NCLEX STRATEGIES
An informed candidate is a relaxed candidate!
Click on this link to the Pearsonvue testing website:
All new nursing graduates should read the NCLEX Examination Candidate Bulletin so they know how to: register and schedule NCLEX; provide acceptable forms of identification on the day of the exam and learn what to expect at the testing center.
Click on the Online Tutorial for NCLEX Examinations. The tutorial is short and provides you with test center regulations and practice answering the different types of questions on NCLEX. If you practice the tutorial before your test date you will recognize it at the beginning of the exam and be able to relax and say…I know this!
Also, take time to review the NCLEX Tips eBook in the next module link, which goes through test-taking strategies for the NCLEX-RN Exam.
Strategies
The best strategy a candidate can take to NCLEX is knowledge! Most of the questions on the exam will require that the tester apply knowledge or analyze information.
That is why it is so important to prepare for NCLEX by taking assessments or tests and then reviewing topics you missed; building your knowledge.
This question illustrates the power of knowledge:
A nurse is caring for an adult client admitted to the emergency department with a sprained right ankle.
Which of the following nursing actions would be most appropriate to include in the client’s plan of care?
- Place an ice bag on the injury site for 30 minutes
- Apply a moist cold compress to the right ankle for 45 minutes
- Immerse lower extremity in a warmed solution for 15-20 minutes
- Directly apply a heated water flow pad to right ankle for 20-30 minutes
In order to answer this question correctly, you must know:
- What happens to tissues when they are injured
- The physiology of inflammation: acute and non-acute stages
- Effects of cold and heat and prolonged exposure to both
Safe and Effective Delegation
Safe and effective delegation of tasks and client care assignments is extremely important when setting priorities for client care. They do not allow for opinion and preference.
Follow them exactly so that the appropriate health care personnel are performing activities that they can administer and are safely within their scope of practice.
The delivery of safe and effective care is always the driving force behind delegation of tasks and client care assignments. Any other option will be incorrect.
“Nurture your mind with great thoughts; to believe in the heroic makes heroes.” -Benjamin Disraeli
Client Teaching
RNs perform all client teaching. No matter how simple the teaching, it still must be done by the RN. PN’s may reinforce teaching.
“It is our choices that show what we truly are, far more than our abilities.”
– J. K. Rowling
Assessment
RNs should perform all admission assessments so that an accurate baseline is established. This includes the first set of vital signs, all aspects of the first physical assessment and a health history.
Delegation and Assigning Tasks
Client care assignments are made by the RN not by support staff. Client care assignments should remain unchanged unless there is an authentic issue of client care safety or a healthcare provider safety is endangered.
Delegation to Assistive Personnel
A nursing assistant can perform tasks such as taking vital signs, range of motion exercises, bathing, bedmaking, obtaining urine specimens, enemas and blood glucose monitoring.
Nursing assistants cannot interpret results or perform any task beyond the skill level of the certification they received.
Communication
All communication between the RN and support staff should be direct, objective and complete to ensure the highest level of safe and effective care delivery.
Delegating Tasks
The PN is managed under the supervision of the RN. Certain higher level skills can be delegated after competency has been established by the RN (e.g., dressing changes or suctioning)
Passing Percentage
Many students ask if there is a “passing percentage” for NCLEX. The simple answer is “no”. For questions about how the NCLEX exam is structured and scored, check out the NCSBN website at www.ncsbn.org .
Click on “NCLEX Examinations” and then click on “Candidates”. There is a wealth of information there about the test itself, and you will also be able to go through a tutorial on how NCLEX will work.
This same tutorial will be offered to you on your test day before you start the NCLEX exam.
Read Carefully
Read the question and all answer options carefully . Make sure you pay attention to words in the question stem such as “most important”, “first”, “initial”, or “last”.
Use these cues to help you select your answer, and make sure that the answer you select is answering the question.
Is the question asking for an intervention, an assessment, or an evaluation? Choose your answer accordingly.
Avoid Common Pitfalls
To avoid some common pitfalls when answering priority questions, be aware of the following:
Never perform ABC checks blindly without considering whether airway, breathing or circulation issues are acute versus chronic or stable versus unstable .
For example, a client who is quadriplegic and on a ventilator has chronic airway/breathing problems. However, if there is not an acute consideration such as pneumonia, the client should be considered chronic and stable.
This client would not be the nurse’s first priority.
Focus
If you find it hard to focus while reading all answer options, try reading the options backwards (start with “D” and work up to “A”).
Read rationales for questions carefully as you are studying
Many students remark that they can get the answer choices narrowed down to 2 and then can’t seem to pick the right one.
A good tip for improving your ability to pick the BEST answer is to read rationales for correct answers and begin to understand WHY the correct answer is correct.
This will help you gain information that you can carry into future tests. Rationales provide insight into how NCLEX “thinks”.
Don’t undermine the power of positive thinking
You have worked hard to get to this point in your nursing career and a large part of your success on test day will be your belief that you CAN DO IT!!
Knowledge is power…review hard, take lots of questions, and do whatever you need to walk into the testing center with confidence.
Application Exercises in Review Modules
The application exercises in your review module books are a great way to get more practice with questions for each content area. Answer keys are provided right after each set of questions.
Answer each question and then read the rationale for immediate reinforcement of the concept. Chose application exercises in Chapters that correlate with your topics to review from each exam.
Early versus late
What do you know about questions asking you to identify early and late signs and symptoms? You should know they all have something in common.
Early clinical manifestations are generalized and nonspecific, whereas late signs are specific and serious. Eliminate incorrect answer choices using this strategy. (NCLEX TIPS)
Pre, post, and intra
You may be asked about complications associated with certain procedures. What should you do if you know little or nothing about the procedure?
Pay attention to whether the question is asking about “pre-procedural,” “intraprocedural,” or “postprocedural” concerns.
Eliminate the options that do not correspond to what is being asked. The correct answer may be quite obvious when viewing the question from this perspective. (NCLEX TIPS)
Time elapsed
The priority nursing action will change based on the time interval stipulated. Obviously the closer the client is to the origination of risk, the higher the risk for complications.
Sometimes the time issue will be stated in terms of hours or days. In other instances the physical location of the client will tell you how long it has been since the origination of risk.
Watch closely for whether the client is in the “recovery room,” “postsurgical unit,” or somewhere else.
The time issue buried in those words should help you eliminate incorrect answers that don’t match what is being asked. (NCLEX TIPS)
Let Maslow’s hierarchy of needs be your guide
When taking the NCLEX®, keep in mind that physiological safety will always be more important than anything psychological.
You can eliminate answers based on the premise that physiologic safety must be established prior to initiating therapeutic psychologic nursing actions.
If you lack knowledge about what do to in a certain situation, let Maslow’s hierarchy guide you toward the correct answer.
Remember, the hierarchy starts with physiological needs and proceeds to safety and security, then love and belonging, self-esteem and, finally, self-actualization. (NCLEX TIPS)
Remember: most complete = least room for error
You’ll encounter items on the NCLEX® that will ask you to choose the instruction or documentation that is most accurate. What should you do if you don’t remember much about the subject matter?
Choosing an answer that is most complete will typically result in the least room for error and subsequent delivery of safe and effective care.
To help you determine which answer is most complete, evaluate answers based on how much objectivity (fact) versus subjectivity (opinion) there is in the answer choices.
A specific value, like a blood pressure, is factual, whereas a client’s report of past incidences of “high” blood pressure is subjective. Responses that are subjective are generally not correct. (NCLEX TIPS)
Use What You Know
Graduate nurses taking the NCLEX ® have a tendency to focus on what they don’t know rather than on what they do know. The ramifications of this mental approach are devastating.
When you focus on your lack of knowledge about a particular topic, you are likely to become anxious and start guessing or changing answers.
There is also a carryover effect that can reduce your ability to answer the items that follow the item causing you distress. You might start losing confidence. When that happens, suddenly the test begins controlling you.
You should pause, take a deep breath, try to relax and move on. Stay focused.
One of the most important factors in achieving NCLEX ® success is feeling in control of the test. This comes from understanding the test construction and administration, and systematically managing the test items. (NCLEX TIPS)
Words of Magnitude
Read the question and options closely for words asking about direction or magnitude.
For instance, stop and concentrate on the terms intra- versus inter- ; hyper- versus hypo – ; increase versus decrease ; lesser versus greater ; and gain versus lose .
It is common to misread these terms by simply skimming over them too quickly. (NCLEX TIPS)
Cause no Harm
When in doubt, always choose a nursing action that could result in harm to the client if not recognized.
Even if you don’t know whether it is related to the stem, it is still a life-saving maneuver that, in all likelihood, is correct. (NCLEX TIPS)
Using Your Presence
Seldom will a correct answer have the nurse physically leave the client. Choose an answer that keeps the nurse with the client. (NCLEX TIPS)
Ruling out an Answer Associated with Something Else
In some instances, rule out an option if you know it is associated with something else. For example, you may not know about the labs for Coumadin therapy, but you do know the labs for heparin and aspirin.
Those labs can be eliminated because you are “using what you know.” (NCLEX TIPS)
Pay attention to Communication Skills
Graduate Nurses taking the NCLEX-RN ® have a tendency to use the same communication skills regardless of whether the client has anxiety, depression, schizophrenia, bipolar disorder or obsessive-compulsive disorder.
Everyone wants to use empathetic listening and everyone wants to be caring. Unfortunately these are not therapeutic responses for all disorders and every situation. Keep it very simple and apply it correctly. Use what you know.
- Responses that are open-ended acknowledge the client’s feelings and seek more information. This approach is appropriate for the client with anxiety, a knowledge deficit or depression.
- Reality orientation is important for the client with paranoia and delusions.
- Distraction is more appropriate for the client with obsessive-compulsive disorder. (NCLEX TIPS)
Use the Nursing Process
Use of the nursing process can be helpful. Always remember to “assess” first . Even if your knowledge of the topic is gray, you can still recognize that an answer choice is an “assessment” rather than an “intervention .” (NCLEX TIPS)
Look for the layers
It would seem that life and death issues would be very easy to recognize in the text of a question.
Unfortunately, they are usually not obvious. Instead they are buried beneath words that, at first glance, seem to bear no clinical significance.
To prevent glancing over these words and missing the most critical or impending symptom, you will need to ask yourself “What could be the possible clinical significance of each answer choice?” (NCLEX TIPS)
Go with your First Instinct
Your first response to a question is usually correct. DO NOT change your answers unless you have a compelling reason for doing so.