Example Questions for Safe and Effective Care Environment

by Prof. Lawes

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    00:00 So, when you're looking at this list again, remember just want to bring you back to it to see we've got 4 major categories and 2 of those major categories have subcategories and there's the percentages. So the questions that you see are going to be broken down by these percentages. See that range like take for example look at health promotion and maintenance. You have a range of 6-12%. So could be any number within the range. That's why everyone's test is a little different as far as the exact percentages but overall it's going to fall within those ranges. Now let's talk about some of the categories. Ready to dive in to an example of one of the test questions? Well, before we get to that I want you to know where this test question is coming from.

    00:50 First, it's the NCBSN test plan for the NCLEX, but it's coming from a very specific category.

    00:57 Now the main category is safe and effective care environment, but we're going to pull this question directly from the coordinated care subcategory. Alright? So, the definition of this subcategory is the LPN or VN collaborates with healthcare team members to facilitate effective client care. So, let's take a look at a question. Now when you're looking at this question, I want to give you some tips on test taking strategies that will work for you in nursing school too but they're essential on NCLEX. Now first of all, look at the words of the question. We call that the stem. So you take the stem of the question and then I have the 4 answer options. Right? Now, these are example questions straight from the NCLEX test plan. So, you know that this accurately represent the type of content that could be in this section. So, let me look at that stem of the question and I'm going to read it to you. So the nurse in a long-term care facility is making client care assignments for unlicensed assistive personnel or UAP. Which of the following statements by the nurse would provide the UAP with the best directions about the assignment? Now, here's what most of our brains do. We kind of use this one a scheme that question and then jump down to the answer choices, we look for our favorite too.

    02:23 We wafu, wafu, wafu, wafu, wafu, wafu, wafu, wafu, wafu and then you pick your answer and you go on to the next one. Hey, are you willing to trust me and see if you try a little bit different strategy. Instead of spending more time in the answered choices, I want you to flip that model and spend more time in what we call the stem of the question or the words of the question. Now, here are things I want you to look for. So first of all, try to ignore those 4 answer choices. I know it's really tough and when you're developing the skill, if you even have to put your hand over the answers do it. So let's focus just on that stem of the question and let's see what kind of things we're looking for. I'm going to look for what's particular in this situation.

    03:11 What setting are we in? What is the context of this question? And then I'm going to put it into my own words. Very important. You want to start scoring better on your test? Just do this one thing. Spend more time in the stem, put it into your own words and make sure you nail the concept, you're going to see your test course go up. So let's take a look. The nurse in a long-term care facility, okay so I know that's where I am, is making client care assignments for the unlicensed assistive personnel. Now, since I am taking the NCLEX-PN exam, the nurse in this question is a licensed practical nurse or licensed vocational nurse. So, the nurse in a long-term care facility, they're making client care assignments for unlicensed assistive personnel. Is that appropriate? Absolutely, because you can delegate to UAPs. Now the question says which of the following statements by the nurse would provide the UAP with the "uh-oh, yeah." you know that word tells me right there with the best directions about the assignment right there that says "Uhmmm there's probably more than 1 right answer down there." So, you just got to Elsa that as they say "let it go." If you spend time arguing with the screen and being frustrated that there's more than 1 right answer, you're just wasting your mental energy. Know that we're not even looking at the answer choices yet but we know and we see a term like "best, most important, first." That's going to tell us it's asking us to prioritize, pick the top answer, the best answer from all of the answer choices. So there is likely more than 1 correct answer. So, let's do what we said. We're going to look at the stem, we're going to put into our own words. I'm going to say a nurse in a long-term care facility is making assignments to UAPs which they would be best for the nurse to get directions about the assignment to the UAP.

    05:19 So who am I? I'm the nurse. Who else is in the question? The UAP and is asking me what are the best directions about the assignment. So I have to think about what I know about delegation. Is this appropriate I delegate to UAP? Absolutely. Now I'm going to look at what's the best way because I know when I'm delegating, I want the most clear, concise directions. Right? I want to be very objective. So clear, concise, and objective are the best type of directions when delegating. So, now we have our answer choices. You see we've got 4 options there. Now, I'm going to pause for a minute and let you read those. Okay, we got to start somewhere. So, I'm going to start with #1. I know this is a prioritization question so I'm going to have to compare the answers to the other ones. So, number 1, encourage the client to increase daily fluid intake.

    06:23 Does that seem wrong? Well, nothing in the question tells me that they are a renal patient or CHF patient so there's nothing wrong with that, but I don't know if it's the best directions yet. So what's my next step? I'm going to look at answer #2. That says ambulate the client 20 feet or 6.7 meters every 4 hours beginning at 0900. Now between answer # 1 and answer #2, which one seems the most clear, concise, and objective, because I'm delegating? Right. #2 is a more clear, concise, and objective answer than #1. Now, let's cross off #1 because that's what I want you to do is to eliminate an answer. Don't just gravitate to the one you like. Eliminate #1, we're keeping #2 in for now. And now let's look at #3. Assist the client to perform passive range of motion exercises. Now, what do you think? Is that one more clear, concise, and objective than #2? Or which one is a better direction? Actually, #2 is still the winner. There's nothing wrong with #3. It's okay. You're going to help them perform passive range of motion and that's what you would do. So, that's why #2 is a better answer, it's more clear, it's more concise, it's more objective, and specific. Now, #4, let's see if it's going to be #2 or #4 that wins. Reinforce physical therapy instructions about the proper use of a walker. Okay, is there anything wrong with that? Can I do that? As a UAP, I can. Right? Because reinforcing teaching is good, I can't do the initial teaching as a UAP but I reinforce with the healthcare team has asked me to do, but which one is the best set of directions. It doesn't mean these other things won't be done, they're just asking you "Can you identify which is the best set of directions?" There you go, #2 is the winner.

    08:34 That is more clear or concise and more objective than #4. Okay, so really all four of these answers could potentially be correct but once they ask me to prioritize, ask me what the best directions are then I know I have to compare each of the answers to each other, eliminate them one by one until I can arrive at the best correct answer. Let's take a look at another one of the categories. So, we're going to look at safe and effective care environment, that's the category. And then we're going to look at safety and infection control which is one of the 2 subcategories of safe and effective care environment. Now, the NCBSN defines this as safety and infection control, is the LPN contributes to the protection of clients and healthcare personnel both from health and environmental hazards. Alright, you ready? Let's take a look at another question.

    09:28 Now remember the recommendations, don't look at the answer choices until you really rip up hard that stem. So let's look at the stem, the nurse is reinforcing teaching with the client who's using a mechanical lift. Which of the following information should the nurse reinforce? Alright, so the nurse, say LPN or the LVN, you as soon as you get your license, you're reinforcing teaching with the client who's using a mechanical lift. That makes sense. They have used it before, they have been taught before, I'm just reinforcing it. Which of the following information should the nurse reinforce? Okay, that's just another way of asking me what's the best instruction to reinforce with this client to keep them safe? Remember talking about environmental hazards, health hazards, so this is an appropriate question in this subcategory. So we've got 4 options. Look at the stem, I've put it into my own words. Now I'm going to work my way through the options. Honestly, it doesn't matter if you start top to bottom, middle to top, it doesn't matter but the idea is eliminate each answer one at a time and that way you can make sure you get your best answer. Now, #1. Place your hands on the sling. Is that reinforcing safe teaching for the client? Really isn't. Okay, you don't want their hands on the sling. That's very specific to a safety hazard with using a mechanical lift. So we can cross out and eliminate #1 and what I recommend to students, take a piece of scratch paper, write down 1, 2, 3, 4 and force yourself to cross write to #1 in this case. Now when you take your NCLEX exam, you'll be allowed to use a write-on wipe-off board. Once you fill it up, they'll give you another one, you don't get to erase it, but I would encourage you to use this strategy in the exam testing center because this is one they'll allow you to use. They don't like you to write lots of things on it, but they will allow you to write like 1, 2, 3, 4. You can write numbers on it and cross through them. So, we identified that #1 is not good safety teaching, right, to put their hands on the sling of a mechanical lift. Let's look at #2. You should lie prone on the sling. Wait a minute, picture what prone is. So, is that lying on my back? No, prone is lying on my stomach. Do we ever put a patient prone in a mechanical lift? No. Now let me tell you, a stressed brain is likely to get confused by things that in the light of day you would not be confused. Why do I know this? Because as a faculty when I do exam reviews with students, they come into my office, we look at a test question and I look at them and say "Why did you pick #2 on this question?" They will say "I have no idea why I picked that answer." If you read it too quickly, if you're not slowing down, if you're not picturing what that answer choice is saying, you might miss that it was prone but we all know since we're doing this together that is not appropriate. Next, we've got #3 and #4. Again, it doesn't matter which way you want to go. Look at #3, look at #4. Now, let's just keep going in order. So, #3, place your arms across your chest. Hey, if I'm taking the test I'm going to place my arms across my chest. I use my body in very discreet movements to help my brain focus because a stressed brain is not usually as efficient. So anything I can do to help my brain out to focus, I do. So #3. Anything wrong with that? No, actually that seems pretty good. Well let me compare it to #4. You will need to rock to a standing position.

    13:25 Okay, between #3 and 4, which one seems the safest? Correct, #3 is appropriate for using a mechanical lift, it will protect my patient and keep them the safest that's why the 3rd option, #3, is the correct answer.

    About the Lecture

    The lecture Example Questions for Safe and Effective Care Environment by Prof. Lawes is from the course NCLEX-PN® Exam.

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     Prof. Lawes

    Prof. Lawes

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