1 NCLEX PREPARATION PROGRAM MODULE 1 Overview, Assessment Testing Preparing to be Successful on the NCLEX-RN

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NCLEX PREPARATION PROGRAM

MODULE 1

Overview, Assessment Testing

Preparing to be Successful on the NCLEX-RN

Philosophy of Learning

Adult Learner

Individual Responsibility

Collaboration

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The Adult Learner is Unique!

1. Like to determine their own learning experiences

2. Enjoy small group interactions

3. Learn from others’ experiences as well as their own

4. Hate to have their time wasted

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5. Some adults will like some lectures but all lectures won't be liked by all adults

6. Are motivated to learn when they identify

they have a need to learn

7. Are motivated to learn when societal or professional pressures require a particular

learning need

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8. Are motivated to learn when “others”

arrange a learning package in such a

manner that the attraction to learning

overcomes the resistance

9. Draw their knowledge from years of

experience and don’t change readily

10. Want practical answers for today’s

problems

11. Like physical comfort

12. Enjoy practical problem solving

13. Like tangible rewards

14. Refreshments and breaks establish a

relaxed atmosphere and convey respect

to the learner


If you have identified values and designated

adequate time and support, you are likely

to be successful at

attaining your goal

Values

Skills the Successful RN Candidate Will

Need:

Comfort with mathematics: Math Tutorial CD

Critical thinking skills and some memorization: Critical Thinking Exam

Reading and reviewing many pages of nursing content almost daily in preparation for class and the NCLEX exam

Time and stress management Self-confidence in one’s ability to be

successful: positive self talk

Computer SkillsBasic computer literacy

and comfort are very important!

Competent working knowledge of Windows programs.

Study Time Required

• 8-12 hours per week classroom

• 5 hours/week computerized testing practice

• 2 or more hours/week for classroom preparation & homework assignments

• Working more than 32 hours/week is not recommended*Commuters add 4-6 hours/week

for travel

We Want You to Be Successful

One day at a time! Know your learning styleOrganize and plan aheadAssume responsibility for your learningPractice first party communicationBe empoweredStrengthen skillsPractice balancePractice “stress busters”!

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What is Your Learning Style?

Each of us has a unique way in which we process information and learn the best. Knowing your learning style preference allows you to choose learning strategies that are most effective for you. Learning Style assessment results indicate learning preferences rather than strengths. Done right, learning can be fun!

Major Learning Styles

Visual draw, diagram, outline, color

To learn more effectively remember to use:

Flow charts, graphs, labeled diagramsVisual imaginationWritten wordsPicturesGraphsTimelineHighlight text


Aural /AuditoryTo learn more effectively focus on:

Lectures in the classroomTape recording the lectures

Group discussionsWeb chat; talk things

throughSort things out by speaking

out loud (to yourself and to others)


Read/WriteTo learn most effectively remember to:

• Read and reread

• Write and rewrite (take notes and use them for study outside the classroom)

• Organize

• Use outlines

• Change graphs, etc. into statements or words


Kinesthetic/tactileRelated to the use of experience and practice

(simulated or real)To learn most effectively, remember to: Be actively involved Touch, act Type notes Make flash cards, Use mind mapping (more information to

follow) Watch videos depicting real-life scenarios


Multimodal (a mix of learning styles)

50 to 70% of the population Choose among your preferences to suit the

occasion or situation

-or- Use strategies from each preference to learn

Mind Mapping

What is it? Mind mapping is a technique for taking notes

in such as way that it produces strong visuals How does it work?

To make a mind map, one starts in the center of the page with the main idea, and works outward in all directions, producing a growing and organized structure composed of key words and key images.

Case Study – Mind Mapping Sample

Mind Mapping

Why does it work? Mind maps help organize information using

the same structure that our brain uses for making memories

By presenting your thoughts and perceptions in a spatial manner and by using color and pictures, a better overview is gained and new connections can be made visible.

Mind maps allow you to use both sides of your brain

Struggling Student vs. Successful Student

STRUGGLING:

• Denial• Avoids problems• Blames others• Avoids Faculty• Disorganized• Tries Hard• Lucky

SUCCESSFUL:

• Realistic• Addresses problems• Accountable• Works with Faculty• Organized & Manages

Time• Tries Hard and Produces• Works Hard & is Prepared

At Risk Students:

Board of Registered Nursing (BRN) Task Force defines “at risk” students as follows:

English as a second language Works >20 hours / week Family responsibilities

If you fit any of these criteria: DEVELOP A PLAN

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Seven Steps to Reach Your Goals

1. Write them down.2. Be specific, measurable.3. Be certain they are YOUR goals4. Be positive.5. Establish a time frame.6. Do goals conflict with goals in

other areas of your life?7. Keep score!

To Enhance Your Success:

• Utilize faculty

• Plan ahead

• Complete and turn assignments in on time

• Read study guides prior to lecture

Study Skills Inventory

Complete the study skills inventory tool located on

page 13 of Module 1;

Study Guide #3

S.M.A.R.T. Outcomes

Specific

Measurable

Attainable

Realistic

Time-targeted

Plan and Prepare!• Organize now• Enlist help from

family (i.e. helping w/ meals)

• Assess finances• Reduce work hours• Schedule fun• What works best

for you is unique

Student/Family Prep Activity

Complete the Student/Family Prep Activity tool located on page 16

of Module 1; Study Guide #3

Support is Available:

• Instructors • Peers/Study Groups• Counseling • Family and Friends• Employer/Supervisor “Return on

Investment”

Return on Investment

Why it’s OK to ask your employer for 4-8 hours per week of paid time-off: Your success at becoming a RN is of benefit

to your employer! Providing support to you during your

NCLEX review is a less expensive way for your employer

to gain a new RN than recruiting a new RN!

Preparation for classroom lecture

discussions A successful participant is a prepared

participant. Read ahead. Come to class with questions if portions

of the study guides were unclear. Your questions in class will help

someone else understand the concept better as well.


discussions When completing your weekly NCLEX-

RN computerized testing practice, focus on the same subject matter being covered in class that week.

Prior to class, brush up on physiology, terminology and the lab values one can expect while caring for patients with the diseases being discussed.

Create flashcards of material that requires memorization and that is new to you.

Write down your questions to ask in class. Also take the opportunity to learn from

your workplace if working in the healthcare field. Tying together what you observe in action and what you learn in the classroom is a great learning strategy.


discussions

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Maslow’s Hierarchy of Needs Theory

What is Maslow’s Hierarchy of Needs Theory?

How will understanding the needs theory help with prioritizing nursing interventions?

How does the hierarchy apply to a NCLEX candidate's life?

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Maslow’s Hierarchy of Needs in Descending

Order

5th. Self-Actualization

4th. Self-Esteem3rd. Love &

Belonging2nd Safety &

Security1st. Physiological

Needs

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Maslow's Hierarchy of Needs

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Physiological Needs

According to Maslow, physiologic needs are the highest priority and must be met first.

Physiologic needs are necessary for survival.

Oxygen EliminationFluid ShelterNutrition RestTemperature Sex

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Safety and Security Physical and Psychosocial

Physical safety includes decreasing what is threatening to the patient.

The threat could be an illness, accidents, or environmental threats.

Psychological safety states that the client must have adequate knowledge and an understanding about what to expect from others in his environment.

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Love & Belonging

Client needs to feel loved by family and accepted by others.

When a client feels self-confident and useful, he will achieve the need of esteem as described by Maslow.

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Self Esteem

How one feels about himself/herself

Feelings of adequacy or inadequacy

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Self-Actualization

This is the highest level of Maslow’s hierarchy of needs.

To achieve this level, the client must experience fulfilment and recognize his or her potential.

In order for self-actualization to occur, all of the lower level needs starting with physiologic must first be met.

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How to Apply Maslow’s Needs to Establish Priorities of Care

First recognize that answer options include

both physical and psychosocial needs. Next eliminate the psychosocial answer. Ask yourself “Does this make sense in this

case?” Finally apply the “ABCs” of care. Airway,

Breathing, Circulation

Maslow’s

Answer

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Application of Maslow's Hierarchy

A woman is admitted to the hospital with a ruptured ectopic pregnancy. A laparotomy is scheduled. Which preoperative nursing intervention is most important for the nurse to consider in this patient’s plan of care?

a. Fluid Replacement

b. Pain Relief

c. Emotional Support

d. Respiratory Therapy

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Physical Needs First

The nurse obtains a diet history from a pregnant 16-year-old girl. The girl tells the nurse that her typical daily diet includes cereal and milk for breakfast, pizza and soda for lunch, and cheeseburger, milkshake, fries and salad for dinner. Which of the following is the most accurate nursing diagnosis based on this data provided?

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Highest Priority Need

1. Altered nutrition: more than body requirements related to high-fat intake.

2. Knowledge deficit: nutrition in pregnancy.3. Altered nutrition: less than body

requirements related to increased nutritional demands of pregnancy.

4. Risk for injury: fetal malnutrition related to poor

maternal diet.

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Prioritizing Care

The nurse plans care for a 14-year-old girladmitted with an eating disorder. On admission, the girl weighs 82 lbs. and is 5’4” tall. Lab test indicate severe hypokalemia, anemia and dehydration. The nurse should give which of the following nursing diagnoses the highest priority?

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Physiological needs are most important. Remember the

“ABCs”!

1. Body image disturbance related to weight loss.

2. Self-esteem disturbance related to feelings of inadequacy.

3. Altered nutrition: less than body requirements related to decreased intake.

4. Decreased cardiac output related to the potential for dysrhythmias.

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Computerized Adaptive Testing (CAT)

CAT is a method whereby the examination is created as you answer each question. If you select the correct answer, the computer selects a more difficult question for your next question. If you selected an incorrect answer, the computer will then select an easier question.

This process continues until the computer has established with 95% confidence that you have been successful or unsuccessful.

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When a test question is presented, it

must be answered in order; move to the next question.

There is no penalty for guessing. A computer keyboard tutorial is

offered at the beginning of the examination in order to orient you to the use of the keys, etc.

Computerized Adaptive Testing

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The maximum testing time is 6 hours. This time period includes: The computer tutorial The sample items All breaks (restroom, stretching, etc.) The examination All breaks are optional!


Time Considerations

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The minimum number of questions that you will need to answer is 75.

The maximum number of questions in the test is 265.

Each exam has 15 “pilot testing” questions that will not be added to your score.


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Each candidate’s exam is unique because it is created interactively as the exam proceeds.

Computer technology selects items to administer that match the candidate’s ability level.

All test items are stored in a large item pool. Items have been classified by test plan area

being evaluated and level of difficulty.

Computerized Adaptive Testing (CAT)

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Scoring the Computerized Adaptive

Test

After the candidate answers an item, the computer calculates an ability estimate based on all of the previous answers the candidate selected.

An item determined to measure the candidate’s ability is selected and this process is repeated for each item, creating an exam tailored to the candidate’s knowledge and skills while fulfilling all NCLEX-RN Test Plan requirements.

The exam continues with items selected being administered in this way until a pass or fail decision is made.

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Computerized Adaptive Testing:

Pass or Fail?

After 75 questions are answered the computer compares the test-taker’s ability level to the standard required for passing.

If the test-taker is above the passing standard, then the test-taker has passed.

If the test-taker is below the passing standard, then the test-taker fails.

If the computer is not able to determine whether the test-taker has passed or failed, then the computer continues asking questions.

The computer must be 95% certain before it stops testing.

Computerized Adaptive Testing:

Pass or Fail? …cont

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How is the NCLEX-RN Exam Written?

First data is collected to reflect the current practice of the entry-level nurse.

Data analyzed regarding frequency of performance, impact on maintaining client safety and client care settings where activities performed.

This guides the selection of content and behaviors to be tested.

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NCLEX Definition of RN

Provides a unique comprehensive assessment of the health status of the client (individual, family or group).

Develops, then implements an explicit plan of care. Assists clients in the promotion of health, in

adapting to and/or recovering from the effects of disease or injury and in supporting the right to a dignified death.

Accountable for abiding by all applicable federal, state and territorial statutes related to nursing practice.

NCLEX-RN Detailed Test Plan

Reviewed and approved by National Council of State Boards of Nursing (NCSBN) every three years.

Expert resources support changes that reflect practice trends.

Comprehensive listing of content for each client need category and sub category.

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Test Plan Components

Questions are written to address:

Bloom’s Taxonomy Levels of cognitive ability Client Needs Integrated Processes

Item writers are master’s-prepared nursing educators.

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NCLEX Test Plan Framework

Bloom’s taxonomy ranks levels of learning from simple to complex, it is used as a basis for writing and coding test items. Nursing practice requires the application

of knowledge, skills and abilities.

The majority of items are written at the application or higher levels of cognitive ability.

This requires more complex thought processing.

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Blooms Taxonomy and Test Question Construction

Levels of Cognitive Ability

KnowledgeComprehension

Application Analysis

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Recall/Recognition

Comprehension

Application

Analysis

Bloom's Taxonomy of Questions with

Increasing Difficulty and Sophistication

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Application Questions

Which of the following symptoms, if observed by the nurse during the first 24 hours after a percutaneous liver biopsy, would indicate a complication from the procedure?

1. Anorexia, nausea and vomiting

2. Abdominal distension and discomfort

3. Pulse 112, BP - 100/60, R - 20

4. Pain at the biopsy site

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It’s the principle of the thing!

Application involves the utilization of basic facts and principle to make nursing judgements.

The NCLEX exam tests your ability to apply nursing knowledge and principles in a variety of clinical situations across the life span.

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One’s ability to solve problems, prioritize care, draw conclusions, perform assessments and synthesize information is not directly tested with recall, recognition or comprehension level questions.

You must be able to answer questions at the application level in order to prove your competence on the NCLEX.

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Analysis Type Question

A man is brought to the emergency room complaining of chest pain. The nurse performs an assessment of the patient. Which of the following symptoms would be MOST characteristic of an acute myocardial infarction?

1. Colic-like epigastric pain.

2. Sharp, well localized unilateral chest pain.

3. Severe substernal pain radiating down the left arm.

4. Sharp, burning chest pain moving from place to place.

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Comprehension Question

The nurse understands that hemorrhage is a complication of a liver biopsy because:

a. There are several large blood vessels near the liver.

b. The liver cells are bathed with a mixture of venous arterial blood.

c. The test is performed on patients with elevated enzymes.

d. The procedure requires a large piece of tissue to be removed.

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The NCLEX Test Plan

The content of the NCLEX-RN test plan is organized into four major Client Needs categories.

Two of the four categories are further divided into subcategories.

All content categories and subcategories reflect client needs across the life span in a variety of settings.

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Client Needs categories include the following:

Safe and Effective Care Environment

Health Promotion and Maintenance

Psychosocial Integrity

Physiological Integrity.

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Client Needs Sample Question

The nurse is delivering external cardiac compressions to a 63 year old woman while performing cardiopulmonary resuscitation (CPR). It is most important for the nurse to: Maintain a position close to the client’s side with the nurse’s knees apart. Maintain vertical pressure on the client’s chest through the heel of the nurse’s hand. Recheck the nurse’s hand position after every 10 chest compressions. Check for a return of the client’s pulse after every 8 breaths by the nurse.

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Sample Recall and Recognition Knowledge-

based Question

Which of the following is a complication that occurs during the first 24 hours after a percutaneous liver biopsy?

a. Nausea and vomitingb. Constipationc. Hemorrhaged. Pain at the biopsy site.

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Woven within the client needs categories are four Integrated Processes.

Nursing process Caring Communication and Documentation Teaching and Learning

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A Closer Examination

Let’s examine each component in greater detail including sample questions that will emphasize key concepts. First Client Needs categories Next Bloom’s Taxonomy Cognitive Domain Finally Integrated Processes

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Advance Directive Advocacy Case Management Client rights Collaboration with Interdisciplinary team Concept of Management Confidentiality/Information Security Consultation Continuity of Care Delegation

Client Need #1 Safe and Effective Care

Environment Subcategory: Management of

Care: 13-19%

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Environment Subcategory: Management of

Care: 13-19% Establishing Priorities Ethical Practice Informed Consent Legal Rights and Responsibilities Performance Improvement (Quality Assurance) Referrals Resource management Staff Education Supervision

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A client scheduled for surgery tells the nurse that she signed an informed consent but was never told about the risks of the surgery.

The nurse serves as the client’s advocate by performing which of the following actions?

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Client Needs (cont’d)

a. Writing a note on the front of the client’s record so that the surgeon will see it when the client arrives in the operating room.

b. Documenting in the client’s record that the client was not told about the risks of the surgery.

c. Contacting the surgeon and asking the surgeon to explain the surgical risks to the client.

d. Reassuring the client that the risks are minimal and unlikely to occur.

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Client Need #1 Safe and Effective Care Environment Subcategory: Safety and Infection

Control: 8 –14%

Accident prevention Disaster planning Emergency Response Plan Ergonomic Principles Error prevention Handling hazardous and infectious

materials Home Safety Injury Prevention

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Environment Subcategory: Safety and Infection

Control: 8 –14%

Medical and Surgical Asepsis Reporting of Incident/Event/Irregular

Occurrence/Variance Safe Use of Equipment Security Plan Standard/Transmission-Based/Other

Precautions Use of Restraints/Safety Devices

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Safety and Infection Control Sample Question

The physician orders tobramycin sulfate (Nebcin) 3mg/kg IV every 8 hours for a 3-year-old boy. The nurse enters the patient’s room to administer the medication and discovers that the boy does not have an identification bracelet. What should the nurse do?

Ask the parents at the child’s bedside to state their child’s name. Ask the child to say his first and last name. Have a co-worker identify the child before giving the medication. Hold the medication until an identification bracelet can be obtained.

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Client Need #2: Health Promotion and Maintenance:

6 – 12%

The Aging Process Ante/Intra/Postpartum and

Newborn Care Developmental Stages and

Transitions Disease Prevention Expected Body Image Changes Family Planning Family Systems Growth and Development

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Client Need #2: Health Promotion and

Maintenance: 6 – 12%

Health and Wellness Health Promotion Programs Health Screening High Risk Behaviors Human Sexuality Immunizations Life Style Choices Principles of Teaching and

Learning Self-Care Techniques of Physical

Assessment

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A nurse is preparing to care for a hospitalizedfemale teenager in skeletal traction. The nurseplans patient care, knowing that the most likely primary concern of the teenager is:

a. Body imageb. Keeping up with school workc. Obtaining adequate nutritiond. Obtaining adequate rest and sleep

Client Need #3 Psychosocial Integrity: 6-

12% Abuse/Neglect Behavioral Interventions Chemical Dependency Coping Mechanisms Crisis Intervention Cultural Diversity End of Life Family Dynamics Grief and Loss Mental Health Concepts

Client Need #3 Psychosocial Integrity: 6-

12% Psychopathology Religious and Spiritual Influences on Health Sensory/Perceptual Alterations Situational Role Changes Stress management Support Systems Therapeutic Communication Therapeutic Environment Unexpected body image

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A boy is brought to the school nurse’s office with reports of abdominal pain. On assessment, the nurse notes the presence of several bruises on the child’s abdomen and back and several cigarette burn marks. The nurse suspects child abuse and plans for which priority action?

a. Documents the bruises noted on the child’s body.b. Calls the parents to ask them how the child’s

bruises and burn marks occurred.c. Notifys Child Protective Services to facilitate the

removal of the child from the abusive situation in order to prevent further injury.

d. Asks the child how long his parents have been abusing him.

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A 50-year-old male patient comes to the nurses’ station and asks the nurse if he could go to the cafeteria to get something to eat. When told that his privileges do not include visiting the cafeteria, the patient became verbally abusive. Which of the following approaches by the nurse would be most effective?

a. Tell the patient to lower his voice because he is disturbing the other patients.

b. Ask the patient what he wants from the cafeteria and have it delivered to his room.

c. Calmly but firmly escort the patient back to his room.

d. Assign a nursing assistant to accompany the patient to the cafeteria.


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Client Need #4 Physiological Integrity

Basic Care and Comfort: 6-12%

Alternative and Complementary Therapies

Assistive Devices Elimination Mobility and Immobility Non-Pharmacological Comfort

Interventions Nutrition and Oral Hydration Palliative and Comfort Care Personal Hygiene Rest and Sleep

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A nurse has provided information to a client about measures that will promote normal urination patterns and prevent urinary tract infections. Which statement by the client indicates a need for further information?a. “I should take my furosemide (Lasix) in the morning.”b. “I should drink plenty of fluids during the day.”c. “I should try and hold my urine as long as I can rather than expelling it when I feel the urge.”d. “I should eat foods that will make my urine acidic.”

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Pharmacological and Parenteral Therapies: 13 – 19%

Adverse effects/Contraindications Blood and Blood Products Central Venous Access Devices Dosage Calculations Expected Outcomes/Effects Intravenous Therapy Medication Administration Parenteral Fluids Pharmacological Agents/Actions Pharmacological Interactions Pharmacological Pain Management Total Parenteral Nutrition

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Cyclosporine (Sandimmune) oral solution is prescribed for a patient who had a kidney transplant. The nurse provides information to the patient about the medication and tells the patient that which of the following is most important to monitor?

a. Temperatureb. Peripheral pulsesc. Platelet countd. Apical heart rate

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Reduction of Risk Potential: 13 –19%

Diagnostic Tests Laboratory Values Monitoring Conscious Sedation Potential for Alterations in Body Systems Potential Complications of Diagnostic

Tests/ Treatments/Procedures Potential for Complications from

Surgical Procedures and Health Alterations

System Specific Assessments Therapeutic Procedures Vital Signs

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A 7-year-old girl with type I insulin dependent diabetes mellitus (IDDM) has been home sick for several days and is brought to the ER by her parents. If the child is experiencing ketoacidosis, the nurse would expect to see which of the following lab results?

a. Serum glucose 140 mg./dlb. Serum creatine 5.2 mg./dlc. Blood pH 7.28d. Hematocrit 38%

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Physiological Adaptation: 11 – 17%

Alteration in Body Systems Fluid and Electrolyte Imbalances Hemodynamics Illness Management Infectious Diseases Medical Emergencies Pathophysiology Radiation Therapy Respiratory Care Unexpected Response to Therapies

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Integrated Processes

These “threads” of knowledge are

fundamental to the practice of nursing and are integrated throughout the Patient Needs categories

and subcategories.

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Four Integrated Processes Categories

1. Nursing Process is a scientific problem

solving approach to client care that includes

assessment, analysis, planning, implementation and

evaluation.

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2. Caring is the interaction of the nurse and patient

in an atmosphere of mutual respect and trust. In this

collaborative environment, the nurse provides

encouragement, hope, support and compassion to help

achieve desired outcomes.

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3. Communication/Documentation

Communication is the verbal and nonverbal interaction between the nurse and the client, the client's significant others and the other members of the health care team.

Documentation relates to events and activities associated with client care which are validated in written and/or electronic records that reflect standards of practice and accountability in the provision of care.


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4.Teaching/Learning is the facilitation of the acquisition of knowledge, skills and attitudes promoting a change in behavior. It is the distribution of content.


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6 Types of Questions on the NCLEX Exam

Multiple choice - one correct answer Fill-in-the-Blank - type in the answer Hot Spot - select a specific area on a

diagram or illustration Exhibit - information needed for the

answer is in the form of an exhibit or spreadsheet.

Ordered response - select choice in the proper sequence (prioritize)

Multiple response - more than one answer is correct; select all that apply

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Multiple Choice Questions

Most of the questions that you will be asked to answer will be in the multiple choice format.

These questions will provide you with data about a particular client situation, together with four answers or options.

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Fill-in-the Blank Questions

Follow the directions for each question.

Use the on-screen calculator and verify calculations a second time.

Type in only the numeric component of the answer as directed.

Round the answer to the nearest whole number if directed to do so.

Do not use abbreviations if directions indicate that they are not acceptable.

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Hot Spot Questions

This type of question allows you to use the mouse or arrow keys to identify a figure, illustration or other item designated in the stem of the question.

In order to answer exhibit questions you will need to click on the button that says, “Exhibit.” This opens up a new smaller window with either a list or a spreadsheet.

There may be more than one page to the exhibit. If this is the case, there will be tabs at the top of the exhibit. Be sure to look at all of the tabs provided.

Exhibit Questions

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Multiple Response Questions

You must select all of the options that relate to the information being asked in the question.

There is no partial credit given for correct selections you have chosen.

You must select ALL that apply in order for the question to be counted as correct.

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Ordered Response Questions

Prioritizing questions ask you to select options in the correct sequence or use the computer mouse to drag and drop your nursing actions in order of priority.

Information will be presented and based on the data you have been provided.

You will need to determine what you would do first, second, third and so forth.

Golden Rules for NCLEX Success

Be prepared Avoid negative people Do not discuss the exam Avoid distractions Think positively

Golden Rules for NCLEX Success

Eat well Exercise Sleep well Eliminate alcohol and other

mind-altering drugs Schedule study time

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Tutorial Prior to NCLEX Exam Each NCLEX candidate is given a tutorial at the beginning of the exam in order to become familiar with how to answer each question using a mouse, arrow keys, and a calculator.

There is no partial credit given for an answer that is only partially correct.

Updated information on the administration of the test plan can be found at NCSBN web site:

www.ncsbn.org

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Test Taking Strategies

If an option contains an absolute word, it is usually an incorrect choice and can safely be eliminated as an option.

If a tentative word is used in an option, then it is more likely to be the correct answer.

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Examples of Absolute Words

Always advise clients to eat low sodium foods.

Drink fluids only if they are fat-free.

Eat only foods that have less than 1% fat content

Never use butter for cooking.

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Nursing actions are usually in the clients’ best interest.

It is sometimes necessary to call for an emergency support team.

Hot liquids may cause skin damage if spilled.

Often times clients who break their legs need instruction in crutch walking.

Examples of Tentative Words

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Questions Containing Laboratory Values

Laboratory values questions will first require you identify whether the results are normal or abnormal. You will need to memorize common laboratory values.

Next you will be asked to analyze the laboratory value as it relates to the client situation being presented.

Finally you may be asked to make the appropriate assessment, judgement and/or nursing action.

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Laboratory Values Sample Question

A client with a diagnosis of sepsis is receiving antibiotics by the intravenous route. The nurse assesses for nephrotoxicity by closely monitoring which of the following laboratory values?

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Laboratory Values Sample Question Possible Answers

a. Lipase levelb. Platelet countc. White blood cell

countd. Blood urea nitrogen

Nursing Interventions

Although sometimes appropriate, avoid jumping immediately to an answer that recommends immediate referral to the patient’s M.D.

NCLEX is examining your abilities as a nurse and doesn’t usually want immediate referral to other members of the health care team.

Key Words Key words in NCLEX-RN test questions

are critical in defining the correct answer. Examples of how key words are used include: …is an early sign of…? …is the most important…? Identify the ___ with the highest priority… Which ____ would the nurse do initially?

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Sample Question – Key Word in Stem

A nurse is caring for a patient with a diagnosis of congestive heart failure who suddenly experiences severe dyspnea. The nurse suspects that pulmonary edema has developed. The immediate nursing action is:

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Sample Question Answer Options

a. Place the client in high-Fowler’s position.

b. Insert a Foley catheter STAT.

c. Obtain a dose of morphine sulfate from the narcotic medication drawer.

d. Begin oxygen at 2 liters per minute.

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Sample Question – Key Word in Stem

A nurse in the emergency department receives a call from emergency medical services and is told that several victims who survived a plane crash and are suffering from cold exposure will be transported to the hospital. The initial nursing action for the emergency department nurse is which of the following?

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a. Call the laundry department and ask the department to send as many warm blankets as possible to the emergency room.b. Call the intensive care unit to request that nurses be sent to the emergency room.c. Call the nursing supervisor to activate the agency disaster plan.d. Supply the trauma rooms with bottles of sterile water and normal saline.

Sample Question Answer Options

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Visualization as a Test-Taking Strategy

Visualize the specific information in the case situation in order to answer the question.

See yourself performing the procedure, assessing the client, delegating the care, etc.

Remember that clinical practice can vary depending upon where it is practiced and who is performing the care.

Be certain that you draw upon knowledge and skills which come from nursing textbooks.

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Visualization Sample Test Question

A nurse prepares to perform a sterile dressing change on an abdominal incision. The nurse explains the procedure to the patient, washes her hands and sets up the sterile field. The nurse takes which action next?

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Visualization Sample - Answer Options

a. Assesses the integrity of the abdominal incision.

b. Cleans the wound with Betadine solution as prescribed.

c. Dons clean gloves and removes the old dressing.

d. Dons sterile gloves and begins the procedure.

Response Options

“Odd man out” Eliminate obvious wrong answers. If two answers are opposites, chances are

one of them is the correct answer. “Wordy” answers tend to be the correct

answer (only use this if two answers look correct but one is more wordy than the other).

Additional Strategies

Read each question carefully and avoid reading more into the question than is there.

Try not to answer a question based on what you’ve seen in a clinical setting.

Reinforce your learning by: testing your knowledge using NCLEX-

RN review resources

Reinforce your learning by: Using NCLEX-RN review videos and

computer programs Frequently asking yourself questions that

reinforce your learning such as, “If I had to do that procedure, what would I need to know?” –or– “If I had to teach a client about that particular diagnosis, how would I explain it?”

Additional Strategies

Pacing Strategies When Testing

Once you’re allowed to begin, check the time. Try to spend no more than 1 minute per test

question Don’t allow difficult questions to immobilize you.

Make your best selection and then move on.

While completing the NCLEX-RN computerized practice testing during this

course, aim to answer one answer correctly per minute.

Strategies – Day of Testing

Eat breakfast. Brains function optimally if blood sugar levels are even.

Use scratch paper as a tool for helping to answer future questions based on information in older questions. Remember you can’t go back to previous questions so this may be useful.

Don’t panic if someone finishes before you.

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Anxiety Anxiety is an individual’s negative

response to the stressor being confronted.

Anxiety is defined as a state of varying degrees of uneasiness or discomfort resulting in energy that can be constructive or destructive.

Learning how to prevent stress from becoming anxiety is an important skill for everyone to learn.

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Tips to Reduce Test Anxiety Sufficient preparation helps

candidates feel confident and that they can be successful. Make a study schedule; cramming isn’t associated with success and therefore doesn’t work!

Decide what and when to study (study plan). Use a study system or technique that works

best for you (study groups, flash cards, diagrams, etc.)

Take a second look at your study environment. Have you provided for your physiological

needs?

Tips to Reduce Test Anxiety

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Tips to Reduce Test Anxiety Rethink your attitude about test

taking. Read all test directions carefully. Remember to breathe and relax your body. Move along at a steady pace without getting hung up on any one question.

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Techniques for Reducing Stress and Anxiety

Reward yourself regularly for your efforts.

Spend more time on your “weak” areas or on those that create the most anxiety.

Know that test anxiety is very common.

Get help from classmates, faculty, counsellors and family.

It is a sign of strength to admit that you could use some help.

Stay focused on the tasks at hand.

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Reducing Stress and Anxiety

Turn to a comforting person Rely on self-discipline Talk it out Think it through - introspection Work it off - physical activity Use symbolic substitutes Religion and spirituality - prayer,

meditation, being with nature.

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Stress Stress can be a good thing or a bad thing! Stress is defined as a broad class of

experiences which are demanding and tax an individual’s resources and coping abilities.

The way a stressor is viewed by an individual plays a big role in helping one cope, work effectively for a solution and organize resources in a productive way.

StressStage 1: Alarm Reaction

Sympathetic nervous system initiates “fight or flight”

Adrenaline (AKA epinephrine) surges! Hypothalamic-pituitary-adrenal axis releases

cortisol, norepinephrine & epinephrine Heart pounds, breathing rapid, BP increases,

mouth dry, sweaty, pupils dilate, digestion slows, muscles tense, hyper-alert

Cannot stay in alarm stage long

StressStage 2: Resistance

Quickly follows alarm reaction Body attempts to adapt to stressor Parasympathetic nervous system

opposes action of sympathetic nervous system. Cortisol levels still increased.

If adaptation occurs, individual will reestablish homeostasis

If not, will enter exhaustion stage

StressStage 3: Exhaustion

All energy for adaptation expended Body cannot defend against stressor Illness and/or death will occur if stress

continues and appropriate outside assistance is not given

Candidates perform at their highest level when stress is at a minimal level

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Final Tips for Passing NCLEX

Set goals and manage your time to accomplish these goals.

Face the challenges by taking small steps!

Think about your past accomplishments!

Think positive thoughts and use positive self talk!

Maintain your self-confidence and control anxiety!

Visualize yourself as an RN!

Final Tips for Passing NCLEX

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Positives that Perfect Your Performance!

Familiarity and repetition can help with retention.

You have assessed your strengths and weaknesses.

You have completed hundreds of similar test questions.

You know what factors were considered when the test was constructed.

You are familiar with the use of the computer.

You are familiar with the testing procedures.

You have studied English and medical terminology.


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You are aware of the content areas where you believe little fine-tuning is necessary.

You have reviewed several areas of nursing content you believe are in need of more in-depth concentrated study.

You have reviewed test taking techniques and learned how to more carefully examine each test question so that it is more easily understood.


Visualize!

Your Name

Photo Acknowledgement:Unless noted otherwise, all photos and clip art contained in this module were obtained from the 2003 Microsoft Office Clip Art Gallery.