Test Taking Strategies:

1) NCLEX hospital- all clients are being care for in an ideal environment- based on textbook practices.
2) Calling someone else- be cautious about passing responsibility of care of client to someone else (Dr., PT/OT,
Respiratory). Evaluate question and see what nursing action should be taken first- only if there the nurse cant do
anything, then call for help, but usually there is a nursing action first (i.e. nurse will identify client data that must be
reported immediately).
3) Doctors Orders- assume its available i.e. if question asks for administration of medication
4) Focus on client- rather than equipment, rules, policies (which come second to the client)
5) Consider clients age- assume adult unless otherwise stated.
6) Lab values- know these and diagnostic procedures that indicate progress or lack of.
7) Positioning- in implementation of care. Know rationales for why in a position (safety, comfort).
8) Math- I/O, drip factor & IV rates
9) Focus on WHO is the client in the question and identify positive and negative words in stem.
10) Make sure know what question is asking, consider info about timing, focus on options, identify similarities (often
times dissimilar answer can be eliminated), identify qualifiers (every, none, all, always, never)- usually incorrect, select
comprehensive/umbrella answer.
Management of client care: nurse manages UAP, CNA, LPN. Know what each can do. Dont assign steps of nursing
process or nursing judgment to anyone except RN. Dont delegate teaching assignments to anyone except RN. Identify
most stable client/most predictable outcome/least likely to change status/ the need for nursing judgment the lower
priorities can be assigned to LPN or CAN. Consider Maslows Hierarcy in determining stability. i.e.- unstable respiratory
problems RN provides care. Delegate tasks that have specific guidelines if pt is stable (bathing, collecting urine
samples, ambulation). Identify priority client (respiratory compromise, unstable/changing condition, risk for
complication).
Establishing Nursing Priorities: whats most important action- usually 3-4 correct answers, but 1 action needs to be
performed first. 3 areas to consider in this decision:
1) Maslows Hierarchy of Needs: ABCs are implied is physiological needs; airway, breathing, circulation. O2 sat
could be airway or breathing; hypovolemia and hemorrhage are circulation. Also the order for priority: Actual
physical, actual psychological, risk for physical, risk for psychological.

2) Nursing process: assessment, diagnosis, planning, intervention, evaluation (ADPIE).

3) Safety issues: hospital or home. First consider basic survival (oxygen, hydration, nutrition, elimination).
Reduction of environmental hazards also (prevention of falls, accidents, med errors). Environmental safety

(prevention/spread of disease- how to avoid/ handwashing). If multiple choices correct, select which one will be
most beneficial to client.
Therapeutic Nursing Process- principles of communication: not always centered on psych client (stress, anxiety,
body image change). Look for responses that focus on concerns of client, open-ended and encourage client to
express feelings, eliminate response that arent honest/direct (i.e. dont worry, everything is going to be OK, your
doctor knows best), response should indicate acceptance of client (dont tell client what should/shouldnt do), be
careful that response doesnt give advice/opinion, dont select response that block further interaction/close ended,
dont use coercion, dont ask why client feels the way does, look for responses that reflect, restate, or
paraphrase clients feelings.
Pharm tips: administer meds in doses ordered without changing dose or discontinuing the med; may need to
withhold med for specific reason (i.e. Digoxin/Lanoxin for pulse of 48 or Metoprolol/Lopressor for a BP of 90
systolic), question order if any part of it is missing/unclear, look for endings (XL, SR, that indicate sustained
release-dont crush or allow client to chew), dont take OTC meds w/ a prescribed med w/o checking w/physician,
teach clients to avoid drinking alcohol while on meds, especially w/CNS depressants as alcohol depresses nervous
system too.
Legal/Ethical Nursing Practice
ANA code of ethics for nurses: developed by ANA to provide guidance to nurses and protection for
clients/families. Guidelines delineate values & standards for professional practice. Key elements = compassion,
respect, commitment, advocacy, accountability when working with clients/families/communities and
responsibility to the profession.
Ethical principles:
Autonomy- freedom to make decisions that affect self
Nonmaleficence: do no harm
Beneficence: do good, act in best interest of others
Justice: fair, equitable and appropriate tx; equal distribution of resources to all.
Fidelity: keeping commitments; remaining faithful to ANA code of ethics of nurses.
Veracity: to tell the truth
Accountability: being answerable to self and others for ones actions.
Nurse practice act: determines scope of practice for nurse in each state.
Liability: nurses are responsible & accountable for incorrect/ inappropriate actions/inactions
Negligence: unintentional failure to act as a reasonable person would in a similar circumstance that results in
injury to another.
Malpractice: negligence by a professional; professional failure to carry out or perform duties that result in injury.
Informed consent: required before care, unless emergency or when client unresponsive (assumed then).
Advance directions: 2 types
-living will: outlines medical tx client wishes to refuse if unable to communicate at time
-health care proxy (DPOA) : designated person to make health care decisions
Organ donations: clients 18+ may choose to donate. Consent through will, advance direction or donor card.
Clinical death- no brain waves, no spontaneous breathing, no superficial/deep reflexes.
Incident reports: report accidents, unusual occurrences, other incidents involving client which arent in keeping
with usual agency operation. These are communication tools that provide info for risk managers and
administration about potential areas of liability (may be used in legal cases). Used to provide solutions/prevent
from happening again.
*When filling out, do so accurately, completely, factually. Include client name, date/time/place of
incident, facts, clients account of incident in quotation, witnesses, equiptment # or med name/dosage.
DO NOT place copy in client record or reference it there. Record only facts of incident in medical record.

Reporting to external authorities/governing bodies: required to report certain communicable disease to public
health department, evidence of crimes/abuse, confidentially report suspected chemical abuse of coworker to
supervisor (BON will investigate hopefully tx is option), report sexual harassment, unsafe working conditions
under OSHA.
Psych: clients DO NOT relinquish informed consent upon admission- can still accept/refuse aspects of tx.
If med error that kills occurs, terminating physician/nurse wont stop lawsuit. Nurse practice act is not about
ethics.