Decision Tree

1. Can you identify the Topic?

Yes= proceed to step 2
No= read answers for clues, read stem, re word question
identify and proceed to step 2

2. Are all answers Assessments or Implementations?

Yes= proceed to step 3
No= determine from stem if assessment needed, validation needed; if so assess
*if no assess in stem then you need to assess
*if assess in stem, do you need validation?
*if assess or validation required and there are no right assess answers, then implement

3. Does Maslows fit?

Yes= Do they make sense? Apply ABC's.
*eliminate psychosocial/pain (consider pain psychosocial for nclex)
*don't always pick airway
No= are all physical? yes..then proceed to step 4
are all psychosocial? yes..then proceed to step 5

4. Are all answers physical?

Yes= apply ABC's
No= proceed to step 5

5. What is outcome of each?

do they make sense?
why?

NCLEX TRAPS
When you read the question ask yourself can I IDENTIFY the TOPIC of this question?
Note: NCLEX HIDES the TOPIC of a question
Example:
A nurse is evaluating the effects of medical therapy for a client with pulmonary edema. The nurse
determines that the interventions that were most effective if the client exhibited which of the following?
U=urine output RR= respiratory rate BP=blood pressure P=pulse

a) BP= 96/56 mmHg; P=110 beats/min; RR=28 breaths/min; U=20 ml/hr

b) BP=88/50 mmHg; P= 116 beats/min; RR=26 breaths/min; U=25 ml/hr
c) BP=108/62 mmHg; P=98 beats/min; RR=24 breaths/min; U= 40 ml/hr
d) BP= 116/70 mmHg; P= 88 beats/min; RR= 20 breaths/min; U= 50 ml/hr

The NCLEX makers want to know if you know how to apply the fifth nursing process which is evaluation within the
context of physiological integrity. You need to evaluate if the set of vitals you took after giving medication therapy
are within normal limits. Eliminate first the wrong answers. Answers #a and # b are wrong (below normal urine
output and BP. You are just left with two choices which is better than having to choose between fours answers.

The next step is to eliminate the last wrong answer, let's look at answer # c...everything is within normal limits
except the respiratory rate (normal for an adult RR=12-20 bpm). Since you have to eliminate # c, then the right
answer must be # d, which is indeed, all those numbers are within normal limits, by the way, normal urinary output
is at least 30 ml/hr. That is a good example of how cleverly the NCLEX makers could hide the topic. They wanted to
know if the test taker knows how to apply the nursing process of evaluation by throwing a question about
evaluating a set of vitals.

IDENTIFY THE TOPIC OF THE QUESTION:

If you have no idea what is the question asking: read the answer choices for clues to identify the topic
In some questions validation is required in order to answer the question correctly...meaning the question may ask
you to assess or evaluate as opposed to implement (do some action, for example, call the doctor, start CPR,
reposition the patient or give oxygen to the patient, etc.) Remember the intent of the question will be hidden to
you.

Read the stem question for determining whether you should assess or implement and within that context
eliminate the answers which do not fit to with what you must do, that will lead you to the right response.
If all the answers fit in to implementation, then move on to use Maslow Hierarchy of Human Needs
--Physical needs take priority over other needs--

Pain is not a physical need--it is considered psychosocial, so it goes higher up on Maslow scheme
If all answers fit in to the physical needs apply ABC (air/blood/circulation) scheme
do not automatically select respiratory answers--remember to throw out wrong answers first
If all answers are psychosocial do not choose the answer that "sounds right": determine the outcome of each
answer, throw out first the answers with negative outcome. Ask yourself "is this answer choice has a desired
outcome?"
Examples of Undesirable Answers you are Looking for to Throw Out First:

a) pass the buck

b) judgmental
c) bad nursing
d) off topic
e) take the buck
f) encourage dependency
g) asking why
h) do not persuade
i) leave patient alone
J) non therapeutic
k) gives false reassurance
l) blame
m) do nothing answers
n) answers which by pass the nursing process such as implementing a particular tx before assessing the situation
o) bypass proper delegation qualifications
p) bypass priority of care
q) do not involve the patient in their own healing process
r) do not listen to the patient in a respectful manner
s) violate patient's rights
t) do not show cooperation with the health team
u) answers that contain absolute worlds such as only, always--watch for those

If Maslow and ABC does not apply: Evaluate ask yourself why, as I did in the example above, the answers
presented are wrong by comparing them against the normal values, throw out first wrong ones for that will lead
you to the one you are looking for: the right answer.

If you have never heard of it, nobody else probably had, so don't choose that answer.
If your pt. is unstable don't choose reassess in 15 min. He might be dead in 15 min - don't delay
treatment.
Find first question that will kill or harm pt., secondly that will delay treatment and eliminate those. If
there is something you can do before calling doctor, do it (pick that question). Sometimes to call the
doctor may be the only right option.

Maslow's hierarchy : Physiologic needs -

A) Maintaining airways and respiration
B) Maintaining circulation
C) Nutrition and elimination
D) Sleep

Safety needs - when no physiological needs exist, safety takes priority - maintaining safe and secure
environment for pt. and nurse
Communication - focus on pt. feelings first
Teaching and learning - motivation and readiness - assess if pt. had previous experiences or any
information first

With removal of the thyroid, elevated vital signs signify thyroid storm, give Inderal, PTU, and oxygen!
With renal calculi, sickle cell, and pancreatitis: Pain is priority...or IV hydration in sickle cell laboring patients.
With otitis media, a complication can be meningitis.
To determine HR, count the small boxes between R waves and divide by 1500.
For dumping syndrome: lay patient flat for an hour after meals and don’t give fluids after meals.
Never remove traction weights!
For hypothermia, monitor for VFIB
PICC LINE complications: air embolism s/s: pale, SOB, tachy. Place pt. in trendelenberg and to their Left!

When getting down to two answers, choose the assessment answer (assess, collect, auscultate, monitor,
palpate) over the intervention except in an emergency or distress situation. If one answer has an
absolute, discard it.

Give priority to answers that deal directly to the patients’ body, not the machines/equipments.