NCLEX-RN Test taking Strategies
NUR 213 Spring 2022
Marian Price, MSN, RNC-OB
The NCLEX-RN Detailed Test Plan
NCLEX-RN Candidate Bulletin
... [Show More] Link
Click link above to obtain more detailed information regarding the detailed test plan for applicants beginning January 1, 2022.
Individual Strategies for Success
Questions, questions, questions…
ATI, Saunders NCLEX Comprehensive Review, Apps., etc.
Virtual ATI (V-ATI)
Consider a formal review-NCSBN, Uworld, Kaplan.
FAQs About the Exam
Computer Adaptive Testing
Prepare | NCLEX
Test-taker must answer each questions before continuing to the next item
Answers are scored as correct/incorrect.
A correct answer will lead to a harder question An incorrect answer will lead to an easier question
Process continues until test plan requirements are met.
Client Needs
Safe, Effective Care Environment
Health Promotion and Wellnes
Psychosocial and physiological integrity
Safe Effective Care Environment
Management of Care: 17-23%
Safety and Infection Control: 9-15%
Health Promotion and Maintenance: 6-12%
Psychosocial Integrity: 6-12% Physiological Integrity:
Basic Care and Comfort: 6-12%
Pharmacological and Parenteral Therapies: 12-18%
Reduction of Risk Potential: 9-15%
Physiological Adaptation: 11/17%
Concepts applied
In addition, the following concepts are applied throughout the four major client needs categories and subcategories of the test plan:
Nursing process
Caring
Communication and documentation
Teaching and learning
Culture and Spirituality
Safe and Effective Care Environment
After receiving report which patient should the nurse assess first?
A. The client who has a nasogastric tube attached to intermittent suction.
B. The client requiring subcutaneous insulin prior to breakfast.
C. The client who is two days postop and is complaining of incisional pain.
D. The client who has a blood glucose of 50 mg/dL and is complaining of blurred vision.
Correct Response
D. The client who has a blood glucose of 50 mg/dL and is complaining of blurred vision.
This client is the priority as the blood glucose and symptoms indicates hypoglycemia and must be address in order to prevent further decrease in the blood glucose and worsening of the client’s condition.
Safety and Infection Control
The nurse prepares to care for the client on contact precautions who has a hospital-acquired infection caused by MRSA. The patient has an abdominal wound that requires irrigation and has a tracheostomy attached to a mechanical ventilator, which requires frequent suctioning. The nurse should assemble which necessary protective items before e Entering the patient’s room.? A. Gloves and a gown.
B. Gloves, mask, and goggles.
C. Gloves, mask, gown, and goggles.
D. Gloves, gown, and shoe covers.
Correct Response
C. Gloves, mask, gown, and goggles.
There is a risk of spattering to the nurse with both the irrigation of the abdominal would and frequent suctioning of the tracheostomy. The most appropriate response is the inclusion of gloves, mask, gown, and goggles.
Health Promotion and Wellness
The nurse is choosing age-appropriate toys for a toddler. Which toy is the best choice for a toddler?
A. Wooden puzzel
B. Toy Soldiers
C. Small legos
D. A Card Game with Large Pictures
Correct Response
Think Growth and Development Concepts
A. A Wooden Puzzle
Age range is 1-3 years.
The toddler refines fine motor skills and the most appropriate toy is the wooden puzzle.
Psychosocial Integrity
Test nurse’s knowledge, skills, & ability required to promote & support the patient, family, significant other and their ability to cope, adapt & problem solve during stressful events.
Addresses their emotional, mental & social well-being & ability to care for the patient/family member with an acute or chronic mental illness
Psychosocial Integrity
A patient with coronary artery disease has selected guided imagery to help cope with psychological stress. Which statement indicates an understanding by the patient of this stress reduction measure?
A. “This will only help if I play music at the same time”
B. “This will only work for me if I am alone in a quiet area”
C. “I need to this when I lie down in case I fall asleep”
D. “The best thing about this is that I can use it anywhere, anytime”.
Correct Response
D. “The best thing about this is that I can use it anywhere, anytime”.
This is the most correct response. Guided imagery does not require music to be played, it does not require a quiet area, and the client does not need to lie down to use the method. Guided imagery is a stress relief method that uses the person’s senses and imagination to picture a person, place or time that makes the person feel relaxed.
So, what is physiological integrity?
Tests the nurse’s knowledge, skills and ability required to:
Provide comfort and assistance with ADLS
Administer medications, parenteral therapies, blood and blood products
Risk Reduction to prevent complications or health problems related to the client’s condition and/or any prescribed treatments/procedures
Physiological adaptation or provision of care to clients with acute/chronic or life-threatening conditions.
Let’s Practice
The client with Parkinson’s disease develops akinesia while ambulating, increasing the risk for falls. Which suggestion should the nurse provide to the client to alleviate the problem?
A. Use a wheelchair for moving around
B. Stand erect and use a cane to ambulate C. Keep the feet close together while ambulating
D. Consciously step over imaginary lines on the floor.
What is your response?
D. Consciously step over imaginary lines on the floor.
Shuffling steps, freezing gate, alterations in balance are common for clients with Parkinson’s Disease. Consciously stepping over imaginary lines on the floor encourages the client not to shuffle their feet and may decrease fall risk.
Pharmacological therapies
The nurse monitors a client who receives digoxin (Lanoxin). The nurse identifies which early manifestation of digoxin (Lanoxin) toxicity?
A. Anorexia
B. Facial Pain
C. Photophobia
D. Tachycardia
What did you choose?
A. Anorexia is correct and is an early sign of digoxin (lanoxin) toxicity as well as other GI upset such as nausea and vomiting. Facial pain, photophobia, and tachycardia are not signs/symptoms of digoxin (lanoxin) toxicity.
Reduction of Risk
The client has been ordered to receive an (MRI) or magnetic resonance imaging study for a suspected brain tumor. The nurse should implement which intervention to prepare the client for the study?
A. Shave the client’s groin area for insertion of a femoral catheter.
B Remove all metal-containing objects from the client.
C. Keep the client NPO for 8 hours prior to the study.
Instruct the client in inhalation techniques for administration of a radioisotope.
Correct Response?
A. Remove all metal-containing objects from the client.
B, C, D are incorrect and are not requirements for the client to undergo a MRI. Magnetic is the key word in the stem of the question. A MRI uses a giant magnet in the MRI machine itself. In the event metal-containing items are not removed from the client they will be pulled toward the MRI machine and potential cause injury to the client.
Physiological Adaptation
The client with renal insufficiency has a magnesium level of 3.6 mg/dL. On the basis of this laboratory result, the nurse interprets which sign as significant?
A Hyperpnea
B. Drowsiness
C. Hypertension
D. Physical hyperactivity
Let’s Talk About This….
B. correct. Drowsiness
Even in the event the student draws a blank on the expected range of magnesium levels then look at our options:
A, is hyper C, is hyper D. is hyper
Based on test taking skills all three of these options are increased and similar and the one that is different or is decreased is B. Drowsiness. The student would have a good chance of getting this right if they breakdown the options.
What are integrated processes?
Caring
Communication and documentation
Nursing Process
Teaching and learning
More Practice
The client is scheduled for angioplasty. This client states to the nurse “I am so afraid this procedure will hurt and make me worse off than I am already”. Which response by the nurse is most therapeutic?
A. “Can you tell me what you understand about the procedure”?
B. “Your fears are a sign that you really should have this procedure”.
C. “Those are very normal fears, but please be assured that everything will be okay”.
D. “Try not to worry. This is a well-know and easy procedure for your healthcare provider”.
What do you think is most therapeutic and why?
Correct response is A. “Can you tell me what you understand about the procedure”?
Class discuss the rationale
Reading the Question
What are the parts?
The case situation
The question stem
Options (correct responses and distractors)
Read the question
Identify the parts of a question
Read carefully
Look for keywords or phrases
Identify the issue
Use process of elimination Avoid “what if”?
Question
The nurse is reviewing the laboratory results of a client who is receiving magnesium sulfate by intravenous (IV) infusion and notes the client’s magnesium level is 7mEq/L. Based on the client’s lab result, the nurse would most likely note which of the following in the client?
A. No specific signs or symptoms.
B. Tremors
C. Respiratory Depression
Hyperactive Reflexes
Response
Case situation-the lab results are a magnesium level of 7 mEq/L.
Questions Stem-Based on the lab result the nurse would most likely expect to note which of the following in the client?
Options
A. No specific signs or symptoms
B. Tremors C. Respiratory Depression D. Hyperactive Reflexes.
Try Another
A. Check the surgical dressing to ensure that is intact.
B. Confirm the placement of the oral airway.
C. Examine the IV site for infiltration.
D. Observe the foley catheter for drainage.
A client has just returned from the operating room to the recovery room with a foley catheter in place, an IV, and an oral airway and is still unresponsive. Which nursing assessment should be performed first?
Keep going…..
Which is associated with a physiologic need of a patient with a colostomy?
A. Disturbance in body image
B. Inadequate nutrition
C. Knowledge Deficit
D. Skin breakdown
Let’s try again….
Which is associated with a psychological need of a patient with a colostomy?
A. Disturbance in body image
B. Inadequate nutrition
C. Lack of knowledge
D. Skin breakdown
The Stem that is an Incomplete
Sentence
Options
Each option should complete the sentence with grammatical accuracy.
Answer
The answer is the only option that correctly completes the sentence in relation to the informational content.
Read all the answers.
Sample
To best understand what a client is saying, the nurse should:
-A. Demonstrate interest.
-B. Listen carefully.
-C. Remain silent.
-D. Employ touch.
Why is nursing knowledge important?
Nursing knowledge is needed to assist in answering questions because the knowledge provides you with information you need to process and think about critically to answer the question.
Process of Elimination
A course of action that involves reading each answer choice and removing the answers which are wrong and do not address the issue.
A client that has Type 1 diabetes mellitus describes shakiness and
hunger 2 hours after receiving a dose of regular insulin. The nurse determines that the client is having a hypoglycemic reaction and prepares to give the client which best item from the dietary kitchen to treat the reaction?
A. Milk C. Sugar-free cookies
B. Diet Soda D. Sugar
Eliminate Only Two Options?
Read the question again. • Identify the case situation from the stem of the question.
• Look for key words or key phrases.
Identify the issue of the question.
• Ask yourself, “What is the question asking?”
• Read the options again.
Make your final choice by focusing on what the question is asking, using nursing knowledge, and implementing test-taking strategies
“What if?”
It is a syndrome that occurs when you read a test question and instead of
simply focusing on the information in the question, you start asking yourself,
“Well, what if?” This question leads you directly into the pitfall of
“reading into the question”.
Let’s Practice
A nurse is changing the tapes on a tracheostomy tube. The client coughs and the tube is dislodged. The initial action is to:
A. Cover the tracheostomy site with a sterile dressing to prevent infection.
B. Call the physician to reinsert the tube.
C. Grasp the retention sutures to spread the opening.
D. Call the respiratory therapy department to reinsert the tracheostomy tube.
Question
A nurse is caring for a hospitalized client with a diagnosis of congestive heart failure who suddenly reports shortness of breath and dyspnea. The nurse takes which immediate action?
A. Prepares to administer furosemide (Lasix). B. Calls the physician.
C. Administers oxygen to the client.
D. Elevates the head of the client’s bed.
True/False Response Questions
True Response
Questions: Keywords
Early
– Late
– Most likely
– Immediately
– Most appropriate
– Understands
– Adequately tolerating
– Initial
– First False Response
Questions: Keywords
Least likely
– Avoid
– Have not been fully met
– Ineffective
– Least helpful
– Needs reinforcement of the medication
administration instructions
– Least priority
Prioritization
High Priority: a client need that is lifethreatening, or if untreated could result in harm to the client.
Intermediate Priority: a nonemergency and non-life-threatening client need that does not require immediate action.
Low Priority: a client need that is not directly related to the client’s illness or prognosis, is not urgent, and does not require immediate action.
Key Words
• Best
• First
• Highest priority• Initial
• Most important
• Most likely
• Next
• Vital
• Essential
Should I call the provider?
The nurse enters a client’s room and finds the client slumped over in bed.
The nurse quickly assesses the client and discovers that the client is not breathing. The nurse immediately:
A. Places oxygen via nasal cannula on the client. B. Sits the client upright in bed.
C. Calls the physician.
D. Begins cardiopulmonary resuscitation (CPR).
When Not to Select “Call the Physician”?
A nurse is caring for a postoperative client who suddenly becomes restless. The nurse would most appropriately:
A. Check the client’s vital signs. B. Notify the physician.
C. Medicate the client for pain.
D. Talk to the client in a calm voice.
When to Select “Call the Physician”
A nurse is caring for a client who just returned from the recovery room after
a tonsillectomy and adenoidectomy. The client is restless and the pulse rate
is increased. The nurse prepares to continue assessing the client, but the client begins to vomit large amounts of bright red blood. The immediate nursing action is to:
A. Call the surgeon.
B. Continue with the assessment.
C. Check the client’s blood pressure.
D. Obtain a flashlight and gauze.
What are the ABCs?
A nurse is assessing the client’s condition after cardioversion. Which of the following observations would be of highest priority to the nurse?
A. Status of airway
B. Oxygen flow rate
C. Level of consciousness
D. Blood pressure
Maslow
Physiological
• Safety & Security
• Love & Belonging• Self-Esteem
• Self Actualization
Maslow
A nurse is admitting a client with a diagnosis of posttraumatic stress disorder to the mental health unit. The client is confused and disoriented.
During the assessment, the nurse’s primary goal for this client is to:
A. Stabilize the client’s psychiatric needs.
B. Orient the client to the unit.
C. Explain the unit rules.
D. Accept the client and make the client feel safe.
Nursing Process
Assessment
• Analysis
• Planning
• Implementation
• Evaluation
Nursing Process -Analysis
A nurse is reviewing the laboratory results of an infant suspected of having hypertrophic pyloric stenosis. Which of the following laboratory findings would the nurse most likely expect to note in this infant?
A. A blood pH of 7.50.
B. A blood pH of 7.30
C. A blood bicarbonate of 22mEq/L
D. A blood bicarbonate of 19mEq/L
Nursing Process - Implementation
Important points:
–You only have one client to be concerned about!
– Answer the question from an ideal and textbook perspective. – Answer the question as if the nurse has all the time available to care for the client and all the needed resources available at the client’s bedside.
Nursing Process - Implementation
A nurse is caring for a client after a cardiac catheterization. The client suddenly reports a feeling of wetness in the groin at the catheter insertion site. The nurse checks the site, notes that the client is actively bleeding, and takes which best action?
A. Dons a clean glove and places pressure on the insertion site with the gloved hand.
B. Dons a sterile glove and places pressure on the insertion site using sterile gauze.
C. Contacts the physician.
D. Checks the client’s peripheral pulses in the affected extremity.
Nursing Process - Evaluation
A client recovering from an exacerbation of left-sided heart failure has a nursing diagnosis of Activity Intolerance. The nurse determines that the client best tolerates mild exercise if the client exhibits which of the following changes in vital signs during activity?
A. Pulse rate increased from 80 to 104 beats/min.
B. Respiratory rate increased from 16 to 19 breaths/min.
C. Oxygen saturation decreased from 96% to 91%. D. Blood pressure decreased from 140/86 to 112/72 mm Hg.
Leadership, Delegation, and Making
Assignments
The nurse who delegates the task or activity maintains accountability for the overall nursing care of the client.
Use general guidelines (Nurse Practice Act), regarding what a health care provider can competently and legally perform.
Avoid using agency policies & procedures to answer the question.
Delegating, Assignment Making
A. An older client recovering from pneumonia who requires ambulation every three hours.
B. A client with a tracheostomy who requires frequent suctioning.
C. An older client who requires turning and repositioning every two hours.
A client who is a new admission to the unit requiring an initial head to toe assessment.
An RN is planning client assignments for the day & has an LPN & CNA on the team. The nurse most appropriately assigns which client to the LPN?
Principles to Delegating and Assigning.
• Always ensure client safety • Focus on the issue of the question & what the question is asking.
• Determine which tasks or clientcare activities can be delegated and to whom, based on the Nurse Practice Act.
• Think about individual variationsin work abilities & determine the degree of supervision required.
Continued
Always provide directions that are clear and concise, accurate, complete and validate the person’s understanding of the directions and expectations.
Communicate a feeling of confidence to the individual and provide prompt feedback.
Provide the individual with a time line for completion.
Maintain continuity of care as much as possible when assigning client care.
Assignment Making
The RN charge nurse is planning the assignments for the day and is reviewing client data and the needs of clients. To maintain continuity of care, the nurse would ensure that which client is cared for by the nurse who cared for the client on the previous day?
A. A client with a cervical radiation implant.
B. A client with active tuberculosis.
C. A client with herpes zoster.
D. A client recently diagnosed with inoperable cancer.
Additional Strategies
Additional Strategies • Eliminate options that contain medical rather than nursing interventions. • Eliminate similar options
• Ensure that all parts of an option are correct.
• Look for the umbrella option.
• Visualize the information.
• Look for similar concepts in the question and in one of the options.
• Visualize the information.
• Look for similar concepts in the question and in one of the options.
• Identify the laboratory value as normal or abnormal.
• Note the disorder present in
the question
• Identify the associated bodyorgan that is affected as a result of the disorder.
Study Tips
Prepare
• Establish a Routine – Daily • Set short and long term goals • Prepare For Class
• Take Class Notes
Repetition
• Repetition
• Memorization – Acrostics,
Acronyms, Alphabet Cues
The client
• Factors such as age, sex, and marital status may be relevant.
• Child’s age is often relevant to the answer.
• Appropriate toys and divisional activities vary with age.
• Consider who is the patient or patient in the situation.
The Odd Answer and Absolutes
The answer is different from the others may be the correct response.
Absolutes
• Answers containing universal or absolute words are very apt to beincorrect.
• Very little in life or nursing is always correct or incorrect.
• Absolute answers should be looked @ with great caution.
What are examples of absolutes?
The Umbrella Answer and Deadly Answers
One answer includes the others.
• There may be more than one correct answer.
• One answer is better than all the others because it includes them.
Deadly Answers:
• All
• Nothing
• Only
• Never
• Every
• Always
• Any None
• Total
• Each
• Nobody
Same Answer and Opposite Answers
If 2 or 3 answers say the same thing in different words, none can be correct.
• If the answers are alike then neither one is correct.
Opposite Answers:
• When two answers are opposite it may be one of the two.
• Examples: high blood pressure & low blood pressure; increase & stop the IV; turn on the right side & turn on the left side.
What is the time frame?
• Time frame is very important when it is given.
• Pay attention to it – early or late in relation to symptoms• Pre or post operative, care on the day of surgery or later postoperative care. [Show Less]