Decision Tree:
This walk-through provides test-taking strategies to determine the correct answer for the different types of questions you will encounter on the NCLEX-RN exam. These strategies are based on the Kaplan Decision Tree (DT) algorithm, a technique that provides a process to determine the correct answer for NCLEX-style questions.
This is a Priority Question.
Priority questions use words such as most, best, first, immediate, etc.
STEP 1: Can you identify the topic of the question?
- Priority action prior to lumbar puncture.
STEP 2: Are the answer choices assessment or implementation?
Assessment vs. Implementation
- Obtain informed consent. Implementation
- Measure pre-procedure vital signs. Assessment
- Explain the procedure to client. Implementation
- Locate a lumbar puncture tray. Implementation
When there is a mix of assessment and implementation answers, ask if assessment or validation is needed. Is assessment or assessment validation needed? Yes, there is no assessment information on the stability of the client. Eliminate answer choices #1, 3, and 4.
STEP 3: Apply Maslow: Are the answer choices physical or psychosocial?
- Move to Step 5 and evaluate the outcome of answer choice #2.
STEP 4: Are the answer choices related to ABCs?
- Move to Step 5 and evaluate the outcome of answer choice #2.
STEP 5: What is the outcome of each of the remaining answer choices?
Evaluate the outcome(s)
2. Measure pre-procedure vital signs. Signs of increased ICP contraindicate a lumbar puncture.
Select the best choice:
Is #2 the correct answer? Yes, herniation of the brain may be possible with a sudden decrease of cerebrospinal pressure.
Does #2 make sense? Yes, if vital signs indicate increased ICP, the lumbar puncture should not be performed. Increased ICP can affect breathing patterns and rate, pulse and blood pressure, and circulation to the brain.
