What Are You Struggling With?

How to Dissect NCLEX® Questions (Facebook Live 6-15-2016)

Podcast Transcription

What’s going on guys? I think we’re live here. It looks like it’s trying to go live. Let’s see. Let me refresh a little bit over here, see if it’s working.


We’re here live. Tonight we’re going to be talking about dissecting NCLEX questions. Let’s see. There we go. It looks like it’s going live now.


Tonight we’re going to be talking about dissecting NCLEX questions, and I have a lot of stuff I want to talk about with you guys. I have all kinds of notes and everything prepared here, because what we’re going to talk about tonight guys is something that I discovered during the first semester of my nursing program. It was something that as soon as I discovered it, it really helped me start to grasp how to take questions in nursing school.


Not only is this stuff important for NCLEX questions. I’m telling you, if you guys understand how to dissect NCLEX questions, how to make these questions work for you, you’re going to be able to just understand nursing school questions better, because nursing questions are so much different than anything else you’re going to take.


A lot of time, if you take a chemistry class, physics class or whatever, all that you need to know there is basically yes or no, how can you do a math problem? Whatever. With NCLEX questions, with nursing school questions, with nursing style questions, we’re really taking that up a notch.


It looks like we’re just getting started here. I got a few people in the room.


What I want to know guys, I want to know a couple of things from you as we get rolling here. Go ahead and comment below and just tell me with one number, how many semesters you have left of nursing school. I just want to know, are you just starting? Have you started yet? Do you have two semesters left? One semester left? Where are you in your journey in nursing school? I want to know.


Like I said, I discovered this stuff my first semester. That’s going to only help you a little bit more. If you’re getting close to your last semester, that’s fine too, because this is going to help you as you get to where you’re taking it.


Awesome. Elisa, 1-0. I’m about to take the NCLEX.


Jessica, one semester left.


Awesome. That’s great. I’m glad that you guys are here tonight because this is going to help you guys a ton.


Jaime, two semesters out of 5 left. That’s … Can you see the light at the end of the tunnel Jaime? I’m not sure. I know that as you’re getting there towards the end, it starts to feel real, but then the real world starts coming in. Yeah, I understand that.


Who else? Who else? Where are you guys out in your nursing school studies? I want to know.


What we’re going to talk about tonight is, really, how to dissect these questions? Okay. Also, if you guys have a minute, tell me where you’re from. Our Facebook page now, we just crossed over 70,000 followers.


John, one more. Awesome. Good for you man.


Getting this far is the hardest part of the journey, I think. For me, walking into nursing school the first day was the hardest part. I had gotten accepted to nursing school a couple of times. For [inaudible 00:03:11] reason, I coward out once and then I … South Carolina. Sweet.


We have Katie [Cleber 00:03:19] on the team who’s from North Carolina. South Carolina. I’ve actually never been, I heard it’s beautiful. Stopped in Atlanta one time on a layover, but that’s about my …


Florida. Florida is awesome. I love Florida. [inaudible 00:03:31] Dallas. I’m from Dallas too, North Dallas. Florida, awesome.


I’ve been to Orlando, I’ve been to Miami, I’ve been to Naples. I really like Naples. I had some friends out there. Looked at the CRNA program out there in Naples too.


Michigan. Awesome. We have Susan on our team who is from Dearborn, Deerbrook, something like that. I can’t remember. She’s from Detroit area.


Oregon. I love Oregon. Oh my gosh. We actually had our last team meeting with all the NRSNG team out in Portland.


Wisconsin. Have I been to Wisconsin? I don’t think so.


North Carolina, sweet.


I don’t think I’ve been to Wisconsin. That’s cool.


We got people from all over. We actually … When I started doing Snapchat … We’re in Snapchat too. I’m trying to figure that out. I think I’m a little bit old for the game there. When we got there up on Snapchat, I started realizing how worldwide this movement of NRSGN is. We had people from New Zealand, from South Korea.


Tampa. Cool. Cool. Cool. Cool. Awesome guys. We’re starting to get some people here in the room.


One more thing. If you guys could do one more favor for me. If you have a friend, a nursing buddy I’d like to call them, who isn’t here, isn’t in on this chat, you can tag them below. Bring them in here, because I think what we’re talking about with … Let’s see here. Dissecting NCLEX questions, is going to be valuable to everyone.


This video will be up on YouTube later once we can get it downloaded and stuff. This is going to be really helpful, and I want to have your questions as we’re going tonight. Because as we work as a group here tonight guys, we’re going to be able to do a lot.


Can you guys hear me okay? I have my mic up here and I’m not sure if you can hear me well. I have my sound off. I want to make sure you guys can hear me.


As we get started here, what I want to share with you before we get going is I know we’ve been talking about NPQ. NPQ is basically our nursing practice questions. If you go to nursingpracticequestions.com, we’ve uploaded our database of nursing practice questions. We have about 4,000 questions in there divided into about 21 categories, where you guys can go over there and take questions.


I’m going to, at the end of this, if you guys are still hanging around, I’m going to give out coupon code for 100 people to get it for 35% off. It comes out to $6 off or something like that.


If you guys are still hanging around at the end … Loud and clear. Awesome. If you guys are still hanging around at the end, I’m going to have that code available. A little enticement to hang around. Always good. Always good.


We’re going to talk about a lot of really important stuff. I have a couple of other little announcement. If you guys just bear with me. I promise, it’s all really good stuff. It’s not like annoucements before class or something. This is all new stuff we’ve created for you guys.


Hannah, if you’ve already bought it, e-mail us, [email protected] and we’ll figure something out for you. Okay? Just e-mail us and Sandy or Heather will help you out with that.


The other thing that I just … I actually just started doing this yesterday. I just got this uploaded. I started a new YouTube channel.


We have our main NRSNG YouTube channel and then we also have this nursing practice channel that I just started. If you go to YouTube and type in NPQ and NRSNG, what I do here guys is I actually take NCLEX questions live. You can see, it’s the third or fourth one down. I actually take questions live, completely unscripted and I see if I can answer them. Then I talk through my thought process. It’s me thinking out loud as I take these questions.


I actually got one wrong yesterday. It was a select all that apply. Yay! We all love select all that apply.


ATI. I think ATI is a good program. We can talk about that here in a minute too. If you go over there … I’m going to actually take questions for you, in front of you and allow you guys to see my thought process as we go through the questions. Completely unscripted. I click record and I start taking questions.


It’s really good to see that, because I’m really going to think out loud and show you everything. If you need help with how to take NCLEX questions. These videos are two minutes, maybe, where I take one.


What else? What else? What else? Oh! Oh! Oh! I just want to throw this out there. I’m just throwing this out there. I’ve been talking with Katie [Cleber 00:07:52], she’s part of our team too. She runs nurse [inaudible 00:07:53] as well.


One thing that her and I had been talking about is speaking at some schools. We love …


Ohio. Awesome. I think I’ve driven through Ohio once.


We’ve been talking about speaking at some schools. We love to get out into a handful of schools and meet you guys in person. I love what we’re able to do, the reach we’ll able to have doing these all online, but it’s a bit limiting because we don’t get to meet you guys in person. This Facebook chat is awesome, but I’d rather talk in person and really get to know your struggles and stuff.


If you think your school would be interested in possibly having us come, speak, to meet you guys, give a little pep talk and maybe give one of our lectures. I would be pumped even to teach a med-surg class or something. I love teaching med-surg. I’d be totally cool with doing a cardiac lecture, neuro lecture, something like that. Bring one of the girls along, Katie, or Susan, or Heather and actually getting in there and lecturing and stuff.


If you guys think maybe your school will be interested in that, just let us know. You can have them even head over to our website, go to the contact page, it’s just nrsng.com/contact. Reach out to us there, or e-mail us, [email protected], and we can get that rolling. We’d love to get out to some schools and meet you guys and everything.


All right. Let’s see, I think we’re ready. Let’s go. Let’s roll.


If you guys are in here, I think our chat is working appropriately this week. If you want to leave a comment in there and ask a question as we’re going, that’d be great. If you guys like what I’m saying, shameless plug. I would be completely okay if you hit the like button or hit the … I don’t really even know if I’m over the right ones here. Hit the comment button or hit the share button. Love to help this message spread. I really hope this is helpful to you guys.


Is that music playing? Here, I’ll turn that off. All right. Let’s keep going with what we’re here for tonight guys. Today we’re going to talk about how to dissect NCLEX questions. Like I was saying as we were getting started. If you guys have a question as I’m going, let me know. I had way too much caffeine tonight at dinner. I drank way too much Mountain Dew. If I’m talking way too fast, let me know. Just full disclosure there.


We’re going to talk about how to dissect NCLEX questions. If you guys had been around NRSNG for a while, you know my general thoughts about the NCLEX. Basically, I even wrote a blog post on a blog about why I think the NCLEX is failing you.


I think the main problem …


Are we still live? It interrupted for a second guys. Let’s see. I think we’re live again.


Can you guys see me? It froze. Dang it.


Let’s see. Just a couple of people say yes if we’re live again. [inaudible 00:10:50] video interrupted. I can’t tell. If we’re still live, if you can still me, let me know. Try refreshing the browser there.


Dang it!


I’m going to scroll down here. I can’t tell if it’s actually live. If we’re actually live … I still got some people in here. Okay. It looks like …


You’re back.


Okay. Thanks [Yana 00:11:14]. Thank you very much. Sorry. It looks like we over ran a little system here. Let me try closing maybe a couple of windows here. All right.


Let’s see. All right. I think … Is it working?


Yes. Close out and reopen and it works again. All right. It’s live. Okay. Good. All right.


Sorry. That’s just … You guys know how I feel about the NCLEX. You know that I believe in my mind that the NCLEX is massively over emphasized in the sense that nursing schools have gotten to the point that that’s what they teach too. That’s all they teach. It’s almost like, without being political or whatever, but it’s almost like no child left behind, where we’ve put out all the standardized testing. Now, that’s all that schools teach too.


They say, “Critical think … Critical thinking. You got to think like a nursing. You got to be like a nurse.” But all they’re actually doing is just simply teaching to this test. That drives me insane, because the NCLEX, to be completely honest with you, does not prepare you to be a nurse. It does a good job of trying to bridge the gap from basic knowledge to practicing on the floor, but it misses a lot. I think what really happens where the big problem is, is that schools start teaching simply to that test. That drives me nuts. Okay?


What we’re going to do as we talk about dissecting NCLEX questions tonight is the reason that I’m teaching this … I just gave the spiel about why the NCLEX bothers me. Now, let me tell you why we’re doing this lecture.


The problem is your ability to become a nurse relies on one thing in the current system. What do you think that one thing is? It’s passing the NCLEX. That’s obviously a problem.


What I want to do with this lecture tonight is I want to give you a couple of tips, a couple of tricks so that you can take your focus away from stressing about this ridiculous test and learn these strategies to help you test better; number one. Then to allow you more time to focus on what really matters, which is understanding pathophys, understanding patient care, and understanding what we really teach about here at NRSNG, which is being a kick-ass nurse. That’s what we want you guys to be.


What I’m going to do? Okay. Let me tell you a quick story. A couple of years ago … I just told you guys I’m from Texas. A couple of years ago, I went down to San Antonio with my family, my parents and my sisters and, I think, my sister’s boyfriend at the time. We go down to San Antonia and we are walking downtown San Antonio. If you’ve ever been, there’s a nice river walk that circles the entire downtown and that’s where the Alamo is. That’s where all these really cool stuff is in San Antonio.


There’s only sounds. You imagine it’s Saturday night, downtown San Antonio. It’s nice weather. You got the riverboats going through. You got people walking around. Lots of sounds. People are walking past the Alamo. It’s really beautiful. It’s really pretty. My parents and I, my one sister are walking ahead and my sister and her boyfriend are walking a little bit behind us. We’re walking through downtown and then all of a sudden we just hear this, “Slam! Boom!”


We turned around. My parents and I, we turned around, and the first thing we see is we see this stop sign just wavering like this, like bouncing in the air. We looked over, we see my sister bent over, holding her head. She had slammed into this stop sign because she wasn’t paying attention as she was walking through downtown. I was hard not too laugh. She was fine. It all worked out okay. She’s just in massive pain because she took her eye off the [goal 00:14:47].


Let me try to relate that to nursing and to what we’re talking about tonight. The NCLEX is important. It’s something that you have to do, but the main goal is becoming a really, really qualified, prepared and good nurse. If you take your eye of that, you get distracted by all the other fancy things that are to look about and to see in nursing school. You start to lose that focus and you lose what really matters.


What we’re going to do tonight, let me just … Let’s talk about a couple of things to help you pass the NCLEX, do well on nursing exams and then focus on what really matters, which is becoming a better nurse.


If we go over to here, I’m actually going to base this a lot on one of our popular blog post and podcast about how to dissect the NCLEX, a nursing school exam.


All right. It looks like it paused again. It looks like it paused again.


[Nisha 00:15:48]. I think that’s the problem, is that nursing instructors … That’s the problem, is they’ve been told that NCLEX is the only focus. That nursing school is to pass the NCLEX and I think that that’s the main problem.


I think what we’re going to talk about tonight is how to think more like a nurse so that you can pass that NCLEX and you can then go on and accomplish your goals.


Let’s see if we can get this working again. It looks like it’s still … I’m going to refresh again, and then we’re going to move on. I’m going to stop bouncing around so much.


All right. It’s live. Sorry you guys. This is really bothering me. I’m just going to ignore every time it goes like that. I’m just going to keep talking.


The first thing I want to talk about with these guys is something called Bloom’s Taxonomy. If you’ve heard of Bloom’s Taxonomy before, that’s great. If you haven’t, that’s okay. I’m going to tell you what Bloom’s Taxonomy is. Essentially, all that Bloom’s Taxonomy is, is a way of organizing cognitive levels. It’s a way of organizing the difficulty of a task, a mental task, and the reason this is important guys is because this what the NCSBN, which is company that writes and administers the NCLEX. This is what they base the entire test around, is Bloom’s Taxonomy.


The way that it works basically is it starts with remembering. Remembering is the easiest cognitive task that there is. We could teach anyone. My five year old [Tass 00:17:08], he could … I could teach him that the normal sodium level is 135 to 145. He could remember that. It doesn’t take a nurse. It doesn’t take a nursing student to understand that. To understand that, or to remember that. To remember that 135 and 145 is normal sodium level.


As we move up Bloom’s Taxonomy, we go to remember, or to understand. Then we go to applying knowledge. At the very top level of Bloom’s Taxonomy, we get to the analysis, the evaluation and the creation phase. These are the most difficult things to do cognitively. Meaning that applying that knowledge, taking that fact, the normal sodium is 135 to 145, and applying that to a real situation is where it becomes much harder. Analyzing a situation and drawing on passed knowledge.


The NCSBN who writes the NCLEX, they actually based all of their testing and everything that they do around this Bloom’s Taxonomy. What they say is that they focused their question on the application level and the analysis level. They focus on, “Can you apply knowledge, and can you analyze knowledge?”


If you’re taking the NCLEX and you’re getting questions like, “What is normal sodium level?” That’s saying that you’re at the base level of knowledge. That’s why people say … If you get to taking a lot of select all that apply questions, you’re doing well on the NCLEX. That’s where that knowledge, thought process came from is that. As we move up this, it gets much more difficult.


Let me give you an example. For an example, if … Like we said. One example would be what is normal sodium level? That’s 135, 145. That’s an easy questions. That’s remembering question. Your probably not going to get that on the NCLEX. Something that you might get on the NCLEX is you have a patient who has fluid overload. Who has a massive amount of edema in the lower extremities. What diet would the nurse expect the physician to order?


You have a patient with a lot of edema. What diet would you expect …


What’s up James? Good to see you here.


That’s James with Benefit Medical. You guys [inaudible 00:19:18] over their website. They got awesome scrubs.


Basically, what … The question you’re going to see on the NCLEX is going to be, “You have a patient who has a sodium … Or you have a patient with a lot of edema. What diet would you expect the physician to order?”


This is the analysis level. The diet you’re going to expect them to order is going to be low sodium. What’s that saying is that we are able to understand, apply and analyze that sodium plays a role in food balance.


We really have to start getting ourselves thinking to that level. Thinking beyond just remembering things. That’s … A lot of times, I think the problem in nursing school is that we’re teaching so much at the remembering level. They’re flying though information. They’re not teaching in a way that you can really understand.


Let’s move on to … I want to talk about the parts of an NCLEX question. This is the next thing of it. Once we understand that, we really need to be looking at everything we learned. We need to be looking at application, analysis and creation. There’s really much higher level of cognitive domain, of understanding.


There’s a few basic parts of an NCLEX question, and understanding how to break a question down is really important. When you look a full question, a question by NCSBN standards as we referred to as an item. Everything on an NCLEX is an item, whether it’s true or false, whether it’s select all that apply. Whether it’s multiple choice. It’s an item.


The question portion of it is called the stem, and then the different options are called options. Then you have a correct answer and you have distractors.


If you think about it like that, the whole goal of every question is to simply isolate the correct answer from the distractors. Everything else on that test is a distractor. You really have too start looking at the stem and how to understand the stem.


Let’s talk about the different parts of a stem. There’s a few different parts of a stem. The first part of the stem is … Or the first kind of stem can be a complete sentence. What diet would the nurse expect the physician to order? That’s a complete sentence. That’s something you can look at and say, “Okay. The physician would order this.” You’re going to be able to look at the options and select the right one.


Then we have incomplete sentences, “The nurse would expect the physician to order …” And then you have to fill in the blank basically. Then we have positive ones. That’s what you’re looking for. Just simply the right answer.


This last one is the one that I want to focus on. Negative stems. A negative stem I think is where a lot of people get distracted and where a lot of people mess up. With a negative stem, these are going to be ones that have words like except, not, never, further, least, avoid, contraindicated.


The nurse would expect the physician to do all of the following, except. Which of the following would the nurse not do? Those types of things. This is where I think … If you guys are missing a lot of questions in nursing school, I would guess that a lot of you are missing in this place.


What you have to do is you have to really look at reading the whole questions, and that’s really hard to do especially when you’re nervous, when you’re excited. You really need to look at these negative things, contraindicated, avoid.


Anytime you see one of these things, you have to really get your mind in that space of looking for the wrong thing. Rather than looking for, “What’s the right answer here?” You’re looking for the wrong thing.


Let’s move on to one more thing. This is where I really want to share with you guys. Because we try to teach critical thinking in nursing school, what we have to do and what nursing as a science has to do is it has to develop frameworks. Frameworks for answering questions.


The NCSBN does this and it does it very, very religiously. Two frameworks that we can use to answers questions are, and I hope that you guys … That this will sound familiar to you guys, is ADIPE and ABCs.


Who knows what ADPIE means? In the comments. Let me know if you know what ADPIE means. If you’ve heard of it, write it down. If you know what ABCs are, write it down. In the comments. Because this is where you really need to be focusing your energy. Everything that you do has to go back to ADPIE and ABCs.


Anytime you’re taking an ENCLEX question. Anytime there’s a question, we use the framework, first of all, ADPIE and then we can … Wrong way. Then we can use the framework ABCs. Which hand am I supposed to move here?


Airway, breathing, circulation. Perfect. Assess, diagnose, plan, implement, evaluate. Yes. Frederick, Kimberly. Perfect. Very, very good.


Airway, breathing, circulation. Elisa. Right on. Perfect.


What I want you guys to do, the problem is, you guys, the problem is as we’re taking questions, we start to read into questions. We start to over think questions. That’s where we can really get ourselves …


Jamie. Exactly.


We can get ourselves in a lot of trouble. Even if you’re a first semester nursing student, I want you to always think ADPIE and ABC. These are the first two I want you to really focus on. Remember, assess, diagnose, plan, implement, evaluate.


Let’s say you get a question about this. The question … Simple one here. The question says, “You have a patient who has a potassium of 6.1. What do you do?” We’ve been given …


[Kush 00:24:27] Exactly.


We’ve been given information that the patient has a potassium of 6.1. What’s the first thing we do? We have to go with our assess, diagnose, plan, implement, evaluate. You never jump a step. According to NCLEX, you never, ever, ever jump a step.


You’re given that information, 6.1. First thing you got to do, you got to assess. The analysis level is we’re given …


I’m going to have to look at that one later Nisha. I can’t read it just yet.


When we’re given that information, we got to go to the analysis level. The analysis of Bloom’s Taxonomy. It says patient has a potassium of 6.1. What is that going to cause?


The NCLEX is going to want to know, do we understand what hyperkalemia can cause. [inaudible 00:25:12] at cardiac arrhythmia. Right? We need to assess. A correct option in that one might be something like ask for an EKG. That’s something you can do to assess this patient further.


The correct answer might be, get an EKG. Then we move on to diagnose. Diagnose would be, “Okay. We got our five lead EKG. We’re seeing a peaked T waves, tall, tented T waves from our hyperkalemia.” Then we plan, “What’s something we can do?” We can give [inaudible 00:25:41], we can insulin, we can give bicarb. There’s all these things that we can do to try to correct this potassium that we’ve assessed, we’ve diagnosed. Now, we’re implementing something.


We plan, “Okay. We’re going to give some insulin.” We know that insulin is going to draw potassium into the cell with it and it’s going to help lower our potassium. Then we go back and we evaluate.


You never, ever, ever skip a step when you’re taking a question in nursing school. If you’re given potassium of 6.1, don’t automatically jump to giving insulin. The first thing you need to do is you have to assess. Is it causing cardiac arrythmias? Is the patient having palpitations? What’s going on with this patient? Don’t ever skip there.


What will happen with you guys sometimes I think is … What happens with me. What happened with me in nursing school, is you’ll try to jump. You’ll try to jump ahead. We all want to be superhero nurse. We’ll try to jump ahead and we’ll try to select an option that doesn’t follow course. I’m telling you guys, the NCSBN wants you to always follow the nursing process.


Next one here is ABCs, airway, breathing, circulation. In that order. Here’s why ABCs matter. If a patient doesn’t have an airway. If they’re not breathing. If they have no circulation. What do we call that patient?


Put your comments down there.


That patient is dead.


While a patient might have pain, while a patient might want some Jell-O. While there might be family disputes …


Thank you Ashley. Yes guys. Good job.


Those things just don’t matter if they’re not breathing. You guys, I know that sounds really, really over simplified right now for you guys. I’m going to tell you in a little sidebar here. In real life nursing, you will get patients come in who are struggling to breath, but family really wants you to get them an ice cream right now, because they’re really hungry.


There are times you’ll have to take the family inside and say, “Look. I understand what you’re talking about here, but if we do not put a breathing tube in your mom right now, she’s going to die.” Those are hard conversations. Those are difficult to have, but this is true on the NCLEX and test taking as well.


Over on the YouTube channel that I was showing you guys earlier where I take NCLEX questions. I fell for an ABC question myself. The question a select all that apply, and it was, “What are the first priorities for this?”


I was thinking through ABCs. I was thinking through ABCs. I was thinking, “Okay. I selected the airway one, I selected the circulation one.” I ruled out two of the responses really easy, but then there was one about a neuro change. While neuro changes are incredibly important. I’m a neuro ICU nurse by training, and so I’m always … Neuro changes are so important to me, but I … It’s not as important as an ABC. If that makes sense, you guys.


Always do ABCs. Even when you’re in real life nursing and when you’re practicing. ABCs are number one. You’ll see a lot of nurses running around the unit sometimes with their … Like chickens with their head cut off. Worrying about this or worrying about that. Worrying about whatever.


If you’re not dealing with those ABCs first, your priorities are wrong. Just flat out. I can be really hard. If you’re talking prioritization delegation, always, always, always start with ABCs. Does that make sense guys? I hope that helps.


What are the big things I want you guys to keep in mind? I want you to keep in mind the parts of a stem, the parts of a question. I want you to keep in mind ADPIE, and I want you, above all, in all your studies, to … Shoot! Let’s see here. To always be thinking about Bloom’s Taxonomy.


When you’re studying, when you’re focusing, are you getting caught up and just trying to remember facts? Are you allowing yourself to get to the higher level of analysis and evaluation and creating? That’s where I want you guys to be spending your time.


Let’s see here. Let’s see here. Let’s see here. All right. All right. All right. Good.


What else did I want to talk to you guys about? What else should we talk about? Oh! The coupon. Sorry. Let’s see here.


I showed you guys, we have nursingpracticequestions.com. What I want to do for you guys tonight is, for people that are here on Facebook live, if you go over to nrsng.com/npqpro. That’s the checkout page, a little purchase page for it. If it’s something that you guys are interested in. If you use facebooknpq, that’s going to take 35% off the monthly fee.


Basically, you guys, what we do here is we allow you to try it out for … You can all try it out for free, of course. Then we do have a $1 five day trial, just to see if getting on the backend and seeing all the stats and everything like that are something that’s going to help you and if it’s something that you need. If it’s not something you need, you can cancel anytime.


Of course, if it’s something that you like, then it’s … With this 35% off, it’s like $9.60 a month and you can cancel it, obviously, anytime.


Yeah. If it something that helps. If it’s something that you like. If it’s something you guys need, head over there. Try it out. Nrsng.com/npqpro. That’s to go ahead and just use this coupon code immediately. It’s good until June 22nd, and it’s for the first 100 that use it.


If you just want to try out nursing practice questions, head over to nrsng.com. There’s a tab up there for practice questions. You can try 25 questions for free anyway. All right?


Yes. Go out there. Try it out. Give it a shot. If you go to nrsng.com/npqpro, scroll down and then it’ll be a button that says, “Try NPQ for a dollar.” Click that. Put facebooknpq in there and you’ll be able to try it out.


Let’s talk now. What questions do you guys have? I’ll try to get through that really quick. I know it’s already been 30 minutes. Gees! Let’s talk.


I can tell you a guys a little bit about myself. A lot of you probably know me just from hanging around, being part of NRSNG for a little while. This is me here with the curly blonde hair. That’s a couple of a my coworkers.


Like I said, straight from nursing school, I went directly into neuro ICU. Super glad I did that. Going into nursing school, I was pretty confident that ICU critical care was where I wanted to be. It absolutely worked out perfectly for me.


This is what a patient’s room would look like in the neuro ICU. Loved it. You guys can see here. You got your propofol, you got your antibiotics. You got … Let’s see. One, two, three, four, five things going right now. We got enough for about …


You’re welcome Melissa.


You got [arterial 00:32:35] line, you got your flow track. Loved it. Absolutely loved everything about working with critical care patients.


What will happen a lot of times, you guys, when I show a picture like this, is you guys feel overwhelmed, “Oh my gosh! I could never do that.” You’re right. Coming right out of nursing school, no one …


You’re welcome Mark.


No one expects you to go directly into a room like that and know what you’re doing. That’s something that’s going to come with time. That came after working with my preceptor for, I think, like 13 weeks or something like that. I had a preceptor. Then building up the difficulty of patient until I was able to walk into a room like that and be excited.


It doesn’t matter if you do critical care, ED, med-surg, home health, [peds 00:33:23], [inaudible 00:33:23], whatever. You’re going to learn, you’re going to grow. The whole purpose of this lecture tonight guys is just to get you to a point that you feel comfortable. Getting through the testing part of it, and getting to the point that you can really dive in and start to learn and start to grow as a nurse, you guys.


That’s our whole goal and everything here at nrsng.com is to give you confidence and tools to excel in nursing school, in life, on the NCLEX, everything.


I had a really, really, really cool experience today. One of … We got a message from a girl that I known about seven years ago. Before I’ve gone to nursing school and before she’d gone to nursing school, she sent a message through our Facebook today and she said, “Hey, John. Just want to let you know, I just passed the NCLEX and I used your stuff.” I was, “That’s cool.” That she had actually just found NRSNG and found everything that we were doing just online and we were able to help her pass the NCLEX. It was just really cool to see somebody that I knew, personally, find our stuff and have it help them.


Do you guys have any questions for me? What test taking questions do you have? What nursing school questions do you have? What life questions do you have? What questions do you have about me? What dirty little secrets do you want about NRSNG? Happy to share.


I’m not seeing questions fully right now, but hopefully they will come through.


All right. Melissa says, “Can you assume an answer when the information is not in the question? Should I look at the answers as options? This is my first semester.”


Melissa, I’m going to give my gut instinct on this. Can you assume an answer when the information is not in the question? You never want to assume anything in the answers. Never look into a question and start jumping to something. The information that you need to answer each individual question is in the question. It always should be. You should never look at the potassium one and assume that a patient has elevated T wave. Never read anything more than what is exactly in the question.


Elisa, thanks for pumping people up. Appreciate that very much.


Meagan, “Select all. How is it best to break them down? Those are what I’ve struggled with the most.”


Meagan, we’re actually looking at making a whole bunch of vidoes about select all that apply questions. One tip I want to give you about select all that apply is each option … Each option is a separate answer. Don’t take option A and option D and say, “Okay. If option A is true, then option D has to be true too.”


Each individual option is a completely separate option. Look at each one of them differently. Never look at one as different. What am I saying? Never look at each … Never assume that like because C is true, A has to be true. Each one is a completely separate option. That’s one thing I would tell you about it.


The other thing I would tell you about select all that apply questions is that if you’re getting a lot of them on the NCLEX, chances are you’re probably doing pretty good.


The third thing I want to tell you is, absolutely just go with your gut. Go with your gut. Never read into a question like I was just saying. Never try to assume that one answer is right, because another one is right, and just go with your gut and go with what you feel is best.


“I struggle with priority questions, like when it’s … Who do you go follow up on first?”


Hannah. Hannah says she struggles with priority questions, like who do you go to when … Who do you go follow up with first? You said, when all of them are ABC type things, always start with the airway person. If it’s a circulation thing, let’s say if blood pressure is low and you have a patient who is not ventilating. Always go to the A first before the C. Go in that order ABC first and A before C. If that makes sense.


You can struggle with … You can get by with a low blood pressure, but you’re not going to get by without breathing for any length of time.


With priority questions, start with ABCs, number one. Again, you have to go with your gut. I know that sounds incredibly oversimplified, but pain is important, but circulation is far more important than pain. If it’s a patient who’s in danger … Patient safety is incredibly important. Patient safety is more important than pain or than frustration or anything like that.


We always want to keep our patients safe. We always want to make sure they have an airway. We want to make sure they’re breathing. We want to make sure they have circulation.


Hannah, “Which labs are more important to go check on first?” Labs that will kill someone.


An incredibly elevated potassium. That’d be an important one to check on. Things like BUN. You can’t do anything immediately to correct a BUN. You know what I mean?


A potassium, a sodium, your electrolytes are going to be … Your electrolytes and your ABGs are going to be the most important labs to look at first, because our ABGs are reflective of what. Our ABGs are reflective of metabolic and respiratory status. We can absolutely do something very quickly about a pH … or a pH of 7.2 and a CO2 of 50.


We can put someone on ventilator, correct them. Your ABGs, because they’re reflective of ABCs. Your electrolytes, again, they’re reflective of ABCs. Those would be the first labs to look at where things like a BUN or even like a … It would have to be a dramatically low H and H, like hemoglobin and hematocrit and RBCs for us to really rush and do something about it, if we’re also looking at a patient with an incredibly whack pH. If that makes sense.


When you’re looking at labs that take a long time to correct, like a BUN, creatinine. Those take a long time to correct unless we do an immediate dialysis. Even that takes time. We’re always looking at the labs that are going to cause those ABC problems and we’re dealing with those first.


Amani says, “We’re going into transitions next week.” I’m not sure I even know what transitions are. “Some of us are nervous that we are going to find out that we’re only book smart. Is that normal?”


Amani, yeah. Yeah. I’m assuming transition has something to do with actually being on a floor. Yeah. I think it’s normal in every stage of nursing to feel like you’re not prepared for that next stage. I don’t know if that makes sense, but I think it’s really normal.


I tell a story a lot. My first shift in the ICU, I was actually late, and I got up the elevator and I was probably white as a ghost. I was terrified. To actually have a really sick person’s life my hands was terrifying, and [in 00:40:44] my first shift alone. I was terrified. My first shift as a charge nurse. I was incredibly terrified because I was all alone on the floor basically that night with a bunch of new nurses. My first shift as a code team nurse. I was more mortified because now I’m basically in charge of helping run codes, and that was massively terrifying.


Yes [Kush 00:41:05]. Thank you.


Yes. What do you think about taking a review course like Kaplan Hurst? Is it worth the extra money?


Jessica, I did not take any of those review courses. I studied in a manner that we tried to show you here at NRSNG. Kaplan, their main focus is teaching you how to take a test. They don’t do any content. Hurst does more content. That’s what Collie says right there too.


I’ve been on Kaplan Hurst and I’m wanting extra content help go through Hurst, but Kaplan will help you with NCLEX questions.


Yeah, and that’s the problem. If you end up taking both of them, you’re looking at 700 bucks or so. That’s what we’re … Let me give you guys a projection into the future. What we’re planning to do here at NRSNG in the next few months is have everything that you need here in a much more affordable price that these big guys, the big K and whatever, Hurst.


I’m not going to bad talk those people because they’ve worked for a lot of people and they’ve worked really well for a lot of people. I didn’t use any of those and a lot of our team used other methods.


Robin, I did not use Uworld, but I hear that they have a lot of good questions. Yeah.


Elisa, you’re the best.


Thank you.


Too bad, the NCLEX is next month.


Yeah. Hit the practice questions man. No matter where you’re at Elisa, hit the practice questions and focus on what you’re doing worst at. I don’t know that sounds a little bit mean, maybe a little harsh, but the point of taking NCLEX questions is to find out where you’re struggling. I think by human nature, we like to feel good about ourselves, and everybody does, myself included. Everyone does this. We like to feel good about ourselves, and so we’ll focus on what we’re doing good at.


If we’re scoring 88 on our cardiac, we’ll keep taking cardiac questions because we’re doing so good at them and we feel really good about ourselves. If you’re scoring 80s on your cardiac and 20s on your whatever.


Awesome. I forgot how to say it and I’m not going to try it again.


Thank you.


Focus on what you’re doing the worst at and really dive in to those rationals. Take those rationals and draw out a huge chart. This is my notes for tonight. Draw out mind maps and everything for the things that you’re doing worst at and realize that a lot of the NCLEX is going to be adult med-surg. There’s a good portion of pharm on there. Some people have more or less than pharm. Focus on your adult med-surg. Focus on the things that you’re doing the worst at.


What are the questions you have? I’m not sure if it’s updating. I think that just about hit all the questions.


Love to answer your questions guys if you have anymore. We got a little bit more time. We can chat here. I would love to hear what we got.


Let’s see. I thought I saw one more.


Pharm. Meagan, Pharm. Pharm is my favorite. Pharm is my favorite.


Heather or Katie, whoever is manning the chat. If you could put a link to the Med Master podcast. Put a link to Med Master podcast on there. We have a whole podcast that goes over 140 of the medications you need to know for the NCLEX. That’s free obviously.


Also, up on the blog, if you go, we have a link for cheat sheets at nrsng.com. We have a lot of pharm ones there. Then we do have a book, 140 Must Know Meds. I think that’s like … It’s like five bucks. It basically is the print version of the podcast.


You’re welcome Melissa.


That could help you a lot.


Thank you. Whoever posted that. Both of them posted it. Thanks guys.


That would be really, really helpful for you. That book is really helpful. A lot of people like it. If you have a little bit of extra money, we have the Med Master Course. I think it’s 60 bucks. Aside from Med Master Course, I obviously highly recommend it. It’s helping a lot of people, because pharm is not being taught well.


Again, with Pharm, biggest thing is looking at those things that matter the most. There’s a couple of meds. There’s a couple of classes that really matter. You know your cardiac meds and you know things like heparin, insulin. Those are the things that are going to cause massive patient safety issues. Your blood pressure meds. Your heparin, your insulins. Learn those ones really good, but never stop learning pharm, you guys. Ninety percent of what we do on the floor … Let me pop this picture back up here.


What was so cool about this patient here is they were taking a ton of meds, and I had the … Okay. We had a center line and we had a couple peripheral IVs.


Awesome Susanna. Thank you so much.


I think a lot of people’s pharm classes were jokes, and that’s why we created this course because I get frustrated when nurses say, “I don’t need pharm. My school doesn’t require it, so I don’t need it.” I got to call BS on that. You need …


Yes Jessica. Pharm is no joke.


Pharm is like … You guys, you got to know pharm. The Med Master Course is actually taught by Tarang Patel, who’s a pharmacist. He’s currently in CRNA school right now. He’s a pharmacist in India, came here and went to nursing school. I went to nursing school with him and heather and then he ended up going to CRNA school. Now, he’s in the number one CRNA … Anyways, intelligent person. Pharm is what we do guys.


I feel I’ve learned more in clinical than in pharm class.


Yeah, that’s unfortunate. Just don’t ever stop with Pharm. Focus, first of all, on those meds I said. Your cardiac meds, your BP meds, the meds that are going to put a patient into danger. Heparin, insulin is a big one they talk about a lot.


Just realize that … This is obviously a … I’m trying to be as political correct as I can. Pharm is important and nursing culture sometimes have … We push it down at something that doesn’t really matter. Guys, that’s what we do as a job.


Like for that patient I was just showing you, like six meds going right there. I think we had up to eight or nine meds going at a time. You have to know compatibility. You have to know rates. You have to know which lines things are going through at any specific time. You have to know, “Can I give the propofol right now when I’m given the nicardipine?” “What’s the nicadipine going to do when I give the propofol?” “What’s the propofol going to do to his calorie count for the day if he’s on TPN?”


I know that’s way more information than you guys need to know right now. Don’t know that. Learn the basics right now. Focus on patient’s safety with your meds. Focus always on generic meds too. Focus on generic name. That’s what NCLEX test is on. That’s what you really need to know. That’s almost physicians and stuff. We’re going to refer to meds.


Don’t give [cardin 00:48:08] with neo. I’m assuming that’s Katie saying that.


Yes, pharm is just not focused on nearly enough. I wish it was, but that’s why we have Med Master podcast. Please go start listening to that. Every episode is like two to five minutes. Completely for you guys. It’s something that I just think needs to be done.


We also have a huge resource that has all of our med podcasts. Ah, shoot! I can’t remember the link for it. I’ll try to throw it up in here later. It’s like 100 links to different meds and stuff.


You all should do a video about first nursing jobs for new grads. I’m very nervous about my first job. You already have something, but I haven’t found it yet.


Yes. If Heather or Katie could go on there. We have a blog post called Why You Should Be Terrified For Your First Nursing Job. That’s probably not giving you any encouragement. Sorry.


I respect nurses that are humble enough and honest enough to say that they’re terrified. Just like I was just saying, it’s freaking terrifying. There’s days as experienced nurses that you walk in still terrified. I think that goes back to the whole thing that once you become complaisant as a nurse, you need to move on to a different job that engages you and that interests you, or you need to …


Thank you.


You need to find a way to become scared again a little bit, because I think being scared keeps you on your toes. It keeps you engaged and it keeps you … You’re going to be scared and I wish there was a way that I could make it less scary.


The biggest thing I can tell you is everybody should be scared. Everybody is scared. Those that say they’re not are probably the nurses you would want to distant yourself from, because those are the ones that are going to cause problems.


Ashley. “When answering questions, I’ve heard several times about if there are two answers exactly opposite, one of them is correct.”


Ashley, I’ve heard that too and that would be a good framework to work with. That will happen. That’s going to happen. You’re going to get two answers on the NCLEX. You have four answers. Usually, every question has four answers, if it’s multiple choice and not select all that apply. There’ll be times when it’s completely opposite answers.


One will be give the patient fluids. One will be restrict patient fluids. Usually, when that’s the case … I’m like making … I’ll better not do that. I’m not in a gang guys. I promise.


Usually, when that’s the case, one of those is going to be the right answer. Really, start … Eliminate the other two options for a minute. Look at those two and say, “Okay. If this is a patient with heart failure, do I want to get fluids or do I not want to get fluids?” The answer there would probably be restrict fluids. That would be the right answer. Really try to focus on those two that are just opposite with each other. I’ve heard the same thing.


Jessica. “I was told by nurses … I used to work within a hospital that when you come a know it all, that’s when you become unsafe. Never be afraid to ask questions and ask your coworkers for help.”


Jessica, I couldn’t say it better myself. We need to make that a quote because it is absolutely true. The moment you become a know it all, you become very unsafe. I think that’s just … What’s the word for it? I don’t know. It’s just humility. It’s just being humble. Respecting the fact that as nurses, no matter where you work, no matter what setting you work in. Even as a school nurse in an elementary school. You have people’s lives in your hand, and nurses are the most trusted profession.


We beat out pastors. We beat out firemen. We beat out policemen. Obviously [not 00:51:48], I guess with policemen. It’s just really important that we respect that. Even to your patients, it’s okay to admit to your patients when you need to look something up. If a patient tells you something, it’s completely possible that a patient who’s been battling diabetes for 45 years might know a little bit more than you about their own personal symptoms, diabetes in general and insulin, than you do who’s only known about it for a couple of years and never experienced it.


Just always being humble and respecting and being honest with the fact that you don’t know everything. That’s completely okay. Don’t be afraid of that. If you’re surrounded by professors or nurses who act like you should know everything. It’s the same thing people always tell you. You don’t want to be friends with those people anyways. Move on. Be a part of our community.


What else can we help you guys with? What other questions? I think we’re coming up here on an hour. We got about 50 people in here. What else can we give you guys? What else can we do?


We want to make sure …


Majority of the time, remove the highest and lowest and pick among what’s left, but most of the time I pick the higher one. Is that true?


I’m not sure on that. Katie or Heather could help with that. I’m not sure.


Are there particular meds you would only give at night time except for sedatives?


One med that just came to the top of my mind are going to be your cholesterol meds. You give those most often at night, like lipitor and stuff like that, because these meds … Your liver, it actually creates cholesterol and things like that at night. It’s important that we give those meds at night when the liver is most active producing cholesterol.


There’s that med. Obviously, sedatives. We give insulin usually around the clock in the hospital. Off the top of my head, pain meds are around the clock.


What other ones guys? Those are the big ones I can think of off the top of my head.


Would you recommend … It looks like it just ended. Is it still live? Can’t tell if it ends it. We dropped off a lot of viewers, but let’s see. We still got a couple of questions. I’m not sure if it just ended. It told me it ended, but we’ll keep going here.


No. You’re there.




Would you recommend a surgical [inaudible 00:54:18] first time RN position?


Erica, if you want to work OR, go for it. If that’s absolutely where you want to work. I talk with Nurse Muscles, he’s up on Instagram. Go follow him if you’re not already. He’s awesome. Nurse Muscles started in OR right out of school. That’s where he always wanted to be in. He’s still doing OR, because that’s where he really wanted to work and he loves it.


As a surgery center, if it’s possible and you really want to do OR, I would try to start in a hospital. My suggestion is, if possible, always try to start in the biggest facility you can, because you’re going to get the most experience, going to see the most amount of things and then start moving to the slower paced, other hospitals. Try to get slammed with as much experience as you can. Try to create as many of those deer in the headlights type of experiences as you can.


The more of those experiences you can create as a brand new nurse the better, because you’re still learning, and when you have that safety net of a preceptor and stuff under you, that’s the time to make mistakes. If you can say it that way.


What other questions? Give me a tough one guys. Give me a tough one. Let’s see if I can answer it.


This had been fun guys. I’m glad I got to see where some of you all are from and get to communicate with you guys.


Again, take it back to you professors. If your student body at your school or anything wants … Would be interested in having us come and speak to you guys.


Let me think about that one.


We would love to come speak at your school, share some thoughts. Like I said, I’d be more than happy to teach a freaking med-surg course or lecture at least, visiting professors, something like that. That’d be really fun, or just to give some speeches or just to meet you guys and stuff like that.


Most embarrassing newbie mistakes?


Man, I can’t even … There’s probably a lot. There’s probably a lot, and I still make some really stupid ones.


One mistake I can think of. In a neuro ICU … Try refreshing guys. In a neuro ICU, you see a lot of death. There’s a lot, a lot of brain-death that happens in neuro ICU, so it’s really embarrassing … Sorry. I was watching the video.


The embarrassing part about … My most embarrassing moment. One time when we … The neurologist comes to let the family know that the patient is brain-dead. I go in there with them and I have my arms crossed like this, trying to be all somber and everything, because it was a sad experience.


I had my phone in my pocket and I had my phone facing my chest and pushed on my phone … Or I just put my arms like this and it pushes on my phone and somehow it turns Pandora on. On the way to work that night, I was listening to screamo music. I don’t know. Get myself pumped up for the shift. The screamo music starts playing like really loud, and I pull it out and the neuro surgeon, he’s a crazy guy. He looks at me … Or the neurologist looks at me all angry and the family is looking at me and I’m trying to pull my phone out and turn it off. It was really embarrassing. The truth of that is that probably happened four or five times. That’s pretty embarrassing.


Other mistakes I’ve made. Big mistake I made a lot of times, honestly, was morphine comes in these little capuject little things. They’re syringes that are ready to go. The way we give is it we’d take a needle and pull out.


I used to always think that you had to fill it with air first. I would pull up how much air I thought I wanted, 1 mil of air, and I would squirt in there and it would just shoot the end of that morphine off and it would just go squirting everywhere.


I probably wasted, I don’t know, dozen things of morphine trying to figure that out. Morphine, dilauded, all those different narcotics, opioids. That was pretty embarrassing.


I’ve done a lot of stuff. I’m trying to think. There are so much guys. It’s so bad.


The good thing is in the neuro ICU, a lot of your patients aren’t fully coherent and so you can get away with a lot of rookie mistakes. That was always really good.


Rebecca. “We should have this up on the channel later and we should have it up on YouTube later as well.”


I think that’s about it. It’s been about an hour guys. Sorry that we had so many lag time in there. It looks like we got some good questions answered. I hope we’re able to help you guys.


If you guys head over …


Oh, Tiffany. Shoot! Yeah, Tiffany. You should replay it later. It will be up to replay as soon as we end.


Any questions you guys have, always, always, hit us up on e-mail. Hit us up on social media. For the most part, Heather mans the social media. Heather … Let me actually go over here. Heather actually mans the social media. A lot of times if you reach out on social media, she’s going to be who you’re talking to.


She’s a cardiac nurse, does wound care now, and she’ll talk to you on Facebook, Instagram, all over there. Right now, I’m manning Snapchat. We’ll probably switch that over eventually every now and then.


Thanks [Millinger 00:59:50]. You’re welcome Amani. You’re welcome Jamie.


Yeah, you guys. I want to hear from you guys. Also, hit us up on e-mail, Heather, myself, Sandy manage the e-mail. You guys, we’re actual real life nurses trying to help better the community.


Anyway, share it with your buddy, share it with your friends. I’d love to hear from you guys, and we will talk to you soon.


Date Published - Jun 15, 2016
Date Modified - Jun 21, 2016

Jon Haws RN

Written by Jon Haws RN

Jon Haws RN began his nursing career at a Level I Trauma ICU in DFW working as a code team nurse, charge nurse, and preceptor. Frustrated with the nursing education process, Jon started NRSNG in 2014 with a desire to provide tools and confidence to nursing students around the globe. When he's not busting out content for NRSNG, Jon enjoys spending time with his two kids and wife.