A second strategy that will assist you in establishing priorities involves the data collection and implementation steps of the nursing process. As a practical/vocational nursing student, you have been drilled so that you can recite the steps of the nursing process in your sleep—data collection, planning, implementation, and evaluation. In practical/vocational nursing school, you did have some test questions about the nursing process, but you probably did not use the nursing process to assist you in selecting a correct answer on an exam. On the NCLEX-PN® exam, you will be given a clinical situation and asked to establish priorities. The possible answer choices will include both the correct data collection action and implementation for this clinical situation. How do you choose the correct answer when both the correct mode of data collection and implementation are given? Think about these two steps of the nursing process.
Data collection is the process of establishing a data profile about the client and his or her health problems. The nurse obtains subjective and objective data in a number of ways: talking to clients, observing clients and/or significant others, taking a health history, evaluating lab results, and collaborating with other members of the health care team.
Once you collect the data, you compare it to the client’s baseline or normal values. On the NCLEX-PN® exam, the client’s baseline may not be given, but as a practical/vocational nursing student you have acquired a body of knowledge. On this exam, you are expected to compare the client information you are given to the “normal” values learned from your nursing textbooks.
Data collection is the first step of the nursing process and takes priority over all other steps. It is essential that you complete the data collection phase of the nursing process before you implement nursing activities. This is a common mistake made by NCLEX-PN® exam takers: don’t implement before you collect data. For example, when performing cardiopulmonary resuscitation (CPR), if you don’t access the airway before performing mouth-to-mouth resuscitation, your actions may be harmful!
Implementation is the care you provide to your clients. Nursing interventions may be independent, dependent, and interdependent. Independent nursing interventions are generally not within the scope of the LPN/LVN’s nursing practice. However, the LPN/LVN can follow established care plans, standards of care, and established protocols. For example, the LPN/LVN can instruct a client to turn, cough, and deep-breathe after surgery. Dependent interventions are based on the written orders of a physician. On the NCLEX-PN® exam, you should assume that you have an order for all dependent interventions that are included in the answer choices.
This may be a different way of thinking from the way you were taught in practical/vocational nursing school. Many students select an answer on a nursing school test (that is later counted wrong) because the intervention requires a physician’s order. Everyone walks away from the test review muttering “trick question.” It is important for you to remember that there are no trick questions on the NCLEX-PN® exam. You should base your answer on an understanding that you have a physician’s order for any nursing intervention described.
Interdependent interventions are shared with the RN and other members of the health care team. For instance, nutrition education would be directed and supervised by the RN and may be shared with the LPN/LVN and the dietician. Chest physiotherapy may be directed and supervised by the RN and shared with a respiratory therapist and an LPN/LVN.
The following strategy, utilizing the data collection and implementation phases of the nursing process, will assist you in selecting correct answers to questions that ask you to identify priorities.
Step 1. Read the answer choices to establish a pattern.
If the answer choices are a mix of data collection/validation and implementation, use the Nursing Process (Data Collection vs. Implementation) strategy.
Step 2. Refer to the question.
Determine whether you should be collecting data or implementing.
Step 3. Eliminate answer choices, and then choose the best answer.
If after Step 2 you find that, for example, it is a data collection question, eliminate any answers that clearly focus on implementation. Then choose the best data collection answer.
Try this strategy on the following question.
THE REWORDED QUESTION: What nursing priority should the LPN/LVN identify in this scenario? What are the risks for a client after abdominal surgery?
Step 1. Read the answer choices to establish a pattern.
There is one data collection answer, (4), and three implementation answers, (1), (2), and (3). You can use the Nursing Process (Data Collection vs. Implementation) strategy.
Step 2. Refer to the question to determine if you should be collecting data or implementing care.
You know that bleeding is a risk for all surgical abdominal wounds. According to the nursing process, you should collect data first.
Step 3. Eliminate answer choices, and then choose the best answer.
Eliminate answers (1), (2), and (3), which are implementation answers. You are left with only one answer choice, (4). Clients with abdominal surgical wounds often find their most comfortable position lying on their backs in bed. Fluid, namely blood, flows via gravity to dependent areas. A cursory look at the top of the dressing may reveal no drainage; however, when the client is rolled to her side, a pool of blood could be noted if the wound is hemorrhaging. Even if this had not occurred to you, you are still able to correctly answer this question using the data collection versus implementation strategy.
Let’s look at another question.
The words “first action” tell you that this is a “priority” question.
THE REWORDED QUESTION: What is the highest priority for a fractured femur?
Step 1. Read the answer choices to establish a pattern.
The answer choices are a mix of data collection and implementation, so use the Nursing Process (Data Collection vs. Implementation) strategy.
Step 2. Determine whether you should be collecting data or implementing.
According to the question, the LPN/LVN has determined that the boy has a possible fracture. This implies that the LPN/LVN has completed the data-collection step. It is now time to implement.
Step 3. Eliminate answer choices, and then choose the best answer.
Eliminate answers (2) and (4) because they involve data collection. This leaves you with choices (1) and (3). Which takes priority: immobilizing the affected limb, or placing the boy in a semi-Fowler’s position to facilitate breathing? The question does not indicate the boy is experiencing any respiratory distress. The correct answer is (1), immobilize the affected limb.
Some students will choose an answer involving the ABCs without thinking it through. Students, beware. Use the ABCs to establish priorities, but make sure that the answer is appropriate to the situation. In this question, breathing was mentioned in one of the answer choices. If you thought of the ABCs immediately without looking at the context of the question, you would have answered this question incorrectly.
Look at this question in another form.
Step 1. Determine whether you should be collecting data or implementing. In this question, the client has stated, “My leg is broken.” This statement is not the LPN/LVN’s assessment. This alerts the LPN/LVN that there is a problem, and the LPN/LVN should begin the steps of the nursing process. The first step is data collection.
Step 2. Eliminate answers (1) and (3). These are implementations.
Step 3. What takes priority? Examination of the leg takes priority over investigation into what happened to cause the accident. The correct answer is (4).