TEST TAKING STRATEGIES

For the NCLEX RN and CGFNS Examination

Dervid Santos Jungco U.S.R.N

DO YOU THINK :

• Is it possible to narrow the

question into 2 options even
without reading the question?
• Is it possible to know the side
effect of a drug without knowing
the drug?
DO YOU THINK :

• Is it possible to correctly answer

an option even without knowing a
thing about the question?
• Is it possible to correctly identify
the correct answer by studying
only the configuration of the
options?
DO YOU THINK :

• Is it possible to answer a question

confidently even without a
question?
ANATOMY OF THE QUESTION
STEM Is the most important part of a question
that asks for the correct response.

The nurse is counseling a patient about the management

of her 6-year-old child who has a chickenpox. Which
statement by the parent indicates that the teaching by the
nurse has NOT been effective?

1. “I will keep my child’s fingernails cut short.”

2. “I will never send my child in school again.”
3. “If one of the vesicles becomes swollen and oozes
yellow drainage, I will call the doctor.”
4. “I will not give my child a baby aspirin if he’s feeling
hot today.”
ANATOMY OF THE QUESTION

MODIFIER Is a single word in the question stem

that changes the whole stem of the question or
give a new meaning to it.

All of the following are possible activities a client with

Tracheostomy can perform EXCEPT

1. Dancing
2. Sexual intercourse
3. Scuba diving
4. Oral food intake
ANATOMY OF THE QUESTION

PITFALL The option set by the author that he

thinks most students will answer.
Which of the following is TRUE with regards to collecting a
stool specimen for culture and sensitivity?

1. The nurse should bring the specimen within 30 minutes

after collection
2. The nurse should properly wash the anal and perineal
area with mild soap and water. Collect an adequate
amount of stool in a clean specimen container. Bring
the specimen immediately to the laboratory.
3. Midstream clean catch collection
4. Obtain the client’s stool from the toilet bowl.
I. Principle Of Contradiction

When two options contradict each other, there is

a higher chance of one of them being the correct
answer.

Orally administered Flagyl is prescribed for a

client with Trichomoniasis. The nurse provides
medication instructions to the client and tells
the client to take the medication
1 without meals
2 with meals
3 1 hour before meals
4 2 hour before meals
I. Principle Of Contradiction

When examining a client with abdominal pain,

the nurse should assess:

1 Any quadrant first.

2 The symptomatic quadrant last.
3 The symptomatic quadrant first.
4 The symptomatic quadrant either second or
third.
I. Principle Of Contradiction
Lithium is taken:

1 During manic phase of bipolar disorder

2 As a short time regimen
3 During hospital admission
4 As a lifetime regimen

A client is taking tapazole, you are to assess

which of the following?

1 Sign and symptoms of hyperthyroidism

2 Sign and symptoms of hypothyroidism
3 Blurring of vision
4 Orthostatic hypotension
I. Principle Of Contradiction
An electrolyte disturbance that is most fatal
in Anorexia Nervosa is:

1 Hyperkalmia 3 Hypokalemia
2 Hyponatremia 4 Hypermagnesemia

Antivert has been prescribed for a client with

Meniere’s syndrome. the client is correct if she
states, “This drug is taken

1 during travel
2 before travel
3 after travel
4 during episode of vertigo
II. Principle Of Commonality and Difference
2 or more options that has the same essential
configuration and thought is unlikely the correct
answer.

Confusion in clients with Alzheimer’s disease is

usually seen:

1 Before lunch
2 At night
3 Upon waking up around 8 A.M
4 After breakfast
II. Principle Of Commonality and Difference
In a client with acute pancreatitis, The dietary
instruction would be:

1 Diet as tolerated
2 Whatever the client choice of food is
3 Regular diet
4 NPO

A client with Trigeminal Neuralgia is receiving

Tegretol with meals to alleviate pain. The nurse
monitors the client for which adverse or toxic
effect of the medication?

1 Dizziness 2 Drowsiness
2 SJ syndrome 4 Lethargy
II. Principle Of Commonality and Difference
In TURP, The client asked where is the incision.
Your most appropriate response is:

1 The incision is in the perineum

2 The incision is in the anal area
3 The incision is in the abdomen
4 There is no incision

Huntington's disease, formerly known as

huntington’s chorea is due to:

1 Environmental causes
2 Polluted environment
3 Exposure to radiation and toxic waste products
4 Genetics
II. Principle Of Commonality and Difference
A client with glaucoma asked “ When will my
vision returns?” The most appropriate response is
?

1 Although some vision has been lost and cannot

be restored, further loss may be prevented by
adhering to the treatment plan.
2 Your vision will return as soon as the medication
begins to work
3 Your vision will return to normal
4 Your vision loss is temporary and will return in
about 3-4 weeks
III. Principle Of Central Tendency
Correct answers in an all numeric options is most
likely located in between the extremes.

What is the KVO of fluids via infusion pump?

1 10 gtts/min 3 20 ml/hr
2 50 ml/hr 4 40 ml/hr

The client is taking Novolin Toronto. How

long will the insulin achieve it’s peak level in the
blood?

1 1 hours 3 8 hours
2 4 hours 4 16 hours
III. Principle Of Central Tendency
The nurse knows that in group therapy, the
maximum number of members to include is:

1 4 3 8
2 10 4 16

Clamping of the catheter for collection of

urinary specimen is performed for how many
minutes?

1 20 2 30 3 60 4 80
III. Principle Of Central Tendency
Which of the following percentage represents the
amount of damage the myocardium must sustain
before sign and symptoms of cardiogenic shock
develop?

1 10%
2 25%
3 40%
4 90%
IV. Principle Of Positive Negative Harmony
A positive question will always ask for a positive
answer and so is a negative question.

The nurse is performing physical assessment on a

client with acute kidney rejection is not expected
to assess which of the following?

1 Fever
2 Serum creatinine > 40%
3 Fatigue, muscle pain and lethargy
4 Anuria or Oliguria
IV. Principle Of Positive Negative Harmony
All but one of the following is NOT a correct
teaching to decrease gastric acid secretion in
clients with gastric ulcer?

1 Limit sleeping to 4 hours a day

2 Eat frequent heavy meals
3 Take antacids 1 hour before meals
4 Limit alcohol consumption
IV. Principle Of Positive Negative Harmony
The nurse is caring for the client who has been admitted
with Glaucoma, When assisting this client for ambulation, All
but one of the following is not inappropriate except:

1 Slightly in front of the client, Offering an elbow to hold.

2 Slightly in front of the client, Grasping the client’s elbow.
3 Next to the client, Offering an elbow to hold.
4 Next to the client, Holding the client’s elbow.
IV. Principle Of Positive Negative Harmony
All but one of the following is not an incorrect
type of non pharmacologic pain relief not use in
not treating cancer pain in patient except:

1 Herbal Plants
2 Guided Imagery
3 Both
4 Neither
V. Principle Of Improbable Extremes
Extreme modifiers, such as always, all, never, or
only make it more likely that the question is false.
Here is a more complete list of EXTREME modifiers.

A client with Renal Failure asks about salt

substitute. Which of the following is a correct
client education by the nurse?

1 Use substitute only when needed

2 Always use salt substitute rather than the
normal salt
3 Do not use salt substitute
4 Salt substitute is recommended only if the
client’s potassium level is normal
V. Principle Of Improbable Extremes
A nurse is providing safety instructions to the
client in preventing Chlamydial re-infection. Which
of the following shows positive understanding?

1 “I will only use diaphragm during sexual

intercourse.”
2 “I will remember safe sex everyday.”
3 “I will never have sex with my partner again.”
4 “My partner will use condom.”
V. Principle Of Improbable Extremes
Which of the following is true with regards to
MANIA?

1 It is always paired with depression

2 It is never a psychotic disturbance
3 The defense mechanism used is only reaction
formation
4 It is a defense against underlying depression
V. Principle Of Improbable Extremes
The nurse is providing teaching about diet management and
colostomy care. Which of the following patient statement
shows positive understanding?

1 “I will always apply Karaya powder inside my stoma and

appliance.”
2 “I will empty my bag if it is truly full.”
3 “Now that I have decrease eating cabbage, broccoli and
sweet potato; I haven’t experienced problems with
flatulence.”
4 “I am going to empty my bag after a satisfying sexual
intercourse.”
VI. Principle of Initiative critical thinking
STEPS :

1.Cover the options

2.Read the question carefully
3.Try answering the question without looking at
the options
4.Select the option that most closely matches your
answer

The most important assessment in an

unconscious client is:

1 Level of consciousness 3 Breathing pattern

2 Pupillary reflex 4 Patency of airway
VI. Principle of Initiative critical thinking
Which of the following method if used by Nurse
Jean will best assure that the tracheostomy ties
are not too tightly placed?

1 Jean places 2 fingers between the tie and neck

2 The tracheotomy can be pulled slightly away
from the neck
3 James’ neck veins are not engorged
4 Jean measures the tie from the nose to the tip of
the earlobe and to the xyphoid process.
VI. Principle of Initiative critical thinking
The nurse knows that in a patient receiving
general anesthesia, the priority nursing
assessment upon its administration is:

1 Respiratory rate 3 Temperature

2 Pulse rate 4 Level of consciousness
VI. Principle of Initiative critical thinking
Which of the following is the most dangerous
symptom of Guillain-Barre syndrome?

1 Paresthesia
2 Weakness
3 Respiratory arrest
4 Bilateral, ascending flaccid paralysis
VII. Principle of Grammatical Harmony
Options that do not coincide with the grammatical
configuration of the stem is not the correct
answer.

After receiving epidural anesthesia, a client

experience sudden severe nausea, cold and
clammy, pale. Her immediate action is to make
sure:

1 Call the physician

2 Increase the rate of infusion
3 No need to be alarmed for this is normal
4 That the client’s leg is elevated
During routine care, Mr. Gary, a client with
leukemia ask the nurse. “How can I be anemic if
this disease causes increased white blood cell
production? The nurse best response is that the
increase in WBC production will cause:

1 Crowding out of RBC

2 Are not responsible to anemia
3 Use nutrients from other cells
4 Have an abnormally short lifespan
A client with cancer is seen by the nurse. The
cancer says, “I would better be dead. Life is
worthless! Why me?” The nurse will:

1 Encourage client to verbalize his feelings

2 “Go on”
3 “Tell me more”
4 “You seem upset”
VIII. Principle of Umbrella Effect
A Choice that is more inclusive is usually the
correct answer.

The nurse should encourage exercise in the

management of diabetes, because it:

1 decrease total triglyceride levels

2 lowers blood glucose
3 improves insulin utilization
4 Decreases total triglyceride levels, lowers blood
glucose and improves insulin utlization
VIII. Principle of Umbrella Effect
To view a person holistically, the nurse should
think of him or her as:

1 Physical being who experiences pathology and

sociological change
2 Social being who needs the dynamics of group
interaction
3 Psychological being whose mind influences his
or her health status
4 Biopsychosocial being who is in constant
interaction with the environment
IX. Principle of Prioritization
In prioritization, The nurse will use 4 processes:
ABC, Maslow’s Hierarchy of Needs, The nursing
process and RACE in cases of fire. HOWEVER, IF
THERE IS AN OFFENDING AGENT, REMOVE THE
OFFENDING AGENT FIRST!!!

In a client with cataract, the nurse will use which

priority nursing diagnosis?

1 Fear r/t loss of eyesight

2 Social isolation r/t inability to see
3 Disturbed sensory perception r/t lens opacity
4 Risk for injury r/t decrease vision
IX. Principle of Prioritization
A nurse is teaching a client with coronary artery
disease about dietary measures to follow. During
the session, the client expresses frustration in
learning the dietary regimen. The nurse would
initially:

1 Identify the cause of the frustration

2 Continue with the teaching
3 Notify the physician
4 Tell the client that the diet needs to be
followed
IX. Principle of Prioritization
A client had an IV fluid hung at 4 pm. The nurse
is making rounds at 4:30 pm and noticed that
the client is complaining of a pounding headache
and is dyspneic, experiencing chills,
apprehensive with an increase pulse rate. The IV
bag has 300 ml remaining. The nurse should
perform which of the following action first?
1 Call the physician
2 Put the client in high fowlers position to promote
oxygenation
3 Slow down the IV fluid
4 Administer oxygen
IX. Principle of Prioritization
The client with a diagnosis of cancer is receiving
morphine sulfate 10 mg Subcutaneously every 3
to 4 hours for pain. When preparing the plan of
care for the client, the nurse includes whith
PRIORITY action?

1 Monitor stools
2 Monitor urine output
3 Encourage the client to cough and deep breath
4 Encourage fluid intake
IX. Principle of Prioritization
A client is seen by the nurse tilting his head and
whispering words, as if he is talking to someone.
What should the nurse do first?

1 Initiate suicidal precaution

2 Ask the client if he is hearing voices
3 Formulate a nursing diagnosis of risk for injury
directed to self
4 Evaluate the effects of the antipsychotic
medication
IX. Principle of Prioritization
The nurse just came after a meal from the
canteen and saw a burning sofa and curtain in
the hospital lobby. She is holding a 500 ml of
mineral water. Which of the following should the
nurse do first?

1 Pour the 500 ml of water in the burning sofa and

curtain
2 Sound the alarm
3 Run away from the immediate vicinity
4 Confine the area by closing all the entrance
IX. Principle of Prioritization
A client who catches flames is now burning and
is running towards you. As a nurse, your priority
is to:

1 Maintain the airway as patent as possible

2 Remove the burning clothes
3 Pour liquids over the client
4 Log roll the client on the ground
X. Principle of “Tell me more”
In Psychiatric Nursing, Remember to focus on the client’s
feeling, concerns, anxieties and fears. This is best
summarized by a response the encourage the client’s
verbalization of feelings.

A mother of two children is to undergo a breast biopsy. She tells the

nurse, “If I lose my breast, I know my husband will no longer find me
attractive.” Which of the following response by the nurse would be most
appropriate?
1 “You don’t know if you are going to lose your breast. They are just doing
biopsy now.”
2 “You should focus on your children, They are young and they need you”
3 “You seem to be concerned that your relationship with your husband
might change”
4 “Why don’t you wait and see what your husband’s reaction is before you
get upset”
X. Principle of “Tell me more”
A mother say to the nurse, “I am afraid that my
child might have another seizure” Which response
by the nurse is most therapeutic?

1 “Why worry about something you cannot

control?”
2 “Most children will never experience a second
seizure”
3 “Tell me what frightens you the most about
seizures.”
4 “Tylenol can prevent another seizure from
occuring”
X. Principle of “Tell me more”
A client is admitted to the emergency room with a diagnosis
of acute myocardial infarction. The client tells the nurse,
“I’m Scared, I think I am going to die.” Which of the
following response 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 had a heart attack once.”
3 “I’ll call the doctor so you can discuss it.”
4 “It is normal to be frightened.”
X. Principle of “Tell me more”
During a conversation with a depressed client on
an inpatient unit, the client says to the nurse,”My
family would be better off without me” The nurse
best response is

1 “Everyone feels like this when depressed”

2 “Have you talked to your family about this?”
3 “You sound upset, are you thinking of hurting
yourself?”
4 “You will feel better once your medication
works”
X. Principle of “Tell me more”
Ms. Jones says that she is the incarnation of the
holy Virgin Mary. She said that she is the child of
the covenant that would save this world from the
evil forces of Satan. One morning, while caring for
her, she stood in front of you and said “Bow down
before me! I am the holy mother of Christ! I am
the blessed Virgin Mary!” The best response by the
Nurse is:
1 Tell me more about being the Virgin Mary
2 So, You are the Virgin Mary?
3 Excuse me but, you are not anymore a Virgin so
you cannot be the Blessed Virgin Mary.
4 You are Ms. Linda Jones
XI. Principle of Reappearing Visage
A word or phrase that appears in the question
and then re appears at one of the 4 choices is the
most probable answer.

A survivor of an accident repeatedly blames

himself and tells the nurse he should have died
instead of his girlfriend. This is an example of:

1 Denial 3 Repression
2 Grief 4 Survivor’s Guilt
XI. Principle of Reappearing Visage
A chronically ill school-age child is most
vulnerable to which stressor?

1 Mutilation anxiety
2 Anticipatory grief
3 Anxiety over school absences
4 Fear of hospital procedures
XI. Principle of Reappearing Visage

The child is afraid in going school. He is

experiencing:

1 Anxiety 3 Grief
2 School Phobia 4 Agoraphobia
XI. Principle of Reappearing Visage
In a pregnant client with thrombophlebitis of the
leg or the inflammation of the vein due to blood
clots, which of the following is an appropriate
nursing intervention?

1 Apply heat
2 Massage the affected area
3 Administer warfarin as prescribed
4 Elevate the leg to lessen the inflammation of the
veins and prevent dislodging of the clots
XII. Principle of Drug Technique

Most drug, especially psychotropic medications

either acts as a CNS Stimulant or a CNS depressant.
The strategy revolves in determining which are the
Central nervous system excitations and which are
the Central nervous system inhibitions. If 3 of the
options are all CNS up and 1 is CNS down, pick the
CNS down. If 3 of the options are all CNS down and
1 is CNS up, pick the CNS down.
XII. Principle of Drug Technique
A client experienced over dosage with a tricyclic
antidepressant will manifest which of the
following?

1 Heart rate greater than 130 bpm

2 Muscular flacidity
3 Areflexia
4 Hypothermia
XII. Principle of Drug Technique
The nurse administers Wyamine to a client. The
nurse should monitor which of the following
adverse effect associated with Wyamine?

1 Hypotension 3 Bradycardia
2 Shock 4 Hypertension

The nurse is monitoring a client receiving

tranylcypromine sulfate (Parnate). Which serious
adverse reaction can occur with high dosages of
this monoamine oxidase (MAO) inhibitor?

1 Muscular Spasticity 3 Bradycardia

2 Hypotensive crisis 4 Depression
XII. Principle of Drug Technique

The nurse is assessing a client who has just been

admitted to the emergency department. Which
signs would suggest an overdose of an antianxiety
agent?

1 Combativeness, sweating, and confusion

2 Agitation, hyperactivity, and grandiose ideation
3 Suspiciousness, dilated pupils, and increased
blood pressure
4 Emotionally blunt, lethargy and impaired memory
XII. Principle of Drug Technique
A client with a history of polysubstance abuse is
admitted to the health care facility. She complains
of nausea and vomiting 24 hours after admission.
The nurse assesses the client and notes
piloerection, pupillary dilation, and lacrimation. The
nurse suspects that the client is going through
which of the following withdrawals?

1 Ecstasy withdrawal 3 Cocaine withdrawal

2 Cannabis withdrawal 4 Opioid withdrawal
XII. Principle of Drug Technique
A client is taking ARCALYST [RILONACEPT] and you
are to assess which of the following potential side
effect?

1 Joint pain
2 Nausea, Vomiting and Diarrhea
3 Polyuria
4 Blurring of Vision
CONCLUSION
I. Is it possible to narrow the question into
options even without reading the question?

Θυεστιον : Βραιν τυµορ, ωηετηερ µαλιγναντ ορ

βενιγν ηασ α σεριουσ ιµπλιχατιονσ. Ασ α νυρσε, ψου
σηουλδ βε αβλε το υνδερστανδ τηε χονσεθυενχεσ οφ
τηε δισεασε ανδ ιτσ τρεατµεντ. Χονραδ, ωηο ηασ
βραιν τυµορ ηασ αν ινχρεασε ιντραχρανιαλ πρεσσυρε.
Κεεπινγ Χονραδ∋σ ηεαδ ανδ νεχκ ιν αλιγνµεντ ωιλλ
ρεσυλτ ιν:

1 Increase intrathoracic pressure

2 Decrease venous outflow
3 Increase venous outflow
4 Increase Intrabdominal pressure
CONCLUSION
II. Is it possible to know the side effect of the drug
even without knowing the drug?

A client has been receiving a dose of

sodium-meta-diamino-para-dioxy-arseno-benzoe-
methylene-sulph-oxylate (Neosalvarsan). Which of
the following is a potential side effect you need to
tell the client?

1 Avoid driving or operating heavy machineries, The drug

causes drowsiness.
2 Avoid exercising, The drug causes Palpitation and
Tachycardia
3 Do not go to high places, the drug causes Tachypne
4 Take a bath using cold water because the drug causes
Flushed and warm skin
CONCLUSION
III. Is it possible to correctly answer an option even without
knowing a thing about the question?

Question : Alio eram penetro in hospitium propter offensus.

Quod of sequens est non an specto in alio?

A client was admitted in the hospital because of shock.

Which of the following is not an expected assessment on a
client?

1 Low blood pressure

2 High blood pressure
3 Heart rate of 120 bpm
4 Low CVP recorded at 3 cmh2o
CONCLUSION
IV. Is it possible to correctly identify the correct answer by
studying only the configuration of the options?

Question : WHAT?
The client is taking an antidepressant for 1 week now and
told the nurse, “ Why should I continue, it has no effect until
now! “ The best response would be:

1 Wait for a while, patience is a virtue.

2 This is not normal, All antidepressant has an immediate
effect.
3 This is normal, antidepressants usually takes 2 to 4 weeks
to take effect.
4 Your depression is getting worst.
CONCLUSION
V. Is it possible to answer a question confidently even
without a question?

Question : No Question
1 Increased heart rate 3 Muscular flaccidity
2 Rapid breathing 4 Diarrhea

Question : No Question
1 Are you feeling guilty about what happened?
2 Why do you feel this way?
3 That happened to me once
4 You seem very upset. Tell me how you are feeling.

Question : No Question
1 CNS Depression 3 Lethargy
2 Bradycardia 4 Pupil constriction
TEST TAKING STRATEGIES

Dervid Santos Jungco U.S.R.N