Free online n-clex questions

Daytonite, BSN, RN · Mar 28, 2008

the problem is with your critical thinking and processing of information. the basic strategy for answering critical thinking (application type) questions is as follows, you must:

know and consider the normal anatomy and physiology
know and consider abnormal anatomy for the disease in question
know and consider the resulting signs and symptoms when the disease occurs and how they proceed from mild to fatal - each sign and symptom can be related back to the pathophysiology of the disease
know and consider how the doctor diagnoses and treats the disease in question
know nursing interventions for the signs and symptoms you are being asked about
know the steps of the nursing process and what goes on in each of the steps and consider how they are affecting the question you are being asked
know and consider the principles behind the actions being done - there are many kinds of principles: principles of nursing, principles of biology, principles of chemistry, principles of physics, etc.
read the stem of the question carefully and answer that because the test makers try to trip you up by distracting you with conflicting information they give you in the answer choices that sounds good but has no relationship to what the question is asking for
ask yourself "why" a patient is experiencing some sign or symptoms to get at the underlying problem. nursing like other disciplines treats the problem/signs and symptoms.

answering these kinds of questions goes to your knowledge of the signs and symptoms of the medical condition of hypothyroidism. if you read about the condition the text should give you the pathophysiology along with the symptoms produced in the sequence they occur from onset to the final outcome. that is basically your list of priority of treatment in most cases. know that list of symptoms in order of occurrence and you generally can determine your most important nursing action. you are looking to break the link in the chain of progressive symptoms to attempt to stop the symptoms from worsening.

assessing as a nursing intervention is an evaluation strategy and never a priority; assessing as an assessment activity when seeing the patient on admission is a priority. evaluation is done after nursing actions. to know the difference you must know the nursing process and what goes on in each step of the nursing process. nursing interventions are performed after initial assessment, problem identification and planning have been completed. there are 4 types of nursing interventions:

assess/monitor/evaluate/observe (to evaluate the patient's condition)
care/perform/provide/assist (performing actual patient care)
teach/educate/instruct/supervise (educating patient or caregiver)
manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)

you must be able to determine what is going on from the information given to you in the question. if the question is telling you that you are already giving the patient some medication, it is reasonable to assume that you are not involved in step #1, initial assessment of a new patient that has just appeared on the unit. medication administration is the performance of actual patient care, thus a nursing intervention ("administer medication as ordered" may sound more familiar). so, that would have been the clue that "assessing the potassium levels before administration" was a nursing intervention of lower priority.

the answer choices required some knowledge of potassium and its replacement. oral potassium is poorly absorbed from the gi tract. you check potassium levels before iv administration because the patient can go into almost instant heart block and die.

dtermineddenise · Mar 29, 2008

Thank you. You are great and so knowledgeable. This really helps.