PRIORITIZATION: Key of Unlocking the Philippine Nursing Licensure Examinations

RATIONALE:
Dwindling success rates
Mismatched of the nursing curriculum and the current PNLE test plan

PNLE evolves and demands critical thinking and decision making skills
Real life situation Measures the ability of the nurse-examinee to respond appropriately by choosing an answer among possible choices provided.

 Decision depends on critical thinking skills in prioritizing nursing actions Prioritization questions take the bulk of the questions of the current PNLE.

GENERAL OBJECTIVES:
After the end of the seminar, the NCM 105 students of the College of Nursing of Medina College, Ipil Campus for the School Year 2010-11 will know the Philippine Nursing Licensure Examination Test Plan and able to build their confidence in successfully passing it.

SPECIFIC OBJECTIVES:
Within the two and a-half hour of lecturepresentation and interactive discussion, the participants will be able to:
Understand current situation of the PNLE especially the discrepancy of the nursing curriculum and the current test plan. Demonstrate an appreciation of the current test plan. Apply critical thinking and decision making skills in prioritizing nursing action called for in each real life situation presented in the PNLE. Respond accurately and speed in a given simulated situation.

The Competency Based BSN Program

ETHICO- LEGAL BASIS

R.A. 9173 Nursing Act of 2002 CHED Memo No. 14, 2009 PRC Modernization Act 8981 E.O. 220 Good Governance Code of Ethics for Nurse

The Features of the Competency Based Approach

It will always be relevant. It is learner- centered not teacher centered It is outcome-focused Evaluation focused on performance of
competencies, criterion-referenced and summative

Over laps will be controlled

Key Areas of Responsibilities

Patient Care Competencies Safe and quality nursing care Communication Collaboration and teamwork Health Education

Empowering

Enhancing Enabling

Legal responsibility Ethico-moral responsibility Personal and professional development Record management Management of resources and environment

Quality Improvement Research

NURSING PROCESS NP I NP II NP III NP IV NP V

Community Health Basic Nursing and Foundation of Care of Nursing and Healthy/At Professional Risk Practice Mother and Child

Care of Care of Care of Clients with Clients with Clients with Physiologic Physiologic Physiologic and and and PsychoPsychoPsychosocial social social Alterations Alterations Alterations [A] [B] [C]

ACROSS THE LIFESPAN INDIVIDUALS, FAMILIES, GROUPS, COMMUNITY IN VARIED SETTINGS

PREVENTIVE
NP I

NURSING PROCESS NP II NP III NP IV

SAFE AND QUALITY NURSING CARE COMUNICATION COLLABORATION AND TEAMWORK HEALTH EDUCATION RESEARCH

NP V

P R O M O T I V E

PATIENT C CARE U R COMPETENCIES

QUALITY IMPROVEMENT
ETHICO MORAL RESPONSIBILITY LEGAL RESPONSIBILITY PERSONAL AND PROFESSIONAL DEVELOPMENT RECORDS MANAGEMENT MANAGEMENT OF RESOURCES AND ENVIRONMENT

A ENHANCINGT I V EMPOWERING E
ENABLING
Care of Clients w/ Physiologic & Psychosocial Alterations Part B Care of Clients w/ Physiologic & Psychosocial Alterations Part C

Basic Foundation of Nursing and Professional Practice

CHN & Care of Normal Mother & Child

Care of Clients w/ Physiologic & Psychosocial Alterations Part A

C U R A T I V E

REHABILITATIVE
ACROSS THE LIFESPAN

 Management of resources and environment Record management

Research

Quality improvement

SQC, Comm, Collaboration & HE (70)

Patient Care Competencies Empowering (10)

Legal responsibilities
Ethico-moral responsibilities Pesonal and professional development

Competency-Based Test Framework

NLE
First day of duty Equipped with nursing school knowledge Decision making:
What would you do in particular situation? In what sequence?

Its all about nursing action!

OUTCOME:

SAFE AND QUALITY NURSING CARE

SOURCES OF NURSING ACTION

PATIENT THEMSELVES SIGNIFICANT OTHERS/FAMILY HEALTH TEAM/DOCTORS ORDER NURSING JUDGMENT PROTOCOLS

Assumptions
Adult Well Hospital-setting

STRATEGIES

General Test Taking Rules

Identify the topic of the question. Select an answer by eliminating

choices.
Do not use background information unless absolutely necessary. Do not read into the question. Think about what the answer choices REALLY mean.

REWORD
Stay focused on the REWORDED QUESTION.

KEY WORDS
TRUE STATEMENT Most or most appropriate Most likely Best Best judgment Initial First Chief Immediate FALSE STATEMENT Except, not, or but Least likely Need further instructions or education Lowest priority Incorrect Unsafe

READ EFFECTIVELY
SKIMMING-TO CREATE STRATEGY SCANNING-TO ELIMINATE CHOICES READING INTELLIGENTLY PICTURE OUT SITUATION CONSIDER ALL DETAILS AND DATA REMEMBER THAT ALL ELEMENTS OF AN ANSWER MUST BE CORRECT FOR THE ANSWER TO BE CORRECT

The nurse describes the procedure for collecting a clean-catch urine for culture and sensitivity to a male patient. Which of the following explanations, if made by the nurse, would be most accurate?

(1) The urinary meatus is cleansed with an iodine solution and then a urinary drainage catheter is insert ed to obtain urine. (2) You will be asked to empty your bladder one half hour before the test; you will then be asked to void into a container. (3)Before voiding, the urinary meatus is cleansed with an iodine solution and urine is voided into a sterile container; the container must not touch the penis. (4) You must void a few drips of urine, then stop; then void the remaining urine into a clean container, which should be immediately covered.

 REPHRASE THE QUESTION AND REREAD IT WITH THE ANSWER

ASK: WHERE IS THE IMPORTANT INFO.? LOOK FOR KEY WORDS IN THE STEM SKIM FOR PIECES OF INFO

 A 12-year-old boy was riding his bike to school when he hit the curb. He fell and hurt his leg. The school nurse was called and found him alert, conscious but in severe pain with a possible fracture of the right femur. What is the first action that the nurse should take?

(1)Immobilize the affected limb with a splint and ask him not to move. (2) Make a thorough assessment of the circumstances surrounding the accident. (3)Put him in semiFowlers position for comfort. (4) Check the pedal pulse and blanching sign in both legs.

A 12-year-old sixth grade boy was riding his bike to school when he hit the curb. The boy tells the school nurse, I think my leg is broken. What is the first action the nurse should take?

(1)Immobilize the affected limb with a splint and ask the client not to move.
(2)Ask the client to explain what happened.

(3) Put the client in semiFowlers position to facilitate breathing. (4)Check the appearance of the clients leg.

A woman is admitted to the hospital with a ruptured ectopic pregnancy. A laparatomy is scheduled. Preoperatively, which of the following goals is most important for the nurse to include on the patients plan of care?

1) Fluid replacement 2) Pain relief 3) Emotional support 4) Respiratory therapy

The nurse plans care for a 14-year- old girl admitted with an eating disorder. On admission, the girl weighs 82 lbs. and is 54 tall. Lab test indicate severe hypokalemia, anemia, and dehydration. The nurse should give which of the following nursing diagnoses the highest priority?

Body image disturbance related to weight loss.

(2) Self-esteem disturbance related to feelings of inadequacy (3)Altered nutrition: less than body requirements related to decreased intake.

(4)Decreased cardiac output related to the potential for dysrhythmias.

KEY WORDS
Prioritization
Initial Essential Vital Immediate Highest Best Most Priority

ONE WORD IN THE QUESTION DETERMINES WHICH ANSWER IS BEST

INITIAL OR FIRST-USE NURSING PROCESS-ASSESSMENT FIRST BEST- ONE MORE ESSENTIAL AND INCLUSIVE OF OTHERS PRIORITY- SAFETY AND ABCS MOST IMPORTANT- MASLOWS

The nurse is caring for four clients on a step-down intensive care unit. The client at the highest risk for developing nosocomial pneumonia is the one who:
a) b) c) d) Has a respiratory infection Is intubated and on a ventilator Has pleural chest tubes Post-op client with a high abdominal incision.

The nurse cares for a 72-year-old man with a diagnosis of cerebral vascular accident (CVA). The nurse is feeding the patient in a chair when he suddenly begins to choke. Which of the following actions should the nurse take FIRST?

(1)Check for breathlessness by placing an ear over the patients mouth and observing the chest. (2) Leave the patient in the chair and apply vigorous abdominal or chest thrusts from behind the patient.
(3)Ask the patient, Are you choking?

(4) Return the patient to the bed and apply vigorous abdominal or chest thrusts while straddling the patients thighs.

A 35-year-old woman with a history of bipolar disorder is admitted to the psychiatric hospital. She was found by the police attempting to climb onto the wing of a plane at the airport. Her husband reports that she has not eaten or slept in two days, and he suspects she has stopped taking lithium. On admission, the nurse should place the highest priority on which of the following patient care needs?

(1) Teaching the patient about the importance of taking lithium as prescribed. (2)Providing the patient with a safe environment with few distractions. (3)Arranging for food and rest for the patient. (4) Setting limits on the patients behavior.

The client discovers that her case of sexual abuse was discussed in a secluded place by the nurses. The ramifications associated with this is:

a) None, it was discussed by healthcare workers in a secluded area b) They can be charged with slander c) They can be charged with libel d) None ,unless it has caused harm to the patient.

 The nurse cares for a 30 year old pt on peritoneal dialysis. The infusate amounts to 2L. Later 1L is returned. The nurse should:

1. Turn the patient side to side 2. Push the catheter in further 3. Milk the catheter 4. Press on the abdomen

The physician order a nasogastric tube inserted and connected to low intermittent suction for a patient with an intestinal obstruction. Two hours after the insertion of the nasogastric tube, the patient vomits 200 cc. While irrigating the nasogastric tube, the nurse notes resistance. The nurse should

(1) replace the nasogastric tube with a larger one. (2)turn the client on his left side.

(3) change the suction from intermittent to continuous. (4) continue the irrigation.

NLE Isnt the Real World

Be careful about using your real world experience. All correct answers are based on textbook nursing practices.

1) The nurse is unable to identify a patient who is confused 2) because his armband is 3) missing. Which of the following actions by the 4) nurse is best?

Have the patients roommate identify him. Ask the patient to state his full name. Ask one of the other nurses to identify the patient. Look in the chart at the picture of the patient.

The NLE is about patients.

Always take care of the patient first before the equipment.

1) A 36-year-old woman with a fractured left femur is placed on a Thomas splint and2) Pearson attachment. The patient tells the 3) nurse she has terrible pain in 4) her left thigh. Initially, the nurse should:

Determine all weights and ropes from traction are in line and hanging freely. Ask the patient for more information about location and characteristics of her pain. Check traction apparatus to make sure they are appropriately positioned. Explain to the patient that pain on the affected leg is a common occurrence.

Recognize NORMAL
Memorize normal lab values and be able to interpret them.

The physician orders furosemide (Lasix) and spironolactone (Aldactone) for a patient. Prior to administering the medication, the nurse determines that the patients potassium is 3.2 mEq/L. In addition to notifying the physician, the nurse should anticipate taking which of the following actions?

(1) Do not administer the Lasix or Aldactone. (2)Administer the Aldactone only.

(3) Administer the Lasix only.

(4) Administer the Lasix and Aldactone.

Dont pass the buck.

Think.the NLE wants to know what you would DO!

A 53-year-old man is receiving packed RBCs. Several minutes after the infusion is started, he complains of itching and develops hives on his chest and abdomen. Which of the following actions should the nurse take first?

1) Slow down the rate of the transfusion. 2) Call the physician for an order for an antihistamine. 3) Mix IV fluid with blood to dilute it. 4) Stop the transfusion.

RELATE AND APPLY PRINCIPLES CONCEPTS AND PROTOCOLS

Ex. A:The Rules of Management

1 Do not delegate assessment, teaching, or evaluation 2 Delegate care for stable patients with expected outcomes 3 Delegate tasks that involve standard, unchanging procedures 4 Stable vs. unstable

Which of the following tasks is appropriate for the nurse to delegate to an experienced nursing assistant?

(1) Obtain a 24-hour diet recall from a patient recently admitted with anorexia nervosa. (2)Obtain a clean catch urine specimen from a patient suspected of having a urinary tract infection. (3) Observe the amount and characteristics of the returns from a continuous bladder irrigation for a patient after a transuretheral resection.
(4) Observe a patient newly diagnosed with diabetes mellitus practice injection techniques using an orange.

After receiving a report from the night nurse, which of the following patients should the nurse see first?

(1) A 31-year-old woman refusing Carafate before breakfast. (2) A 40-year-old man with left-sided weakness asking for assistance to the bedside commode. (3)A 52-year-old woman complaining of chills who is scheduled for a cholecystectomy. (4) A 65-year-old man with a nasogastric tube who had a bowel resection yesterday.

EX . B:Therapeutic Communication

FEelings!
Feelings reflected. Encourage verbalization.

Remember, dont ask why !

Eliminate Dont worry

Focus on the client, not on the nurse.

A 35-year-old man has been hospitalized for treatment of hepatitis. When the nurse enters the room, he asks the nurse to leave him alone and stop bothering him. Which of the following responses by the nurse is appropriate?

1) I understand and will leave you alone for now. 2) Why are you angry with me? 3) Are you upset because you do not feel better? 4) You seem upset this morning.

A patient in the psychiatric unit asks the nurse, Am I in a special radioactive shelter? Which of the following responses made by the nurse would be the most appropriate?

1) This is a hospital, and we do not have a nuclear medicine department here. 2) Dont worry, you are safe. There is no radioactivity here. 3) Im sure your safety is of concern to you, but this is a hospital. 4) Please share with me what makes you think there is a radioactivity here.

A 58-year-old woman states she is afraid to have her cast removed from her fractured arm. Which of the following is the most appropriate response by the nurse?

1) I know it is unpleasant. Try not to be afraid. I will help you. 2) You seem very anxious. I will stay with you while the cast is removed. 3) I dont blame you. Id be afraid also. 4) My aunt just had a cast removed and shes just fine.

EX.C.:Strategies for Positioning Questions

1 Are you trying to prevent or promote? 2 What are you trying to prevent or promote? 3 Think A & P

Immediately after a percutaneous liver biopsy, the nurse should place the patient in which of the following positions? (1) Supine (2) Right side-lying (3) Left side lying (4) Semi-Fowlers

USE YOUR COMMON SENSE

CALCULATED INTELLIGENT DECISION MAKING

Dont underestimate yourself!

You have a body of knowledge use it!

Dont give up!

Saying This is too hard wont help you!

Picture it!
Use imagery when reading test questions.

Attitude is Everything!
Think positively!

Even if it hurts

THINK!