NCLEX-RN®: Example Questions for Safe and Effective Care Environment

by Rhonda Lawes, PhD, RN

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    00:00 We're going to take a look at some example questions, but I can't start with those until I want to remind you about the test plan.

    00:07 So remember, there's those four major categories of client needs there.

    00:11 On the left, you see them in the different colors, the blue, the pinkish, the orange all the way down. Those are the four major categories of client needs.

    00:19 Now, when there's extra topics listed next to them, like you see at the top, management of care and safety and infection control and at the bottom that tells you those categories have sub categories.

    00:30 So if you do all the math and count that up, there's eight potential categories.

    00:35 Now the one on the bottom, remember, is 39 to 63% of your exam.

    00:40 So if you're going to focus your studies, you really want to make sure you are solid in all four of those, every category and subcategory is important.

    00:50 But I don't want you to be frustrated when you look at your results and see like, Huh, I seem to be scoring low in physiological integrity every time.

    00:57 That's because it's so much content in there, so safe and effective care environment. That's a management of care topic, right? So safe and effective care environment is the main category and management of care is the sub category.

    01:12 Why do you care? Well, really you should because when you're practicing and on these questions, you want to see how you're performing in each of the categories.

    01:21 And if the category has a sub category drill down, take a look and see which particular sub category is where you're struggling the most because that's where you want to focus your study. That's why you care.

    01:34 So let's look at the official definition of management of care.

    01:37 The nurse provides and directs nursing care that enhances the care delivery setting to protect the client and health care personnel.

    01:45 So what this means is the RN oversees all of the care.

    01:50 Our job is to keep both our team members and our patients safe.

    01:55 That's what's in this category.

    01:57 Now, let's take a look at a sample question.

    01:58 So you see the nurse has been made aware of the following client situations.

    02:04 The nurse should first assess the client.

    02:09 Okay, so who should they see first is what this question is asking us.

    02:14 So we know that every one of these people will be seen.

    02:17 It's just my job to see who's in the most danger.

    02:20 That would be who I should see first.

    02:23 So pause the video for just a second and I want you to work through each of these patients. Start with the first one, get a solid understanding of where they are.

    02:31 Then compare number one to number two, see who's worst or in the most danger.

    02:36 Take that choice. Compare it to number three and work your way down to number four.

    02:40 Make the same decision, then come back and you and I will walk through it together.

    02:50 I hope you took the opportunity to really try and do this on your own because that's how you're going to teach your brain to be familiar with these questions and to recognize patterns and to know what to do if you didn't and you were too anxious.

    03:03 No problem. We've got lots of other practice questions for you to do.

    03:06 So let's look at number one.

    03:07 I know what my what my goal here is because I look at that last sentence.

    03:11 The nurse should first assess the client.

    03:15 Okay. Number one, with diverticulitis, that's no fun.

    03:18 It's kind of painful.

    03:19 Who is reporting left lower quadrant pain.

    03:23 Okay, so that's an assessment.

    03:24 Piece of information.

    03:25 Do I expect left lower quadrant pain with somebody with diverticulitis? Yeah, you kind of do.

    03:32 Right. So that seems somewhat normal for an abnormal diagnosis, but I'm going to keep it in for now because now I'm going to compare it to number two, someone with chronic obstructive pulmonary disease who is reporting hemoptysis.

    03:47 Okay. I think that's a little more intense than number one.

    03:50 So I'm going to cross through number one, I'm going to eliminate that answer.

    03:55 And for now, between number one and number two, I think number two is more serious.

    03:58 I do know that COPD ers, they can have hemoptysis, but I just I just think that number two is more of a priority than number one.

    04:08 Now, let's compare number three.

    04:10 The client had an evacuation of a subdural hematoma eight hours ago and has become agitated. Okay.

    04:21 Compared to and three and three, I have abnormal assessment.

    04:26 They had a procedure eight hours ago and a pretty significant one.

    04:29 It was a central nervous system one, and now they're agitated.

    04:33 That's a change.

    04:34 And that would be an indication of some ICP problems.

    04:37 So I'm going to stick with number three for now.

    04:40 I've got one more patient to compare.

    04:43 And let me encourage you.

    04:45 You're going to want to find the quickest answer and just pick it and go on because nobody likes to take a test.

    04:49 But do your due diligence, do the work, go all the way through, check on number four and see if they are as high a priority or a lower priority.

    04:59 So number four, a client who had a total knee replacement eight hours ago and whose affected extremity is internally rotated, I want you to stop and picture that.

    05:10 Who's the higher priority? Well, as you have eliminated answers, did you come up with number three? Because that is the correct answer.

    05:18 And why? Well, they've had a recent procedure just eight hours ago.

    05:23 It's pretty complicated procedure.

    05:25 They evacuated a subdural hematoma and now they've had a change in status that indicates things are worsening, that they're having elevated intracranial pressure.

    05:34 That's why number three is the one that you should see first.

    05:38 Now, safe and effective care also has safety and infection control.

    05:43 In this, the nurse protects the clients and health care personnel from health and environmental hazards.

    05:49 So this is where your things like vaccines come in, knowing how not to transmit infections, all those types of questions on top of are you following precautions, universal precautions and lots of questions like that are in this category.

    06:03 But let's take a look at a sample question.

    06:05 The nurse is assigning unlicensed assistive personnel to assist the following clients to ambulate. It would be most important for the nurse to review the safety precautions with the UAP prior to ambulating the.

    06:19 Okay. Here's what the question is asking us.

    06:21 Who of these four patients is the most likely to have difficulty with ambulating or probably at a risk for falls? So that's who I want to make sure that I'm looking for the patient who's going to have the most difficulty ambulating, and they'd be at a risk for falls.

    06:37 Now, the UAP, they're capable of walking the patient.

    06:40 We just want to give them extra instructions if we think the patient is at risk.

    06:44 So, number one, 44 years old, that's not necessarily a risk méniere's disease.

    06:51 Okay. So we know that's an inner ear thing.

    06:55 It kind of gives them problems with balance.

    06:57 I'm thinking that is somebody who's going to need some help ambulating, because if we're in a hospital setting, they're clearly having some problems now compared to number 259, still not too old with a unilateral cataract.

    07:12 Okay, that compared to number one.

    07:15 Number two is not going to need as much help.

    07:17 You do the same thing with number three and number four.

    07:20 And what's the answer you come up with? Hopefully you picked number one.

    07:30 And that's because Méniere's disease is going to cause that problem with vertigo and make it really difficult for them to walk upright.

    07:37 This is who the nurse would need to give extra instructions.

    07:40 It's everybody and they're going to get walked.

    07:42 Yes, everybody will be walked.

    07:46 But this is the one who would need a UAP to walk with them.

    About the Lecture

    The lecture NCLEX-RN®: Example Questions for Safe and Effective Care Environment by Rhonda Lawes, PhD, RN is from the course NCLEX-RN® Introduction to the Exam.

    Author of lecture NCLEX-RN®: Example Questions for Safe and Effective Care Environment

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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