2. START AT THE BEGINNING
• THOROUGHLY read the entire question and then read it again!
• Pull out key words
• Try to figure out what CONCEPT the questions is trying to focus on
• Just read the question first without looking at the possible answers (cover them if you
need to) and then think about what you know about the topic itself, then when you
see that in your answer choices you can be confident about what you know
• Don’t add anything to the question, read the question as it is
• DO NOT SECOND GUESS YOURSELF. You should rarely change your answer, your first
answer is more often right
3. PRIORITIZATION
• If you could ONLY DO ONE thing and then your arms fell off, which thing would be
most important
• Which thing could result in your patient dying?
• ABCs comes first
• Safety is important
• Maslow’s Hierarchy
• Nursing Process – ASSESS FIRST
• Which patient to see first, “who is going to die first?”
4. SAMPLE QUESTION
• A patient who has just been admitted with pneumococcal pneumonia has a
temperature of 101.6° F with a frequent cough and is complaining of severe pleuritic
chest pain. Which of these prescribed medications should the nurse give first?
– A. Guaifenesin
– B. Acetaminophen
– C. Azithromycin
– D. codeine phosphate
5. SAMPLE QUESTION
• The nurse has just received change-of-shift report for four clients. Based on this report,
the nurse should assess which client first?
– A. a 38-year-old who is 2 days post-mastectomy due to breast cancer, having difficulty
coping with the diagnosis
– B. a 52-year-old with pneumonia and chronic back pain who is requesting pain medication
for severe pain
– C. a 35-year-old admitted after motor vehicle accident whose urine output has totaled 30
mL over the last 2 hours
– D. an 84-year-old with left-sided weakness who is slightly confused and has been awake
most of the night
6. WORDS THAT SHOULD JUMP OFF THE
PAGE AT YOU
• ALWAYS and NEVER are usually NOT correct
• The word ASSESS is often the correct option, you need to collect the data before
DOING anything
• Notify the physician is RARELY going to be correct because you need to either assess
first or DO something for your patient first
7. SAMPLE QUESTION
• An 82-year-old female has been admitted to the hospital with pneumonia and an UTI.
She has been too weak to get out of bed for the past 3 days. As the nurse is giving her
a bed bath, the nurse notices some new redness over her sacrum. What should the
nurse do first?
– A. Use a finger to apply pressure to the reddened area
– B. Notify the physician
– C. Apply a dressing to the area for cushioning
– D. Document your observations
8. ELIMINATE WRONG OPTIONS
• Without even reading the question, some answers in multiple choice questions are
incorrect statements, regardless of what the question is asking.
• Narrow down your answers to the fewest options before even rereading the question
9. SAMPLE QUESTION
• The nurse notes that the international normalized ratio (INR) of a client with atrial
fibrillation who is taking warfarin is 3.2. What is the priority intervention at this time?
– A. Prepare to administer Vitamin K
– B. Hold the next scheduled dose and notify the provider.
– C. Administer the daily dose of warfarin as ordered.
– D. Prepare to administer protamine sulfate
10. REMEMBER THERAPEUTIC
COMMUNICATION FROM MENTAL HEALTH
• Therapeutic communication is key, those concepts apply even outside of the Mental
Health realm
• Anything that sounds like “Tell me more….” or “How does that make you feel”
– Open-ended
• Never ask “Why”; never sound judgmental
11. SELECT ALL THAT APPLY (SATA)…
• Look at each statement on it’s own and determine on each statement whether the
statement is True or False
• Think of these as multiple True/False questions
• Many times the question is recall/symptom related so less complex than critical
thinking questions
12. SAMPLE QUESTION
• A nurse is caring for a male client who has a diagnosis of urolithiasis (renal calculi).
Which of the following findings should the nurse expect? (Select all that apply.)
– A. Flank pain
– B. Hypertension and bradycardia
– C. Nausea and vomiting
– D. Upper back pain
– E. Hematuria
– F. Pain radiating down one leg
13. DELEGATION
• Do NOT choose the answer that you think is what you see at work.
• Answer this in an IDEAL WORLD situation where the unit is correctly staffed
• LPNs cannot assess, teach, care for an acute situation
• CNAs can take vitals but not INTERPRET those vitals, cannot evaluate, cannot teach
14. SAMPLE QUESTION
• The charge nurse is preparing assignments on a busy medical unit. For this shift, there
are two LPNs, two RNs, and one nursing assistant. Which client assignments are most
appropriate? (Select all that apply.)
– A. An LPN is assigned to a client who is receiving the first dose of an oral
immunomodulating agent to manage acute glomerulonephritis
– B. An RN is assigned to the client who is receiving an IV corticosteroid twice daily to manage
systemic lupus erythematous that has resulted in chronic glomerulonephritis
– C. An LPN is assigned to replace a urinary catheter (in place >2 weeks) in a client with a
fever who requires a chronic urinary catheter to help healing from a genitourinary fistula
– D. An RN is assigned to administer IV antibiotics to a client admitted with pyelonephritis
– E. A nursing assistant is assigned to do all the morning baths
– F. LPNs are assigned to clients who have oral drugs prescribed and will do the vital signs for
those clients
– G. An RN is assigned to the client who is being discharged with a new diagnosis of diabetic
nephropathy that is serious (stage 3 chronic kidney disease)
