Mark Klimek notes

Mark Klimek notes
How to guess

1. Use knowledge
2. Common sense
3. Guessing strategy

Psych

 Nurse will examine own feeling about something-so do not counter transfer
 Establish trust relationship

Nutrition

 Pick chicken not fried chicken
 Fish but not shellfish
 Never pick casseroles for kids
 Never mix meds in food
 Toddlers-finger foods
 Preschool-one meal a day is OK. Leave them alone

3 expectations to have

 Do not expect 75 questions-think 265
 Do not expect to know everything
 Do not expect everything will go right

Pharm

 Most tested area is side effects
 Do not worry about route or dose
 If know what drug does but do not know side effect-pick a side effect in same body system the drug is
working
 No idea what the drug is-look to see if it is PO-pick GI side effect
 Never tell kids that med is candy

OB-check fetal HR

Med Surg

 1st thing assess-LOC
 1st thing do-establish airway

Peds

 All based on principle-give child more time to grow and develop
 When in doubt-call it normal
 When in doubt-pick the older age
 When in doubt-pick the easier task-more time to do the harder one
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,General

 Rule out absolutes
 If 2 answers say same thing-neither is correct
 If 2 answers are opposite-one is probably right
 Umbrella strategy
 If questions has 4 right answers and ask for priority of needs of a patient-worse consequences game-worst
outcome
 When stuck between two answers-read the question

Sesame street rule-use only as last option

 Right answer tends to be different than the rest
 Wrong answers are usually all similar
 Right answer is most unique or different

Answer based on what you know, not what you don’t know

 If you dont know something in a question-pull it out of the equation-use common sense
 Nclex also testing on common sense-do not overanalyze-do not think like a nurse
 Go with gut answer-only if other answer is superior




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, Prioritization

 Decide who is sickest or healthiest--->based on question
 ABC does no work with prioritization questions

 Answers will have 4 parts
 Age
 Gender
 Diagnosis
 Modifying phrase

 2 are irrelevant ---->age and gender
 In Peds pay attention to age but in prioritization age is not important
 Modifying phrase most important
 Ex: pt has angina pectoris vs MI ----> MI is high priority
 Pt has angina pectoris and unstable BP vs MI with stable VS ---->angina with unstable BP is now the
priority

4 rules to prioritization

1. Acute beats (higher priority than) chronic
Example: COPD versus appendicitis--->appendicitis is the priority

2. Fresh postop (<12 hrs) beats medical or other surgical
Example: 2 hr post op versus appendicitis--->2 hr post op is the priority

3. Unstable beats stable
Stable words Unstable words
 Stable  Unstable
 Chronic illness  Acute illness
 Post op >12 hrs  Post op <12 hrs
 Local or regional anesthesia  General anesthesia (1st 12 hrs)
 Lab abnormalities A or B level  Lab abnormalities C or C level
 Unchanged assessments  Changed/changing assessment
 To be discharged  Not ready for discharge
 Ready for discharge  Newly diagnosed
 Admitted longer than 24 hrs ago  Newly admitted
 Experiencing the typical expected S/S of  Experiencing unexpected S/S
disease with which they were diagnoses


Example:
 16 yo w/ meningococcal meningitis who has had temp of 103.8 F since admission 3 days ago.
 61 yo male w/IBS who spiked temp of 103 F this afternoon.
 Who is higher priority and why?--->2 nd option is priority-->have more high priorities than 1st

Always unstable no matter what-even if expected
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