Using Study Strategies Specific to Alternate Format Questions Marnie Kramer-Kile RN, PhD What you need to know to answer a question correctly: Basic content knowledge Ability to combine concepts Ability to understand the information in the question stem and the question query Strategies to remove potential answers Do not read into the question or engage in What if syndrome (Silvestri, 2014) Reflect without doubting yourself and changing your answers. (Knowledge Level Question) (Silvestri & Silvestri, 2014, p.349-350) The nurse in the newborn nursery is performing admission vital signs on a newborn. The nurse notes that the respiratory rate of the newborn is 50 breaths per minute and should take which action? 1. Document the findings 2. Contact the health care provider 3. Apply an oxygen mask to the newborn 4. Reassess the respiratory rate in 15 minutes 1
(Knowledge Level Question) (Silvestri & Silvestri, 2014, p.349-350) The nurse in the newborn nursery is performing admission vital signs on a newborn. The nurse notes that the respiratory rate of the newborn is 50 breaths per minute and should take which action? 1. Document the findings 2. Contact the health care provider 3. Apply an oxygen mask to the newborn 4. Reassess the respiratory rate in 15 minutes (Application Level Question) (Silvestri & Silvestri, 2014, p.543-544) The nurse is caring for a client who was diagnosed with suspected acute pancreatitis. When reviewing the client s laboratory results, the nurse determines that which finding will support the diagnosis? 1. Elevated cholesterol 2. Elevated serum lipase 3. Decreased serum amylase 4. Decreased serum bilirubin (Application Level Question) (Silvestri & Silvestri, 2014, p.543-544) The nurse is caring for a client who was diagnosed with suspected acute pancreatitis. When reviewing the client s laboratory results, the nurse determines that which finding will support the diagnosis? 1. Elevated cholesterol 2. Elevated serum lipase 3. Decreased serum amylase 4. Decreased serum bilirubin 2
(Critical Thinking/Analysis Level Question) (Kramer-Kile, 2015) A client with a history of type 2 diabetes is undergoing angiogram for suspected coronary artery disease. Which of the following medications should be held 48 hrs prior to the procedure? 1. Glyburide 12.5 mg daily 2. Metformin 500 mg po bid 3. Lipitor 40 mg po daily 4. Metoprolol 50 mg po daily (Critical Thinking/Analysis Level Question) (Kramer-Kile, 2015) A client with a history of type 2 diabetes is undergoing angiogram for suspected coronary artery disease. Which of the following medications should be held 48 hrs prior to the procedure? 1. Glyburide 12.5 mg daily 2. Metformin 500 mg po bid 3. Lipitor 40 mg po daily 4. Metoprolol 50 mg po daily Alternate Format Questions (NCSBN, 2015) Fill-in-the-blank calculation Exhibit Hot spot Multiple response Drag and drop/ordered response Audio Graphic 3
A client has been started on an IV heparin drip. The IV bag is mixed 25,000 units heparin sulfate in 250mL D5W. The infusion is to run at 200 units per hour. How many ml/should the infusion run at? ml/hr A client has been started on an IV heparin drip. The IV bag is mixed 25,000 units heparin sulfate in 250mL D5W. The infusion is to run at 200 units per hour. How many ml/should the infusion run at? 25,000 units/250 ml= 100 units/ml 2 ml/hr Study Strategies: Fill-in-the-blank calculation Review common formulas used (p. 230-231 of the study guide) Pediatric calculations Ensure that you are familiar with units of measurement and which type of unit of measurement the answer needs to be in Always write the formula down before answering the question (Nugent et al., 2016) Remember if the answer requires a whole number you must round up. 4
Exhibit Best way to practice is to build client charts based on pathologies you are unfamiliar with. Templates for building information for an exhibit question exercise as a group Build an exhibit question for a pediatric client experiencing: acute glomerulonephritis : Exhibit Question A seven year old boy presents to the emergency department with a three day history of severe flank pain and difficulty voiding. His mother states he has eating and drinking very little due to a severe sore throat all week. Which of the following conditions should the nurse suspect? 1. Renal calculi 2. Rhabdomyolysis 3. Acute glomerulonephritis 4. Dehydration Chart Information Assessment: Kidney pain on percussion Voiding less than 30 cc per hour Lethargic Lab Results: Elevated Creatinine Elevated BUN Negative myoglobin +ve group A strep throat culture Urine cola coloured 5
Hot Spot Identify the most appropriate area to insert a chest tube to drain a pleural effusion in the left lung. Hot Spot Identify the most appropriate area to insert a chest tube to drain a pleural effusion in the left lung. Study Strategies: Hot Spot Questions Focus on physical assessment Objective findings Anatomical Landmarking Surgical incision sites Placement of ostomies Placement of chest tubes Any other suggestions? 6
Multiple Response Which safety measure(s) should be included in the plan of care for a client with internal radiation implant? Select all that apply. 1. Wear a lead shield when in the client s room 2. Place the client in a room with a cohort client 3. Limit the time with the client to 1 hour per shift 4. Wear a dosimeter badge when entering the client s room 5. Save bed linens and any dressings until the implant is removed Multiple Response (Silvestri & Silvestri, 2014, p. 2) Which safety measure(s) should be included in the plan of care for a client with internal radiation implant? Select all that apply. 1. Wear a lead shield when in the client s room 2. Place the client in a room with a cohort client 3. Limit the time with the client to 1 hour per shift 4. Wear a dosimeter badge when entering the client s room 5. Save bed linens and any dressings until the implant is removed Study Strategies: Multiple Response Group Exercise Create your own multiple response question Use the topic lists provided in the multiple response question building sheet to help guide your studying for this area 7
Drag and drop/ordered response A client has been admitted with an acute asthmatic episode. List in order of priority the following medications to be given to the client. 1. Prednisone (Deltasone) 2. albuterol (Ventolin) 3. theophylline (Theo-dur) 4. salmeterol (Serevent) Drag and drop/ordered response A client has been admitted with an acute asthmatic episode. List in order of priority the following medications to be given to the client. 1. prednisone (Deltasone) 2. albuterol (Ventolin) 3. theophylline (Theo-dur) 4. salmeterol (Serevent) 1. albuterol (Ventolin) 2. salmeterol (Serevent) 3. theophylline (Theo-dur) 4. prednisone (Deltasone) Study Strategies: Drag and drop/ordered response Usually focus on responses that require prioritization Can use a prioritization framework (next slide) Study psychomotor skills in regards to the steps involved Be able to prioritize nursing interventions Focus on emergency management 8
Prioritization Framework Rubenfeld & Scheffer (1999): Priority 1: Life-threatening situations Priority 2: Safety issues Priority 3: Client priorities Priority 4: Nurse priorities Audio A client is admitted with pericarditis. Which of the following heart sounds should the nurse assess for? Click to hear the sound 1. S1, S2 2. S1, S2,S3 3. Systolic murmur 4. Pericardial Rub Audio A client is admitted with pericarditis. Which of the following heart sounds should the nurse assess for? Click to hear the sound 1. S1, S2 2. S1, S2,S3 3. Systolic murmur 4. Pericardial Rub 9
Study Strategies: Audio Primary area of focus is assessment Communication techniques Helpful resource for practice: http://depts.washington.edu/physdx/heart/demo.html Graphic Which of the following heart rhythms puts the client at the highest risk for stroke? 1. 2. 3. 4. Graphic Which of the following heart rhythms puts the client at the highest risk for stroke? 1. Atrial Fibrillation 2. 3. 4. 10
Study Strategies: Graphic Study any pictures of equipment in your Fundamentals of Nursing textbook Rhythm analysis Central lines Positioning Safety References Kramer-Kile, M.L. (2015). Transitioning to the NCLEX-RN : A Study Guide for Canadian-Educated Nursing Graduates. Author. Retrieved from canadiannclex-rnstudyguide.com NCSBN (2015). Detailed test plan for national council licensure examination: Item writer/item reviewer/nurse educator version. Chicago: Author. Retrieved from https://www.ncsbn.org/1287.htm Nugent, P.M. & Vitale, B.A. (2016). Test success: Test-taking techniques for beginning nursing students (7 th ed). Philadelphia: F.A. Davis. Rubenfeld, M.G. & Scheffer, B.K. (1999). Critical thinking in nursing: An interactive approach. Philadelphia: Lippincott Williams & Wilkins. Silvestri, L.A. & Silvestri, A. (2014). Saunders Q&A review cards for the NCLEX-RN examination (2 nd ed). St. Louis: Elsevier. 11