NCLEX Test-Taking Strategy Tip

Tip #8: Don't focus on predicting a right answer!


Frequently, the answer you anticipate is not going to be an option! Keep in mind the characteristics and concepts of nursing care for a client with the condition or problem in the situation presented. Eliminate options: every time you eliminate an option, you increase your chance of selecting a correct answer. If all of the options are plausible, then rank the options. The first one is the highest priority, and the fourth one is the lowest priority. Which one is the first
action or answers the question?

Example: A client has an ulcer (2 in X 2 in) on the calf of his right leg. The area around the ulcer is inflamed, and the ulcer is draining purulent fluid. The vital signs are pulse, 114 beats/min; respiration, 22 breaths/min; temperature, 101 degrees Fahrenheit. Which order will the nurse implement first?

Reword the question: The client has an infection in the ulcer on his leg. His temperature is elevated, and so is his pulse; this is a normal response to infection. Of the orders listed here, what nursing actions do I need to do first?

1. Administer ceftriaxone (Rocephin), 1 g, intravenously every 4 hours.
2. Perform blood cultures X2, 20 minutes apart and drawn from different sites.
3. Apply polysporin (Bacitracin) ointment topically to leg ulcer three times a day.
4. Administer acetaminophen (Tylenol), 650-mg suppository, every 4 hours for temperature above 101.8 degrees Fahrenheit.

Rank the options:
1st - Option 2; blood cultures must be obtained prior to antibiotic.
2nd - Option 1 needs to done after the blood cultures have been drawn.
3rd - Option 4 will not produce any immediate response or assistance in treating the problem, although it will make the client more comfortable.
4th - Option 3 will help to reduce the infection, but the priority is to obtain the culture and then for the antibiotic to be started.

Here is another approach to the options:
Consider option 1 - This is an antibiotic that will begin to fight the infection.
Consider option 2 - This is important to do to identify the causative bacteria. This is more important now than option 1; eliminate option 1.
Consider option 3 - This is treating the infection topically. It will cause a decrease in the surface bacteria, but the blood cultures are still a priority. Eliminate this option because both options 1 and 2 are more important.
Consider option 4 - This is treating the symptoms rather than the cause of the problem, which is not as important as option 1 or option 2; eliminate it.

All of these options are feasible for treating this client; however, obtaining the blood culture is the most important (option 2). If you had approached this question with a specific answer in mind (give an antibiotic), you would have found that answer; however it would have been wrong.

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