Event 2: Supercharge Your Test-taking Strategies for End-of-course Exams

00:00 Welcome to Lecturio. How to survive nursing school series.

00:05 This is our Supercharge Your test taking strategies for end of course exams.

00:10 So we know this is always a hot topic because end of course exams are those hurdles you have to get through just to get to the end.

00:17 Right. So these are really important to you and we understand that.

00:21 Let's go ahead and get started.

00:25 Hey guys I am so excited that you're here.

00:29 And on the afternoon. I know it's hard to kind of keep your energy going, but I promise I'm going to give you tools today that are going to help you be successful on your very next exam.

00:40 Alright. But this is what we're talking about today because it's what we're all here for.

00:45 So I want to give you the best strategies for picking the most correct answer when all of them are correct, or at least when more than one of them is correct.

00:53 That's prioritizing. I want to show you how to dissect a question so you know what it's really asking with the skill of a cardiothoracic surgeon.

01:01 We're going to teach you how to just dissect that right down.

01:06 And then last, I want you to recognize how one question changes everything.

01:12 In this question. All right. So you're ready to go.

01:15 Okay. Now we're not going to do 100 questions, but we're going to do few questions really well.

01:20 This is one of my favorite nursing school memes okay.

01:24 Nursing school exams be like which one is the most orange? Does that sound familiar to you? Okay, tell me in the chat what was the last test you took in nursing school? That felt really frustrating, like you really struggled on it.

01:39 Tell us what subject it was in the chat.

01:42 Okay. Go ahead. I'll wait.

01:45 So give us something in the chat. Tell us what was the the oh ati fundamental.

01:49 Yes, I've heard that before.

01:51 Mental health. Yeah that's really hard.

01:54 Leadership can be good.

01:55 Oh med surge. We've got you.

01:57 There you go. Farm. Yeah.

02:00 Okay. Now, when you look at the Chat, do you see how all of us have really similar struggles? Right? So you are not alone.

02:09 I'm going to kind of talk about how our thoughts also impact our ability to test.

02:13 Because look at these little guys.

02:14 Do you know what these are? Yeah.

02:17 We call these ants. Right.

02:19 But I want you to think about it from the perspective of autonomic autonomic automatic negative thoughts. That's what these are.

02:28 A N Ts. Now I've got to work with students a long time in helping them prepare for the NCLEX. And then, um, if students have been unsuccessful, I've worked with those students too.

02:40 So in helping tutoring, I think, yes, the most number of times I've had a student who was not successful in the NCLEX was five times before they came to me for tutoring. And so by the time we sat down and talked about it, what we realized was wasn't a content problem.

02:56 He knew his stuff. It was not a content problem.

02:59 It was controlling his mind.

03:02 So let me show you some of the things you can do to help reframe those thoughts when you're taking a test so you can do your best.

03:09 Okay. I want you to look at this.

03:12 Now these are some examples of automatic negative thoughts that just means they pop into your head. You didn't really know they were there.

03:19 They're not usually based in reality, but they can kind of become these really loud voices in your head. So there's all or nothing black or white thinking, man, if I didn't do it perfectly, then I'm rubbish.

03:31 If I'm not getting an A in nursing school, then I'm never going to make it right.

03:35 What about over control and perfectionism? Unless I do it perfectly, I am so disappointed in myself.

03:43 That's also when we get stuck in perfectionism.

03:45 It's hard to study because you're so afraid that you think because you can't do it and you'll never get it. It's hard to study now.

03:52 Magical thinking, boy, I've done this more than once.

03:56 We're like, I know exactly what they are thinking, or I know why they did that, when really we don't.

04:03 We're just filling in the blanks now.

04:05 The next one is my superpower catastrophizing.

04:09 That means, oh, if I don't do well on this, I'm going to fail everything.

04:13 I'm going to get kicked out of the nursing program. I'm going to be a failure for the rest of my life. Yeah, those were some of the thoughts I had.

04:20 Taking my own NCLEX was like, that's it.

04:23 I'm going to be the only one who doesn't pass out of her class. I'm going to be the one that takes our ranking down. I mean, I had all those thoughts and the last one pessimistic or negative bias.

04:34 I will never pass this class.

04:37 Things are harder for me than anybody else, or I'm the only one in here that doesn't understand what we're talking about.

04:45 Now, if you're brave enough, which I don't think you need to be brave because this is a really safe place.

04:51 But if you recognize you've ever had any of those thoughts in nursing school, just type a me or a yes in the chat.

04:59 Okay. I want you to see.

05:01 Yeah. I want you to see that.

05:03 Oh, Jennifer, I love you.

05:06 All of them. Yeah. Okay.

05:10 Alright. See, we're just among friends here.

05:12 Yes, Katie. Especially in prereqs.

05:14 I cried in chemistry. I hated it when they made us go up to the board and draw a molecule. It just made me break out in a cold sweat.

05:21 Alright, so let's start here.

05:25 We all have similar struggles, might be a little different, but we've got a common theme.

05:30 I want you to start being aware of automatic negative thoughts.

05:33 Now we will give you some more tips and go in more detail on that and how you can reframe those thoughts. But just first of all, owning them, that you have them. And none of these are rational.

05:44 Okay. They're not based in fact.

05:47 So when you can start to recognize, oh, I got to get a hold of that, I'm going to show you from today what you should focus your energy.

05:54 So I want you to move your energy from this thought.

05:56 I want you to move it over to what you can do and what you can control.

06:01 So I promise we'll come back and talk more about those at another session.

06:04 But now I want to show you some practical strategies, because here's another thing that we say to ourselves, I can always get it down to two answers, and then I always pick the wrong one.

06:18 Anyone else felt that way? Yeah. Karina, I'm not impressed.

06:23 I'm not impressed at how hard the NCLEX has been for you because we understand.

06:29 I know some fantastic bedside nurses that I would allow and be excited that they're taking care of my family member, and they had a tough time with an NCLEX.

06:38 It becomes a head game and that's what we're talking about.

06:41 So welcome. And you are so cool that you guys share that.

06:46 I love it because that's how we get better and we get stronger.

06:49 So this right here I'm going to tell you when that comes in your head, stop it. It's not helping you.

06:55 Okay. So a lot of times we get it right.

06:58 We get it wrong. We get it done. One, we get it. Two. Sometimes we're picking between two wrong answers.

07:03 But I want to teach you how to not do that.

07:05 Here's the secret. Are you ready? Safety first. Okay. That is the secret to NCLEX.

07:16 Safety first. Now let me show you how you do that, okay? So if you're always thinking the center of an NCLEX question is a patient, and their safety is what matters.

07:27 Now this is really important.

07:29 Okay. So for this particular patient in this particular setting what keeps them the safest. Well remember we talked about there being more than one right answer.

07:40 That's because the let's call them angry South Pole elves that write the NCLEX or that write your end of course exams.

07:48 Everyone you're taking a high stakes test is trying to test you on something within context. So that means looking for clues in the stem is really going to serve you well.

08:02 So you're thinking safety, right? Safety first. That's our most important thing. So what keeps this patient the safest.

08:10 And you want to know what the particulars are.

08:12 Now here's some examples.

08:14 When you're looking at particular patient variables here's some examples.

08:18 It could be their age their gender their symptoms or their complaint medications that they're taking, medications that they're not taking.

08:27 Diagnosis or a procedure.

08:29 Wow. That seems like a big list.

08:31 But what I want you to recognize is there is no one right answer on every exam question.

08:37 It doesn't exist. It's all relative.

08:41 So for this question, we're expecting you to be able to sort through and to prioritize.

08:47 What answer keeps your patient the safest.

08:51 Okay. Now, when we're thinking about that particular patient variables, these are things that make somebody different. It's different for an older person than a neonate. It's different than a neonate and a middle aged person.

09:03 So that's why age matters.

09:05 Some things are different male to female.

09:07 Um, if they're giving us clues with their symptoms, those are things we're looking for. So the number one thing you could stop right now? I hope you don't. But you could leave right now, if you understand, if you will slow down and really take a look at these variables, you're going to get a better chance at picking the right answer.

09:26 Now, settings are also different.

09:28 So remember we said for this particular patient in this particular setting what keeps them the safest. Well on this settings yeah that matters.

09:39 We do things different.

09:40 If you're a school nurse in the question versus if you're an ER nurse, or if you're at a health screening at a mall or you're in acute care hospital.

09:49 So use that to kind of get your head in the game.

09:51 Think about what's the context of this question meaning for what's particular about this patient. What's particular about this setting.

09:59 Because what I want to figure out is what do they need right now to be safe? What's the imminent danger? Now always when it comes to prioritization, prioritization, airway, breathing, circulation is also something we'll consider okay.

10:15 So thinking about what's unique or particular about this patient.

10:19 What's unique or particular about this setting.

10:22 How do I keep this patient in this setting the safest.

10:27 And let's deal with the here and now right here.

10:30 So strategy number one, if you write anything down be particular.

10:35 That's what we're looking for.

10:37 Know that hey prepare yourself.

10:39 We know there's going to be more than one right answer, so there's no reason for you to get angry about it.

10:45 Or to say, man, these are all wrong.

10:48 Nobody cares. We always say we can yell at the screen, but the screen doesn't care when you're taking a test.

10:54 It's a given. There's going to be more than one right answer, because that's what high level questions do.

11:01 See if you can pick the best, the most, the first.

11:05 All those words that are not very fun.

11:07 But that's what we're looking at.

11:09 Those particulars help us get the context of the question that helps us recognize when the answer is right in this question and when it is wrong.

11:18 Because remember, no one right answer.

11:21 It's not always the airway question.

11:24 It depends on the context.

11:26 You know, students always ask me, hey, Prof. I had a question on like labor and delivery, which right then I know I'm in trouble because I'm a med surge specialist, but I got a question on labor and delivery, and this was going on. Do you think this was the right answer? And I always say, I would be happy to sit down with you and look at the entire question.

11:44 But I can't tell you what I think was the best answer unless I see the full question, not just your memory of it and all of the answer choices.

11:53 Same goes for you. Don't shortcut yourself.

11:56 So let's practice. First, let's look at the stem of the question.

12:01 Now that means the words before the answer choices.

12:05 Okay. So we're looking at the stem of the question.

12:07 If I could tell you one thing before you leave today and before we say goodbye, it would be students don't spend enough time in the stem of the question, so they end up picking an answer choice, and it doesn't really answer the question or keep the patient the safest.

12:24 Now, how do I know this for sure? Well, because I've had hundreds and hundreds of office hours.

12:30 I've been around a very long time.

12:32 And when students come into my office and I look at their exam and I say, well, Jose, can you tell me why you picked this answer to the question? And they look back at me like I have no earthly idea why I picked that.

12:47 That tells me they usually miss something in the stem.

12:50 Completely understandable, because I don't know about you, but I want every test to be over as quickly as possible.

12:57 But that's not your best strategy.

12:59 So right now, thinking about and on top of being particular, I want you to spend more time in the Stem and I'm going to show you how to do that.

13:09 Right. I'm going to show you how to do surgery there.

13:11 But for right now, let's start taking a look at the particulars okay.

13:16 Tell me in the chat what is one of the particulars variables for a patient.

13:21 All right. Can you write in the chat. What are some of the examples we use that you want to look for in your patient that says they're particular.

13:27 Yes. Gender. There you go.

13:29 Location. Age. Good. Good.

13:32 Good. Now you guys are even going at this question.

13:34 Look at you. You're ripping apart the question already.

13:37 Beautiful. Oh, you guys are fun to be with this afternoon, I love it. Right. So, 56 years old.

13:45 That's an age. Emergency room is a setting.

13:47 I'll come back and get that.

13:48 They're a female insulin.

13:50 Look at you guys go. Fantastic.

13:54 I am so impressed with what you're going.

13:56 Right. So what's particular about this patient? Is there a 56 year old female there in the emergency room? They didn't take their insulin this morning.

14:06 They're complaining of nausea, tightness in their chest for the past 4 to 5 hours. Now I'm going to.

14:13 There you go. You. Yes.

14:15 Good job. Really good feedback in the chat.

14:18 So all those factors are right there.

14:21 So when you're thinking through your questions and those stems I want you to think what's particular about this patient. Let me get a picture in my mind of who this patient is. So I picture somebody about that age.

14:34 I know we have a diagnosis of diabetes.

14:36 They didn't take their insulin, so I'm not sure if it's going to be like a I'm not sure what the purpose of this question is going to be before I look at the answer choices, but it could be dealing with their blood sugar, could be dealing with the chest pain might be thrombolytics we don't know, but we know that we're in the emergency room.

14:54 Okay. So you already have skated right through the first strategy of finding what's particular about a patient.

15:01 Good job. Remember, there's more than one right answer.

15:04 Why do I keep repeating myself? Because it's one thing when we know something intellectually.

15:09 But when you get in a stressful situation, like, I don't know, a test, it's hard to remember those things.

15:17 So when you feel those automatic negative thoughts coming back in saying, that's not true, that I always get it down to two and pick the wrong one.

15:25 Sometimes that happens, but it isn't always.

15:28 Okay. So when those start peeking in, you want to push them back out and say, no, I'm going to do what I know to do to get the right answer.

15:36 Context matters and no one right answer in all situations, no matter what some well meaning faculty have told you in your program.

15:48 There is not one right answer.

15:51 Sometimes faculty give you tips and strategies for NCLEX and they're just wrong.

15:56 Okay, it worked on their tests, but it didn't work on NCLEX.

16:00 And so you don't ever want to study if you are in class taking a semester test, which is what we're talking about today.

16:08 You don't want to study just to get what the faculty wants.

16:12 You want to become a safe nurse.

16:15 Now, after you've done all that, you've done the particulars. I want you to reword the question in your own mind.

16:20 Let me give you an example.

16:22 So I would say, putting this question in my own words, I would say, okay, I've got a 56 year old female who's diabetic did not take their insulin. If that's my attention, they have abnormal assessment because their chest is tight and they've been nauseated for 4 to 5 hours.

16:40 So anytime they're telling me numbers I'm always thinking about is that normal? 4 to 5 hours is a long time.

16:48 And if this is a question about thrombolytics, I know that they probably won't be eligible for Thrombolytics if they've had chest pain longer than that period of time.

16:58 So why does it matter that I put the question in my own words? Because I'm tricking my brain.

17:05 That's what you're doing.

17:07 So when you do the mental gymnastics that it takes to put a question into your own words, it's a double check to laser focus you to make sure you're looking to answer the question the test is asking.

17:23 Okay. That's the best way to avoid missing something in the stem is making sure you know all the particulars. Now we're going to get serious.

17:32 You ready? Tell me in the chat if you're serious.

17:34 I mean, if you're ready. I know you're serious. Tell me if you're ready to go on to the next one. Sweet. Okay, now, write one thing in the chat just really quickly on what you can do in the stem.

17:48 Is there anything you can do different now from what we just talked about in the stem? So you can you can shorten it just needs to be meaningful to you.

17:56 Is there one thing you can do different now in the stem of a question? What are you going to do? Cool. Reread. Good. Reword.

18:07 Yeah. Put it in your own words. Good. Good.

18:09 Now, are you going to enjoy this strategy? No. Probably not. Right.

18:14 Are you going to enjoy the results? Absolutely. That's like burpees.

18:19 That's like burpees, man.

18:21 Nobody likes them, but they're really good for your body because it's all about the stems. See that there? I know it's a pretty amazing graphic, isn't it? But the stem of the question is the key. No, Aunt Suzette, you and me.

18:36 I'm still working on that.

18:38 It's all about the stem of the question.

18:40 Spend more time in the stem.

18:42 You'll have better results in the end.

18:44 Now, what is this? What do we call this? Anybody tell me in the chat.

18:48 What is this? Alright, that's an automatic negative thought.

18:54 Those are the things we keep telling ourselves. And you know, the more you tell yourself you're teaching the neurons in your brain to form relationships.

19:02 So that's why we're doing studying like we talk about.

19:06 You have the spaced repetition where in Lecturio we will keep asking you practice questions and then we have harder questions too.

19:13 But we'll keep asking you practice questions as you're studying content with us.

19:18 And you want that to remind you, hey, no, I don't always get a question wrong.

19:23 No, I don't have to do this perfect.

19:25 What I'm striving for is to learn this so I'll recognize when a patient's in danger.

19:30 So no automatic negative thoughts, right? Our goal is to fix those.

19:35 Now these are four things I want you to look for in the stem okay.

19:40 So this is the big four.

19:43 Now we already talked about the first one that was the particulars.

19:46 So that was for the patient and for the setting.

19:49 Now I'm going to give you the secrets of how we write questions and things that we're looking for. Right. So anytime you see number two, number three, number four, this is what I recommend that you do.

20:03 So if you see a diagnosis or a procedure okay.

20:06 So tell me in the chat give me a diagnosis in the procedure okay.

20:10 Give me a no. Give me a diagnosis.

20:12 So just write any type of diagnosis I don't care first thing that comes to your mind.

20:19 Am I perfect asthma. Perfect COPD good Pancreatitis.

20:23 Ooh. Fancy spelling. Type two diabetes.

20:26 Heart failure. Pleural effusion. You got it.

20:28 All right. So you get the concept.

20:30 I'm not really surprised because you guys have been sharp right out of the gate.

20:35 But we've got a diagnosis, so I'm going to think about the worst case scenario. What most puts that particular patient in danger? Now, name a procedure for me.

20:45 I'll do them first. Heart cath, you name another procedure that we do to patients. Anything. Cat scan? Yep. What else you got? Ercp. Ooh. Fancy. Yeah.

20:58 Endoscopy. Good, good.

21:00 Good, good. Let me give you a little tip.

21:04 Anytime you do a scopy and a scopy.

21:07 Right, sister. Scopy. Scopy means camera.

21:11 And then before the word scopy, that tells you where that camera is going.

21:15 Now, when you say cystoscopy, we are ramming a camera through a very personal space. Because what are we trying to look at with a cystoscopy? Anybody know? You're bladder.

21:30 So remember, anytime a patient has a scopy procedure endoscopy cystoscopy, you're at risk for perforating whatever features they're moving through.

21:40 So keep that in mind if you have unrelieved pain.

21:43 After a cystoscopy and endoscopy, we could have perforated something.

21:47 Even when the physician does their very best, there's no ill will. They did good practice.

21:53 It just can sometimes happen.

21:55 Okay. So number one particulars. You got it. Patient in setting number two you've got diagnosis or procedure.

22:02 Uh, we know that is um, for if someone has a cystoscopy.

22:05 Let me write that out for you.

22:07 Um. Hey, um, Casey, will you, um, write that out for them? Cystoscopy. And what we talked about with that comment real quick, and I'm going to keep moving on. Now, anytime you see numbers and assessment, that is numbers. That means like a lab work or a vital sign.

22:25 Then I want you to say high, low or normal.

22:29 What? Yeah. No, you really need to do that.

22:32 And here's why. Think of your brain as this giant board.

22:38 Right. And you've got all these knobs and dials on it.

22:40 So to get your brain to give you the result that you want, I want you to set all of the dials to the right place before you take off.

22:48 So think of your brain as a giant dashboard.

22:51 Step one you set the dial.

22:53 Step two you look out for any diagnosis or procedure, and you think through about worst case scenario.

23:00 Evelyn. And I'll show you how to do that next.

23:03 Look for any numbers and you have to make yourself say make a call.

23:08 Is that high, low or normal? It's really important. And the fourth one.

23:12 Anytime you see assessment data, you're going to make yourself say A normal or abnormal. Okay, so think of this as giant dashboard right of my brain.

23:26 I'm setting all the dials.

23:27 So what I get out at the end is the correct answer.

23:31 Particulars I'm looking for any diagnosis or procedure.

23:35 I'm looking for assessment numbers and making a judgment call all before I look at the answer choices. Okay, now this is going to feel really slow to you at first, but I promise you it will get better.

23:47 Let's look at it. A client has been diagnosed with Addison's disease ten years ago and is being admitted to the medical surgical unit.

23:56 What symptoms might the nurse expect for this client when experiencing extreme stress? Now let me tell you how this probably went for most of you. Wah wah wah wah.

24:06 Wah wah wah. After I got to the word diagnosed, you probably were like, gosh, this is a long question. Our minds really, particularly when they're stressed.

24:14 Hopefully you're not stressed now, but they can go in different directions.

24:18 So this is why this strategy one two, three, four will help focus your brain so you don't get lost in the weeds.

24:26 So we know what we do.

24:27 First we look at the particulars.

24:29 When you look at the particulars here.

24:31 Oh look I've got a disease Addison's disease.

24:35 And it tells me a specific time frame.

24:37 That's a number. Oh, anytime I see a number.

24:40 High, low or normal. So is that a long time to have Addison's disease? Yeah, it's it's not an acute thing.

24:48 It's it's this has been a chronic disease.

24:50 That's what it tells us.

24:52 So we know they've got Addison's disease.

24:53 They've had it for ten years.

24:55 They're being admitted to a medical surgical unit.

24:58 So our setting is in the hospital.

25:00 What symptoms might the nurse expect for this client when experiencing extreme stress? So my particulars Addison's disease.

25:10 Chronic. They're going to med surge.

25:12 What happens when they have extreme stress in Addison's disease.

25:18 Now, here's what you asked about with worst case scenario.

25:23 So we know that we have a diagnosis.

25:25 Tell me in the chat what's the diagnosis that we have.

25:30 Oh wow. They very good adrenal insufficiency I like how you said that.

25:35 Yeah yeah Addison's disease is adrenal insufficiency.

25:39 Brilliant. That's what we've got.

25:42 So here this is where I want to introduce you to the secret of looking at how we write test questions. So the diagnosis that we're dealing with is Addison's disease.

25:55 Where did that diagnosis come from? We got it from the stem of the question.

26:00 Right. So you're going to get this recording again.

26:04 But if you have some paper and pencil just write this down. Really quick diagnosis.

26:11 Recognize and do. Okay.

26:13 Just give us that in the four columns.

26:16 This is the key to taking notes to get ready for a test.

26:19 Then as you study those notes, you can run through these tables in your head when you're taking your test.

26:26 Okay. All right. So I'm going to come back to that.

26:30 But I just want you to stay with me right now.

26:32 We're going to go through that some little bit more in that question.

26:35 Assessment numbers. Are there any in this one.

26:39 No. What about assessment data.

26:42 No it doesn't really tell us anything on that.

26:45 So let's go back to this worst case scenario.

26:48 The only diagnosis we had there was Addison's disease.

26:51 Now they already told us that's adrenal insufficiency.

26:55 So the worst case scenario with somebody with Addison's disease is an addisonian crisis.

27:03 Now, an addisonian crisis means you don't have enough of the adrenal hormones, as I always say. Now, I listed them there from you.

27:11 For you. And these are the things that, as you're watching Lecturio videos with me, will teach you all these things.

27:17 You can download our notes.

27:19 You can write these straight away.

27:21 This is what will help you prepare for exams.

27:23 But when you put it in this format, we know that this because this patient has Addison's disease. We know worst case scenario is they don't have these hormones to run their body. Cortisol, inflammation blood sugar.

27:36 Aldosterone is that hormone that tells my body to hang on to sodium.

27:42 And then water follows.

27:43 So that keeps my blood pressure up.

27:45 Epinephrine. That's adrenaline.

27:48 When my body goes into fight or flight, that adrenal gland.

27:51 See, it's sitting right there on top of my kidney. She squirts out epinephrine and norepinephrine, too. That's when my adrenal gland is functioning.

28:01 If I have Addison's disease.

28:03 And what's the other factor in the stem of question that says this patient is even more at risk. So we know they have Addison's disease, but what else is a big problem? What else is going to make their risk for an addisonian stress? Heather. Beautiful. Yes.

28:22 Thank you. Okay. Now how you would recognize it is you'd see a vital sign change.

28:27 And we'll talk more about that in thinking somebody on cortisol tends to have a higher blood pressure. Somebody with aldosterone has a higher blood pressure because of sodium and water. Um, people with epinephrine, norepinephrine have a faster heart rate.

28:43 And they have as their heart is beating stronger.

28:46 So faster heart rate and a higher blood pressure.

28:49 Now, what would you do? Well, you can't fix a crisis without fixing the steroids, encouraging them to rest and replacing the fluids.

28:56 So yeah, you're right on this.

28:58 Really good job. Thank you for coming today.

29:01 It's fun to have you here.

29:03 Okay, now let's back it up and say, wait.

29:05 Focus me again. Now we're on a chart.

29:07 We're on a question. We're doing okay. Step one is particulars.

29:11 Right? And then we said all the things that you should be looking for.

29:15 Second piece was any diagnosis or procedure.

29:19 Think through. Worst case scenario.

29:21 I have not even looked at the answers yet like it takes discipline, but I haven't even looked at the answers yet.

29:30 And I'm thinking through Addison's disease.

29:33 Those are all those hormones. They don't have those hormones. Worst case scenario, Addison's owning crisis.

29:38 How would I recognize it? Usually vital signs change all that.

29:43 Then what I would do now, I keep going with the question, because now I'm ready to put it into my own words.

29:50 So somebody with Addison's disease long time risking an addisonian crisis.

29:55 We're in the hospital, and I'm looking for what I would expect when they're experiencing extreme stress.

30:02 Sometimes questions will ask you if it's resolving, but this one is asking me what would I expect if the patient was under extreme stress? Now here's your next strategy.

30:12 Eliminate. Don't gravitate.

30:15 I'm going to let that sink in.

30:19 Our natural tendency on tests is to read the stem too quick, and then kind of look through the answer choices and pick the one we like the most.

30:27 Or that sounds familiar.

30:29 I'm telling you, you're playing right into the hands of angry item writers.

30:34 Why? Because when they're writing a test question, they do some type of chart like this.

30:41 They determine what they're going to test you on, and then they think, hmm, if this person read the question too quickly, are they likely to make a mistake? And that's how they write the distractors, or they just put another correct answer in there. So what I'm going to encourage you to do is when you're if you're in the NCLEX, you'll be given a write on wipe off board when you're studying.

31:02 You can use scratch paper.

31:04 And here's the key. Eliminate the answers one by one and say why you are eliminating them.

31:11 Okay. Let's practice. Alright, so here's our strategy.

31:14 Eliminate. Don't gravitate.

31:17 So let's practice that with this.

31:19 So somewhere around you write down 1234.

31:22 Got it okay. Now I want you to do this for every question when you're practicing.

31:27 Remember we got a lot of questions.

31:28 You see other questions.

31:30 Make sure you do this strategy I'm going to show you how it works.

31:34 Now we've got this here.

31:35 Look, I gave you also our little notes down there at the bottom for the adrenal gland.

31:39 Worst case scenario. But you've run through this in your head.

31:43 Now I have four answer choices, and that's what I'm going to look at.

31:47 And what am I looking for? The symptoms that I have with extreme stress, which I know is going to be an addisonian crisis.

31:54 So we start thinking through these answer choices.

31:57 Now am I going to have increased inflammation response.

32:01 Well, cortisol if I the higher my cortisol level is, the more that suppresses inflammation.

32:07 They don't have cortisol because they're in a crisis.

32:09 So yes I'm going to have increased inflammation.

32:12 But I won't have high blood glucose levels so I can get rid of that one.

32:17 That means on your paper you cross through number one.

32:20 Just put a little x through number one.

32:23 And I'm saying why I did it.

32:25 Because yes, they would have increased inflammation but they would have decreased blood sugar not elevated blood sugar.

32:31 So that's not the right answer.

32:34 Number two um, increased blood pressure.

32:37 We'll look at that. We've got it crossed out for you. But let me read it for you.

32:41 Increased blood pressure.

32:43 Would I have an increased blood pressure with this? Nope. And why not? Because in an addisonian crisis, you have less dasturan, which tells your body to hang on to sodium and to water so we can get rid of that one.

32:58 Now, are you going to have an increase of Cynefin release? You might.

33:02 That may definitely happen, but you absolutely will not have increased blood pressure in an addisonian crisis because of the lack of aldosterone.

33:11 So cross off number two.

33:13 And we said, why now? Why am I asking you to say why? Because it's one more chance to focus your brain and give a rationale as to why you're eliminating that answer.

33:24 Then no turning back. Anyone else? An answer changer to tell me in the chat.

33:29 If you're an answer changer, just give me a why.

33:33 Yes, you are my people.

33:36 You are my people. Back when I took tests on paper, I would have erased my answer so many times.

33:41 You could, like, see through it when I turned it in.

33:44 This will change that habit for you.

33:47 Because when you eliminate it and you say, why stop it? Because on a test I can talk myself into the most ridiculous of answers, and I'm guessing probably so can you.

33:59 So looking at this last one, extreme fatigue would I have that.

34:05 Would I have extreme fatigue with an addisonian crisis? Yes. Because I don't have epinephrine I don't have norepinephrine.

34:13 Um, that's going to be a real issue.

34:16 So yes, I'll be really, really tired, but my blood glucose will not be elevated. Why? What's the hormone that I don't have? And that's why I won't have an increased or elevated blood glucose level.

34:34 Insulin controls blood sugar. But because you don't have cortisol.

34:37 Yes. See, you guys aren't even afraid of endocrine.

34:40 Go go go. Now I'm left with number four.

34:44 Low blood pressure. Does that make sense for an addisonian crisis? Does it make sense for them to have low blood pressure? Absolutely. Because they don't have norepinephrine and epinephrine.

34:55 They epinephrine. They don't have aldosterone to bring them fluids.

34:58 Yes. That's what you're going to do. Would they have a low blood glucose level.

35:03 Absolutely. Because they don't have cortisol like you already told me.

35:07 So what do we do different here when we say eliminate, don't gravitate. I went through work through every answer, just one at a time, almost treating this like four separate questions.

35:19 All right. That's a really good strategy.

35:21 And when I eliminated it, I cross it off on my paper.

35:24 And I didn't turn back at the end.

35:27 When I'm left with one answer, I get one more shot to say, does that answer make sense? And if it does, I pick it.

35:35 No turning back. Okay, answer changers, I promise you, you can do it. And this is the most effective way to change that.

35:44 Well, um, if you're thinking about the NCLEX, you will have that much time.

35:48 But here's the key. You want to answer your question.

35:50 It's a great question.

35:51 What about an end of course Exam.

35:54 Will I have that much time? The more you practice taking questions, you will get faster on NCLEX.

36:00 The more accurate you are, the shorter your exam will be.

36:04 Okay, so there you go.

36:06 Whether you're taking it in nursing school, um, you will become more accurate and your test will be a better experience.

36:13 But you need to practice these things we're talking about today.

36:16 You need to practice them on questions.

36:19 So that's how we got to the right answer on that one by eliminating and not gravitating.

36:25 Now the last one one sentence changes everything.

36:29 If you look at this I'm going to give you just a second to read it okay.

36:32 So you take a minute and just read this question.

36:42 Okay. So I let you read it without listening to me yammer.

36:46 Now this is a practice question.

36:48 Remember here's our rule for the fours.

36:50 What's particular? Well, the Well, the patients on a ventilator, they have CO2 level of 55.

36:56 Is that you know what we do.

36:57 That's a number. Is it high, low or normal? Well, normal is 35 to 45.

37:02 So this is high. Okay.

37:04 So they have a high CO2. They're on a ventilator.

37:06 The question asks me the nurse should immediately follow up with the provider regarding their order for an adjustment to their ventilator setting.

37:15 So we're going to have an option here where we look at this.

37:18 We know ventilator with abgs drawn we have high CO2.

37:24 Worst case scenario for this is acidosis.

37:26 You state to acidotic for too long you're not going to survive.

37:30 So that's the worst case scenario.

37:32 How would I recognize that worst case scenario.

37:35 Well, I have the beauty of abgs so I would know the CO2 is high and that's what I do know there. And there's no other assessment data.

37:44 So putting this in my own words, that last sentence is completely different than what we talked about before.

37:51 So we've got it in our own words.

37:53 But I want to focus you on that last sentence.

37:56 The nurse should immediately follow up.

37:59 This means I'm looking for something that is unsafe for the patient.

38:04 Now, when you see the answer choices, that's what you have to make sure you're focused on. That last sentence can change everything.

38:12 I divide it into two columns for you looking for the wrong or unsafe answer, or looking for the correct or safest answer.

38:19 If you see an example like which indicates the need for further patient teaching, you're looking for the wrong or unsafe answer.

38:27 If it says which statement indicates patient understanding, you're looking for the one that's correct or safe.

38:33 Okay. This is one that usually new nursing students struggle with all the time.

38:38 That last sentence really can change everything.

38:41 On this question we're looking at, which requires immediate follow up or intervention. That means I'm looking for the wrong or unsafe answer.

38:50 Now I've got four options here.

38:52 Here's a mistake students usually make.

38:54 Sometimes we think like, oh, we've got four options. So we must be doing all four of these.

38:58 No, they're just asking you which one should you follow up on.

39:02 So we've got decrease the respiratory rate to 16 beats per minute.

39:08 Would that be breaths per minute.

39:10 Would that be wrong or unsafe to turn down the respiratory rate.

39:16 So you think of it. You think based on what you know, they're on a ventilator.

39:20 If we decrease their respiratory rate, what impact will that have on CO2? Well, if they're breathing fewer times a minute, that means they won't be blowing off as much CO2.

39:32 So we should not do that one.

39:34 So we're crossing off number one on your paper.

39:36 Got it. Okay, good. Now the next option was increase fio2.

39:44 Now, sorry about this. Someone. We got some editing on our slides, so I didn't mean for that to be written through right away, but increasing fio2 that may or may not be okay. I mean, it would be okay.

39:56 I don't have to immediately follow up on that, right? Might not fix the problem, but that's not the one I need to follow up on. Now look at number three.

40:06 Increase the respiratory rate to 20.

40:08 Oh, would that help us with the high CO2 level? Yes it would. Okay. Now so let's leave that one in.

40:17 Don't cross through that yet on your sheet.

40:19 And number four increase the peep to five centimeters.

40:25 Okay. Would that help our CO2? Yeah it could because it helped those alveoli stay open.

40:31 But definitely when I compare them number three is a bigger problem.

40:36 Okay. So increasing the respiratory rate.

40:40 Oh wait a minute. Increasing the respiratory rate I'm supposed to be looking for which one I would follow up on. So look at this.

40:49 Do we get it right? No.

40:52 And that's what I want to show you.

40:55 Good deal. Hopefully you stayed with us.

40:58 What should this last answer say in order for number three to be correct? What should this last part of the sentence say? Ah, because increasing the rate to 20 is correct.

41:14 So that last sentence should say something like what should the nurse anticipate the healthcare provider ordering.

41:22 Do you see? Okay. So what is the answer that is really wrong or unsafe for this patient? Which one of these answers? Yes. Man, I try to trick you guys and you're on it.

41:37 Okay, so you got the drill.

41:39 Excellent, excellent, excellent.

41:42 You got it. And you let me kind of walk through there thinking like what is going on.

41:46 And then you nailed it really good.

41:48 I'm so proud of what you did.

41:51 So, see, you can do this.

41:53 When you slow down and take your time, you're really going to be able to do this.

41:56 Remember strategy one be particular.

41:59 Then use your own words and eliminate.

42:02 Don't gravitate. Those are three biggies.

42:05 And remember how to be how to be focused in the stem of your question.

42:09 Think of those four things.

42:12 Remember the four steps. The first one was be particular, right? So look for those variables in a patients about a patient in the question.

42:20 So give me some examples in the chat.

42:22 Give me some variables that are particular about a patient. Just spill them out there.

42:29 I'm looking I'm waiting.

42:32 Yes good good good good good good good sweet sweet sweet sweet.

42:37 And setting is also good.

42:38 The second thing what was the second thing we're looking for? One word was D and one word was P.

42:44 So diagnosis or yeah. Oh I love it.

42:48 I love you guys writing DS or procedure.

42:52 And what are we thinking about with any diagnosis or procedure.

42:56 We're looking for a w.

42:59 What. Yes yes worst case scenario.

43:04 Because then we'll see the clues more obviously in the stem of the question.

43:08 Fantastic. Anytime I see what do I ask myself? High, low or normal? And I tell him I see, what do I ask myself? High, low or normal? So if I see this in a question, when do I ask myself, is it high, low or normal? Got it. Nice. Beautiful.

43:27 Any number? Assessment numbers.

43:28 And lastly, what do I ask? Abnormal or normal? Whenever I see any piece of information, do I ask abnormal or normal? Write any assessment data.

43:40 You got it. Because then you know.

43:42 Hey, here's another tip.

43:44 If you've got abnormal assessment data in the stem, the correct answer is not to document it.

43:50 Sometimes you will document things if they're trying to test if you recognize normal.

43:54 But if it isn't then you don't want to document it as your choice.

43:59 Okay. You guys rocked it.

44:02 You know, some of the best strategies are controlling your mind, really ripping through that stem and dissecting it with the precision of a surgeon to make sure that you've got that down cold.

44:14 And always remember, one sentence changes everything.

44:20 And just say no to automatic negative thoughts.

44:24 I'm going to turn you back over to Nicole.

44:26 Thank you so much for coming today.

44:28 I hope you'll join us for our other webinars and come be part of our family and on Facebook. And Nicole has all that information for you.