Chapter 12

Additional Pyramid Strategies

In addition to all the test-taking strategies that you have reviewed so far in this book, you can use other helpful strategies to assist in the process of elimination and answering questions correctly. This chapter reviews these helpful strategies and provides sample questions to illustrate how these strategies are used. Also included in this chapter are useful strategies for answering questions that relate to medication and intravenous (IV) calculations, laboratory values, client positioning, therapeutic diets, and disaster planning. Some additional pyramid strategies include:

1. Eliminating options that contain closed-ended words

2. Eliminating options that contain medical rather than nursing interventions

3. Eliminating comparable or alike options

4. Ensuring that all components of an option are correct

5. Selecting the umbrella option

6. Visualizing the information in the case event, question query, and options

7. Looking for concepts in the question that are comparable or alike to a concept in one of the options

STUDY TIP

Lifestyle Planning

In addition to all of the strategies you have learned about so far in this text, remember that self-care is one of the most important factors that will lead to your success. Take the time to care for your own needs, and you will notice that you are able to focus much better on your schoolwork!

Eliminating Options That Contain Closed-Ended Words: How Will This Help?

In most situations, if an option contains a closed-ended word, it is incorrect. As you read each option, if you note a word that is closed-ended, eliminate that option. Conversely, as you read an option and note an open-ended word, then that may be the correct option. A list of closed-ended and open-ended words follows.

Closed-Ended Words

Closed-ended words may indicate an incorrect option!

Open-Ended Words

Open-ended words may indicate a correct option!

Following are sample questions that illustrate the strategy of closed-ended versus open-ended words.

SAMPLE QUESTION: Eliminating Options That Contain Closed-Ended Words

Case Event:

The nurse is providing dietary instructions to a client about a low-fat diet.

Question Query:

The nurse should make which statement to the client?

1. “Never use butter for cooking.”

2. “Drink fluids only if they are fat free.”

3. “Eat foods that have less than 1% fat content only.”

4. “Read the labels on food items to determine the fat content.”

Answer: 4

TEST-TAKING STRATEGY

Read every word in each option carefully. Note the closed-ended words never in option 1 and only in options 2 and 3. Remember that the use of a closed-ended word in an option will most likely make the option incorrect!

TIP FOR THE BEGINNING NURSING STUDENT

For a regular healthy diet it is usually recommended that of the total calories eaten, no more than 30% should come from fat. A low-fat diet may require even greater restriction. Low-fat diets may be prescribed for a variety of conditions, including gastrointestinal disorders such as liver disease or gallbladder disease, cardiovascular disorders, or obesity. You will learn about the various types of diets in your fundamentals of nursing course or nutrition course and in your medical-surgical nursing course when you study nutrition.

SAMPLE QUESTION: Selecting Options That Contain Open-Ended Words

Case Event:

A client scheduled for a computerized tomography (CT) scan of the abdomen asks the nurse when the results of the test will be available.

Question Query:

The nurse should make which most appropriate response to the client?

1. “The results will not be available for at least 1 week.”

2. “You must ask the CT technician for that information.”

3. “Your health care provider (HCP) may have the results in about 3 days.”

4. “Every scan is read by a radiologist, and this process always takes 1 week.”

Answer: 3

TEST-TAKING STRATEGY

Read every word in each option carefully, and note the strategic words most appropriate. If you were unable to answer this question using nursing knowledge, note the use of the open-ended word may in option 3. Also, note the closed-ended words will not in option 1, must in option 2, and every and always in option 4. Remember that the use of a closed-ended word in an option will most likely make the option incorrect, and the use of an open-ended word in an option tends to make the option correct.

TIP FOR THE BEGINNING NURSING STUDENT

A CT scan is an x-ray procedure that combines x-ray images with the aid of a computer to generate cross-sectional views and, if needed, three-dimensional images of the internal organs and structures of the body. A CT scan is used to define normal and abnormal structures in the body and/or assist in procedures by helping to accurately guide the placement of instruments or treatments. You will learn about this diagnostic procedure during your nursing education, most likely in your medical-surgical nursing course.

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Preparing for Clinical

When in clinical, you should be aware of any diagnostic procedures your assigned client(s) have recently undergone, what the results of these procedures are if they are available, and any related postprocedure care that needs to be followed. Additionally, you should be aware of any procedures your assigned client(s) are scheduled to undergo while you are caring for them, and ensure implementation of any specific preprocedure instructions, such as diet prescriptions or withholding of certain medications.

Eliminating Options That Contain Medical Rather Than Nursing Interventions: How Will This Help?

An important point to remember is that the NCLEX® exam is a nursing examination, not a medical one. Therefore, focus on nursing and select the option that relates to a nursing intervention rather than a medical one. The only situation in which you may need to select a medical intervention is if the question indicates to do so. For example, if the question query states, “Which intervention does the nurse anticipate to be prescribed?” then you may need to select the option that contains a medical action or prescription. Following is a review with sample questions that illustrate this strategy.

Focus on nursing rather than medical interventions!

SAMPLE QUESTION: Eliminating Options That Contain Medical Rather Than Nursing Interventions

Case Event:

The nurse is caring for a client with a diagnosis of heart failure who suddenly experiences severe dyspnea and suspects that pulmonary edema has developed.

Question Query:

What is the immediate nursing action?

1. Insert a Foley catheter

2. Place the client in high-Fowler’s position

3. Obtain a vial of furosemide (Lasix) and a syringe

4. Obtain a dose of morphine sulfate from the opioid medication drawer

Answer: 2

TEST-TAKING STRATEGY

Note the strategic word immediate, and note the subject of the question—a nursing action. Although options 1, 3, and 4 are interventions that would be done in this situation, they all require a medical prescription from the health care provider. Option 2 is a nursing action that does not require a medical prescription. Remember that your exams are nursing examinations, not medical examinations!

TIP FOR THE BEGINNING NURSING STUDENT

Heart failure is an inability of the heart to maintain adequate circulation to meet the metabolic needs of the body because of an impaired pumping ability. Heart failure can progress to pulmonary edema, a condition in which fluid accumulates in lung tissue. This is a medical emergency. If this occurs the immediate action of the nurse is to place the client in an upright (high-Fowler’s) position. You will learn about heart failure and pulmonary edema when you learn about cardiac disorders. One important thing to remember is that with all clients, airway is the priority.

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Scope of Practice

Be sure to be familiar with the scope of nursing practice with regard to various aspects of client care. Knowing this information will help you with questions that relate to scope of practice and require you to differentiate between medical actions and nursing actions.

SAMPLE QUESTION: Selecting an Option That Indicates a Medical Intervention

Case Event:

The nurse is admitting an infant to the pediatric unit with a diagnosis of respiratory syncytial virus (RSV).

Question Query:

The nurse anticipates that the health care provider will prescribe which measure?

1. A private room

2. Contact precautions

3. Ribavirin (Virazole)

4. Strict handwashing procedures

Answer: 3

TEST-TAKING STRATEGY

Note the subject of the question—the intervention that the health care provider will prescribe. Although the health care provider may document options 1, 2, and 4 on the medical prescription sheet, these are interventions that the nurse can implement for an infant with RSV. That is, a health care provider’s prescription is not required for these interventions. In contrast, option 3 requires a health care provider’s prescription. Remember that your exam is a nursing examination, not a medical examination, and the only situation in which you may need to select a medical intervention is if the question indicates to do so!

TIP FOR THE BEGINNING NURSING STUDENT

RSV is a viral infection that is a common cause of acute bronchiolitis, bronchopneumonia, and the common cold in infants and young children. Symptoms include fever, cough, and severe malaise. Treatment includes rest, humidity, adequate fluid intake, oxygen, and the administration of ribavirin (Virazole). You will learn about this virus when you study respiratory infections in your pediatrics course.

Eliminating Comparable or Alike Options: How Will This Help?

An important point for you to remember is that multiple choice questions have only one correct option. As you read the options, if you note options that are comparable or alike with regard to their context, eliminate these options. The correct answer to the question will be the option that is different. Following is a sample question that illustrates this strategy of eliminating comparable or alike options.

Eliminate comparable or alike options!

SAMPLE QUESTION: Eliminating Comparable or Alike Options

Case Event:

The nurse is preparing a plan of care for a client who will be receiving a blood transfusion.

Question Query:

The nurse should write which intervention in the plan that relates to monitoring for a transfusion reaction?

1. Weigh the client before and after the transfusion.

2. Check the client’s lung sounds hourly for crackles.

3. Monitor the client’s temperature during the transfusion.

4. Monitor the client’s intake and output during the transfusion.

Answer: 3

TEST-TAKING STRATEGY

Note the subject of the question—a transfusion reaction. If you know the signs of a transfusion reaction, you can answer this question easily. If you do not know these signs, read the options carefully. Note that options 1, 2, and 4 are comparable or alike in that they relate to the complication of fluid overload. Because they are all comparable or alike, they are incorrect and need to be eliminated. Remember that the correct answer to the question will be the option that is different!

TIP FOR THE BEGINNING NURSING STUDENT

A blood transfusion involves the IV administration of a component of blood, such as packed red blood cells, to replace blood or one of its components lost as a result of trauma, surgery, or a disease. One complication that can occur when administering blood is a blood transfusion reaction. Some signs and symptoms of this complication include fever; facial flushing; rapid, thready pulse; cold, clammy skin; itching; dizziness; difficulty breathing; or low back or chest pain. You will learn about blood transfusions, the complications, and the nursing care involved with the administration of blood during your medical-surgical nursing course when you study hematological disorders.

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Student-to-Student

Watch for comparable or alike options when answering exam questions, and if you encounter them, eliminate them because it is not possible for both of them to be correct. Additionally, look for options that are opposite. It is likely that one of the opposite options is the correct one!