NCLEX THERAPEUTIC COMMUNICATION

THERAPEUTIC COMMUNICATION: The NON-Therapeutic Responses
Closed-ended question

o   “Are you feeling guilty about what happened”

o   “How many children do you have?”

“Why” Questions

o   Tell me the reason why you did that.

o   Why do you feel this way?

“Don’t worry” questions / FALSE REASSURANCE!

o   “It is going to be OK”

o   “Don’t worry your doctors will do everything necessary for your care”

Nurse focused answers

o   “That happened to me once”

o   “I know from experience this is hard for you”

A 50 year old woman is admitted to the emergency room with a diagnosis of acute myocardial infarction. She tells the nurse, “I’m scared, I think I’m going to die.” Which of the following responses by the nurse would be MOST appropriate?
     1. “Everything would be alright.”
     2. “I know what you mean. I thought I was having a heart attack.”
     3. “I’ll call your doctor, so you can discuss it.”
     4. “It’s normal to feel frightened. We’re doing everything we can for you.”
Answer: 4

   REMEMBER:

1       Don’t use real world experience to answer NCLEX questions! (“Where I am working…this is what we do……”)

2       You have the time, the staff, and the equipment

3       NCLEX is what the textbook says is correct or ideal!

4    Eliminate wrong options. That increases your chance of getting the correct answer.
What’s left is the answer…

   If you eliminated three answer choices, the fourth answer choice is the correct answer.

   NO second Chances!

   Eliminate only what you know is Wrong!

   *Reword!  Reword each question in your own words! (reword the entire situation into a one line question answerable by the option(s).

   *Clueless? If you are clueless, look for clues in the answer choices

   *Do Everything by the Book. All correct answers are based on textbook theoretical nursing practice.

STRATEGY: TWO OPTIONS OF THE SAME CONTENT, ELIMINATE!

   Identify equally plausible or unique options.

   Sometimes items contain two or more options that are similar.

   Usually equally plausible options are distractors and can be eliminated from consideration.

To most effectively help meet a patient’s basic safety and security needs, the nurse should:

1.    Serve adequate foods

2.    Provide three meals a day with two snacks in between

3.    Place the call bell near the patient

4.    Store the patient’s valuables in the hospital safe

Answer: 3

NCLEX TIPS with Q & A

NCLEX

Measures entry-level competency.

 It is not a test of achievement or intelligence.

 Primarily tests nursing judgement and discretion.

 Computer adaptive test.

 75 – 265 items. Maximum of 5 hours.

 Mostly multiple choice questions, some alternate format questions.

 Prioritizations & delegations.

 Integrated exam.

Knowledge is POWER!

   The first step in preventing panic is to learn everything you can about the exam.

   Anxiety can be lessened by solving the fear of the UNKNOWN

Test Blueprint:

Safe & Effective Care Environment: Management of Care (13 – 19%), Safety & Infection Control (8 – 14%)

Health Promotion and Maintenance (6 – 12 %)

Psychosocial Integrity (6 – 12%)

Physiological Integrity: Basic Care & Comfort (6 – 12%), Pharmacological & Parenteral therapies (13 – 19%), Reduction of risk Potentials (13 – 19%), Physiological Adaptation (11 – 17%)

Don’t underestimate yourself! You have a body of knowledge, use it!

STRATEGY: Picture it!

   Use imagery when reading SOME test questions. Picture the situation. Picture the patient(s).

The nurse teaches an elderly client with right-sided weakness how to use a cane. Which of the following behaviors, if demonstrated by the client to the nurse, indicates that the teaching was effective?

1.    The man holds the cane with his right hand, moves the cane forward followed by the right leg, and then move the left leg.

2.    The man holds the cane with his right hand, moves the cane forward followed by his left leg, and then moves the right leg.

3.    The man holds the cane with his left hand, moves the cane forward followed by the right leg, and then moves the left leg.

4.    The man holds the cane with his left hand, moves the cane forward followed by his left leg, and then moves the right leg. 

Answer: 3

   *Does hope springs eternal? Don’t use the “hope “ method of study!

   All nighters won’t work! Don’t cram for the exam , it is not a test about recognition and recall.

   *You can Procrastinate later! Establish a study plan. Attitude is Everything! Think positively!

   *Brain at work! Work on your areas of weaknesses. Know what you’re getting into!

   Be prepared!

   STRATEGY: CLANG ASSOCIATION. Occasionally a word or a phrase in the stem is identical to a word or phrase in the correct answer.

To meet a patient’s basic physical needs, the nurse should:

1.    Pull the curtain when providing care

2.    Answer the call bell immediately

3.    Administer physical hygiene

4.    Obtain vital signs

Answer: 4

   Sixth sense don’t work: Do not answer questions based on feeling and hunches.

Remember before you answer that question:

   Hold the phone…Think before calling the physician (Think! What should a nurse do first before calling the physician?)

   Always take care of the patient first before the equipment!

A 53 year old man is receiving packed red blood cells. 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?

A.   Slow down the rate of the infusion

B.   Call the physician for an order for an antihistamine

C.   Mix IV fluid with the blood to dilute it

D.  Stop the transfusion

   *Is this normal? You need to be able to recognize normal. Know what’s Normal!(If it’s normal then it needs documentation)

   *Memorize lab values (We can’t do away with it).

The physician orders furosemide (Lasix) and spironolactone (aldactone) for the patient. Prior to administering the medication, the nurse detremines that the patient’s 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
Answer: 2.