Nursing Exam: How To Surely Pass It

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The percentage of students who pass the board exam for nursing has been consistently low over the past decade. The average passing rate has never exceeded half of the total number of examinees, and last year’s figure of 34% has been one of the lowest nursing exam results. This leads nursing students to think: “How can I surely pass the nursing licensure examination?” As a teacher, I’ve been able to figure out the things that make students fail the board exam, and here are the tips that I would like to share with everybody who wants to surely pass the NLE:

1.       Make sure that your basic knowledge of nursing concepts is sufficient.

This is the most basic requirement for any student who wishes to pass the nursing exam – simply put, you won’t pass the exam without sufficient basic knowledge. If you don’t have a solid foundation, how would you be able to rationalize questions? Some students think: “It’s OK, I can rely on my review materials or a nursing review program.” But this way of thinking almost always leads to failure.

“How would I know if I have sufficient basic knowledge?” you might ask. Try to ask yourself questions that only require memory work and recall, like:

·         What’s the drug classification of Prednisone?

·         What parameters should I look at to assess a patient’s cardiovascular function?

·         What bones make up the skull?

Do you notice that the examples are “what” questions? This is how you could accurately gauge your basic knowledge. Are you able to tackle questions that only require you to look up the answer from your textbooks? The hard truth is this: if you can’t even answer these questions, then it is highly unlikely that you’ll pass the nursing exam. And I’m not kidding; it’s almost predictable that a student will fail if he or she cannot recall a body part, a drug’s action or a disease. Remember, this is the most basic requirement. If you lack knowledge, there’s only one thing to do: read.

2.       Practice answering sample board exam questions.

This is how you can develop your analytical and critical thinking skills, and this is how the Board of Nursing gauges your ability to think beyond the basic. In most cases, the nursing exam questions go with a situation that influences the way you will analyze them. Furthermore, most of these questions don’t have incorrect choices, meaning that you have to really think deeply to properly select the best answer. Take a look at this example:

Situation: Alex, a registered nurse, witnesses an old woman hit by a car while crossing the street and the old woman fell in the middle of it. Alex rushed at the scene.

As a registered nurse, Alex knows that the first thing that he must do is

a.       Leave the person for a few moments to call for help.

b.      Move the person to a safer place.

c.       Reduce the fracture manually.

d.      Encourage the person to remain still and immobilize the leg while waiting for an ambulance.

It’s not that easy to jump at one answer. Since there is a situation that modifies the question, you have to consider the circumstances in order to arrive at the best answer. And choosing the best answer is another thing: you notice that each choice seems to be a viable answer, and that requires you to choose the one that should be prioritized on the situation. In short, this question requires application and analysis, not mere recall of concepts. Reading your books is one thing, but to broaden your understanding and increase your chances of passing the nursing exam, you have to practice answering sample board exam questions.

3.       Base your answers on textbooks, not on your RLE.

The nursing exam is a theoretical exam, don’t forget that. One objective of the Board of Nursing is to make sure that nurses adhere to standards of practice, and the board exam is one of their measures to ensure that nurses will be guided to what is right. Don’t base your answers from what you see in your related learning experience, as some nurses in hospitals, community health centers and other field areas perform tasks that not are not within the standards of practice.

A classic example is when the IV line becomes clogged. It is observable that some nurses in the area would get a syringe, place it on the IV port, aspirate some fluid from the patient’s end, and push it back. This causes confusion for the learner, and what makes things worse is that clinical instructors even tell them that this is the right thing to do, and that we are permitted to deviate from the standard in these situations. What’s the point of reading and studying books if we won’t apply it?

Keep in mind that the practice standards set what is right, and the right answer for nursing exam questions is always based from it.

4.       Develop your reading endurance.

Some people read fast, some read slow – and it’s perfectly fine because we process information differently. But you can’t make it as an excuse to not finish a single chapter because of your slow reading rate. You have to develop your reading endurance to keep up with the coverage of the nursing exam. Set yourself to finish at least a 30-page portion of a book or a chapter every day. If you’re a person who can’t finish reading a chapter in 2 hours, you can have a short break and continue reading afterwards. Keep in mind that reading is also a skill, and it can be improved. Keep on reading, and reading, and reading – you’ll be surprised later that you already know a great deal.

5.       Give your brain a rest.

Although it’s beneficial to have extensive periods of studying, rest is equally important for the nursing exam. Our brains are just like computers, and it needs some time to rewire. The ideal reading time would only be 2 hours; after that, you need to rest your mind, do a little stretching, and find ways to relax. Have adequate sleep and rest periods. Have fun and socialize; this is absolutely fine as long as you are able to meet your study objectives and balance your time.

Don’t overdo your review for the board exam, after all too much of everything is always bad. It’s good practice to finish at least one chapter and 100 practice questions every day.

Remember these tips, and keep on reading and answering practice questions. Repetition is the key to mastering the concepts and the more prepared you are, the more that you’ll surely pass the nursing exam.

How To Treat A Sore Throat And Cold

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A sore throat and cold are common ailments that can be caused by a lot of factors, and many people would like to know how to treat a sore throat and cold on their own. The term ‘cold’ is a non-medical term; a cold is a condition that has the combined symptoms of fever, malaise, nasal congestion and runny nose. Although the most common causes of sore throats and colds are respiratory infections, it can also be caused by non-infectious factors, like cigarette smoke. Other factors such as weather changes and allergies to pollen can also trigger these conditions.

How To Treat A Sore Throat And Cold On Your Own

Although it’s advisable to seek first the opinion of a doctor, sore throats and colds can be treated at home. Here are the things that can be done:

• Gargle with warm saline solution or oral antiseptic solutions if symptoms persist.
• Get ample sleep.
• Drink plenty of water.
• Sneeze out nasal secretions to clear the upper respiratory tract.
• In case of fever, take antipyretics such as Paracetamol every four hours as needed.
• Get fresh air.
• Stay away from irritants such as cigarette smoke. Don’t smoke while symptoms persist.
• Avoid known allergens such as pollen or dust.

 How To Treat A Sore Throat And Cold If Self-Treatment Doesn’t Work

If the sore throat and cold is caused by infection, and if the above self-treatment is followed, it is expected for the condition to subside. But if symptoms persist for more than two weeks, you should consult a doctor and follow professional guidelines on how to treat a sore throat and cold. Here are the things that you must bear in mind:

• Always take antibiotic treatment on schedule. Don’t skip or miss doses.
• In case decongestants are prescribed, don’t stop the treatment abruptly to prevent rebound congestion.
• In case the patient has difficulty breathing, follow the proper guidelines in nebulization.
• If the patient develops symptoms of allergy from medication, stop taking them and consult the doctor.

 How To Check If Treatment Is Effective

• Ask the patient if swallowing is still difficult.
• Note for any signs of dyspnea (difficulty of breathing), such as grunting, labored breathing, and shortness of breath.
• Observe if the patient is still sneezing and coughing.
• Ask the patient if he is still experiencing a runny nose.
• Check the temperature.

 When You Should Seek More Medical Help

However, if symptoms still persists even with the doctor’s advice, the person experiencing the illness must seek further consultation and emergency treatment. Here are some things can indicate the need for further medical treatment:

• When the tonsils become more swollen
• When the patient is unable to talk or breathe
• When the patient verbalizes increased difficulty of breathing
• When fever is not subsiding
• When the patient becomes unconscious
• When the patient becomes cyanotic (bluish discoloration of the skin)

The key is to prevent the worsening of symptoms and avoiding allergens and other respiratory tract irritants. In addition, it would be very beneficial if we maintain a healthy lifestyle and a balanced diet to increase our body’s resistance. How to treat a sore throat and cold can be relatively easy.

What You Should Put In Your Nursing Assessment Documentation (part 2)

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In part 1 of our discussion, we have pointed out that limiting your nursing assessment with the sign or symptom would result in a poorly planned and executed care plan. Aside from the sign (1), the nurse should note the (2) onset, (3) location, (4) duration and (5) character of the sign or symptom. Let’s continue, shall we? (Later, we will also have a nursing assessment example that applies what we have discussed here.)

6.       Aggravating factors. Aside from the sign and symptom, the nurse should also look at the possible causes and risk factors that brought about the problem. If the client is experiencing stomach cramps, you could ask about things that usually cause or trigger stomach cramps. “Do you drink coffee?” “How many cups of coffee do you drink in a day?” “Do you frequently eat spicy food?” “What was the last food that you ate?”

Aside from exploring the etiology and risk factors, the nurse should include information that makes the symptoms worse in the nursing assessment documentation. For a person experiencing difficulty of breathing (DOB), you could ask the patient if he had any strenuous activity prior to the onset of DOB. Does he smoke? How many cigarettes per day?

7.       Relieving factors. Likewise, the nurse should also explore about things that lessen or alleviate the symptoms felt by the patient. In our example regarding stomach cramps, we could ask the patient regarding the medications that he takes. Does the medication relieve the symptoms? Other than medications, is there anything else that the patient does that lessens the symptom?

8.       Timing of the sign/symptom. This assessment parameter in the nursing assessment documentation, the nurse takes note of the frequency of the symptom, and which time of day do the symptoms appear. Going back to our client experiencing stomach aches, we could ask: “Is there any particular time of the day that you experience stomach cramps?” “How many times in a day do you feel these stomach cramps?” Moreover, the nurse should also note of the time interval between symptoms.

9.       Severity. This is perhaps one of the most important parameters that should be included in the nursing assessment documentation. Aside from the character of the symptom, patients are also particular with the severity of what they are experiencing. The perfect example to demonstrate the assessment of severity is pain: how painful is it? One great tip in assessing the severity of pain is by using a pain scale. On a scale of 1-10, with 10 being the highest level of pain, have the patient rate the pain using the scale. With children, the nurse can use the Wong-Baker Faces Pain Scale.

In exploring a patient’s sign or symptom, remember this acronym: OLDCARTS (onset, location, duration, character, aggravating factors, relieving factors, timing and severity). Although there are many things to explore about a symptom, this guide is already a good start for you to have substantial nursing assessment documentation. Aside from our discussion, don’t forget to always practice your assessment skills. Know your patient, and learn how to ask assessment questions properly. Moreover, keep in mind that nursing assessment is not just about knowledge and skills; you have to learn how to interact well with your clients to help identify their nursing problem and formulate the appropriate nursing care plan for the problem.

What You Should Put In Your Nursing Assessment Documentation (part 1)

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Most nurses struggle with what to put on the patient’s chart or with a good working nursing assessment example, especially when it comes to putting assessment data on the nurse’s notes. Nurses often ask themselves where to draw the line between relevant and irrelevant data, and “too much” or “too few” data - and this becomes a source of numerous documentation problems. When the chart lacks substantial data, the nurse finds it difficult to determine a patient’s problem. Consequently the nursing care plan would be inefficient in solving the problem. On the other hand, if the nursing assessment documentation has too much data, it would create confusion for the nurse on how to properly cluster and organize it to come up with a relevant care plan.

With this in mind, it’s time to ask: what should you put in your nursing assessment documentation, to ensure that you would be able to accurately identify a nursing diagnosis and make the necessary plan of care for that diagnosis? While there are numerous ways to make proper documentation, let me share with you a tested framework that can help you achieve accurate and relevant documentation:

1.       Identify the sign or symptom. This is always the first thing to do. Is the client experiencing pain? Fever? Cough? Difficulty walking? A problem with urinating? If you’re going to ask the patient about a symptom, it’s categorized as subjective data, and should be included in the patient’s health history. With subjective data, you should take note of the patient’s verbalizations as he describes it. If you found a sign during a physical exam, you must document the sign with the appropriate term (i.e. ecchymosis, pallor, cyanosis)

2.       Ask about the onset of the sign or symptom. When did it start? Whatever the client states, it would give you an idea of whether the problem is long-term or short-term. It’s not enough to document only “cough” in your nursing assessment documentation. Having knowledge of the onset will also hold a clue to the cause of the problem. A short onset of cough can be caused by a common viral infection, while a cough that started three months ago may be due to chronic obstructive pulmonary disease.

3.       Where’s the symptom located? Is the problem located in a small region of the skin? Does it involve a larger portion, like a limb? Does the symptom occur bilaterally? Do the signs occur on the whole body? Having noted the symptom’s location would hold clues on the characteristics of the disease. Local lesions that progress to systemic lesions over a period of time could tell that the disease is worsening. The location would also tell which part of the body is experiencing a pathological condition. For example, pain felt at the right upper quadrant of the abdomen might be due to a liver or gallbladder disease.

4.       How long has he been experiencing this symptom? Having knowledge of the duration of the problem is equally important; it can determine if the problem is acute or chronic. Acute pain can be attributed to short-term injury or inflammation, while pain that has been occurring for more than 6 months might be a signal for a chronic condition such as cancer.

5.       Let the patient characterize the symptom. Taking note of the character of the symptom on the nursing assessment documentation can significantly improve the way nurses diagnose and treat client responses. A patient who describes an “excruciating” pain on his limbs might be experiencing a fracture. A client who is experiencing a “hacking” cough might be developing lung cancer. A patient who tells that “something kinda gave way” on his operative site might be experiencing wound dehiscence.

Remember that documenting the symptom or sign alone is not enough; you have to know and document the (1) onset, (2) location, (3) duration and (4) character of the sign or symptom. 

Click for part 2 of this discussion.

Nursing Assessment: Why It's Important

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Most nurses see it as a challenging task to make accurate and comprehensive nursing assessment documentation because there are lots of factors that affect the process. A good nursing assessment can be obtained if the nurse has the ability to consider both nurse factors and client factors, and adapt effectively with the situation brought about by these factors.

Most nurses take nursing assessment for granted; even though the topic is constantly being emphasized in lectures. Most nurses are very much preoccupied with medication administration, assisting with medical procedures and carrying out of doctor’s orders, but they fail to realize that the nursing process is the core of their profession, and nursing assessment is the first step. It is necessary to point out that the nursing process involves a step-by-step procedure, thus a poorly conducted assessment will lead to a poorly executed care plan.

Nursing assessment is important, and here’s why:

• It provides basis for formulating nursing diagnoses. Nursing assessment is perhaps the most important step of the process because it will direct you to precisely diagnose a client’s response to illness. Without assessment, the nurse would be unable to determine which aspect of the client’s health needs nursing assistance. It’s also parallel with the medical process, where the physician gathers the necessary data in order to arrive at a medical diagnosis. It’s just like detective work: how can you establish the case if you don’t have evidence to prove it?

• It guides the care plan. The assessment data also helps the nurse in setting the outcome criteria that are needed in the care plan. For example, if the client is experiencing fever, the nurse would accordingly set outcomes related to temperature regulation. 

• It provides baseline for evaluation. Assessment also directs the final step of the nursing process: evaluation. The data that you’ve gathered provides baseline values, and it tells the degree of deviation from the normal values. If the data are accurate and comprehensive, it would be easier for the nurse to set outcome criteria and determine if the client’s condition has improved based on the criteria. 

• It complements other people’s efforts for the patient. Aside from the benefits brought to the nursing process, nursing assessment also helps the other members of the healthcare team; if some piece of data about the client was not uncovered or examined by the other healthcare team members, the assessment data made by the nurse might have the necessary data that would fill it up. That’s the good thing about working with a team; even though each member uses the patient data differently, the data can be used by the whole team.

There are numerous points to consider why nursing assessment is important, but the crucial point is that without accurate and comprehensive assessment, it’s virtually impossible to carry out any nursing care plan.