I. PRINCIPLE OF CONTRADICTION
When two options contradict each other, there is a higher chance of one of them being the correct answer.
Example: Which physiologic effect should the nurse expect in a client taking anticholinergics?
A. Dilated pupils
B. Constricted pupils
II. PRINCIPLE OF COMMONALITY AND DIFFERENCE
Two or more options that have the same essential configuration and thought are unlikely the correct answer.
Example: When injecting subcutaneous injection in an obese patient, it should be angled at around:
D. Parallel to the skin
III. PRINCIPLE OF CENTRAL TENDENCY
Correct answers in an all numeric options is most likely located in between the extremes.
Example: What is the KVO rate of BT?
A. 5 gtts/min
B. 9 gtts/min
C. 15 gtts/min
D. 20 gtts/min
IV. PRINCIPLE OF POSITIVE AND NEGATIVE HARMONY
A positive question will always ask for a positive answer and so is a negative question.
FORMULA: [-] [-] = (+) answer (even)
[-] [-] [-] = (-) answer (odd)
[+] [+] = (+) answer
[+] [-] = (-) Question
Example: All but one of the following is an Anxiolytic:
V. PRINCIPLE OF IMPROBABLE EXTREMES
Extreme modifiers, such as always, all, never, or only make it more likely that the question is false. Here is a more complete list of EXTREME modifiers.
All, every, nothing, none, best, absolutely, always, never, worst, absolutely not, only, nobody, everybody, certainly, invariably, no one, everyone, certainly not, ignore.
Example: The most effective way in limiting the number of microorganism in the hospital is:
A. Using strict aseptic technique in all procedures
B. Wearing mask and gown in care of all patients with communicable diseases
C. Sterilization of all instruments
VI. PRINCIPLE OF INITIATIVE CRITICAL THINKING
1. Cover the options
2. Read the question carefully
3. Try answering the question without looking at the options
4. Select the option that most closely matches your answer
Example: The nurse knew that the normal color of Michiel’s stoma should be:
A. Brick Red
D. Pale Pink
VII. PRINCIPLE OF GRAMMATICAL HARMONY
Options that do not coincide with the grammatical configuration of the stem is NOT the correct answer.
Choices that are grammatically incorrect or contain typographical errors are probably not the correct answer.
Example: When planning a care for a client who is pancytopenic, The major goal should be:
A. Prevent hemorrhage, infection and decrease oxygenation
B. Administering an oral iron preparation
C. Preventing Fatigue and fluid overload
D. Encouraging a consumption of a neutropenic diet
VIII. PRINCIPLE OF UMBRELLA EFFECT
A choice that is more inclusive is usually the correct answer.
Example: To view a person holistically, the nurse should think of him or her as:
A. Physical being who experiences pathology and sociological changes
B. Social being who needs the dynamics of group interaction
C. Psychological being whose mind influences his or her health status
D. Biopsychosocial being who is in constant interaction with the environment
IX. Principle of ABC, Maslow’s Hierarchy and Nursing Process
When questions require prioritization, these principles should apply. Keywords that indicate the need to prioritize include:
FIRST HIGHEST PRIORITY
Example: A nurse is reviewing the plan of care for a pregant client with a diagnosis of sickle cell anemia. Which nursing diagnosis, if stated on the plan of care, would the nurse select as receiving the highest priority?
C.Disturbed body image
D.Deficient fluid volume
Example: When caring for Aida after a chest surgery, your priority would be to maintain:
A. Supplementary oxygen
B. Chest tube drainage
C. Blood replacement
D. Ventilation exchange
X. Principle of “Tell Me More”
In Psychiatric Nursing, Remember to focus on the client’s feeling, concerns, anxieties and fears. This is best summarized by a response that encourages the client’s verbalization of feelings.
Example: A mother says to the nurse, “I am afraid that my child might have another seizure” Which response by the nurse is most therapeutic?
A. “Why worry about something you cannot control?”
B. “Most children will never experience a second seizure”
C. “Tell me what frightens you the most about seizures.”
D. “Tylenol can prevent another seizure from occuring”
XI. Principle of Reappearing Visage
A word or phrase that appears in the question and then reappears at one of the 4 choices is the most probable answer.
Example: A chronically ill school-age child is most vulnerable to which stressor?
A. Mutilation anxiety
B. Anticipatory grief
C. Anxiety over school absences
D. Fear of hospital procedures
XII. The Drug Technique
Most drugs, especially psychotropic medications either act as a CNS Stimulant or a CNS depressant. The strategy revolves in determining which are the Central nervous system excitations and which are the Central nervous system inhibitions. If 3 of the options are all CNS up and 1 is CNS down, pick the CNS down. If 3 of the options are all CNS down and 1 is CNS up, pick the CNS up.
Example: The nurse is assessing a client who has just been admitted to the emergency department. Which signs would suggest an overdose of an antianxiety agent?
A. Combativeness, sweating, and confusion
B. Agitation, hyperactivity, and grandiose ideation
C. Suspiciousness, dilated pupils, and increased blood pressure
D. Emotionally blunt, lethargy and impaired memory