Speaker 1: 0:00

It's the Nursing Student Coach giving you the strategies you need the most. Hello everybody, and welcome back to Nursing Student Coach. My name is Lauren, I'm a registered nurse and, as you've probably heard me say many times before, it is my personal mission to help put more great nurses into the world, and I think one of the best ways to do that is to help you, the nursing student, the future nurse, crush those nursing exams by boosting your confidence, boosting your scores, and we will do that. One question at a time, one strategy at a time. We will break things down, simplify it. If you're finding that you are learning the information but it's not quite translating when you go to take that test, or if you're preparing for NCLEX right now and you are just overwhelmed and need a little refresher, this podcast will hopefully help you do those things.

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Today I want to go over best versus first questions. I'm going to go through three example questions, three practice questions. We're going to break them down. So let's get to it. Guys, when it comes to best versus first, you're going to see this a lot which action by the nurse is best and which action should the nurse take first? It's really important to understand the difference. So when it comes to best best means, you can only do that one thing, you can say that one thing, you can do that one intervention and then you go home. So when you look through that list, you have to realize you can only choose one thing. What is the one best thing you can do? You cannot do any of the other things. What must get done in order to not kill your patient? Order to not kill your patient, because in testing world, in NCLEX and nursing school exam world, you have to not kill your patient. That's the priority, right. And then, when it comes to first questions, which action should the nurse take first? That means you can do everything else on the list, but you need to pick what is the most important thing to do first. What's going to save their life, right? All right, let's get to it. Let's do an example question. All of these questions come from ATI. Maybe your school has ATI, but even if it doesn't, they're a great resource for practice questions. So here we go.

Speaker 1: 2:42

A nurse in the emergency department is caring for a client who reports pain in her left leg following a motor vehicle crash. The nurse notes that her left leg has bruising, swelling and displacement of the bones. Which of the following actions should the nurse take first? Let's read it again, because that is the number one do and the number one don't. Number one do is to always read the question twice. Number one don't is. Don't change your answer, but we'll get to that. A nurse in the emergency department is caring for a client who reports pain in her left leg following a motor vehicle crash. The nurse notes that her left leg has bruising, swelling and displacement of the bones. Which of the following actions should the nurse take first? Okay, anytime you have a question, you always want to say what is the most important word in this question. In this case, it is first. Which action should the nurse take first? And remember, you can do this one thing, you can do everything else, but this is the most important thing to do first. So let's realize that first is the most important word. Next, what are some complications that could develop? And if you're not sure, that's okay. But you want to start thinking what are the clues that the question is giving me before I've even started? So the client has bruising, swelling and displacement of the bones. That is crucial.

Speaker 1: 4:11

If there's a dislocation, then circulation is going to be your biggest priority? What's going to promote circulation to that area and below so that that patient does not lose their limb? Remember life and then limb. What's going to prevent your patient from losing their life or their limb? Let's look at the answers. I'm just going to read them. See what stands out to you. Does anything stand out to you as either absolutely not, or you know what that could be it?

Speaker 1: 4:44

One obtain an x-ray of the injured leg. Two apply ice packs to the affected area. Three check neurovascular status distal to the injury. Four elevate the affected leg on two pillows. I'm going to read them all again because you want to read the answers twice as well. One obtain an x-ray of the injured leg. Two apply ice packs to the affected area. Three check neurovascular status distal to the injury. Four elevate the leg on two pillows. What do you think? Pick your answer, be confident, land on it and stick with it. The correct answer is three check neurovascular status distal to the injury.

Speaker 1: 5:28

And here's why, if you think about Maslow's hierarchy of needs, maybe you've gone over that. Physiological needs first, right, neurovascular checks, checking pulses, checking sensation distal to that injury is going to be the best way. First assessment you want to do have them wiggle their toes, have them touch their leg and ask if they have sensation. You want to promote circulation to that area. You want to make sure that they have pulses, that they have circulation going to that area. That is the first thing you should do. Everything else, sure, you'll get an x-ray. I mean it's clearly dislocated and broken. But you're going to confirm that with an x-ray. Apply ice packs. Sure, you'll get an x-ray. I mean, it's clearly dislocated and broken, but you're going to confirm that with an x-ray. Apply ice packs. Sure, you want to, you know, decrease the swelling, elevate the leg. Sure, that's going to promote circulation. But those are not priority. Those are not what you want to do first. So also, guys, here's a little clue Anytime you see the word check, it's a synonym for assess.

Speaker 1: 6:34

If you see assess, check, these are assessment words and it is very likely not always, but that is very likely your answer. So if you're in doubt and you see check or assess, that's probably it, especially in ATI world. All right, let's go to another one. A client arrives at the emergency department stating that a mosquito flew into the ear and that they are hearing a constant buzzing noise. Well, that sounds pretty terrible. Which intervention would the nurse take first? I'm going to read it again A client arrives at the emergency department stating that a mosquito flew into the ear and that they are hearing a constant buzzing noise. Which intervention would the nurse take first? Again, what is the most important word in this question? When you are taking an exam, you want to read that question twice and you want to say what are my key words and what is the question asking. What is the most important word? And here it is first, right. So what is happening with your patient? What's going on here? Is their life in danger? Are they at risk of losing their life? Are they at risk of losing a limb? Are they bleeding? What are the most priority interventions? Well, they stated that a mosquito flew into their ear and that it's constant buzzing. They're not going to die. We don't even know if the mosquito is actually there. They could be a psychiatric patient. So what is something you'd want to do first? Let's read through the answer choices and see what stands out to you as the thing that you'd want to do first. One initiate a consult for an ear specialist. Two look into the ear canal using a headlamp. Three irrigate the ear and try to drown the mosquito. Four use an ear forcep and try to pull the mosquito out. I'm going to read these again. Guys, think about what stands out to you. What sounds right, what sounds wrong? Is there anything we can get rid of? One initiate a consult for an ear specialist. Two look into the ear canal using a headlamp. Three irrigate the ear and try to drown the mosquito. Four use an ear forcep and try to pull the mosquito out. Land on your answer and let's see what it is. It is to look into the ear canal using a headlamp. Here's the thing we don't know if the mosquito is in there. What is the least invasive thing we can do to check and make sure there actually is a mosquito in there? Well, we can look. Let's look. That's the least invasive. You're looking, you're assessing, you're doing an assessment. So it says here, maybe you were thrown off by headlamp. I mean, are you really going to put a headlamp on? Maybe if your ER has them? But in reality you're probably going to look with the light that's on the wall or your pen light if you carry one in your pocket. But yeah, you want to look. That's what you'd want to do first. Everything else, would you? Would you initiate a consult with an ear specialist? Sure, would you stick a foreign object into their ear first to try to pull it out? No, and you probably wouldn't be the one to do that. Um, so let's see substances such as let me just suffocate this. Okay, you may want to do these things to irrigate the ear and use a forcep, but that's not what you would do first, and you probably wouldn't do that without speaking to the doctor first. So the first thing you'd want to do is look into the ear canal using a headlamp. What's the least invasive thing, right? If they're not going to lose their life, they're not going to lose their limb why don't you just look at it, assess the situation, look into the ear canal using a headlamp, is your answer. All right, now we're going to move into the other type of question we were talking about today the best question. A six-year-old child has just been diagnosed with localized Hodgkin's disease and chemotherapy is planned to begin immediately. The parent of the child asks the nurse why radiation therapy was not prescribed as part of the treatment. The nurse would plan to make which best response. Again, a six-year-old child has just been diagnosed with localized Hodgkin's disease and chemotherapy is planned to begin immediately. The parent of the child asks the nurse why radiation therapy was not prescribed as part of the treatment. The nurse would plan to make which best response. Okay, what is the most important word in this question? It's best. And what clue does that give you? Well, it tells you. I can only say this one thing. So imagine you're the nurse. You have a six-year-old patient and their parents are asking you this question. They want to know hey, my kid is about to start chemo. Why wasn't radiation prescribed? What is the best thing you can say in this instance? One, it's very costly and chemotherapy works just as well. Two, I'm not sure. I'll discuss it with the primary healthcare provider. Three, sometimes age has to do with the decision for radiation therapy. Four, the primary healthcare provider would prefer that you discuss treatment options with the oncologist. All right, I'm going to read them again. One, it's very costly and chemotherapy works just as well. Two, I'm not sure I'll discuss it with the primary healthcare provider. Three, sometimes age has to do with the decision for radiation therapy. Or? Four, the primary healthcare provider would prefer that you discuss treatment options with the oncologist. Okay, guys, you want to pick the best thing. You want to pick something that will give the parents accurate information and you want to not avoid their question. You want to give them a direct, informed answer. A direct, informed answer. So I think, personally, I would rule out saying it's very costly, it's extremely insensitive and it's not something you'd want to give as an answer because it costs too much. Four, to say that the doctor prefers that you discuss it with the oncologist. No, you are equipped to provide this information. You are the nurse. So no, that would not be your answer. So, between two and three, what do you think, guys? The answer is three. Sometimes age has to do with the decision for radiation therapy and I know there might be some confusion here. Ati isn't perfect, but what they say is you don't? They're saying it's an inappropriate response and puts the question on hold. If you say I don't know, I'll discuss it with the provider. I think in real life, if you didn't know, let's pretend in real life the parents ask you you don't know, sure, you could say you know what? Let me just double check with the provider so that I can give you the best accurate information, or have them come in here with me. But in ATI land, nclex land, nursing school land. You have the answers. You have all of the information. So what would the most appropriate answer be? Radiation. Sometimes age has to do with the decision for radiation therapy. Usually, I guess, radiation is put on hold until a child is eight years old because of bone growth. But if you didn't know that, you would have to just kind of use process of elimination here and understand ATI's rationale. That saying you're not sure and you'll discuss it with the provider is not the best answer. To say you want to give them accurate information that addresses their question and that answers their question. Okay, guys, I have lots more practice questions like this. If you like the episode that you heard today, let me know I am going to make this episode the last episode of season two and I have 38 episodes from seasons one and two that you can go back and listen to. If you've missed any, and let me know what you want to hear next, we will be back with season three. I will let you know when we're coming back, but you can always find me on Instagram at nursing student coach, and you can find me on my website. Shoot me an email, nursingstudentcoachcom. If you found today helpful. I do offer private coaching, where this is one of the many things we can do together. We can break down these questions, go through questions that are tripping you up so that you can boost your scores, boost your confidence the next time you go to take one of those exams, because I want you to soar through nursing school, I want it to be one of the best experiences of your life because, on the other side, becoming a nurse, becoming a registered nurse, is the best thing of your life, because, on the other side, becoming a nurse, becoming a registered nurse, is the best thing I could have ever done, and I am just so excited to help you get there as well. I hope you have an amazing day. I love you all and until next time, bye-bye.