Test-Taking Tips for NCLEX NUR 292 NCLEX Review

Test-Taking Tips for NCLEX NUR 292 NCLEX Review

FACTS ABOUT NCLEX-RN

PURPOSE n n n To determine if you are a safe and effective nurse To safeguard the public To test for minimum competency

TEST CONTENT n n n Based on the knowledge & activities of entrylevel nurse Written by nursing faculty & clinical specialists Presented as multiple-choice questions with four possible answer choices or alternate format Based on integrated nursing content Includes 15 experimental questions

TEST ADMINISTRATION n n n Computer adaptive test adapts to your knowledge, skills, and ability level Question sequence is determined interactively Questions are selected based on the item difficulty and the test plan Test dates and times are individually scheduled through a Pearson Testing Center Tests are administered at individual computers

TAKING THE EXAM n n n Computer knowledge is not required Mouse is utilized to make choices (more later) You receive instructions & a practice exercise before beginning the exam Any necessary background info appears on the screen with the question The computer selects a relatively easy first question

TAKING THE EXAM – cont. n n The next question is selected by the computer based on your response to the first question If your answer is correct, the next question is slightly more difficult If your answer is incorrect, the next question is slightly easier Questions are selected to precisely measure your ability in each area of the test plan

TIMING n n n There is no time limit for each individual question You will answer a minimum of 75 questions to a maximum of 265 questions The maximum time for the exam is 6 hours, including the practice exercise & all breaks There is optional 10 minute break after 2 hours There is an optional 10 minute break after 1 ½ hours additional test time

THIS EXAM WILL END n n n When the computer has determined your ability, or When a maximum of 6 hours of testing is reached, or When a maximum of 265 questions have been answered

SCORING n n n It is a pass/fail exam There is no penalty for guessing The 15 experimental questions are not counted

CONCERNS n n n No answer changes. Questions are selected by computer based on previous responses No scrolling back No skipping questions. You must answer the question to go on

ADVANTAGES n n n Testing is available year-round, 15 hours a day, six days a week, in six-hour time slots Results are released by individual state boards If you fail, you can retest in 45 days

Alternate Item Format n n n Short answer (includes drug dosage/IV problems) Choose all that apply Diagrams – choose the correct location (auscultation points, fetal position, pulses)

Example A client is receiving a blood transfusion and complains of headache and low back pain. What are the nurse’s actions? (Choose all that apply) a. Administer Tylenol (acetaminophen) 1 gm b. Stop the blood transfusion c. Flush the line with saline d. Submit the tubing and bag to the Blood Bank e. Establish a saline lock or patent IV f. Obtain first voided urine (within one hour of reaction)

The client has received Fentanyl, Atropine, and topical anesthetic for an endoscopic procedure. The nurse is monitoring the client and notes the pulse is increased form the pre-procedure baseline. The most likely explanation for this finding is the increased pulse is a side effect of the ______.

Tip 1 n BE POSITIVE You learned the material in school & graduated You choose to take the test, so you can prepare & schedule when ready Establish a study schedule Worry in a constructive manner

Tip 2 n Know the structure of the test plan: Client Needs A. Safe, Effective Care Environment: 1)Management of care 2) Safety & Infection Control Health Promotion & Maintenance B. 13 -19% 8 -14% 6 -12%

Test Plan Structure – cont. C. D. Psychosocial Integrity Physiological Integrity: 1) Basic Care & Comfort 2) Pharmacological/Parenteral Therapy 3) Reduction of Risk Potential 4) Physiological Adaptation 6 -12% 13 -19% 11 -17%

INTEGRATED CONCEPTS Nursing Process n Caring n Communication and Documentation n Teaching/Learning Integrated throughout the four major Client Needs categories n

Tip 3 n Schedule your study time The minimum time for preparation is 2 hours/day for six to eight weeks. Spend 1/3 time reviewing content Spend 2/3 time answering test questions Develop a study plan/calendar (see example) Review med/surg, peds, maternal/child, psych Spend 50% time in med/surg

Tip 4 n Answer many questions Answer a minimum of 3, 000 test questions Include answering questions in your study plan. For example, answer 100 questions/day for a month. Use at least three different review books Your scores should be at least 75%, preferably, 7585%. Review wrong answers.

Tip 5 Answering Questions Read the situation and stem question carefully. Try to understand what knowledge the question is asking for. Determine whethere is a true-response or false-response stem. Be clear before you look at answer options. If not clear, reword using your own words.

True-Response Stem Requires an answer that is a true statement: An appropriate nursing action The most essential or highest priority nsg action A safe nursing judgment A therapeutic nursing response An accurate rationale for a nursing action An action by client indicating the success of nurse’s client teaching

False-Response Stems n n n Answer will be inappropriate nursing action or inaccurate explanation. Look for negatives in stem. They indicate that 3 choices are correct and one is incorrect. The incorrect choice is the answer. Not, false, least, except, unlikely, all but, inconsistent, inappropriate, untoward, unrealistic, lowest priority, atypical, incorrect, contraindicated, avoids, unsafe

Practice Questions The nurse caring for a client with urolithiasis knows which nursing interventions would be inappropriate? 1. Forcing fluids 2. Straining the urine 3. Complete bed rest 4. Medication for colic or discomfort

Practice Question The nurse is admitting a client suspected of having diabetes mellitus. If the client does indeed have d. mellitus, the nurse would expect to observe: 1. Shallow, labored respirations 2. Increased BP associated with slight periorbital edema 3. Periods of altered pulse rate 4. Increased urinary output

Tip 6 Use the process of elimination in selecting answers. You can usually narrow down to two choices. Then utilize other rules to make your choice: Global Response Similar distractors Similar words

Global Response n Look for an answer that has a broader focus (global) when narrowed down to two choices. Examine the answers and try to determine if one answer may be included in the other.

Example The nurse understands that the overall aim of therapy for a client with cerebral palsy is to: 1. Improve muscle control & coordination 2. Correct the underlying cause of the disease 3. Prevent contractures & emotional disturbances 4. Maximize the client’s assets & minimize limitations

Similar Distractors n When answers are grouped by similar concepts, activities, or situations, select the one that presents a different concept.

Example A female client has been treated for severe chronic emphysema for several years with bronchodilators and relatively high does of prednisone. Which of the following activities would pose the least risk for this client in relationship to the side effects of prednisone therapy? 1. 2. 3. 4. Shopping at the mall on Saturday afternoon Spring cleaning her two-story house Attending Sunday morning church services Serving refreshments at her 6 -year old son’s school play

Example In providing care to a client with COPD, the primary nursing consideration is to: 1. Not overtire the client 2. Plan adequate rest periods throughout the day 3. Give only low-flow oxygen 4. Allow the client to set the pace when walking

Similar Words If you don’t know the answer, look for global response, then try to eliminate similar distractors. If you still cannot choose, look for a similar word or phrase used in the stem and one of the options.

Example In caring for a client immediately following a cardiac catheterization procedure, which nursing action is appropriate? 1. Applying warm compresses to the puncture site 2. Assisting with passive ROM exercises 3. Monitoring the client for cardiac arrhythmias 4. Assisting the client into a high-Fowler‘s position

Tip 7 n Avoid selecting answers with absolutes in them. They will be incorrect. n Always, all, every, never, only, none

Tip 8 Communication n n If you cannot communicate therapeutically, it is difficult to practice safely. If the question has a true response stem, only options that use therapeutic communication tools can be correct answers.

Therapeutic Tools n Silence, general leads, clarification, reflecting, empathy, giving correct information, focusing, offering self for assistance

Eliminate Blocks Avoid statements which include: “Don’t worry”, “Why? ”, closed-end questions, “Let’s explore” (Let’s talk about…), nursefocused answers These are non-therapeutic responses n

Example A 50 -year-old woman is admitted to the emergency room with a diagnosis of acute myocardial infarction. She tells the nurse, “I’m scared, I think I’m going to die. ” Which of the following responses by the nurse would be MOST appropriate? 1. “Everything is going to be fine. We’ll take good care of you. ” 2. “I know what you mean. I thought I was having a heart attack once. ” 3. “I’ll call your doctor, so you can discuss it. ” 4. “It’s normal to feel frightened. We’re doing everything we can for you. ”

Tip 9 Priority Setting Examples of stems which select priorities: Nurse’s initial response Essential nursing actions Vital consideration in planning care Give immediate attention to which of the following: Highest priority Best nursing judgment Most important

Guidelines for Selecting Priorities Maslow’s Hierarch of Needs – physiological needs first-if none identified, safety needs then receive priority Nursing process – assessment comes first Communication theory – focus on feelings first Teaching/Learning theory – focus on motivation first and readiness to learn

Example A client is hospitalized with COPD. Oxygen per nasal cannula at 2 L/m is initiated. When the nurse made an assessment at 3: 00 pm, the client appeared to have made a good adjustment to hospitalization. At 5 pm, the nurse found the oxygen cannula on the floor. The client was angry and said, “It’s about time you got here. Where am I? Where is my breakfast? ” The nurse should give immediate consideration to which of the following questions? 1. Has the oxygen cannula been off long enough to cause hypoxia? 2. Is the client’s anger related to being hospitalized? 3. Does the client need a clock in the room to keep track of time? 4. Is the client accustomed to eating dinner very early in the day?

Example A client hospitalized with COPD is receiving oxygen by nasal cannula. At 5 pm the oxygen cannula was found on the floor, the nurse assisted the client with the oxygen cannula and raised the head of the bed to high-Fowler’s position. At 8: 45 pm, the client reports feeling short of breath and requests to change position. In addition to repositioning the client, the nurse should give highest priority to which nursing action? 1. Put the client on 15 -minute checks. 2. Call the physician to report the shortness of breath. 3. Observe the rate, depth, and character of the client’s respirations. 4. Help the client relax by giving a back rub.

Example In preparing an elderly client with COPD to be discharged, the nurse is teaching the client about the correct position for postural drainage. To achieve success in this teaching program, which information about the client is most important? The: 1. Type of bed the client will be using at home for the procedure 2. Amount of time required for the client to change positions 3. Client’s goal concerning the ability to be self-sufficient 4. Client’s ability to move about without assistance from others

Tip 10 Rules of Management n n n Do not delegate the functions of assessment, evaluation & nursing judgment (teaching) This is not the real world – NCLEX is ivory tower nursing – TEXTBOOK nursing Delegate activities that involve standard, unchanging procedures – bathing, feeding, dressing, transferring. Complex activities are not delegated.

More Management Tips n n n Delegate activities for stable patients with predictable outcomes Remember priorities! Maslow, ABCs, stable vs. unstable, when determining which patient the RN should attend to first. NCLEX is all about caring for patients

Example A 7 -year-old boy with a compound fracture of the left femur is being admitted to a pediatric unit. Which of the following actions is best for the nurse to take? 1. Ask the nursing assistant to obtain the child’s vital signs while the nurse obtains a history from the parents. 2. Ask the LPN/LVN to assess the peripheral pulses of the child’s left leg while the nurse completes the admission forms. 3. Ask the LPN/LVN to stay with the child and his parents while the nurse obtains phone orders from the physician. 4. Ask the nursing assistant to obtain equipment for the child’s care while the nurse talks with the child and his parents.

Example A home care nurse is planning her visits for the day. Which of the following patients should the nurse visit first? 1. A 62 -year-old man two days after an inguinal repair. 2. A 40 -year-old woman with type 1 diabetes mellitus (IDDM) with a foot ulcer. 3. A 76 -year-old man with chronic obstructive pulmonary disease (COPD) 4. A 50 -year-old woman three days after a right mastectomy.

Tip 11 NCLEX is not based on the real world – but is based on TEXTBOOK knowledge. You have time, staff, and equipment Take care of the patient first, then equipment You are caring only for one client n

Remember – Textbook, not Real World Don’t pass the buck. Avoid “Notify physician” answer options. NCLEX does not want to know what the physician will do, but what the RN will do Lab values – Know normal. Correctly interpret normal/abnormal values 5 Rights of Medication Administration

Example A 53 -year-old man is receiving packed red blood cells. Several minutes after the infusion is started, he complains of itching and develops hives on his chest and abdomen. Which of the following actions should the nurse take first? 1. Slow down the rate of the transfusion. 2. Call the physician for an order for an antihistamine. 3. Mix IV fluid with the blood to dilute it. 4. Stop the transfusion.

Tip 12 n Avoid looking for a pattern in the selection of answers.

Tip 13 n DO NOT PANIC if you come across a totally unfamiliar question. Some are impossible to answer correctly. Use other rules and you may choose the correct answer. n Example: use the nursing process, Maslow.

Tip 14 n Avoid answers that make the client seem unworthy or ignorant. n She would not understand. Don’t bother to explain. He’s not intelligent enough. n n

Tip 15 n Trust your intuition. Your first answer selection is usually the best. If you read the question too many times, you may read into the question.

Tip 16 Remember BE POSITIVE!

How to register for NCLEX n n www. ncsbn. org for instructions and examples Register on-line, by telephone, or mail $200 to Pearson testing and also application to Board of Nursing Candidate will receive ATT card from Pearson when Board of Nursing authorizes testing.

n n n Must bring ATT card & one form of ID to test Will be photographed & fingerprinted prior to test Will be provided an erase board to use while testing, drop-down calculator available

n n n Family or friends cannot wait in testing center No hats, scarves, or coats may be taken into test Do not bring any NCLEX review material to testing center