KAPLAN DECISION TREE FOR ANSWERING QUESTIONS

STEP ONE: Can you identify the topic of the question?

NO

YES

Trap: NCLEX hides

the topic of the
question

Read answer choices for clues

Identify the topic of the question
Proceed to Step2

Proceed to Step2

STEP TWO: Are the answers assessments or implementations?

A mix of assessments and

Implementations?

Trap: Is validation
required?

Are answers all

Assessment or
Implementation?

Read stem of question to

Determine if you should
Assess or implement

Proceed to Step3

Select correct answer.

STEP THREE: Does Maslow fit?

NO

YES

Are all answers physical?

Proceed to Step4

Trap: Physical needs take

priority over psychosocial
needs. Eliminate pain, its
considered as psychosocial
Are all answers psychosocial?
need.
Proceed to Step5

Eliminate Psychosocial answers

Do the physical needs make

sense?
Apply ABCs.

STEP FOUR: Are all answers physical?

Trap: Dont
automatically select
respiratory answers.

NO

YES

Proceed to Step5

Apply ABCs

STEP FIVE: What is the outcome of each of the remaining answers?

Trap: Dont select
answers that sound
right. Do evaluation,
ask yourself, If I do
this, what will the
outcome be?
Determine outcome of each answer. Is it desired?

Select correct answer

ANSWERING STRATEGIES
1. Read word for word.
2. Determine what the question is asking>FIGURE IT OUT, ANALYZE, THINK!
3. Look for danger words: FIRST, INITIALLY, HIGHEST PRIORITY, MOST IMPORTANT, BEST, MOST
CONCERNED
4. Picture the question, use imagery
5. Clang Association- sometimes a word/phrase in the question comes out exactly at the correct answer
6. Hold the phone- if the doctor is on the phone, you should not answer it, care for the PATIENT FIRST
7. Think before calling physician- do independent nursing actions first then assess outcome then report to
physician.
Ie: If px has fracture on upper and lower extremity, assess first for neurologic/circulatory defects. If px
complains(subjective assessment), do an objective assessment (vital signs) THEN call doctor.
Tip: get complete assessment, subjective and objectiveif subjective only, its unreliable.
8. Know whats normal, know lab values
9. Look for clues, DO EVERYTHING BY THE BOOK!
10. Reword/rephrase the question
11. 2 choices of same content, ELIMINATE!
12. Umbrella answer is the right answer
13. Choose HERE and NOW answer

14. Use nsg process

15. Use Maslow
16. Real prob is a priority vs. potential prob
17. Predict outcomes
18. Ask yourself, does this answer make sense? Does it answer the question?
19. Dont choose answers with absolutes: ALL, ABSOLUTELY, ENTIRE, ONLY, ALWAYS, TOTAL,
EVERY, EACH, MUST etc.

NCLEX TOPICS
I.

Chain of Command- probs associated with co-workers>inform to YOUR NSG SUPERVISOR BUT
if the outcome of the action of the co-worker is harmful to the patients rights in the HERE and
NOW, you can call their attention.
Ie. If you hear two nurses talking about a patient in the elevator, mentioned the name and case,
you call their attention then report to nsg supervisor.

II.

Rule of Cohorting- patient with infection put in a room with another patient with the same infection.

III.

Rules of Delegation
1. RNs: a. dont delegate assessment, teaching, evaluation to LPN, UAP (unlicensed assistive
personnel), Nsg aide
b. delegate STABLE patient with EXPECTED outcomes
TIP: 24hr post-op patient is considered stable
c. delegate tasks that involve STANDARD UNCHANGING tasks ie. Bed bath, feeding,
bed
making
2. RNs communicate to health team about changes in patients condition
3. LPNs CAN: a. perform STERILE dressing changes, sterile technique
b. give SQ, IM, PO meds but NOT IV, NEBU & TOPICAL
c. give supplementary health teachings
d. do suctioning, catheterization

IV.

Pleur-Evac Dislodgment
1. If youre asked what to do when its dislodged FROM THE PATIENT:
Question asks What to do: a. FIRST: choose Cover opening on patients chest with any
CLEAN
Material possible.
b. BEST: choose Cover opening on patients chest with STERILE
VASELINIZED GAUZE
GOAL: prevent air from entering
2. If youre asked what to do when its dislodged FROM THE CHAMBER:
Question asks What to do: a. FIRST: choose Insert/Submerge tube tip in a container with
STERILE
NSS
b. BEST: choose CLAMP tube farthest from the patient.
V. Fetal Heart Rate
1. Early deceleration- normal finding; due to head compression
- FHR decelerates at the BEGINNING of contraction then return to baseline

AFTER

Contraction
2. Variable deceleration- due to cord compression
- FHR decelerates without regard with the contraction
-Intervention: decrease perineum; knee-chest position, elevate foot of
bed
3. Late deceleration- due to utero-placental insufficiency
- FHR decelerates at the PEAK or AFTER peak of contraction then returns
to baseline
after contraction
- Intervention: turn mom to left side
VI. AV Fistula
Assessment for: a. Thrill- put finger over fistula and feel
b. Bruit- auscultate
VII. Immunization
Birth- Hep B

1 mo- Hep B

2 mos- IPV, Dtap , Hib

4mos- IPV, Dtap, Hib

6mos- IPV, Dtap, Hib, HepB 12-15mos- Hib, MMR
12-18mos-Dtap, Varicella Zoster
4-6yrs-IPV, Dtap, Hib 11-12yrs- MMR(if not given at 46yrs)
11-16yrs- Td
Legend: IPV-Inactivate Polio Virus (via IM) Dtap-Diptheria, tetanus, pertussis
Hib- Hemophilus Influenza B
Td- Tetanus toxoid
Types of Vaccines:
a. Component Vaccines- Hib, Pneumococcal, Hep A/B
b. Live Vaccines- MMR, OPV, Chicken Pox/Varicella
*cant be given to immunocompromised patients
c. Killed/Inactivated Vaccines- Inactivated influenza vax, IPV(Salk Vaccine)
d. Toxoid Vaccine- DPT, Td
VIII. Cultural Differences
A. Chinese Amer may nod head to indicate yes or shake head to mean no
- Excessive eye contact means rudeness
- Excessive touching is offensive
- Nsg implications: ask questions carefully and clarify responses
- YIN- cold/ negative force
- YANG- hot/positive force
B. Islam- no pork and alcoholic beverages allowed
- prefer foods with HALAL seal
- prior to death, family members are asked to be present so they can read the
Koran and
Pray with the client.
- must face Mecca(where the sun rises) and confess sins, beg for forgiveness in the
presence of the family
- burial is done ASAP before sundown
-donation of organs is prohibited
C. Amer Indian/ Native Amer
- prone to accidents, alcohol abuse, TB, arthritis
-lactose intolerant
-does yoga (mind body therapy)
D. Jehovahs Witness
- blood transfusions violate Gods law, prefer to die than transfuse blood
-food with blood is prohibited

-can consume animal meat that has been drained from blood
-give plasma expander instead of blood transfusion
E. Orthodox Jews
Kosher Diet- prohibit mixing of meat and milk in one meal
-if both meat and milk eaten at the same meal, body should not be
touched for
48hours .
-utensils used for meat cant be used for milk or non-kosher food
-fish, eggs, fruits, vegetables and grains can be eaten with either meat or
dairy
-meats allowed: animals thatre vegetable eaters, cloven-hoofed animals,
animals thatre ritually slaughtered (sheep, cattle, goats, dear)
-fish with scales are allowed
-During Yom Kippur-24 hour fasting
- Passover week, only unleavened bread is eaten
F. Russian Orthodox
-abstain from meat and dairy products on Wed, Fri and Lent
-during Lent, all animal products, including dairy are prohibited
-fasting during Advent, exception are illness and pregnancy
-can transplant organs except HEART