Test taking strategies and prioritization for 2026.
Let's get into prioritization big time because this is your
analyze and recognize cues. This is that taking action,
prioritizing your hypotheses. This is clinical judgement.
Part of the the test is critical thinking, a logical deduction,
and we have to have those skills.
It's one of the skills that the boards are going to be testing
and it is one of the five types of questions.
And I talk about the five types of questions in a different
lecture. So look out for that because
there really are only five ways I can ask you a board question.
This is a second type of question, prioritization.
These are the ones that I literally want you to look at
these four clients that you have, 4 patients that you have
and say which one am I freaking out about?
Now? I know every person that comes
to me or is watching is probably at least been exposed to AB, CS
or airway breathing circulation at this point.
And if that works for you, stick to it.
It's a great tool if you understand airway breathing
circulation. I found a little bit more of a
specific pattern that worked for me and it's worked well for our
students. And that is Ask Graf.
But we have to be able to recognize and analyze cues
first. That's one of the the things
that the boards are testing. Look at your CPR report.
And when we look at these four different patients, we're
looking at ones that were freaking out about.
So look for those questions that ended first.
Initial priority, urgent, most concerning, immediate report to
HCP. These 7 words are cues.
You must recognize them and be able to analyze that.
These are 4 situations that you are freaking out about.
Which one do you have less time with and what more can you do?
And in this situation, AB CS didn't work for me.
For my students, it got a little too unclear on who to choose.
Yet we were able to find ask Graph.
It leads us to the nine ways that we can find one of the
patients that we're going to prioritize, the one that we're
freaking out about. And Asgraf starts with airway,
airway, airway, airway above all else.
The remainder of them, they don't go in order.
So look for sepsis, changes in potassium, glucose, less than 70
in pediatric patients that let RG or grunting, altered mental
status, peritonitis, hemorrhage and heart attack.
Asgraf Airway again, above all else, the remainder of them find
them for me. But remember, the boards are not
going to just tell you that hey, this patient is septic, they may
and that'd be great. However, it's going to be a lot
harder than that. And that's where that critical
thinking, logical deduction comes in.
And that latter part of your CPR, especially moving forward
in 2026, is finding trends, finding clue words that that
will indicate to you that this is in fact a patient that we are
freaking out about. It is our person that we're
going to prioritize and we're going to take action with.
So look for these clue and keywords that the boards love
throwing at you when it comes to airway.
Look at drooling, strider nasal flaring, accessory muscle use,
irritability, that tripod position where they got their
hands on their knees, angioedema, especially when
you're thinking about ACE inhibitors, pulmonary embolism,
which may derive from a DVT, our attention, pneumothorax,
sustained tachypnea, smoke inhalation or singed facial hair
and look for those other ones that may not scream airway.
But how about overdose things like insulin, benzos, opioids
where respiratory rate drops below 12?
Or how about aspiration that emesis all over the face?
Those are telling you that this patient is one that we're
freaking out about. You're going to see that patient
first, initial priority, urgent, most concerning, immediate
report to HCP because they don't have a lot of time.
Then the remainder of them find them sepsis.
Now, sepsis has a triad hypotension, tachycardia, along
with being either hypothermic or febrile below 96.8 or above
100.4. Remember for the boards, every
single lab value is concrete. There's no like it's kind of
low. No, it's either low or it's not.
So you have to make that decision.
It is concrete. The boards are not going to be
in this ambiguous state. Well, it's 59 of a heart rate
and 60 is normal. So it's right there.
That's how the boards work. 59 is Vadycardia, 60 is normal.
So again, look for those lab values and now look more so in
2026 for trends. Patient went from 98.8 to 99.6
and now is 100.5. And that trend tells you that
something is going on. Their blood pressure went from
1:00 20 / 75 to one O 5 / 65 to 86 / 42.
But the trend is going towards wait a minute, this patient is
becoming septic. OK, maybe this is the one that
I'm freaking out about. This is Asgraph, but there's
subtle situations that the boards are going to throw at you
to see if you actually can recognize and analyze these
cues. Can you use your clinical
judgment to tell me that this patient is septic?
How about purulent discharge at the incision site, tachypnea and
the one that the boards love, elevated lactate.
But what are we going to do first?
What is our most appropriate action to take?
And then there's a drop down menu and now it's going to say,
well, I could do antibiotics, I can give them supportive
measures, I can monitor them, or I can start IV fluids.
Well, that goes back to the concept of nipa and POIV fluids.
Pain if they need it, PPI if they need it, anti emetic if
they're nauseous, and antibiotics as needed.
So again, one of those concepts that I teach you watch that
video as well too. And the ones that may not seem
obvious are that transfusion and transplant patient is post op
post procedure when we get into ash of ASGRAF and now they've
received blood products or they received an organ, can we
transmit infection, a viral infection or blood products are
left out too long and bacterial infection?
Absolutely. So look for this patient to
become septic. The key is changes in potassium.
With changes in potassium, high or low hyper or hypokalemia.
When potassium has a big role in the heart as an electrolyte and
that electrolyte becomes imbalance, we're worried about
that heart becoming unstable. And when it becomes unstable,
we're worried about that dysrhythmia.
And the most lethal dysrhythmia that we're concerned about is in
fact ventricular fibrillation. Now the boards may give you 2.8,
5.66 point O as a lab value, but what if they don't?
How are they going to see if you can analyze or recognize these
cues? Well, they may give you a
hypokalemia, muscle cramps. Well think about that.
Why does that make sense and how do you spot it?
Well, let me give you an example.
Let's say an athlete, those of you that watch my videos about
me knocking out my tooth, how about when I was practicing out
in the heat here in Vegas and I'm running, running, running,
sweating, sweating, sweating, sweating.
And I'm like, oh, coach, I got a cramp.
I got a cramp and coach tells me to go do what?
Eat a banana, which has potassium in it.
How about that patient that's on the loop diuretic and that says,
hey nurse, I have been sitting here all day but my calf is
just, it keeps cramping up and you're like, whoa, what's going
on? How about that patient that has
hyperkalemia and has that chest palpitations or something Feels
funny in my chest and on EKG they have peaked T waves.
Well, that's not telling you hyperkalemia directly.
It's not telling you a lab value, but it is screaming you
better prioritize this patient. There is an action to take here.
Remember, when it comes to recognizing and analyzing cues,
the boards now, especially now in 2026, are giving you age,
gender, location, meaning, anatomical or physical location,
and gender for a reason. If it's in there, pay attention
to it. It's not just coincidental.
They're doing this to see if you can recognize and analyze why
they give it to you. Glucose less than 70?
Well, when we're having hypoglycemia of that magnitude,
our body's going to shut off. We're going to become comatose
and die. And the boards will give you
specifically a lab value. Glucose is 54.
OK, what about some signs and symptoms that scream
hypoglycemia, fatigue, headache, disorientation, sweating,
nausea, coma, shakiness, tremors, seizures?
And now we're looking at this patient saying, wow, I don't
have time. What more can I do?
Is this that patient that has a blood glucose of 64, which is
low? That's concrete and it's telling
you they would like more fruit juice.
No, it's not because who do I have less time with?
Not somebody that's requesting analyze that cue more fruit
juice. So meaning they've already
gotten that that sugar, that 15 grams of sugar that we talked
about in the endocrine and they're talking to you.
Look at those cues and clues that live value is low and it is
screaming hypoglycemia. But again, who do I have less
time with? If they're talking to me and
requesting more fruit juice and now they're stable, they're
talking to me, what more can I do?
While I would have given them fruit juice, am I going to
monitor them? Absolutely.
But in that question, there's probably another one of Asgraf
that you have to look at. Find me that one.
And between the two, tell me who do I have less time with and
what more can I do? So this is the way that we apply
Asgraf. In a later video, I'll do
practice questions. So you can actually see how we,
one, use the method and two, how we're able to actually apply
Asgraf with pediatric patients. I love the words let RG or
grunting and the emphasis on the R there in Asgraf because in
pediatric patients, how do you tell?
How do you how do you express that a patient that is young,
five years or younger typically could be older, but how do you
say that they're in dire need of treatment?
Well, call them lethargic or say that they're grunting or maybe
they have a high pitched crying or they're in severe hypoxia to
having respiratory distress, which is airway, but they're
also going to be lethargic. They're going to be grunting.
So look for things like meningitis or infection, Look
for abusive head trauma. Altered mental status is a
second a in Asgraf and look for the cure words, seizures,
hallucinations, confusion, psychosis.
Especially when we're talking about that psychosocial
integrity. This is a big deal because we
don't think about things like suicidal ideation as altered
mental status, but it is or homicidal ideation.
It is that psychosocial integrity, psychosis, bipolar
confusion, changes of level of consciousness, delusions again,
psychosocial integrity, disorientation, increased
intracranial pressure. And again, look for those clue
words of time. Why did this happen in the last
hour? What just happened that this is
now happening, or it's an acute setting, or they're not acting
like themselves. Pay attention to these Q words
and Q words and find them. Peritonitis.
For what is a peritoneum? It is a lining that encases a
good majority of the GI tract and parts of the female
reproductive organs. And with the peritoneum, if
something is wrong in any of those areas, it is going to get
inflamed. So look for those peritoneal
signs. Look for things like rigidity,
guarding, rebound, tenderness board like abdomen, diffuse
abdominal pain, severe abdominal pain.
Look for those quadrant pains that are screaming that this
patient is actually developing. Maybe like we talked about GI
perforation leading to peritonitis leading to sepsis.
Look at those concepts that I teach you in other sections.
The first H in ASCA is hemorrhage.
Again, we're losing volume, so our blood pressure goes down.
Our hearts trying to compensate for it because we don't have the
volume, so it beats faster. So hypotension, tachycardia,
when they become hemodynamically unstable and they're not pushing
out that warm, red oxygenated blood, then look for a weakened
or diminished pulses. Look for cold and clammy or
pale. Look for the places where
they're losing blood, things like saturated pads or
dressings. Look for that capillary refill.
Continuous drainage. Is that that Sarah Sanguinous
drainage? No.
And if you don't know what Sarah Sanguinous, that light pinkish
type of a drainage that is expected, then look up the word.
Don't just breeze through them. Again, every single word in
these exams is there for a reason.
When you're practicing and you see words like this, write it
down so that way when you do see it, you're able to identify it
or recognize that cue. But what are we going to do in a
situation where hemorrhage, again, get them hemodynamically
stable, Ivy fluids, Ivy fluids. And the last one is heart attack
or myocardial infarction. Again, look for that chest pain,
that pressure tight. It's like somebody's they're
going to tell you that I feel like an elephant is sitting on
my chest. Look for that pain that radiates
to the left jaw, left neck, left arm, that epigastric pain that
will be a differential when it's GERD or acid reflux.
Look for that costochondritis as a differential diagnosis.
And now we've got or maybe even some sort of pleuritic pain
differential diagnosis. If things present similarly,
rest assured, one, they could be a prioritization question. 2.
They could be differential diagnosis, meaning a bow tie
question or the signs of symptoms that are similar or
that are different. Compare and contrast these
columns that make up your matrix or grits.