STRATEGIES FOR ALTERNATE ITEM FORMATS

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STRATEGIES FORALTERNATE ITEM FORMATS

• Linda Anne Silvestri, MSN, RN
• AUTHOR
• Saunders Pyramid to Success for the NCLEX-RN
  Examination
• Elsevier Health Sciences

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TYPES OF QUESTIONS

• Multiple Response
• Fill-In-The-Blank
• Prioritizing (Ordered Response) Drag and Drop
• Figure or Illustration
• Chart/Exhibit

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MULTIPLE RESPONSE

• Can ask about various nursing content areas, such
  as interventions, assessment findings, intended
  medication effects, side effects or adverse
  effects, or expected responses to treatment.
• You will use the computer mouse and click in a
  small box.
• You need to do exactly as the question asks,
  select or check ALL options that apply.
• There is no partial credit given for correct
  selections.

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MULTIPLE RESPONSE STRATEGIES

• Read the data and determine exactly what the
  question is asking (subject of the question).
• Use nursing knowledge and clinical learning
  experiences.
• Think about the pathophysiology associated with
  the disorder, if a disorder is presented in the
  question.
• Visualize the situation in the question and think
  about what applies.
• Form a mental image of the situation.

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MULTIPLE RESPONSEA nurse is caring for a client
receiving intravenous (IV) therapy who is
exhibiting manifestations of circulatory
overload. What nursing interventions should the
nursetake? Select all that apply. 1. Remove
the IV 2. Monitor vital signs 3. Notify the
physician 4. Prepare to administer oxygen 5.
Place the client in an upright position 6.
Prepare to administer a prescribed diuretic

• Answer 2, 3, 4, 5, 6

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FILL-IN-THE-BLANK

• You will need to perform a medication
  calculation, calculate an intravenous flow rate
  or infusion time, or calculate an intake or
  output record on a client.
• You will need to type in your answer and the
  answer will be in a numeric format.
• Round the answer to the nearest tenth or whole
  number as directed
• An intake and output calculation question may
  require that you convert ounces to mL.

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FILL-IN-THE-BLANKSTRATEGIES

• Always follow the directions.
• Read the question and set up the formula on the
  erasable noteboard.
• Be alert to the need to perform conversions.
• Perform the calculation and verify your answer
  using the on-screen calculator.
• Round answer to the nearest tenth or to a whole
  number if asked to do so.
• Place a zero before a decimal point and avoid
  placing trailing zero(s) following the decimal
  point in the answer.

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FILL-IN-THE-BLANKA client drank 6 oz of juice
and 8 oz of tea for breakfast 4 oz of water to
swallow medications at 900 am and 4 oz of water
at 100 pm and 8 oz of milk and 8 oz of coffee
for lunch. The nurse determines that the client
consumed how many mL of fluid?Answer ________mL

• Answer 1140

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PRIORITIZING (ORDERED RESPONSE) DRAG AND DROP

• You will need to use the computer mouse and drag
  and drop the answers in order of priority.
• You may be asked to prioritize nursing
  interventions or the steps in a procedure you
  need to determine what you will do first, second,
  third, and so forth.

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PRIORITIZING (ORDERED RESPONSE) STRATEGIES

• Use the ABCs, Maslows Hierarchy of Needs theory
  , and steps of the nursing process
• Visualize or form a mental image of the situation
• Use teaching and learning principles
• Remember Hands are always washed before any
  client contact
• Remember Treatments and procedures are always
  explained to the client before implementation
• Remember The nurse checks for a signed informed
  consent before any invasive procedure
• Remember Documenting a clients condition and
  response to treatment is done following care and
  implementation of treatments

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• PRIORITIZING (ORDERED RESPONSE)
• Question
• List in order of priority the steps that the
  nurse takes in performing adult cardiopulmonary
  resuscitation. Drag and drop the actions in order
  of priority.
• Open the airway
• Check for breathing
• Give two slow breaths
• Check for a carotid pulse
• Begin chest compressions
• Establish unresponsiveness

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• PRIORITIZING (ORDERED RESPONSE)
• Answer
• List in order of priority the steps that the
  nurse takes in performing adult cardiopulmonary
  resuscitation. Drag and drop the actions in order
  of priority.
• Establish unresponsiveness
• Open the airway
• Check for breathing
• Give two slow breaths
• Check for a carotid pulse
• Begin chest compressions

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FIGURE/ILLUSTRATIONSTRATEGIES

• You will be provided with a visual item and will
  need to answer the question based on that item.
• Examples rhythm strips, orthopedic or other
  assistive client devices, anatomical areas of the
  body, or medication labels.
• Read all of the data and focus on the
  figure/illustration and what it is representing
• Ask yourself, What is the question asking
  about?
• Use nursing knowledge and clinical learning
  experiences
• The question could be presented in any format
  including multiple choice, fill-in the-blank,
  multiple response, prioritizing (ordered
  response), or chart/exhibit.

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FIGURE/ILLUSTRATION

• The nurse looks at a hospitalized clients
  cardiac monitor screen and notes this cardiac
  rhythm. The nurse prepares to administer which
  priority measure?
• 1. Defibrillation
• 2. Measurement of the vital signs
• 3. Insertion of an endotracheal tube
• 4. Administration of antidysrhythmic medication
• Answer 1

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CHART/EXHIBIT

• These questions will most likely provide you with
  data from a clients medical record and will ask
  you a question about that data.
• They may also provide you with an exhibit of some
  type, such as a physicians order form with
  written orders or a laboratory result form
  listing results from various laboratory tests.
• These questions will most likely be in the
  multiple choice format but may also be presented
  in other types of alternate item question
  formats.

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CHART/EXHIBITSTRATEGIES

• Read all of the data in the chart or exhibit.
• Avoid skimming over the information presented.
• Focus on the subject of the question
• Use nursing knowledge and clinical learning
  experiences to answer correctly
• Identify a relationship between the subject of
  the question and the data provided
• See example on the next slide

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Clients Chart
History Medications Diagnostic Tests
Diabetes mellitus NPH Insulin 16 Units subcutaneous daily Electrocardiogram normal
Gout Allopurinol (Zyloprim) 100 mg po daily Chest x-ray normal
Hypertension Atorvastatin (Lipitor) 10 mg po daily
Metaprolol tartrate (Toprol XL) 50 mg po daily
Ramipril (Altace) 5 mg po daily

• Prednisone (Deltasone) is prescribed for a
  hospitalized client with severe rheumatoid
  arthritis. Which daily laboratory result should
  the nurse monitor most closely?
• 1. Lipase level
• 2. Chloride level
• 3. Uric acid level
• 4. Blood glucose level
• Answer 4

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• ELSEVIER HEALTH SCIENCES
• WISHES
• YOU
• THE BEST SUCCESS
• IN YOUR
• NEW CAREER!