Wednesday, February 20, 2008

Will this be on the test?

I find myself giving test-taking tips at every tutoring session lately.

Five tips for taking tests in nursing school: *

  • Read the question.
Seriously, read it. Stop, don't look down at the answers yet. Read the question once more, looking for these words or phrases: LEAST LIKELY, MOST LIKELY, PRIORITY INTERVENTION, NOT, FIRST. Underline them when you find them. You absolutely must know what the question is asking before you attempt to answer it. If the question makes you think of that awesome little song that you made up to remember the cranial nerves, go ahead and jot them down out to the side right quick BEFORE you look at the answers.

  • Think of the patient.
When you study, think of how this will look in an actual patient. If I was in the room with someone who had a Foley cath in, what is the very first thing that I need to think about before that patient ambulates? My list of ALL the things to consider before they start traipsing about would include: where's the bag and who's going to hold it, when's the last time this person got up and should we sit and dangle first, are there any obstacles in the intended path and who will move them, and what other lines do we need to pay attention to (like IV poles, or wound drains, or whatnot). Now prioritize them. What must happen first? What can wait? What means Something Bad and what is an Expected Outcome?
Of those, I think that passing out onto the cold dirty hard floor of orthostatic hypotension has to top the list of Things to Pay Attention To. Having one's foley pulled out with balloon still inflated would be right up there as a very close second.

  • ABC, 123.
When prioritizing interventions, as above, or in questions where you are asked to assess a patient and choose the most worrisome data, start as low on Maslow's pyramid as possible.
Airway Breathing Circulation
1 heart, 2 lungs, oriented x3 (who are you, where are you, when is it)
Risk for Powerlessness is always going to appear on my list of Relevant Nursing Diagnoses for any hospitalized patient. Always. Let's face it, laying in bed with no underwear does not increase one's self-efficacy. But I cannot assess anyone's psychosocial needs or even their pain level (which is usually next on my list after the ABCs and 123s) if they are currently not breathing or bleeding out.

  • Do another med check.
Patient safety has got to be right up there at the top of the priority list. You have to do three med checks, but four can't hurt, especially if you're in a skills evaluation and you simply can't remember doing that 2nd one before you left the Pyxis. "Put on gloves" is always a good idea, along with "Wash hands and document". The phrase - siderails up times two bed low and locked call bell in reach - is burned into my brain forever. This stuff will find its way onto the written exams, too, so be on the look-out.

  • "Call the doctor" is almost never the answer.
It seems like a good idea, I know. Interdisciplinary blah-blah-blah? They're going to have to write the orders? I know. But resist, for just a second.
Think about this - What are you going to say when she returns your page? Stammer, stammer, the patient uh, is, uh, doesn't look right and I think you should come down here. Click.
Assess before paging anyone - unless it's a code that you think you should call, and then holler away! Think through the information that a consultant is likely to ask you if you paged them - axillary temp, blood pressures for the last ten minutes, hematocrit levels, intake and output totals for the last 12 hours? What is the thing that made you worry about this patient and what information do you need to gather about that worrisome sign or symptom? Get it all written down, and then call (abcd - assess before calling doc).

*of course, I only know about MY nursing school. I know that all nursing students do skills evals, but I don't know if you will be able to talk to yourself throughout yours the way we were encouraged to do. I think these are pretty universal, and not just based on my Fundamentals professor. of course, your mileage may vary.


Emory Student Midwife said...

These are great study tips. :)

You are *so* right about the "call the doctor" choice. It has never been the correct answer. Lol.

GingerJar said...

Sounds like you are getting the hang of it. I love "Head Nurse" blogs too!

Oh, and suggestion....if you are calling a MD at 3 am to report "vomiting" and "difficulty breathing" ...don't tell that newly awaken physician that the 50 something pt "spit up" and the other nurse is concerned that her respirations are 40 and her O2 stat is 80's...then panic and throw the phone at somebody who doesn't even know the patient...but does know PROJECTILE VOMITING OF DK GREEN BILE AND POSSIBLE ASPIRATION!!!! lol. Good luck!

Oh, and fear of screwing up...well that's what makes us check and double check in our heads that we are doing ALL the right interventions to care for a patient....