Priority questions... I need help!

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So, I took NCLEX for the first time a few weeks ago and found out that I did not pass. I took all 265 questions and seemed to have had a lot of priority questions. Ex. Who do you see first at the end of shift report? I did the Hurst review and am in the process of remediation for the Hurst review, but it is just content. I feel like I know the bulk of the content, but don't know how to pick the most critical pt. I can even remember while taking the test that I could describe the pt's diagnosis, but how do I decipher which one is most critical? PLEASE ANY ADVICE IS BETTER THAN NO ADVICE!

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For priority stuff, the most recommended book around here is LaCharity's Prioritization, Delegation and Assignment. The questions are hard enough to teach you how to think about them on the NCLEX, there's whole case studies in the back, and the rationales are great.

Do the questions, read the rationales for both the right and the wrong answers. It worked for me, and I know a number of others around here will say similar of it.

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Hi! I understand your frustration..if you have the funds, try and purchase the Prioritization book by Linda LaCharity. Its called Prioritization, Delegation and Assignment and focuses on application/analysis type questions that will help you better prepare for the who do you see first, who you assess first, which client do you return the phone call 1st to types of questions. Remember your ABC's and think safety, and stable vs unstable patients, and real vs potential. Try not to read into the question, it can steer you into picking the wrong answer. Remember to pick out your 2 most STABLE patients and then from the last 2 choices pick the most UNSTABLE. Hope this helps! :)

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Specializes in Med Surg.

I agree with the above posts about the Delegation, Prioritization and Assignment book. I havent taken my boards yet but this book has been a great help in my studies.

Good Luck!

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I did Hurst too but LaCharity was a key element in my success.

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Another vote for Linda LaCharity's book on prioritization.

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This is a small tip, but I used it many times on my priority questions: acute before chronic. It seems like common sense, but when you look at the options, usually there is one that is acute, or more acute than the others.

I really think these questions made up half of my test. I just took it a month ago, and passed. It really helps to read about prioritization, if you already have NCLEX books, there's probably a section in there.

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I just took my test in June and got all 265 and failed as well. I also took the Hurst review (which i decided not to remediate and to get my money back) I think it was a great review of content, but that's only 1/2 the battle. I bought the Kaplan NCLEX-RN 2010 review book and it is really helping me understand how to break down questions. It gives you some methods to use which really do work. I also bought the LaCharity book, but i have not started that one yet. I retest on August 10 so I really won't know how well these will help until then but it's making me feel more confident already.

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Hi - I also recommend the LaCharity book, but I primarily used Kaplan. I paid for their live review course, but what I found most helpful was their QBank. I found that Kaplan's questions were the most like the NCLEX questions, and there are good number of priority like "A nurse receives 4 telephone messages from patients. Which one do you return first?" and "You have 4 patients that are post-op, which do you see first" etc.

Good luck! I hope you succeed on your next try!

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Specializes in Telemetry.

I, too, had many priority questions and they were tricky. I prioritized pt's by:

(in this order)

1 - ADPIE (nursing process) - always assess first, if you dont assess the situation then you dont know what to do or if anything is needed to be done anyways

2 - Maslows hiarchy of needs: PHYSICAL -> Breathing

Circulation (body fluids)

Comfort (pain, nausea)

nutrition/fluid/electrolytes

SAFETY -> physical (back up to maslow)

bacteriological (immune issues, isolations

psychological (not suicide-thats physiological safety)

3 - communication - always focus on the client's feelings (the client is not always the pt in the scenario: if the son of the pt comes to you because he says that his father is in pain and he doesnt know what to do, you dont just walk away from the son and go get the meds for the pt, you have to acknowledge the son's feelings -even for a second-and then deal with the pt because at that point the son is your client....

4 - teaching/learning : which is admissions and discharges [this doesnt apply to trauma admissions]

example: 1. you have to administer these meds to one pt but you can only give 1 (dont question why that is) which one would you give: steroid, anticholinergic, antibiotic, anticoagulant. ......

answer: anticoagulant because it is dealing directly with circulation.

example2: you have 4 pt complaining of nausea and vomiting, who do you go medicate first with an anitemetic:

pt with a peptic ulcer

pt with a side effect (the nausea and vomiting) of a different med

pt who is receiving chemo

pt wiht a brain tumor

answer: the pt with a brain tumor and n/v becuase the n/v will increae intracranial pressure which inturn will decrease respriation (ABC's), then you would go to the peptic ulcer which will have a circulation issue (any body fluid shift is a circulation issue whether blood, urine, diarrhea)

example3: ER RN, 4 pt come in at the same time, who do you assess first:

pt bleeding with stab wound to chest

pt bleeding from the head from a fall

pt bleeding with a gun shot to leg

pt who is 30 wk pregnant and has moderate lady partsl bleed

answer: ...this order exactly, chest wound-breathing issue

And NEVER ask yourself "what if ", if they haven't' included that information that you're trying to guess then it must not matter in answering that question appropriately.

Hope that helps :) GOOD LUCK :up:

PS. I just took the NCLEX-RN this friday and I passed with 75!!! :nurse:

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So... I took NCLEX on Sept 9, and fast results say that I PASSED!! The computer shut off around 75-80 questions (I wasn't paying attention and freaked out when it shut off: for the last time I took the test I had to take all 265) Thank you all for your advice and here is a little from me. Hurst review is good for content but not so much for test taking strategies for those of us who have a hard time taking tests. I feel like the Kaplan test strategy book helped me to take what I learned from Hurst and be able to apply it and answer the question correctly.

For all of the repeat test takers, don't get discouraged, keep a positive outlook, and know that you got this.

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