful. What’s more stressful is waiting for the
results and PASSING the tests.

What you have here are PROVEN ways that most people doesn’t
know or doesn’t utilize when taking exams.

Utilize them and you’ll see results when you take your next exam*

Good Luck and God Bless.

To your success,

1nurses Team
*Disclaimer: Taking exams is an individual endeavor, and each person has a different set of skills and knowledge. This report does not
guarantee that you will fail or pass your tests.



DEVELOP CRITICAL THINKING SKILLS!!!
According to Scriven & Paul from Criticalthinking.org, Critical Thinking
is the cornerstone of one’s ability to function in today’s society.

It has 2 components namely;

- A set of skills to process and generate information and beliefs
and
- The Habit, based on intellectual commitment, of using those
skills to guide behavior.


So Where do you start?
I strongly suggest that you follow these steps if possible but if not go to the
sample test taking lessons in the next pages.

1. Outline your notes to each Disease – Create a Visual guide/Map
of your own notes about the Topic you are studying
2. Pathophysiology of the Disease- CRITICAL- don’t even start your
review without understanding what is the brief
summary/overview of the disease
3. Signs/Symptoms (Including Laboratory Exams) – Remember to
Highlight special S/Sx for each Disease
Eg. RLQ pain for Appendicitis
4. Know the Different Nursing Diagnosis
5. Nursing Goals for the patient
6. Specific Implementation Plans
7. Patient Teaching



Here’s some great TEST TAKING STRATEGIES

If you have to GUESS think

st
1 PHYSIOLOGICAL NEEDS

A irway

B reathing

C irculation

D isability

nd
2 SAFETY
rd
3 COMMUNICATION
th
4 NURSING PROCESS



NEXT STEP ↓
Critical Thinking and the Nursing Process
ASSESSMENT – Collect Data, communicate information
about assessments

ANALYSIS/NURSING DIAGNOSIS – Clustering
and Interpreting Data, Identifying and communicating Nursing
Diagnosis

PLANNING – Identifying goals, projecting outcomes, setting
priorities, identifying interventions.

IMPLEMENTATION - Implementing Nursing Care
EVALUATION – Identifying patient responses, comparing
outcomes to goals, modifying plan of care.

When we think of patients, we apply the Nursing Process, let’s apply it
also when we take our tests…



When answering PRIORITIZATION Questions

Remember Maslow’s Hierarchy of Needs!
1st Priority PHYSIOLOGICAL NEEDS
Food
Shelter
Sleep
Rest
Air
Exercise
Sensory Stimulation
Sex
Proper Nutrition
Vitamins
Freedom from Disease/Pain

2nd Priority SAFETY/SECURITY NEEDS
Personal Safety
Job security
Insurance
Retirement
Future Satisfaction
Freedom from Illness and Pain



3rd Priority LOVE/BELONGING NEEDS
To be loved
To receive affection
To belong
To be Accepted
To have a place in a group
To be a part of a team
To have friends and Family
To be understood

4th Priority SELF-ESTEEM NEEDS

5th Priority SELF ACTUALIZATION NEEDS


• PYRAMID TO SUCCESS
– Read the question and every option thoroughly and
carefully!

– Ask yourself “What is the question specifically asking?”

– Be alert to key words, true and false response stems

– Eliminate all the incorrect options!



 IDENTIFY the STEM of the QUESTION
- It follows the case situation and asks something about the case
situation
- Read the stem carefully and specifically identify exactly what is
being asked (Saunders)
- Identify the topic of the question (GAPUZ)
- Identify the critical elements in the question ( NCLEX )

- Identify the issue :
o A drug (effect or side effect) - e.g. digoxin (Lanoxin

o A treatment or procedure – e.g. glucose tolerance test,
cardiac catheterization

o A nursing problem- e.g alteration in comfort,potential for
infection

o A disorder/ complication – e.g. DM, HPN

Choose the Correct Option
• The options are all the answers and you must select one!

• Read every option carefully, and if you must, reread the stem of
the question to be sure!

• Use the process of elimination!

• Once you have eliminated two incorrect options, read the stem
again to identify the question is asking then select the best one!



Here’s an Example!
• A client has received Atropine Sulfate IV during a surgical
procedure. The nurse monitors a client for which of the ff effects
of the medication in the immediate post op period?

A. bradycardia
B. Excessive salivation
C. Diarrhea
D. Urinary retention

Issue of the Question

• The issue is the problem that the question is being asked (NCLEX)

• Assist you in eliminating the incorrect option (SAUNDERS)


ANSWER

D
• Atro SO4 is anti cholinergic drug (all are increased except GIT, thus
increases blood flow to the skeletal muscles, heart and brain)

Anticholinergic Properties

• Tachycardia (all VS are increased!)

• Dilates pupil – to be more aware of surrounding



• Dry mouth

• Constipation

• Urinary retention

• Keywords
• LOOK FOR IT!

• THIS FOCUSES YOUR ATTENTION ON WHAT IS IMPORTANT AND
THEY MAY APPEAR IN BOLD PRINT

- EXAMPLE QUESTIONS
– During the early period, which of the ff nursing procedure
would be best?

– Which of the ff nursing actions is vital?

– Which of the ff nursing actions would be best initially?


Common Key Words( SAUNDERS)
• Early or late

• Best

• First

• Initial

• Immediately

• Most likely/ Least likely



• Most/least appropriate

• On the day of

• After several days

• TRUE RESPONSE

• A TRUE response stem requires an answer which is a true
statement.

• Examples:
1. Which of these interpretations is most justifiable?

2. The chief purpose of the drug is to:

• Key words of true response

• Most likely

• Most helpful

• Best

• Best judgment

• Initial

• First

• Chief

• Immediate

• FALSE RESPONSE




• A FALSE response requires a false statement (negative or not
true)

• Ex.

– Which of the ff nursing actions is inappropriate?

– Which of the ff describes incorrect placement of the
hands during CPR?

– Which of the ff actions would place the client at risk?

• Key words of FALSE Response

• Except

• Not

• Least likely

• Need for further instruction (NFI)

• Need for further understanding/ education

• Lowest priority

• Incorrect

• Unsafe / at risk



• QUESTION

• #1. A patient with Parkinsons disease will most likely
exhibit:

a. Fine hand tremors

b. Intentional tremors

c. Resting tremors

d. Coarse hand tremors

• Tremors

• Rhythmic, purposeless, quivering movements of muscles

• Causes:

A. Fine hand tremor ( hyperthyroidism)

B. Intentional tremors (alkalosis/ MS)

C. Resting tremors ( Parkinsons)

D. Coarse tremors ( Alcohol / DT)



QUESTION = Mr. Tan is an 80 y/o man who just had cataract surgery
performed in his right eye.

• As the nurse reviews the history of the patient, which finding will
not be expected:

A. Blurred vision

B. Cloudy white pupil

C. Eye pain at night

D. Absent red reflex

• Answer = C

• Cataract is not characterized by pain.

• The S/Sx of CATARACT:

– Blurred vision

– Photophobia-client complains of glare

– Opaque or cloudy white pupil

– Difficulty to identify colors

– Indirect opthalmoscope-red reflex is distorted/absent

– Patient does not experience pain



• Answering questions that focus on Setting Priorities

• Priority setting questions asks the test takers to identify either
what comes first, is most important or gets the highest priority

• Sample questions

• What is the nurse’s initial response?

• The nurse should give immediate consideration to which of the ff?

• Which nursing action receives the highest priority?

• What should the nurse do first?

QUESTIONS THAT REQUIRE PRIORITIZING

• IDENTIFY the KEY WORDS

– Initial

– Essential

– Vital

– Immediate

– Highest

– Best

– Most

– Priority

– Use GUIDELINES in PRIORITIZING



• Use Maslow’s Hierarchy of needs – when a question ask you to
establish priorities for the patient

– Physiological comes first! (air, water,
food,shelter,sex,activity, comfort, sleep)

– SAFETY ( ALWAYS THINK OF SAFETY! Avoiding harm, feeling
secure)

• Example of Maslow’s

• The doctor orders the following for a patient with diabetes
insipidus, which one should the nurse carry out first?

– Administer IV fluids

– Measure urine output

– Check the urine specific gravity

– Monitor the blood pressure

– ABC’S


• Remember the order of priority:

– Airway

– Breathing

– Circulation



Sample Question

• A client undergoes a subtotal thyroidectomy. The nurse ensures
that which priority item is at the client’s bedside on arrival from
the operating room?

a. An apnea monitor

b. A blood transfusion warmer

c. A suction unit and oxygen

d. An ampule of vit. k

• Answer = C

• Following thyroidectomy, resp. distress can occur due to tetany,
tissue swelling or hemorrhage. O2 and suction should be at the
bedside for emergency purpose

• Recall the anatomical location of the thyroid gland and its close
proximity to trachea

Using the Nursing Process

• When a question asks you to prioritize nursing interventions, use
the nursing process.

• Indicates that assessment comes first!

• Key words:

• Initial nursing action

• First nursing action

• Most appropriate nursing action


Example

• A nurse in ambulatory care clinic takes a client’s blood pressure.
The nurse measures the client’s BP in the left arm as
200/118mmHg. The first action of the nurse is to:

a. Notify the physician

b. Inquire about the presence of kidney disorders

c. Check the blood pressure in the right arm

Recheck the pressure in the same arm within 30 seconds
• Assessment Key Words

• Ascertain

• Assess

• Check

• Determine

• Find out

• Identify

• Monitor

• Observe

• Obtain info



– Other strategies

• Global options

Similar distractors

Look for qualifiers – DO NOT SELECT!

As well as ABSOLUTE TERMS – INCORRECT!

QUALIFIERS

• GENERALLY

• USUALLY

• TENDS TO

• POSSIBLY

• OR MAY

ABSOLUTE TERMS

• NEVER

• ALWAYS

• EVERY

• ALL

• NONE

• MUST

• ONLY



Communication theory

– Indicates that we should focus on feelings first!

– Watch out for responses which are considered NON
THERAPEUTIC:

• Don’t worry, WHY,

• Pay particular attention to therapeutic phrases such
as:

• it seems

• It sounds

• Tell me

• A client with aldosteronism has developed renal failure and says
to the nurse, “This means that I will die very soon.” The most
appropriate nursing response is:

a. What are you thinking about?

b. You will do just fine.

c. You sound discouraged today.

d. I read that death is a beautiful experience

• Assessment key words

• Therapeutic

• Being silent

• Offering self for assistance



• Showing empathy

• Restatement

• Paraphrasing

• Validation/clarification

• Giving info

• Non therapeutic

• Giving advise

• Showing approval

• False reassurance

• Devaluing client’s feelings

• Being defensive

• Placing your clients on hold

• Summary

• Knowledge on facts – go back to basics!

• do everything by the book

• Use the guidelines/ test taking strategies

• Use some clinical experiences

• PRAY! And Pray!

GOOD LUCK & God Bless NURSES! From

1Nurses.com Team



Resources

Test Taking Tips – site to improve your test taking skills and studies

Test Taking Strategies – From Google Books by Judi Kesselman-Turkel,
Franklynn Peterson

Free Nclex Questions – Practice NCLEX Questions

Nursing Lectures – Free Powerpoint, Downloadable Nursing Lectures

Free Nursing Ceu – Free Nursing Continuing Education Units

1NURSES.COM – Your #1 Source Of Nursing Related Information


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