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April 24, 2024 16 mins

Have you ever found yourself stumped by those  'best' versus 'first' questions on nursing exams? Fear not! I'm here to coach you through mastering these tricky questions, a must-have skill for acing your tests and conquering the NCLEX. With my guidance, we'll dissect a practice scenario involving a patient with a leg injury after a car accident, emphasizing the critical decisions that can prevent limb loss and save lives. By the end of our session, you'll have a foolproof approach to these questions, armed with the know-how of double-checking answers for unparalleled clarity and accuracy.

Then, we'll switch gears and tackle assessment words that crop up in nursing scenarios, especially for those of you facing ATI exams. Imagine a patient rushing into the emergency room with a mosquito singing in their ear—what's your first move? Together, we'll go step-by-step through the assessment and intervention process for such an unusual and urgent situation, ensuring you're prepared for the unexpected. This episode isn't just about passing exams; it's about refining your instincts for those all-important initial actions that set the stage for effective clinical care. Join me, and let's boost both your confidence and your exam scores!

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Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
It's the Nursing Student Coach giving you the
strategies you need the most.
Hello everybody, and welcomeback to Nursing Student Coach.
My name is Lauren, I'm aregistered nurse and, as you've
probably heard me say many timesbefore, it is my personal

(00:22):
mission to help put more greatnurses into the world, and I
think one of the best ways to dothat is to help you, the
nursing student, the futurenurse, crush those nursing exams
by boosting your confidence,boosting your scores, and we
will do that.
One question at a time, onestrategy at a time.

(00:43):
We will break things down,simplify it.
If you're finding that you arelearning the information but
it's not quite translating whenyou go to take that test, or if
you're preparing for NCLEX rightnow and you are just
overwhelmed and need a littlerefresher, this podcast will
hopefully help you do thosethings.

(01:04):
Today I want to go over bestversus first questions.
I'm going to go through threeexample questions, three
practice questions.
We're going to break them down.
So let's get to it.
Guys, when it comes to bestversus first, you're going to
see this a lot which action bythe nurse is best and which

(01:27):
action should the nurse takefirst?
It's really important tounderstand the difference.
So when it comes to best bestmeans, you can only do that one
thing, you can say that onething, you can do that one
intervention and then you gohome.
So when you look through thatlist, you have to realize you

(01:50):
can only choose one thing.
What is the one best thing youcan do?
You cannot do any of the otherthings.
What must get done in order tonot kill your patient?
Order to not kill your patient,because in testing world, in
NCLEX and nursing school examworld, you have to not kill your

(02:15):
patient.
That's the priority, right.
And then, when it comes tofirst questions, which action
should the nurse take first?
That means you can doeverything else on the list, but
you need to pick what is themost important thing to do first
.
What's going to save their life, right?
All right, let's get to it.
Let's do an example question.
All of these questions comefrom ATI.
Maybe your school has ATI, buteven if it doesn't, they're a

(02:38):
great resource for practicequestions.
So here we go.
A nurse in the emergencydepartment is caring for a
client who reports pain in herleft leg following a motor
vehicle crash.
The nurse notes that her leftleg has bruising, swelling and
displacement of the bones.
Which of the following actionsshould the nurse take first?

(02:59):
Let's read it again, becausethat is the number one do and
the number one don't.
Number one do is to always readthe question twice.
Number one don't is.
Don't change your answer, butwe'll get to that.
A nurse in the emergencydepartment is caring for a
client who reports pain in herleft leg following a motor
vehicle crash.
The nurse notes that her leftleg has bruising, swelling and

(03:22):
displacement of the bones.
Which of the following actionsshould the nurse take first?
Okay, anytime you have aquestion, you always want to say
what is the most important wordin this question.
In this case, it is first.
Which action should the nursetake first?
And remember, you can do thisone thing, you can do everything

(03:44):
else, but this is the mostimportant thing to do first.
So let's realize that first isthe most important word.
Next, what are somecomplications that could develop
?
And if you're not sure, that'sokay.
But you want to start thinkingwhat are the clues that the
question is giving me beforeI've even started?
So the client has bruising,swelling and displacement of the

(04:09):
bones.
That is crucial.
If there's a dislocation, thencirculation is going to be your
biggest priority?
What's going to promotecirculation to that area and
below so that that patient doesnot lose their limb?
Remember life and then limb.

(04:29):
What's going to prevent yourpatient from losing their life
or their limb?
Let's look at the answers.
I'm just going to read them.
See what stands out to you.
Does anything stand out to youas either absolutely not, or you
know what that could be it?
One obtain an x-ray of theinjured leg.
Two apply ice packs to theaffected area.

(04:49):
Three check neurovascularstatus distal to the injury.
Four elevate the affected legon two pillows.
I'm going to read them allagain because you want to read
the answers twice as well.
One obtain an x-ray of theinjured leg.
Two apply ice packs to theaffected area.
Three check neurovascularstatus distal to the injury.

(05:11):
Four elevate the leg on twopillows.
What do you think?
Pick your answer, be confident,land on it and stick with it.
The correct answer is threecheck neurovascular status
distal to the injury.
And here's why, if you thinkabout Maslow's hierarchy of

(05:32):
needs, maybe you've gone overthat.
Physiological needs first,right, neurovascular checks,
checking pulses, checkingsensation distal to that injury
is going to be the best way.
First assessment you want to dohave them wiggle their toes,
have them touch their leg andask if they have sensation.

(05:54):
You want to promote circulationto that area.
You want to make sure that theyhave pulses, that they have
circulation going to that area.
That is the first thing youshould do.
Everything else, sure, you'llget an x-ray.
I mean it's clearly dislocatedand broken.
But you're going to confirmthat with an x-ray.
Apply ice packs.
Sure, you'll get an x-ray.
I mean, it's clearly dislocatedand broken, but you're going to
confirm that with an x-ray.

(06:15):
Apply ice packs.
Sure, you want to, you know,decrease the swelling, elevate
the leg.
Sure, that's going to promotecirculation.
But those are not priority.
Those are not what you want todo first.
So also, guys, here's a littleclue Anytime you see the word
check, it's a synonym for assess.
If you see assess, check, theseare assessment words and it is

(06:40):
very likely not always, but thatis very likely your answer.
So if you're in doubt and yousee check or assess, that's
probably it, especially in ATIworld.
All right, let's go to anotherone.
A client arrives at theemergency department stating
that a mosquito flew into theear and that they are hearing a

(07:01):
constant buzzing noise.
Well, that sounds prettyterrible.
Which intervention would thenurse take first?
I'm going to read it again Aclient arrives at the emergency
department stating that amosquito flew into the ear and
that they are hearing a constantbuzzing noise.
Which intervention would thenurse take first?
Again, what is the mostimportant word in this question?

(07:24):
When you are taking an exam,you want to read that question
twice and you want to say whatare my key words and what is the
question asking.
What is the most important word?
And here it is first, right.
So what is happening with yourpatient?
What's going on here?
Is their life in danger?
Are they at risk of losingtheir life?

(07:47):
Are they at risk of losing alimb?
Are they bleeding?
What are the most priorityinterventions?
Well, they stated that amosquito flew into their ear and
that it's constant buzzing.
They're not going to die.
We don't even know if themosquito is actually there.
They could be a psychiatricpatient.
So what is something you'd wantto do first?

(08:07):
Let's read through the answerchoices and see what stands out
to you as the thing that you'dwant to do first.
One initiate a consult for anear specialist.
Two look into the ear canalusing a headlamp.
Three irrigate the ear and tryto drown the mosquito.
Four use an ear forcep and tryto pull the mosquito out.

(08:29):
I'm going to read these again.
Guys, think about what standsout to you.
What sounds right, what soundswrong?
Is there anything we can getrid of?
One initiate a consult for anear specialist.
Two look into the ear canalusing a headlamp.
Three irrigate the ear and tryto drown the mosquito.
Four use an ear forcep and tryto pull the mosquito out.

(08:52):
Land on your answer and let'ssee what it is.
It is to look into the earcanal using a headlamp.
Here's the thing we don't knowif the mosquito is in there.
What is the least invasivething we can do to check and
make sure there actually is amosquito in there?
Well, we can look.

(09:13):
Let's look.
That's the least invasive.
You're looking, you'reassessing, you're doing an
assessment.
So it says here, maybe you werethrown off by headlamp.
I mean, are you really going toput a headlamp on?
Maybe if your ER has them?
But in reality you're probablygoing to look with the light
that's on the wall or your penlight if you carry one in your

(09:34):
pocket.
But yeah, you want to look.
That's what you'd want to dofirst.
Everything else, would you?
Would you initiate a consultwith an ear specialist?
Sure, would you stick a foreignobject into their ear first to
try to pull it out?
No, and you probably wouldn'tbe the one to do that.
Um, so let's see substancessuch as let me just suffocate

(09:59):
this.
Okay, you may want to do thesethings to irrigate the ear and
use a forcep, but that's notwhat you would do first, and you
probably wouldn't do thatwithout speaking to the doctor
first.
So the first thing you'd wantto do is look into the ear canal
using a headlamp.
What's the least invasive thing, right?
If they're not going to losetheir life, they're not going to

(10:19):
lose their limb why don't youjust look at it, assess the
situation, look into the earcanal using a headlamp, is your
answer.
All right, now we're going tomove into the other type of
question we were talking abouttoday the best question.
A six-year-old child has justbeen diagnosed with localized
Hodgkin's disease andchemotherapy is planned to begin

(10:42):
immediately.
The parent of the child asksthe nurse why radiation therapy
was not prescribed as part ofthe treatment.
The nurse would plan to makewhich best response.
Again, a six-year-old child hasjust been diagnosed with
localized Hodgkin's disease andchemotherapy is planned to begin
immediately.
The parent of the child asksthe nurse why radiation therapy

(11:05):
was not prescribed as part ofthe treatment.
The nurse would plan to makewhich best response.
Okay, what is the mostimportant word in this question?
It's best.
And what clue does that giveyou?
Well, it tells you.
I can only say this one thing.
So imagine you're the nurse.
You have a six-year-old patientand their parents are asking

(11:27):
you this question.
They want to know hey, my kidis about to start chemo.
Why wasn't radiation prescribed?
What is the best thing you cansay in this instance?
One, it's very costly andchemotherapy works just as well.
Two, I'm not sure.
I'll discuss it with theprimary healthcare provider.
Three, sometimes age has to dowith the decision for radiation

(11:51):
therapy.
Four, the primary healthcareprovider would prefer that you
discuss treatment options withthe oncologist.
All right, I'm going to readthem again.
One, it's very costly andchemotherapy works just as well.
Two, I'm not sure I'll discussit with the primary healthcare
provider.
Three, sometimes age has to dowith the decision for radiation

(12:14):
therapy.
Or?
Four, the primary healthcareprovider would prefer that you
discuss treatment options withthe oncologist.
Okay, guys, you want to pickthe best thing.
You want to pick something thatwill give the parents accurate
information and you want to notavoid their question.
You want to give them a direct,informed answer.

(12:37):
A direct, informed answer.
So I think, personally, I wouldrule out saying it's very
costly, it's extremelyinsensitive and it's not
something you'd want to give asan answer because it costs too
much.
Four, to say that the doctorprefers that you discuss it with
the oncologist.
No, you are equipped to providethis information.

(13:00):
You are the nurse.
So no, that would not be youranswer.
So, between two and three, whatdo you think, guys?
The answer is three.
Sometimes age has to do withthe decision for radiation
therapy and I know there mightbe some confusion here.
Ati isn't perfect, but whatthey say is you don't?

(13:21):
They're saying it's aninappropriate response and puts
the question on hold.
If you say I don't know, I'lldiscuss it with the provider.
I think in real life, if youdidn't know, let's pretend in
real life the parents ask youyou don't know, sure, you could
say you know what?
Let me just double check withthe provider so that I can give
you the best accurateinformation, or have them come

(13:45):
in here with me.
But in ATI land, nclex land,nursing school land.
You have the answers.
You have all of the information.
So what would the mostappropriate answer be?
Radiation.
Sometimes age has to do withthe decision for radiation
therapy.
Usually, I guess, radiation isput on hold until a child is

(14:08):
eight years old because of bonegrowth.
But if you didn't know that,you would have to just kind of
use process of elimination hereand understand ATI's rationale.
That saying you're not sure andyou'll discuss it with the
provider is not the best answer.
To say you want to give themaccurate information that
addresses their question andthat answers their question.

(14:30):
Okay, guys, I have lots morepractice questions like this.
If you like the episode thatyou heard today, let me know I
am going to make this episodethe last episode of season two
and I have 38 episodes fromseasons one and two that you can

(14:52):
go back and listen to.
If you've missed any, and letme know what you want to hear
next, we will be back withseason three.
I will let you know when we'recoming back, but you can always
find me on Instagram at nursingstudent coach, and you can find
me on my website.
Shoot me an email,nursingstudentcoachcom.
If you found today helpful.

(15:14):
I do offer private coaching,where this is one of the many
things we can do together.
We can break down thesequestions, go through questions
that are tripping you up so thatyou can boost your scores,
boost your confidence the nexttime you go to take one of those
exams, because I want you tosoar through nursing school, I

(15:35):
want it to be one of the bestexperiences of your life because
, on the other side, becoming anurse, becoming a registered
nurse, is the best thing of yourlife, because, on the other
side, becoming a nurse, becominga registered nurse, is the best
thing I could have ever done,and I am just so excited to help
you get there as well.
I hope you have an amazing day.
I love you all and until nexttime, bye-bye.
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