NLE Prioritization

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    Dwindling success rates

    Mismatched of the nursing curriculum and

    the current PNLE test plan PNLE evolves and demands critical

    thinking and decision making skills

    Real life situation Measures the ability of the nurse-examinee

    to respond appropriately by choosing an

    answer among possible choices provided.

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    Decision depends on critical thinking

    skills in prioritizing nursing actions

    Prioritization questions take the bulk ofthe questions of the current PNLE.

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    After the end of the seminar, the NCM

    105 students of the College of Nursing of

    Medina College, Ipil Campus for theSchool Year 2010-11 will know the

    Philippine Nursing Licensure

    Examination Test Plan and able to buildtheir confidence in successfully passing

    it.

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    Within the two and a-half hour of lecture-

    presentation and interactive discussion,

    the participants will be able to: Understand current situation of the PNLE especially

    the discrepancy of the nursing curriculum and the

    current test plan.

    Demonstrate an appreciation of the current test plan.

    Apply critical thinking and decision making skills in

    prioritizing nursing action called for in each real life

    situation presented in the PNLE.

    Respond accurately and speed in a given simulated

    situation.

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    The CompetencyBased BSN

    Program

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    ETHICO- LEGAL BASIS

    R.A. 9173 Nursing Act of 2002

    CHED Memo No. 14, 2009

    PRC Modernization Act 8981

    E.O. 220 Good Governance

    Code of Ethics for Nurse

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    The Features of theCompetency Based Approach

    It will always be relevant.

    It is learner- centered not teacher centered

    It is outcome-focused

    Evaluation focused on performance ofcompetencies, criterion-referenced and

    summative

    Over laps will be controlled

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    Patient CareCompetencies

    Safe and quality nursing care

    Communication

    Collaboration and teamwork

    Health Education

    Empowering Legal responsibility

    Ethico-moral responsibility

    Personal and professional development

    Enhancing Record management

    Management of resources and environment

    Enabling Quality Improvement

    Research

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    NURSING PROCESS

    NP I NP II NP III NP IV NP V

    Basic

    Foundation ofNursing andProfessional

    Practice

    Community

    Health

    Nursing and

    Care of

    Healthy/At

    Risk

    Mother and

    Child

    Care ofClients with

    Physiologicand

    PsychosocialAlterations

    [A]

    Care ofClients with

    Physiologicand Psycho-

    socialAlterations

    [B]

    Care ofClients withPhysiologic

    andPsycho-social

    Alterations

    [C]

    ACROSS THE LIFESPAN

    INDIVIDUALS, FAMILIES, GROUPS, COMMUNITY

    IN VARIED SETTINGS

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    PREVENTIVE

    REHABILITATIVE

    PROM

    OTIVE

    CURAT

    IVE

    NURSING PROCESS

    NP I NP II NP III NP IV NP V

    SAFE AND QUALITY NURSING CARE

    COMUNICATION

    COLLABORATION AND TEAMWORK

    HEALTH EDUCATION

    RESEARCH

    QUALITY IMPROVEMENT

    ETHICO

    MORAL RESPONSIBILITY

    LEGAL RESPONSIBILITY

    PERSONAL AND PROFESSIONAL DEVELOPMENT

    RECORDS MANAGEMENT

    MANAGEMENT OF RESOURCES AND ENVIRONMENT

    BasicFoundation of

    Nursing and

    Professional

    Practice

    CHN & Care ofNormal Mother &

    Child

    Care of Clients w/Physiologic &

    Psychosocial

    Alterations

    Part A

    Care of Clients w/Physiologic &

    Psychosocial

    Alterations

    Part B

    Care of Clientsw/ Physiologic &

    Psychosocial

    Alterations

    Part C

    ACROSS THE LIFESPAN

    CUR

    ATIV

    E

    PATIENTCARE

    COMPETENCIES

    ENHANCING

    EMPOWERING

    ENABLING

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    SQC, Comm,Collaboration

    & HE (70)

    Empowering (10)

    Management ofresources andenvironment

    Record

    management

    Research

    Qualityimprovement

    Legal responsibilities

    Ethico-moral responsibilities

    Pesonal and professional development

    Competency-Based Test Framework

    Patient Care Competencies

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    First day of duty

    Equipped with nursing school knowledge

    Decision making:

    What would you doin particular situation?

    In what sequence?

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    OUTCOME:

    SAFE ANDQUALITY

    NURSING CARE

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    PATIENT THEMSELVES

    SIGNIFICANT OTHERS/FAMILYHEALTH TEAM/DOCTORS

    ORDER

    NURSING JUDGMENT

    PROTOCOLS

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    Adult

    Well

    Hospital-setting

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    Identify the topic of the question.

    Select an answer by eliminatingchoices. Do not use background information

    unless absolutely necessary. Do not read into the question.

    Think about what the answer choices

    REALLY mean.

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    REWORD

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    TRUE STATEMENT Most or most

    appropriate

    Most likely

    Best

    Best judgment

    Initial

    First

    Chief

    Immediate

    FALSE STATEMENT Except, not, or but

    Least likely

    Need further

    instructions or

    education

    Lowest priority

    Incorrect

    Unsafe

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    SKIMMING-TO CREATE STRATEGY

    SCANNING-TO ELIMINATE CHOICES

    READING INTELLIGENTLY

    PICTURE OUT SITUATION

    CONSIDER ALL DETAILS AND DATA

    REMEMBER THAT ALL ELEMENTS OF

    AN ANSWER MUST BE CORRECT FOR

    THE ANSWER TO BE CORRECT

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    The nurse describes the procedure for collecting a

    clean-catch urine for culture and sensitivity to a male

    patient. Which of the following explanations, ifmade by the nurse, would be most accurate?

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    (1) The urinary meatus is cleansed with an iodine

    solution and then a urinary drainage catheter is insert

    ed to obtain urine.

    (2) You will be asked to empty your bladder one

    half hour before the test; you will then be asked to

    void into a container.

    (3)Before voiding, the urinary meatus is cleansedwith an iodine solution and urine is voided into a

    sterile container; the container must not touch the

    penis.(4) You must void a few drips of urine, then stop;

    then void the remaining urine into a clean container,

    which should be immediately covered.

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    REPHRASE THE QUESTION

    AND REREAD IT WITH THEANSWER ASK:

    WHERE IS THE IMPORTANT INFO.? LOOK FOR KEY WORDS IN THE STEM

    SKIM FOR PIECES OF INFO

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    A 12-year-old boywas riding his biketo school when he

    hit the curb. He felland hurt his leg.The school nursewas called and

    found him alert,conscious but insevere pain with apossible fracture of

    the right femur.What is the firstaction that thenurse should take?

    (1)Immobilize theaffected limb with asplint and ask him

    not to move.(2) Make a thorough

    assessment of thecircumstancessurrounding theaccident.

    (3)Put him in semi-Fowlers position forcomfort.

    (4) Check the pedalpulse and blanchingsign in both legs.

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    A 12-year-old sixthgrade boy was

    riding his bike toschool when he hitthe curb. The boytells the school

    nurse, I think myleg is broken.What is the firstaction the nurseshould take?

    (1)Immobilize the affectedlimb with a splint andask the client not to

    move.

    (2)Ask the client to explainwhat happened.

    (3) Put the client in semi-Fowlers position tofacilitate breathing.

    (4)Check the appearanceof the clients leg.

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    A woman is admittedto the hospital with a

    ruptured ectopicpregnancy. Alaparatomy is

    scheduled.Preoperatively, whichof the following goals

    is most important forthe nurse to includeon the patients plan

    of care?

    1) Fluidreplacement

    2) Pain relief3) Emotional

    support

    4) Respiratorytherapy

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    The nurse plans care for

    a 14-year- old girl

    admitted with an eatingdisorder. On

    admission, the girl

    weighs 82 lbs. and is

    54 tall. Lab testindicate severe

    hypokalemia, anemia,

    and dehydration. The

    nurse should givewhich of the following

    nursing diagnoses the

    highest priority?

    Body imagedisturbance related toweight loss.

    (2) Self-esteemdisturbance related tofeelings of inadequacy

    (3)Altered nutrition:less than bodyrequirements related todecreased intake.

    (4)Decreased cardiacoutput related to thepotential fordysrhythmias.

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    Prioritization

    Initial

    Essential

    Vital

    Immediate

    Highest

    Best

    Most

    Priority

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    INITIAL OR FIRST-USE NURSINGPROCESS-ASSESSMENT FIRST

    BEST- ONE MORE ESSENTIAL ANDINCLUSIVE OF OTHERS

    PRIORITY- SAFETY AND ABCS

    MOST IMPORTANT- MASLOWS

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    a) Has a respiratory infection

    b) Is intubated and on a ventilator

    c) Has pleural chest tubesd) Post-op client with a high abdominal

    incision.

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    The nurse cares for a 72-year-old man with a

    diagnosis of cerebral vascular accident (CVA). The

    nurse is feeding the patient in a chair when he

    suddenly begins to choke. Which of the followingactions should the nurse take FIRST?

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    (1)Check for breathlessness by placing an ear over

    the patients mouth and observing the chest.

    (2) Leave the patient in the chair and apply vigorous

    abdominal or chest thrusts from behind the

    patient.

    (3)Ask the patient, Are you choking?

    (4) Return the patient to the bed and apply vigorous

    abdominal or chest thrusts while straddling the

    patients thighs.

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    A 35-year-old woman with a history of bipolar

    disorder is admitted to the psychiatric hospital. Shewas found by the police attempting to climb onto the

    wing of a plane at the airport. Her husband reports

    that she has not eaten or slept in two days, and he

    suspects she has stopped taking lithium. On

    admission, the nurse should place the highest

    priority on which of the following patient care

    needs?

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    (1) Teaching the patient about the importance of

    taking lithium as prescribed.

    (2)Providing the patient with a safe environment

    with few distractions.

    (3)Arranging for food and rest for the patient.

    (4) Setting limits on the patients behavior.

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    a) None, it was discussed by

    healthcare workers in a secludedarea

    b) They can be charged with slander

    c) They can be charged with libel

    d) None ,unless it has caused harm to

    the patient.

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    The nurse caresfor a 30 year oldpt on peritoneal

    dialysis. Theinfusate amountsto 2L. Later 1L isreturned. The

    nurse should:

    1. Turn the patientside to side

    2. Push thecatheter infurther

    3. Milk the catheter

    4. Press on theabdomen

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    The physician order a nasogastric tube inserted andconnected to low intermittent suction for a patient

    with an intestinal obstruction. Two hours after the

    insertion of the nasogastric tube, the patient vomits200 cc. While irrigating the nasogastric tube, the

    nurse notes resistance. The nurse should

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    (1) replace the nasogastric tube with a larger one.

    (2)turn the client on his left side.

    (3) change the suction from intermittent tocontinuous.

    (4) continue the irrigation.

    NLE I t th

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    NLE Isnt the

    Real World

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    The nurse is

    unable to

    identify a patient

    who is confused

    because his

    armband is

    missing. Which

    of the following

    actions by the

    nurse is best?

    1) Have the patients

    roommate identifyhim.

    2) Ask the patient to

    state his full name.

    3)Ask one of the other

    nurses to identify the

    patient.4) Look in the chart at the

    picture of the patient.

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    Always take care of the patient

    first

    before the equipment.

    A 36 ld 1) Determine all weights

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    A 36-year-old

    woman with a

    fractured left femur

    is placed on a

    Thomas splint and

    Pearson

    attachment. Thepatient tells the

    nurse she has

    terrible pain inher left thigh.

    Initially, the nurse

    should:

    1) Determine all weights

    and ropes from traction

    are in line and hanging

    freely.2) Ask the patient for more

    information about locationand characteristics of her

    pain.3) Check traction apparatus

    to make sure they are

    appropriately positioned.

    4) Explain to the patient that

    pain on the affected leg is

    a common occurrence.

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    Memorize normal lab

    values and be able to

    interpret them.

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    The physician orders furosemide (Lasix) and

    spironolactone (Aldactone) for a patient. Prior to

    administering the medication, the nurse determines

    that the patients potassium is 3.2 mEq/L. In addition

    to notifying the physician, the nurse should

    anticipate taking which of the following actions?

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    (1) Do not administer the Lasix or Aldactone.

    (2)Administer the Aldactone only.

    (3) Administer the Lasix only.

    (4) Administer the Lasix and Aldactone.

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    Dont pass the

    buck.

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    Think.the NLE wants toknow what you would DO!

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    A 53-year-old man

    is receiving packed

    RBCs. Severalminutes after the

    infusion is started,

    he complains of

    itching anddevelops hives on

    his chest and

    abdomen. Which ofthe following

    actions should the

    nurse take first?

    1) Slow down the rate

    of the transfusion.

    2) Call the physician for

    an order for an

    antihistamine.

    3) Mix IV fluid with

    blood to dilute it.

    4) Stop the transfusion.

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    RELATE AND APPLY

    PRINCIPLES CONCEPTS

    AND PROTOCOLS

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    1 Do not delegate assessment,

    teaching, or evaluation2 Delegate care for stable patientswith expected outcomes

    3 Delegate tasks that involvestandard, unchanging procedures

    4 Stable vs. unstable

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    Which of the following tasks is appropriate for the

    nurse to delegate to an experienced nursing

    assistant?

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    (1) Obtain a 24-hour diet recall from a patient recently

    admitted with anorexia nervosa.

    (2)Obtain a clean catch urine specimen from a patient

    suspected of having a urinary tract infection.

    (3) Observe the amount and characteristics of the

    returns from a continuous bladder irrigation for a

    patient after a transuretheral resection.

    (4) Observe a patient newly diagnosed with diabetes

    mellitus practice injection techniques using an

    orange.

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    After receiving a report from the night nurse,which of the following patients should the nurse

    see first?

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    (1) A 31-year-old woman refusing Carafate before

    breakfast.

    (2) A 40-year-old man with left-sided weakness

    asking for assistance to the bedside commode.

    (3)A 52-year-old woman complaining of chills who

    is scheduled for a cholecystectomy.

    (4) A 65-year-old man with a nasogastric tube who

    had a bowel resection yesterday.

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    Feelings reflected.

    Encourage verbalization.

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    Remember, dont ask why

    !

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    Eliminate Dont worry

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    Focus on the client, not on

    the nurse.

    A 35 year old man

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    A 35-year-old man

    has been

    hospitalized for

    treatment of

    hepatitis. When the

    nurse enters the

    room, he asks thenurse to leave him

    alone and stop

    bothering him.

    Which of the

    following responses

    by the nurse is

    appropriate?

    1) I understand and

    will leave you alone

    for now.

    2) Why are you

    angry with me?3) Are you upset

    because you do not

    feel better?4) You seem upset

    this morning.

    A patient in the 1) This is a hospital and

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    A patient in thepsychiatric unitasks the nurse,Am I in a specialradioactiveshelter? Which

    of the followingresponses madeby the nursewould be the

    mostappropriate?

    1) This is a hospital, andwe do not have a nuclearmedicine department

    here.2) Dont worry, you are

    safe. There is noradioactivity here.

    3) Im sure your safety is ofconcern to you, but this isa hospital.

    4) Please share with mewhat makes you thinkthere is a radioactivityhere.

    A 8 ld

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    A 58-year-old

    woman states

    she is afraid tohave her cast

    removed from

    her fracturedarm. Which of

    the following is

    the most

    appropriateresponse by the

    nurse?

    1) I know it is unpleasant.

    Try not to be afraid. I will

    help you.2) You seem very anxious.

    I will stay with you while

    the cast is removed.3) I dont blame you. Id

    be afraid also.

    4) My aunt just had a castremoved and shes just

    fine.

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    1 Are you trying to prevent orpromote?

    2 What are you trying to preventor promote?

    3 Think A & P

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    (1)Supine

    (2)Right side-lying

    (3)Left side lying(4)Semi-Fowlers

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    CALCULATEDINTELLIGENT

    DECISION MAKING

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    You have a body ofknowledge use it!

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    Think positively!

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