Prioritization and Delegation Exam with 100% Correct Answers, Exams of Advanced Education

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Mark Klimek - Prioritization/Delegation

Exam With 100% Correct Answers 2023

Prioritization questions will always have: -Age -Gender -Diagnosis -Modifying Phrase What is important? - Correct Answer-IGNORE age/gender Most important = modifying phrase Angina Pectoris vs Myocardial Infarction - who is higher priority? - Correct Answer-MI Angina Pectoris with unstable BP vs Myocardial Infarction with stable vital signs - who is higher priority? - Correct Answer-Angina pectoris with unstable BP (modifying phrase more important) 4 rules for prioritization - Correct Answer-1. acute > chronic

2. fresh postop (first 12 hrs) > medical or other surgical
3. Unstable > stable
4. More vital the organ, the higher the priority (organ of the modifying phrase) (only use this as a tie-breaker) What is the tie-breaker used for prioritization questions? - Correct Answer-More vital the organ, the higher the priority Vital Organs - order - Correct Answer-Brain Lung Heart Liver Kidney Pancreas Who is the priority? COPD CHF Appendicitis - Correct Answer-Appendicitis (acute) Who is the priority?

COPD

CHF

Appendicitis 2 hour post-op cholecystectomy 3 day post-CABG - Correct Answer-2 hour post-op cholecystectomy (fresh post-op within 12 hr) Who is the highest priority? A. 23 yr old male with CHF with a potassium of 6.6 and no ECG changes. B. Chronic Renal Failure with a creatinine of 20.7 and pink, frothy sputum. C. Acute hepatitis with jaundice and increased ammonia level, who you cannot arouse. - Correct Answer-C. Acute hepatitis with jaundice and increased ammonia level, who you cannot arouse. Potassium = heart (3rd organ) Pink, frothy sputum is PE = Lung (2nd organ) Cannot arouse = brain (1st organ)*** UNSTABLE words - Correct Answer--Unstable -Acute illness -Post-op <12 hrs -General anesthesia (12 hrs) -Lab abnormalities of a C or D -Not ready for discharge -Newly admitted -Newly diagnosed -Admitted less than 24 hrs ago -Changed assessments -Unexpected signs/symptoms STABLE words - Correct Answer--Stable -Chronic illness -Post-op >12 hrs -Local/Regional anesthesia -Lab abnormalities of an A or B level -Ready for discharge -Admitted more than 24 hrs ago -Unchanged assessment -Experiencing the typical expected signs/symptoms with which they were diagnosed

Stable or Unstable: Kidney stones with severe colicky pain - Correct Answer-STABLE because expected sign Stable or Unstable: Mild pain while having a chest x-ray - Correct Answer-UNSTABLE because unexpected sign Who is the highest priority patient?

1. 16 yr-old female with meningitis who has had a temp of 103.8 since admission 3 days ago
2. 67 yr-old male with IBS who spiked a temp of 100.3 this afternoon - Correct Answer-
3. 67 yr-old male with IBS who spiked a temp of 100.3 this afternoon BECAUSE...A patient with Meningitis is expected to have a fever. A patient with IBS who recently developed a fever is an unexpected and new symptom. Always high priority (5) - Correct Answer-Hemorrhage Fever >105 (seizures) Hypoglycemia (<70) Pulseless Breathlessness Black tag (triage) - Correct Answer-Pulselessness Breathlessness Fixed and dilated pupils LPNs can NOT: - Correct Answer--Starting an IV -Hang or mix IV meds -IV push meds -Administer blood -Central lines (no flushing, dressing changes, etc) -Care plans -Perform or develop teaching -Take care of unstable patients -Cannot do the 1st of anything (1st assessment, 1st post-op dressing, 1st feeding after stroke, etc) -Admission, discharge, transfer, first assessment after a change LPNs can: - Correct Answer--Maintain and document IV flow -Reinforce teaching

UAP's can NOT: - Correct Answer--Chart about the patient -Give meds (except topic OTC barrier creams) -Do assessments or treatments (except enema's)

-Be cautious with catheters* UAP's can: - Correct Answer--Vitals -Accu-checks -Enemas -ADLs (but they should never do the first) UAP's can give what meds? - Correct Answer-Topical, over-the-counter, barrier creams DO NOT delegate what you can EAT! - Correct Answer-E - evaluate A - assess T - teach Do NOT delegate safety responsibilities to.... - Correct Answer-family How do you intervene with inappropriate behavior of staff? - Correct Answer-There is always 4 answers:

1. Tell supervisor --> illegal activity
2. Confront them and take over immediately --> harmful/danger
3. At a later date, talk to them about the situation --> not harmful, but inappropriate
4. Ignore it --> NEVER the answer HOW TO ANSWER:
5. Is what they are doing illegal? --> Tell Supervisor
6. Is anyone (patient/staff) in immediately danger? --> Confront them and take over immediately
7. Is this behavior legal, not harmful, but inappropriate? --> Approach them later on and talk to them Is what they are doing illegal? - Correct Answer-If so, tell the supervisor. If not, next question Is what they are doing physically or psychologically dangerous to staff or pt? - Correct Answer-Confront and take over immediately How to remember heart auscultation points: - Correct Answer-A PeT Monkey A - 2nd right ICS at sternal border P - 2nd left ICS at sternal border T - 4th left ICS at sternal border M - 5th left ICS midclavicular line How do you guess on the NCLEX? - Correct Answer-1. Knowledge
8. Common sense
9. Guessing Strategy:

Psych questions: -the nurse examine their own feelings about something in psych nursing -establish a trust relationship Food Questions: -In a tie, pick chicken -NEVER pick casseroles for children -Never mix medications in children's food -Never mix medications in food without permission -Toddlers = finger food (hot dogs and french fries, even though its not healthy) Pharmacology: -Memorize side effects -You know what a drug does but don't know the side effects --> pick a side effect in the same body system that a drug is working examples: -GI drug --> pick diarrhea -Heart drug --> pick tachycardia -CNS drug --> pick drowsiness -If it's PO --> pick a GI side effect NEVER tell a child that medicine is - Correct Answer-candy MedSurg - what is the first thing you assess? - Correct Answer-Level of Consciousness OB question - what do you pick when you don't know the answer? - Correct Answer- Check Fetal Heart Rate What is the first thing you do in a Medsurg situation? - Correct Answer-Establish an airway 3 rules of growth and development questions (always give child more time to grow, dont rush it) - Correct Answer-1. When in doubt, call it normal

2. When in doubt, pick the older age
3. When in doubt, pick the easier task General guessing skills - Correct Answer-1. Rule out absolutes
4. If two answers say the same thing, both are wrong
5. If two answers are opposite, one of them is probably right
6. Umbrella --> which answer is more global? An answer that is very broad and covers everything else
7. Always think, what is the WORST that can happen? Post-hip replacement. What is most important to do? -Sips of water -Put side rails up --> Because if you didn't do it, then you could break your hip again, etc

-give pain meds -use abductor pillow ***Sesame street rule: only when NO other way. Right answer tends to be ____ than others. Wrong answers are similar. When something really ____ right it probably is- go with your gut - Correct Answer-Right answers tend to be DIFFERENT than the others. Wrong answers are similar. When something really feels right it probably is. GO WITH YOUR GUT. ***Countertransference - Correct Answer-Refers to the nurse's behavioral and emotional response to the client Transference - Correct Answer-the patient's transfer to the analyst of emotions linked with other relationships The first 10 questions... - Correct Answer-USE COMMON SENSE!!! NEVER have these expectations: - Correct Answer-1. Don't expect 75 questions

2. Don't expect to know everything
3. Don't expect everything to go right