Originally Posted by Cay
I am in my first semester of FON and really struggling as several of my class mates are too. We were "A:" students before nursing and realized how difficult our classes would be in addition to dedicating ourselves five straight semesters to nursing school. We study hard, answer all our study guide questions, definitions, fill out our work book.............Where do these questions come from? They are not what we studied! If this is critical thinking we need help as I, we, need more help that we can get at school. I am open to replies of just what to study from and how to go about it. We are not fresh out of high school, but seasoned adults. HELP!!!
Thanks,
Cay
Something that may help is Bloom's Taxonomy - This is the guide to gauging critical thinking in the cognitive domain. All nursing instructors refer to this. Please check out these links:
http://faculty.washington.edu/krumme/guides/bloom1.html
http://www.officeport.com/edu/bloomq.htm
http://www.kcmetro.cc.mo.us/longview/ctac/blooms.htm
The cognitive domain, according to Bloom, is divided into 6 levels of difficulty: knowledge, comprehension, application, analysis, synthesis, and evaluation. Most students (outside of nursing) are used to multiple choice questions written on the knowledge level, which is "simple" memorization of facts, or at the level of comprehension, which advances one step further toward understanding. The instructor lectures the material, and the student simply "regurgitates" it back on a test.
Critical thinking, according to Bloom, is only accessed on the "higher" levels of application and above. To encourage critical thinking, therefore, the majority of the questions you will encounter in nursing school will be at the level of application and analysis. Also, the majority of the questions on the NCLEX-RN are written at the level of application and analysis. Very few NCLEX questions are "mere" knowledge questions.
For some of these types of questions (especially analysis), there will be more than one "right" answer; you will need to choose the "best" or "top priority" answer. These "higher order" type questions create quite a culture shock for the first semester nursing student. There are many students with 4.0 averages prior to nursing school, who barely squeak by with a "C."
Here are some examples of questions (concerning diabetes) written at different levels of Bloom's. Can you see the advancing level of difficulty?
Knowledge question
The nurse is monitoring blood glucose levels for a group of clients. Which of the following ranges represents a normal fasting blood glucose level?
1. 60-100 mg/dl*
2. 101-140 mg/dl
3. 141-180 mg/dl
4. 181-220 mg/dl
Comprehension question
The nurse is evaluating a client who is diabetic and on insulin. Which of the following statements by the client would indicate that the client may be experiencing a reaction to insulin?
1. "I am feeling sweaty and nervous."*
2. "I have ringing constantly in my ears."
3. "I feel hot and thirsty."
4. "Things look yellow and blurry to me."
Application question
The nurse concludes that a client newly diagnosed with type 1 diabetes mellitus needs additional teaching, when she states:
a. "I will rotate my insulin injection sites to avoid tissue damage."
b. "I will check my blood glucose several times daily and keep a record."
c. "If I feel faint or sweaty, it means my insulin level is low."*
d. "It is important to eat three meals and two snacks at scheduled times."
Analysis
The client has a serum glucose of 600 with positive serum ketones. The nurse understands it is MOST important to monitor this client's:
a. hydration status.
b. level of consciousness.
c. serum electrolytes.*
d. oxygenation status.
Something that may help you is purchasing a good NCLEX review book - One that is broken down into subject matter. Saunders Comprehensive Review is excellent - We recommend this to our students. With a good NCLEX review book, you can "practice" going through these "higher order" types of questions, over and over again. It is important to review each possible answer for each question, along with the rationales. After awhile, you will develop an instinct as to which answer is correct. Hope this helps. Best wishes to you
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