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The Next Generation NCLEX (NGN) Exam for Nurses

Hi, everybody, and welcome. Welcome to the lefora talk show. This is season three, Episode 10. We are very excited today to present a an important topic. We're going to be talking about the NCLEX exam and specifically about next generation NCLEX. And we have a bonus class coming to you today as well. I am your host, Tanya Freedman, CEO of Connetics USA. And I'm joined today by Paul and by Rachelle, who are going to be sharing their insights, tips and pointers about the NCLEX exam, and more specifically about how the next generation NCLEX is going to have implications for international nurses. Welcome, Rachelle. Welcome, Paul. Good morning.

Good morning, Tanya. Good morning. Morning. And if you are watching from anywhere in the world, please put into the chat, where you're watching from it is so fun to see all our viewers that are watching from all over the world wanting to learn from our experts, Rachelle and Paul and Dr. Paul. And I see we have the not saying hi I see we have Kaye oh hi. Great to see Kay Jasmine's watching from Australia. So if you're watching right now, please put your questions into the chat for the panel. And we would love to hear your views and your input about the NCLEX exam as well as how this is going to how next generation NCLEX is going to impact nurses from all over the world. So let's start off with introductions. I know probably Rachelle and Dr. Paul don't need any introductions in the Hora onwards and upwards. But let's start with that anyway. And ladies first.

A pleasant evening to all our viewers here in the Philippines. Good morning to those who are in the USA. And good afternoon to all those nurses who are in the Middle East. And wherever you are, wherever your location is. Welcome to our live for a talk show to today. I'm Rachelle Oliver. I'm one of the founders of IPASS processing. We provide assistance for the envelopes USA and plus Australia application. And we also have our NCLEX online review program to the IPASS on and review and mentoring Academy who've been in partnership with Connetics, USA nursing for quite some time now where I pause time it's really an honor for us where we're in IPASS processes, their candidates and NCLEX application. And additionally some of the connected scholars are also enrolled in our NCLEX online review program.

Thank you, Rachelle. So we are very proud and excited to have Rachelle on the show today. IPASS is a great partner of Connetics USA. We have many nurses going through an NCLEX scholarship. And IPASS have done an amazing job for international nurses. And I see we have people that are joining us. So we've got Jasmine is from Australia. We have Apple from Iran, and be from Maryland and Mary from Riyadh. And so many people joining us if you have questions about the NCLEX with the next generation NCLEX please put them into the chat and our expert panel will answer them. And then Dr. Paul, go ahead and give an introduction. warning everyone.

I'm streaming live from Houston, Texas. My name is Paul and social media I am doctor nurse Paul. I am an admin of Lefora group. It's the biggest Facebook group for nurses migrating to the United States with 168,000 members. That's how we met Rachelle and that's how I met Tanya. I do a lot of info sessions as well as my facebook page doctor nurse Paul I've been doing a lot of live shows for next generation NCLEX and I'm happy to be here to get to share my expertise. I am also the CEO of Aspire RN NCLEX currently also in partnership with Connetics USA for their scholarship program.

And we've been doing a lot of NCLEX classes almost every day. We've been operating here in Texas for three years now. And continuously expanding. So if that's something that you guys are interested, you can send me a message or Tanya as well because she provides scholarships to nurses. They can tell you thank you doctor nurse Paul. And I think that for any nurse who is watching this for the first time and is wondering where to start. The NCLEX is the place so this is a very, very important show for any nurse who's wanting to come to the United States. And I see we have peace from Nigeria Frank from Garner's from Riyadh. So many people joining from all over the world. It's so fun to have everybody watching and sharing in the information that Sephora talk show is all about information. And nurses helping nurses. Information is empowering. And that's really what this is all about. And so both Rachelle and Dr. Nurse Paul, thank you for being here. And for sharing your expertise with everybody watching around the world. All right, so let's, let's dig in. Oh, and before we do that, I just want to give a shout out to the Lefora admin team. And to, obviously, in this Paul to Miss Jean, who's Rachelle sister, to nurse one to Louise, to James to all of them to enter to Kaye all amazing admin of this, of this look forward to Lefora who do such wonderful ways of giving back to the nursing community. So thank you for giving the opportunity to share this information. All right, Rachelle, for any viewer that is watching right now who's joining for the first time thinking of coming to the United States, but really doesn't know what this is all about. What is the NCLEX and why is it important?

So for the National Council licensure examination is designed to test the knowledge the skills and abilities essential to the safe and effective practice of Nursing at the entry level. There are two categories the NCLEX RN and NCLEX RN both of these exams are invariable in computerized and adaptive test, the NCLEX is only provided in a computer adaptive testing format. Currently, we have 75 to 145 items for the NCLEX are in, regardless of the number of the items administered. The time limit for this examination currently is five hours. The exam is administered by Pearson VUE Testing Center, and only nursing regulatory boards can release the Angliss results to the candidates. Thank you, Rachelle. And Dr. Paul why is the NCLEX important? you unmute you unmute.

Sorry, sorry, I have a little pharyngitis I have to mute my mic anyway. Like Rachele said, NCLEX is the licensed or examination. Here in the United States, you need to pass the licensure exam to be able to register as an RN, or as an bn, to practice as a nurse you cannot be hired or employed here in the United States. Without your RN or B and licensed in a very similar manner. We're immigrant nurses come over here to recruitment agencies, and direct our agencies like Connetics, USA, your petition for immigration will actually not be started, we will not be able to petition you without your NCLEX. So NCLEX is very important want to practice as a nurse here in the United States and to for immigrant nurses, to be able to start the petition to get you here to the United States. And the sooner that you can get it done, the faster the immigration services could start with your petition.

Okay, thank you. So I heard one nurse telling me once it's the key that unlocks the door. So I think that's kind of a good way of putting it. If you look at the Connetics USA website as well, we have our success path, which gives you a very good itemized way of exactly how to get to the United States. And you'll see number one on the on that list of seven items on that success path is the NCLEX Fast Pass blueprint, which is the first step the key to unlock the door, as we say, in order to come to the United States. Rachelle, can you tell us a little bit about the application process and who qualifies to take the NCLEX. So tonight, there are 50 states in the USA and four US territories. So each of these States and its territories has its own board of nursing, which is a member of the National Council of State Boards of Nursing. The Board of Nursing is responsible for the Evaluate, for evaluating the licensure application for each candidate. And they have different requirements in procedures that an interested applicant must follow to be approved for the NCLEX examination.

So to qualify for the NCLEX. Basically, one must be a graduate of an approved nursing education program. So for eligible eligibility requirements, it varies from each state Board of Nursing, but as an overview, a candidate must complete an application with a chosen Board of Nursing. Some states have requirements such as the evidence of English language proficiency, or an applicant may need to complete the fingerprinting procedure or the board might require application to complete coursework or evaluation of credentials through a credentialing party. So the application or the qualification, I mean to say, and the eligibility requirements in taking the NCLEX will vary on which Board of Nursing we applied for the NCLEX.

And it can be very confusing. So if you are confused about that process, then I pass is a great partner to help you to navigate it. It is possible, of course, to do it on your own, but it is confusing, and there are a lot of requirements. And, you know, it's something that you can't just kind of jump into MRI for Shell, you've got to do some planning. Yes. It's a complicated procedure, actually. Okay, so, Dr. Paul, we have a question in the chat from Juliana. Julian is watching from Dubai, I have my NCLEX RN scheduled in a month where can we reach out to get a crash course, please. And is this advisable for nurses to do a crash course? Well, the thing is, it really depends on your preparation level. So seven nurses would have prepared months prior to their exam, they can join a crash course a crash course are meant to like, enhance what you already know, improve what you already know and give you a little more tips. But it's not. Of course, because it's crash course it's rapid course, it's not meant to replace the comprehensive course where it builds on your foundation and your test taking strategies. But if this is something you're interested with, I offer a crash course this for 10 days, I have a batch coming up on December, give me a message on my social media doctor, nurse Paula that could help you for that or with that.

Okay, and this is what we love about the lefora talk show is nurses helping nurses at Jolina best wishes with the NCLEX exam. And for any nurse who's going to be taking the NCLEX exam soon. Rachelle and Dr. Paul, do you want to share your experiences of taking the NCLEX. It's funny because I took my NCLEX a long time ago took my NCLEX 2000 Year 2008. Some 15 years ago, I was fresh out of college. I didn't have nursing experience. But I know that I took nursing so I couldn't get to the United States because I mean from the Philippines, your parents would bring you to you know eventually go to the United States. That's a true comparison. Right. So as soon as they pass that local boards, I submitted my application to the United States. And it took about a couple of months to get my eligibility took my NCLEX in 2008. Although it's been 15 or 16 years, I still remember it to be very nerve racking took me almost off of my seat with how anxious I was during the exam.

All I remember was I do not remember the exact questions it was a long time ago. But I do remember the feeling it was a bit traumatizing to say the least because it was expensive, it was very difficult. And I know my future career hang on it, but was able to pass it and eventually got recruited for the United States. But nevertheless, at that time, because I grew up poor, so I didn't have finances to put me in scholarship programs or review classes. So I had to like exert extra effort, double the effort to prepare myself because I did self review. But I'm happy that we're doing shows like this, because we can, you know, provide few hours of classes every now and then the nurses can really take advantage of if they don't have the finances to enroll in review classes like what I provide. But even then Connetics USA has provided scholarship programs and there's hundreds of scholars that are enrolled in our program right now either Connetics USA, and if that's something that you're interested with, please get in touch with the recruiters and Connetics USA and they can get you on board with a scholarship programs.

Yeah, it's expensive. And it's really quite dicey to be able to take the NCLEX without doing a proper review course. So if you see we have a question here about the NCLEX scholarship. And I would definitely suggest that you apply online and that you and that, you know we can see if you meet the requirements for selected nurses, we work with both IPASS and with Aspire in terms of the NCLEX scholarship and have seen incredible results. And an answer to the question. The requirements are that you would meet the eligibility requirements that Rachelle has just she's nodding her head that that that nurses are required to meet in order to take the exam and also that you would pass a predictor test. So both IPASS and Aspire will administer a predictor test and if you pass that predictor test, you can be eligible for the Scott Asha Richelle. I see we have a question here from Diana, who is saying, I'm from Ghana practicing midwife midwifery. Can I apply for the NCLEX? What would you say to Diana?

For usually, usually they require the nurse to have a to be able to grad with a nursing program. Usually for international educated nurses, they consider the Diploma in nursing and the BSN. But I'm not so sure with mid Midwest with my with Midwifery, we have to probably you can probably submit your application to the board, because it's really the Board of Nursing who can decide they have to go through your transcript of records, they have to go through the education that you had, and then they are going to let you know whether you are eligible for the NCLEX or not. Okay, so Diana, it is going to be a process that you're going to need to go through in order to see if you qualify. So I see we've got Sarah from Zimbabwe, Mercy from Zambia, Ashkar from Pakistan. So lots of nurses joining from all over the world. Dr. Paul, how long should a nurse study for before they actually take the exam? Well, how long should they be in a review course? Ideally, if they're going to be? So yeah, this is a very individualized question. But for the most part, standard or average time of preparation and the study plan that I created for us by our end, it's we have a two month, four month six month study plan.

But the most popular is four month plan. In the four month plan, study plan that I developed, it's two months or eight weeks of comprehensive comprehension building or concepts building for weeks of test taking strategies and four weeks of final coaching. So that's what I do. But again, some students, for example, they've been out of nursing field for years, I had a student recently who passed he graduated from 1995. And he's never had a nursing experience, he worked somewhere else outside healthcare. So of course, he passed the NCLEX once I'm under my guidance, but it took him a while to really prepare. And I'm glad that we're doing a lot of personal mentorships, because he was able to listen to me, it took him about six to 12 months to prepare because of the length of time that he was out of the nursing field. But there are nurses who are currently practicing or who has just graduated two to four months is already enough for them to prepare, there are high performing students that are very smart from the get go, they probably need just one month or two months, the Crash Course would serve them well. So really, the average is about three to four months. But it still depends on the individual performances. If you guys are on the fence of deciding how long should they prepare, maybe I can help you with that. Let me know I can give you a probably an evaluative exam and tell you what I, on my honest opinion to prescribe you what type of study blood you can roll, whether you enroll with me or somewhere else, but at least give you an idea of how long you should be able to prepare.

Okay, well thank you for that. So it seems like it's on a case by case basis, but on average about two to four months, Rachelle, how long does it take on average to be able to get the eligibility and the ATT to take the actual exam? Well, across all boards, usually the processing timeframe right now is about six to eight months. So we first have to do the credential evaluation. It can be through a third party service provider, a credentialing agency. And then we provide we submit the application to the Board of Nursing. As you have mentioned earlier there, there might be coursework that you will be required fingerprinting that you have to do so this takes a while, and then after some time that you are already done with everything, then you are approved for the examination. But usually the processing timeframe right now is about six to eight months before you will be approved. And then once you are already approved, then you decide whether you are ready to sit for the exam, then we can proceed with the Pearson VUE registration or your if you're not yet ready, then you have to still continue your preparation for the NCLEX.

Okay, so that gives you a good idea everybody of how long it takes from a processing perspective. And then it's kind of to combine those two factors of your study review program as well as the NCLEX application. So it's not an easy process, especially if you're working and if you've got family and there's a lot to take care of. And it's gonna get a little bit more complicated, everybody. So put on your seatbelt and let's now move to the next generation NCLEX and what is that all about? So first of all, Dr. Paul, who are what makes the decision had to change the NCLEX exam. And why did they do that? Why are they?

Yeah, so I think I want to share my slide right now. There you go. So the NCLEX, the changes to the NCLEX number of items, content study plan, these are all decided by the NCSBN, or the National Council of State Boards of Nursing. These are all the boards of nursing from all the 50 states plus Canada. So they all convene every now and then usually every three years before they change the test plan and content or the passing rate. But in the last 10 years, there has been a push for a change in the NCLEX. And now we have confirmed that come April 120 23, there will be a significant change. This is what we call the next generation NCLEX. So what really is the next generation NCLEX. Next Generation NCLEX is a new type of exam where there will be 14 different types of questions, three different types of scorings, and so many other changes it will get, or it will make the NCLEX more complicated. And the reason why we're doing this is a lot of questions that get asked of me when I did my show about three weeks ago is why change the NCLEX.

The reason is this clinical judgment is the reason they have seen in the literature studies that they did in the last 10 years, plus the survey of the nursing community of all the stakeholders in the healthcare including the Department of Labor, they have found out that the most important skill of a nurse is the clinical judgment or critical thinking. However, the current setup of the NCLEX that we're using right now does not necessarily or does not measure the clinical judgment directly. There are three things that they found out in their study. And the first one is clinical judgment is a very important skill for entry level nurses here in the States. The complexity of healthcare is continuously evolving. They say it's becoming harder to become a nurse now than before, because of the complexity of the diseases, new diseases, new evolution of viruses, and it is important for nurses to have clinical judgment. The second one is clinical judgment is heavily integrated in nursing practice, about 46% of all vital nurse duties or responsibilities at the bedside, is anchored in clinical judgment. And number three, this answers our question, in the current NCLEX setup, clinical judgment is not measured by current NCLEX. So because of that, the NCSBN. The board that creates the changes in the NCLEX created what we call the nurse, or the NCSBN clinical judgment measurement model.

And this is how they create the new NCLEX. But I'd like for us to focus on the clinical judgment elements in the current I'm sorry, in the NG and next gen NCLEX. We will be tested under these six categories of the assessment elements. Think about your nursing care plan, think about your nursing process, from assessment analysis to planning, intervention and evaluation. It's the same thing. They just reworded it, but in a manner where they can accurately or directly measure it through the examination. And later on, I'll tell you what are those specific changes that they'll do to monitor or measure the clinical judgment through the examination?

Okay, so this is going to be a big change everybody. And it's really important, really important to understand what that change is, and how it's going to what the implications are going to be for nurses around the world. Michelle, in your opinion, what do you think is going to be the biggest implications for any nurse who has not yet passed the NCLEX exam besides the fact that if they can, they should try and take the NCLEX before April next year?

Well, with regard to the application procedure or the licensing process, actually, there will be no change as to the process. There is no effect because there's no change as to the requirements of the application. But however, what we are seeing right now is that everyone is in a rush to be approved for the for the exam, everyone is in a hurry the seat for the for the NCLEX so that they cannot be so that they will not be sitting for the NCLEX by April of 2023 in which this appealing is really understandable because it's new. So there is an increase in influx of nurses applying for the NCLEX. But the same thing that will happen with the processing timeframe because it will not change here. There's no change as to the processing timeframe. Therefore the application will just be the same. And as with regard to the test candidates, I think, since it is very new, some of the nurses are getting hesitant to sit for the NCLEX. And what I can say is that they just have to also master the, the concept, they have to do a lot of preparation as well do a lot of practice questions, because as we are going to get along with this and Ng and format, they will be able to ease their NCLEX.

Okay, so they are going to be so no real change in terms of the processing for the application at this stage. But obviously, you're going to be changes in the actual test. Doctor Paul, what are the changes in the new NCLEX? Yeah, by the way, before I proceed, I would like to add to what Rachelle said, I agree with Rachelle that, yes, the exam is changing, yes, you need to prepare for the exam. But the unfortunate part of it is, the processing times for application does not change. So certain boards actually take months to get to eligible. So that's something that you guys do your nurses need to consider Do not force yourself to actually take the exam before the engine, if you know if there's a very small reason, or if you're ready, and also if you're not eligible, because you're not really going to be able to take the exam. So I guess the key takeaway there is, we always say this in the ER being you know, an emergency provider, we always prepare for the worst hope for the best. So yes, if you can take it before ng ensure, but if not, at least you prepared for the worst, right? So there's no going away from it, there's no way that we can turn our backs on it. It's gonna happen, but at least prepare yourself if that's gonna happen, right, anyway. Oh, yes.

Dr. Paul, they have also the date, the format of the current and costs will still be applicable by April of 2023. Although there will be in addition to there will be additional new test formats. So they just really have to master the concept because, you know, hypothyroidism in the current NCLEX is the same hypothyroidism when engine arms, you know, II, they just half the pump familiar to get the familiar with the new format. They need to educate themselves with regard to the change to the changes and do a lot of practice questions. Yeah, I think the key thing that I think is coming across from the experts is the preparation. Because it's a new, it's means that that that nurses had to prepare well before next generation, and they're going to have to probably prepare even better going forward. Right? Everybody's nodding their head.

Yeah, here's the difference. Because here in the United States, the education process for BSN and ADN are the nurses. We've already started using case studies since two to three years ago. So the nurses that will be taking the NCLEX. Next year, he indeed here in the United States are believed to be ready for the edge. And the problem is the foreign graduates because the education did not really update. Because I mean, other countries do not have to follow the American curriculum all the time. So that's the problem when these nurses, the foreign graduates, the International educated nurses, sorry about that will take the NCLEX, they will have to do a little extra in preparation. Like Rachelle said, the concepts did not change, you talk about myocardial infarction, it's going to be the same diabetes, it's going to be the same stroke, it's going to be the same. But the familiarity to the new types of questions, how they are scored, will be important. So yes, the contents are the same. But the test taking strategy will differ just a little bit. And that requires preparation. Yes.

So really good advice and tips, then I'm just thinking back to previous shows that we've done. And just thinking of a show that Dr. James was on also an admin up before and an expert in this area did his PhD on how many international nurses pass the NCLEX, or why the international nurses don't pass the NCLEX at the same rate as an American grad. And the pass rate is not was not that high, just generally speaking for all international nurses. So now this is going to mean even more important to prepare yourself. And I think that's a good place to move into the next segment of the show, which is where our experts are going to be taking us through a bonus class and sharing some of the tips and pointers specifically of how to navigate next generation NCLEX and prepare yourself as a nurse and I'm looking at a comment that Mary made In the chat, and said that the engine is not scary at all, if taken, if the takers us mentally and emotionally well prepared, and I think marry you, right, it's important to be emotionally and mentally prepared and to be positive. But it also is going to take work.

So with that said, I'm going to hand over to our experts, who are going to be taking you through the bonus class now for the next 30 minutes. So thank you so much for doing that. And if you are joining, joining us now, and please feel free to continue to put chat question questions into the chat for our experts. Because they have agreed after this show to go into the chat and answer any questions that we were not able to get to. So again, thanks to Rochelle and to doctor, nurse poor from my side. And thanks again to the lefora admin team who do such an awesome job of nurses helping nurses. And I'm gonna hand over now to the team to do the next step of the of the show with the bonus class. Thank you, everybody.

So Tanya, it will just be Dr. Paul, who will be doing the bonus class, because I will not be doing the rationalization, because I'm not an educator, it's my educators in diverse mentoring. Thank you, Rachelle, thank you for clarifying. That. Thank you, Rachelle. And thank you, Dr. Paul. Thank you, everybody. And we will see you next month on the lefora talk show. Where again, we will be having nurses come in to help nurses empower you with information, pointers and tips so that you can to live your American dream. Thank you, everybody. Thank you. And thank you, Tanya. Thank you, Rachelle. And before I continue with a bonus class, I will be going through tinius Last question which I was not able to really answer but I've prepared a slide for it. This slides I've also shared on my show the doctor nurse ball show, which I actually piloted last month, last October. And I do this every Saturday at 8am Central time. But since you guys are already here, and some of you have questions on the comments, the changes are here, I'm going to breeze through it real quick and standby with me.

Because after this, I'm going to do a sample question. And we're going to rationalize it together. And this will be interactive, because I would need you guys to help me answer the question that I'm going to be showing you and this question is actually battered with the next generation and clicks we've been talking about next generation aspects. But what does it really look like? And what does it really feel like? So you're gonna help me whether you've passed your NCLEX in the past, whether you're actually practicing as a nurse right now, or you're about to take your NCLEX soon, or in the future helped me with answering the question that I will be doing in a little bit. But what are the changes to the NCLEX with the NGS next generation NCLEX, like I said, I've she shared this in my own live show, the doctor nurse ball show, and I'll talk to you about it later.

But 14, there will be 14 new types of questions which is actually flashed on the screen right now. And I'm not going to go through one, all of them, but later, I'm going to use one type of question. It's called the bowtie, and I'm going to explain why I chose that. And how to answer that question. It's a very special type of question the number seven it says bowtie. We're going to use that later. And I'm going to tell you how to answer or attack that question using test taking strategies that I've developed for you guys. Now, there will be standalone questions, and the most anticipated change are the case studies. And this Saturday, I'm going to do a live show where I present to you an evolving case study to tell you guys how to answer that type of question. The minimum items beginning next year will be 85 items, and the maximum is 150 items, you have to consider that 15 items of these questions are not scored, they are called pre tests, but even then you would not know which are pre tests and which are actually scored items.

So don't worry about it, you're gonna take 85 Minimum you're gonna take 150 items maximum, and the time limit is still five hours and in us in an eight to five item question again. 15 items are pretest so there will be 70 items that are scored 52 questions will be stand alones which means it's not a case study is going to be by itself. 18 questions will be case scenarios this this will be part of three case studies. And each case study will have six questions each. If you're getting confused what case study looks like I'm going to do a show this Saturday, so please join me online in Facebook In YouTube, I'll be I'll be announcing that later. And there will be three types of scoring zero over one scoring. I have discussed this in one of my shows in the past, my playlist is in YouTube, or you can also check the videos that I've posted in my Facebook. But you can also check it in YouTube, I've arranged my playlist it says there the secrets of next generation NCLEX. And the show is entitled, different scoring system or types of scoring system, we also have the plus minus this is one of the toughest type of scoring because it's getting to be correct minus incorrect. So if you get three items correct and four items incorrectly, then your score is zero.

So you can totally get zero points out of eight or 10 items out of eight or 10 points in an item. So very detrimental because it can pull your score down, okay. And there's also rationale as scoring, where this course will be based on pairs, or three, three bears right answers, and I've discussed this in detail in my show. I've also provided sample questions based on these types of scoring. Now, in the ng lead values will be shown, which makes the risk reduction potential of the of the NCLEX be a little easier, because it's gonna show the lab values today, we're not seeing we have values in the exam, where we do not see the normal values. But in the ng n, they will show the lead values and the art and test when will change, there will be an increase in the items of safety and infection control and pharmacology. Currently pharmacology is 12 to 18%. But now it's going to be 13 to 19%.

So think about getting one or two more items, in the minimum items of 85, you get two more items for pharmacology. I know we all hate pharmacology. But that's the name of the game, we have to know what we have to know. And we have to know what we need to pass the NCLEX the passing standard will be published on January 2023. So we do not know yet if the board's want to increase the passing standard, make it stricter or tighter or lower the passing standard to make it a little easier. And when will the ng n be implemented? This will be on April 1 20 23. So for now, I'm going to be using my slides my other slide. And somebody asked has there been any changes to the length of fast Park and number of questions. I just mentioned that based on the last slide that they use. So this is the show that I do on Facebook and YouTube. This is every Saturday 8am Central Standard Time or central USM because I'm based in the US. So I think in the Philippines, for my folks in the Philippines, it's about 10pm in the Philippines. And in Africa, because I have students in Africa as well, this will be somewhere around.

I think it's afternoon 2pm If I'm not mistaken, two or 3pm in Africa and Europe, based on your location, but I'm doing that show join me on Saturday because we're gonna do case scenarios. And I want it to be interactive whenever I do my classes, and this is one of the demos that I'm doing. And I have pharyngitis because in the last four days, I've been doing classes in my own company and as far as I'm not only the CEO of the company, but I'm also the lead instructor. Just recently I did a personal one on one mentorship for a student for the final coaching and she passed the NCLEX she just messaged me this morning, I woke up very happy because I was so confident that the nurse would pass but even then I still get, you know, very excited when I get those news because I feel like I pass the NCLEX as well, right? But if that's something that you're looking for personal guidance, personal mentorship, allow me to help you or connect with Connetics, USA recruiters go to their website and apply for a scholarship. And they can connect you to me or you can also message me in Facebook.

And so clinical judgment we have been talking about this there are six step steps of the clinical judgment we have recognizing queues, we have analyzing queues, we have prioritizing hypothesis, we have generating solutions, we have taking actions, and we have evaluating outcomes. So these are also synchronized with your nursing process. The assessment part is the recognizing cues. The analysis before when I was a student, we call it diagnosis, but they don't really want you to do medical diagnosis. But I think that that debate is actually confusing because yes, we don't do medical diagnosis. But honestly, when you're practicing as a nurse, you're using medical diagnosis right? When a patient has asthma, the patient has asthma. When the patient does stroke, the patient has a stroke. So I really don't believe in nursing diagnosis because as an ER nurse, I've never used it in all my practice and fit The years and analyzing queues and prioritizing hypotheses are part of the analysis of the nursing process.

Generating solutions is part of the planning phase, taking actions as part of the implementation phase of your nursing process and evaluating outcomes as part of your evaluation phase in the nursing process, so basically this is just nursing process rebranded changed name, right to fit the clinical judgment model, but this is now how they measure or score your exams based on this clinical judgment model or items right now. Somebody asked what is the name of your Facebook page Dr. Paul, my Facebook page name is doctor nurse ball you see my handle there on my on the screen under me that's my name Doctor Nurse Paul. Or you can also follow my company Aspire RN. And make sure you also follow Connetics USA Facebook page and YouTube and LinkedIn because we're streaming this show live in those social media. And thank you for everyone that's watching right now. Okay, now, we're gonna use the bowtie type of questions. And I'm about to flash up right now. Old still and look at your screen.

Right now. We're all going to answer this question. Okay. So there you go. So we have a bigger screen now. So the bowtie look at the right side where you see the questions, right, you see, like a butterfly structure. We're gonna fill that out later. But we're gonna read the situation together. This is a case study. But you know, what's good with bowtie question is it's one question, but it answers the six parts of the clinical judgment model from recognizing cues to evaluating outcomes. So both type question is a type of question that was actually piloted, right, originally created by NCSBN, the state boards for the NCLEX. So no other licensure exam has this type of question. But the NCLEX, RN are good speed and brand. If you're not an RN, and you're a practical nurse, I'll be launching a BSN review classes beginning next year, because a lot of people are approaching me about NCLEX .

And I can help you as well. I'll start to do classes for B and next year, but mostly right now I'm focused on the AR IDs. Now, in this type of question, there will be five things that you need to answer two actions, actually to take one condition most likely experiencing or diagnosis and two parameters to monitor. Okay, so the actions to take will answer your analysis, prioritizing hypothesis conditions most likely experiencing as you're getting solutions or gathering solutions and parameter to monitor will be your evaluating outcomes and taking actions. And by reading the case you're actually doing, you're recognizing the cues. So what I'm trying to say is if you complete the bowtie question, you've actually been able to perform all the tasks in the clinical judgment, all the six steps from recognizing cues, until evaluating outcomes. All right, now, let's read this question together. This is a long case. So please bear with me, you got okay, if you guys are still with me. This will take about 15 to 20 minutes. Can you put in your comments right now?

Your current location and time so I know where you guys are coming from. I know there are people that are watching this from Zimbabwe, from Ghana from Saudi Arabia. But thank you for joining us today. Right make sure you are sharing this show to your Facebook page so we can reach out to your friends that are nurses as well because I'm about to rationalize this question with the right we have Mark from Philippines. We have mail from Saudi. We have one Facebook user from Facebook Australia, another one from the Philippines. And thank you guys for joining me today. And we have van from Kuwait Leah from Qatar we have someone from Ghana I'm sorry could you pronounce the name Gina from USA which part of you is a Gina I mean used to in Texas right now. Rachelle from UAE Sarah from Zimbabwe. There are Facebook users. I couldn't see the names right now. I guess because of privacy issues with your Facebook accounts from Philippines. Vietnam. Jasmine is from Australia. Someone is watching us from LinkedIn and the person is from UAE.

I could pull out your name. We have serenity from Philippines, Singapore, Kuwait, Jordan, Riyadh Miss Suri here in United States, Saudi Arabia, more people from Philippines in Abu Dhabi. Thank you guys for joining us today. We're all over the world today. I guess we're covered in all six continents with the exception of Antarctica, because nobody lives there, but they can guess we have people from Asia, Europe, Africa and the northern Americas. I don't think I've seen someone from Southern Americas anyone here from Brazil. I usually have viewers from Brazil, Argentina, Mexico, Panama, but thank you guys for joining now. We're gonna answer this bowtie question help me read.

There you go. We have surrender from South America. So it's official. We're all covering six continents in the show today. Thank you guys for joining. Don't leave just yet. You're gonna answer this question with me. I don't care if you're already an NCLEX passer. I don't care if you're into practicing or the United States. But let's just see this is just a little mental drill for all of you guys. And this is a preview of what I'm going to show on Saturday. Okay. The nurse is in the emergency department is caring for a 79 year old female client, right? And the first step we see the nurses notes at 12 o'clock 15 PM. The client presents with right sided ptosis facial drooping right sided hemiparesis expressive aphasia clients adult child reports that the client reasonably had influenza and assessments can it's warm and dry lung sounds are clear. apical pulse is irregular. Bowel sounds are active in all quadrants. Glide is incontinent of urine two times in the IDI.

The adult child reports that the client is typically continental period, capillary refill of three seconds, the referral bonus is palpable. tubeless vital signs 97.5 Fahrenheit bolts 126 are 18 blood pressure 188 over 90 pulse oximetry 90% on room air Okay, before I go to the next step, which is history and physicals Can you guys put in the comment section what abnormal findings have you found in the nurses notes? What abnormal findings so if you're the nurse what abnormal findings have you seen in the notes? Can you guys figure out give me one or two words or vital signs or assessment findings that you've found that is abnormal? I'm going to give you one that ptosis is abnormal, right? T

hose this is like sleepy eyes right ptosis what else anyone else? unstable. I knew shot said the vitals are unstable. What exactly in the vitals are unstable give me objective symptoms B are in blood pressure are both abnormal, very good. Pulse is high blood pressure is a very good one else. There's facial drooping. Very good. What else? There's white sided. hemiparesis. Very good. What else? Aside from vital signs everybody else said vital signs aside from vital signs. Oxygen saturation is low. 90%. Very good. I'm trying to determine your recognizing cues ability, the first step in the clinical judgment. There's facial palsy, blood pressure is that there's urine incontinence, there's hypertension, let's move on from vital signs because everybody said by vital signs aside from vitals, there's so much more abnormal findings in your incontinence low SPO. Two, there is expressive aphasia, right. apical pulse is E regular. All right, very good arrhythmias. So there, we've found the abnormal problems. So you were able to recognize cues completely do not just get fixated with vital signs. I know us nurses when we see when you see long contents like this, the first thing that you look for is vital signs.

But there are also findings that are written in words, right. So find the abnormal findings. And we're good. We found everything that's abnormal, right? I think that capillary refill is normal two to three seconds is normal fare for bonuses. palpable two plus that is normal, one plus is weak. Alright. So very good. Now let's go to the history and physicals all right. We're going to click the history and physicals tab and it will get us here. So what are our history findings? Neurological, there is a history of stroke two years ago, in the cardiovascular there's history of hypertension, AFib hyperlipidemia, gastro intestinal history of GI bleed two months ago, and the green history of diabetes and immunological. There was an influenza three weeks ago, right. So what do you think? What do you think is the one you think is most significant here? Actually, all of them are significant right? stroke, high blood pressure, afib, lipids, GI bleed, diabetes and influenza. Right? And see, look at this, the lab results. The only lab results that we have is random serum glucose, right And the result is 76. Is it normal or abnormal? Is it normal or abnormal? So you see in the next gen NCLEX, it will show you the normal values. Right? So 82 to 115 is normal, right? So is the sugar normal? Yes. Yes, it's normal, correct. So, what we say and er, and of course, anywhere else, this is emergency, right? It can happen in the floor. It can happen in. It can happen anywhere.

Whenever you have neurologic symptoms, do not assume it's stroke right away. Check the sugar first because it might also be hypoglycemia, has neurologic symptoms like dizziness and disorientation. But since sugar is normal, we're gonna take out hypoglycemia as a differential diagnosis and see, the NCLEX is now not only forcing you to diagnose through the analysis, but it's also forcing you to do differential diagnosis or prioritizing hypotheses in the medical field. As nurse practitioners we do differential diagnosis, right. So what are the possible differential diagnosis? Let's answer the first question. Right, let's go to the right side. It says here, the nurse is reviewing the client's assessment data to prepare the client's plan of care. Let's go to the question on the right side of your screen. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing. Two actions the nurse should take to address the condition and two parameters the nurse should monitor to assess the client's progress right now, let's go to the first question.

Let's go to the middle part of the bowtie. What is the question? Condition? Most likely experiencing? Right? And I've told you earlier, do we have hypoglycemia risk? Possibly. But this sugar is normal. So can we safely remove hyperglycemia? That's not part of the differential diagnosis anymore, because the sugar is normal. Right? What else can I remove? What else can I remove? UTI? Right? If you go back to your history, there is no there's no history of UTI here. What are the symptoms of UTI aside from incontinence? That's the only symptom that I see there that's possibly UTI. But UTI has fever, or foul smelling urine or what the low turbidity urine so the urine is cloudy, we don't see that in the scenario. So we're gonna remove UTI, we're gonna remove hypoglycemia. All right, what is your answer for the first question condition? Most likely anyone?

Anyone? Anyone? So we have to answer so far, I want more answers. Before I proceed. Let's talk about condition. First, check the blue, the dark blue options in the middle the potential conditions. So some people said ischemic stroke. Some people said those policy because we removed hyperglycemia and UTI already Bell's palsy or ischemic stroke. I want more answers and that about 15 answer so far, I want more answers. And make sure to share this show to your page so people can see this. And you can also tell your friends about it. Okay, so the more we share this, the more we're helping our community this, this what we're doing is a live class. This is free. We don't ask for payments here. But we just want to be able to serve our community. It's my way of paying it forward since I know I feel like I'm very blessed with my life right now. So this is my way of sharing to everybody. What I can write in the best way that I could. So we have stroke and Bell's palsy just pick one because it's only asking you for one condition that's most likely between stroke and Bell's Palsy.

Right I would answer stroke. You know why? You know why? Why while Bell's Palsy is possible because of the history of influenza, because they symptom of ptosis and facial drooping. What makes ischemic stroke the answer versus Bell's Palsy. Alright, did you guys see two things expressive aphasia, expressive aphasia Bell's Palsy. Alright, go back to your pathophysiology. Bell's Palsy is the inflammation of cranial nerve number eight on the face, right? It does not affect the speech center on your frontal lobe. If there's expressive aphasia, that's not Bell's Palsy. That's possibility of stroke because the stroke might be happening on the brockers speech area. That's why there is expressive aphasia, right. And the other finding that makes me suspect stroke versus Bell's Palsy. is what hemiparesis one sided paralysis. Again Bell's Palsy. Go back to your factor physiology, right? Bell's Palsy is the inflammation of cranial nerve number eight facial nerve.

The facial nerve does not control your arms and legs. However, the spinal cord and the brain water area more than urines control your arms. And so if there's aphasia, and Hemi paralysis, is this more likely stroke? Or Bell's Palsy? Is this more likely stroke or Bell's Palsy? I'm sorry, I'm very persistent with asking questions when I teach. I like it to be interactive. I don't want to be answering the question that I already know. I want you guys to help me analyze because it's all about you. It's not about me, I want to improve your thinking process. So is it more likely stroke or Bell's Palsy? Very good? It's stroke, because Bell's palsy does not have he does not have hemiparesis and expressive aphasia. So the first answer is ischemic stroke. For those who have gotten this correctly, you get one point for those who did not get it correctly, you get zero points. This is a total of five points. Okay. So you get zero, you get zero, okay, zero. All right. Now, we're gonna total your score. Later. Next, we're gonna go to actions to take considering that you are thinking of stroke, give me two actions that you think we should prioritize your options are on the left side, it says administer oxygen to leaders request a prescription first to avoid insert peripheral venous access device of Thane urine specimen or request an order for 50% dextrose.

What is your answer? What is your answer? Give me two actions to take two actions to take two actions to take you over again. I want more answers. I'm looking at your answers. Somebody said I could not see all the names in the comment section because of your privacy settings in your social media. But people are participating to us from YouTube LinkedIn, I'm very happy with this. We're reaching a lot of social media today. And Facebook, some Facebook user said oxygen access device. Somebody said oxygen somebody said access device. I need two answers. One and three. Okay. So guys, when you have a stroke, what are the management's that you're thinking? What are the management's you're thinking you want to tackle ABC right? Airway, Breathing circulation, right. Why? Because stroke is basically oxygen problem to the brain. You want to give oxygen? That's correct. You want to give you want to monitor neurologic status. If they're complicating, you want to assume that you might want to give IV fluids you want to give antihypertensive with the blood pressure. So you might want to give what medication are we going to give supposing the most common cause of stroke is clots. Right? What medication are we going to give to dissolve those clouds? We call it clot?

Was there anyone you're working in the neuro ICU? Er, ICU neurologic floors? What medication are we going to give to dissolve those clots to dissolve those clots? Anyone? thrombolytic right. No, no, no, no, no aspirin. And as they go as heparin. Plavix is an anti platelet. They do not dissolve clots. I said we need to give something to dissolve blood. So see, we're not only using your pathophysiology and assessment skills here. We're also thinking about your pharmacologic intervention here. What is that? If we call it out the place the other name is TPA, or tissue plasminogen activator again, if they go ambulance, and Heparin, or aspirin or Plavix, clopidogrel, they do not dissolve clots, I need something that will dissolve clots faster, and that's TPA or alteplase. Now, how do you give alteplase do you give it by IV? Do you give it through the IV? Yes. So the answer we're about to wrap up is twofold. administer oxygen to leaders and insert venous access device, right? Do right so by giving oxygen you're  treating the airway and breathing problem. And by putting an IV device for medications, fluids, antihypertensive alteplase. You're also managing the circulation. All right. Very good to June I do stroke lectures, but this is not it today because stroke is a different question.

And it's but yes, it's weight based, right? It's point nine milligram per kilo. Grab a maximum of 90 milligrams, and it's administered 10% bolus for within one minute. And the remaining amount, the 90% will be administered over one hour right to counter skorts. Now, I've given you three points. So far, some people only gave me one answer. So that gives you another point. Some people gave me two answers. So that gives you two points. Right. Now, let's go to the final question of the bowtie. Are you loving next gen NCLEX. I'm so excited to next gen. Edwards. You know, guys, I'm not working as a nurse right now. I just finished my Hawaii travel nursing contract two weeks ago, three weeks ago. And all I did on my free time. All I do in my free time is sit down and write case scenarios every now and then. So I would write six questions every now and then. I've gathered 20 questions on the 20. I'm sorry, 24? Because it's six questions, each 24 Questions so far. So I'm writing my own questions, okay. Because that's how I teach. I write my own questions. And I love writing questions. I've been an educator and NCLEX, instructor for 16 years. And I bring in a lot of experience, and how I teach, it's because of my experience, and because of, you know, I've developed this skill for a long time anyway. So what are the parameters to monitor? Give me two parameters to monitor.

All right. So definitely I've mentioned neurologic status earlier. So that's one point. What else? What else? What else? Earlier, I asked you about what abnormal findings you found in the situation in the nurses notes, right? That's recognizing cues. And then we identified what diagnosis it is. So that's your analyzing cues. And the third step in your ng n. clinical judgment model is prioritizing hypothesis, right? And then now we took action by providing your intervention, that's your gathering.

Gathering and taking actions, the fourth and fifth step, now we're down to the final step of the clinical judgment, evaluating outcomes. What do I need to do? Do I need to monitor temperature? What was the temperature earlier? 97.5 Fahrenheit? It's normal. I don't need to monitor that removed temperature. What else do I need to remove? Remove serum glucose level, right? Because the sugar is normal. So now you're down to three choices, but I need to so neurologic status and what? Anyway, some people answered urine, do I need to answer urine? Yes or No? Do I need to answer urine? You would answer your in if your differential diagnosis is UTI. Right? Right. You would answer sugar. If your differential diagnosis is hypoglycemia. Right? Right. It would answer Bell's palsy temperature if your differential diagnosis is Bell's Palsy, or Uta? Right? So the answer is actually neurologic status an EKG right in the actual NCLEX. You're going to drag these boxes up, you're going to fill in the boxes by dragging it's drag and drop, drag and drop. I just couldn't do it. Because I'm using an app right now. That doesn't allow me to do it. Now question, why do we need to monitor EKG, you found to abnormalities in your nursing notes earlier that you've mentioned to me to abnormalities in your nursing notes that led me to decide we need EKG right? It says there the apical pulse is irregular and the pulse rate is 126. All right. Go back to your history. Okay, I know you guys got four or five points, but go back to your history. Did you remember that in your history, you said, right.

I'm sorry. In your history, you said that the patient has atrial fibrillation. Right and atrial fibrillation can increase the heart rate and make your pulse irregular. Right. An atrial fibrillation can create gluts. clots can cause stroke. So the AFib is causing stroke. So do you need to monitor EKGs? Do you need to monitor EKGs? Yes or no? Yes. So the answer our final answer would be neurologic status and EKG. So what am I telling you? Yes, I know you got the answers correctly. But ng n wants you to be able to connect concepts right through clinical judgment and critical thinking it does not want you to guess guessing this time does not work because some of the questions are correct minus incorrect if you guess you're going to have penalties, right? But it wants you to get through pathophysiology you Your knowledge about pharmacology, your knowledge about physical assessments, your knowledge about your nursing interventions, everything to get there, right. Now, here's my question, who got five points? Who got five points? Anyone who got five points, or four points four and five are passing those who got one, two and three?

Well, that's not a really good score, but it's okay. Because you still have five months to prepare, perfect. Prepare for NCLEX. Next Gen NCLEX. All right. All right, Mark madrigal said, and he's right. If the diagnosis is wrong, everything else follows. You are correct, right. That's why clinical judgment is very important here. All right, and who's gonna be taking their NCLEX this year, you're lucky because you're not going to do ng n. Anyone taking the NCLEX this year, but who are taking the NCLEX next year? All right. If you're taking the NCLEX next year, you might want to join my free classes that I do. Alright, but anyway, join me this Saturday. If you guys have time. Please join me. Thank you Connetics for hosting this show. Thank you for allowing me to share my expertise. Thank you, Tanya, and, Rachelle for being with me today. Thank you guys for joining me and allowing me to explain to you what bowtie question is, but that's only one question. We have 14 different types. There are more sample questions that I will be doing on the show this Saturday. 8am Central Standard Time Live on Facebook and YouTube. Follow me on my Facebook at the doctor nurse fall, Instagram, TikTok and YouTube.

Okay. And this is a major announcement that I'll do on my show this Saturday, one lucky winner will get an NCLEX unlimited package that includes personal mentorship by yours truly, the doctor, nurse fall, all right, allow me to help you. If you want scholarship, and you don't have funds to finance your NCLEX review class, let me know and join my show, you may be able to win the raffle. I do the raffle almost every week. So make sure to join my show, follow my page so you can see if I'm doing a live and share it to your friends check their mechanics online, you might win. And if you guys somebody asked me do you guys have Crash Course or rapid courses? I'm going to take the NCLEX next month, I'm going to take the NCLEX in the next three weeks. Yes, approached me message me in Facebook message Aspire RN and Facebook as well as my team on standby. They're waiting for your message. And I will be able to help you connect it to resources. If you are interested with scholarships with Connetics USA. Do we have the link down here if we're they can apply I think it's ConneticsUSA.com/apply. Right.

But Connetics is a will message it to you in the comment section if we cannot flash the link right now. But we offer scholarships as well. Or you can message me as well, right because I can also connect you to Connetics USA, I've just connected to them several nurses that I've chosen as a scholar, but you have to take the eligibility exam. It's the same process as going through Connetics USA. But I can also help you with that. I do a lot of information sessions free classes. You don't have to enroll to my classes, but I do master classes online as well. Right? If you have more questions about NCLEX preparation, that's something I can help you with. If you have questions about living your life in the USA, I've been here for six years. I'm now an American citizen as my own house car and living the life of my dream and if I can do it, you can do it as well. Thank you guys for listening. Thank you for joining onwards and upwards. Thank you Tanya. Thank you Rachelle. Thanks to the Connetics USA team. And I'll see you soon Saturday 8am The Doctor Nurse Paul show bye