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Test Taking Skills

Successfully Preparing for


HESI & NCLEX-RN

LeeAnn Danner-Wilson

Worth your time, paper, and ink to


download!
NCLEX Examination Candidate
Bulletin
http://www.pearsonvue.com/nclex/

Will provide you with all the


information you need about testing
and filling out your paperwork!

Taking the NLCEX-RN


Testing Center
Plan to arrive 30 minutes early. If you are 30 minutes
late you forfeit your appointment.
Will need your Authorization to Test (ATT) Form
2 forms of ID that are signed and current
Names must match
A digital fingerprint, signature, and photograph will be
taken at the test center and accompany the NCLEX
results to confirm your identity.

Taking the NLCEX-RN


If you leave the room, you will be required to have
your fingerprint taken to re-enter
Personal belongings are not allowed in the testing
area
Family members or friends are not allowed to wait at
the testing center.

Testing Center Continued


Once you complete the admission process and a brief
orientation, the proctor will escort you to your assigned computer.
Work space
No electronic devices are allowed
No items are allowed in the room
You will be observed at all times (video and audio recordings)
If typing bothers you, request ear plugs
MUST follow directions of the test center staff; can not leave your
seat unless authorized by the proctor.

Taking the NCLEX-RN


Time
6 hours which includes: tutorial, two preprogrammed optional breaks (2
hours, 3.5 hours), any unscheduled breaks.

How many questions?


Minimum is 75; of those 75- 60 will be scored and 15 will be unscored
Maximum is 265

The computer cut me off.


You are now finished. At this point you will complete a questionnaire about
your testing experience.

Pass or Fail
All of the examination questions are categorized by test plan area and
level of difficulty.

Test Plan
Each Examination Question will address:
Levels of Cognitive Ability
Client needs category
Integrated Process

Levels of Cognitive Ability


Knowledge
Comprehension
Application
Analysis

Client Needs
Categories/Subcategories
Safe, Effective Care Environment
Management of Care
Safety and Infection Control

Health Promotion & Maintenance


Psychosocial Integrity
Physiological Integrity

Basic Care and Comfort


Pharmacological & Parental Therapies
Reduction of Risk Potential
Physiological Adaptation

Integrated Processes

Caring
Communication & Documentation
Nursing Process
Teaching/Learning

Preparation
Developing a Study Plan
Good Time Management
Calendar

Study Sessions
Quality vs. Quantity

Materials needed
Computer
Questions & Answers
Special Notebook

HESI
Minimum of 100 Questions a day

NCLEX-RN
Minimum of 200 Questions a day

Preparing the Night Before

Good nights sleep


Be confident (positive self talk)
Eat Breakfast
Set your alarm early
Be prepared
Avoid conversations
Dont study the day of!

MEMORY DUMP

Just a few facts..


Nursing exams are difficult because
the questions ask you to make
judgments and apply informationnot just recall facts.
No matter how hard you study or
how much you can recall, you will
not pass unless you can apply your
nursing knowledge and make good
nursing judgments.

First Things First


Setting the Stage

Glass House Theory

Answer your
questions as if the situation were ideal, and
you had ALL the resources and time needed.
The only client you need to be concerned
with is the one in the question

Perfect Medical World

Components of a
Question
Case Scenario
Stem
Four Answers

My New Routine
After reading the Question ask:

What is the question telling me?


What is the question asking me?
Who is the patient in the question?
Are there any key words?
What is the issue?

First
What is the question telling me?
What is the question asking me?
Look at the stem!!!!

Second
The Client
Who is the focus of the question?
You must identify the client in the question
because the answer MUST relate to the client.
The client is NOT always the patient, it
sometimes is a family member.

Example
A nurse will be going on vacation. To involve the
patient in the excitement, what is the best thing the
nurse should say ?

A. Let me tell you about the plans for my vacation.


B. Tell me about some of your past vacations.
C. Ill bring the brochures for you to see.
D. What do you think about vacations.

Third
Key Words (Circle These)
The important phrases or words in a question

Early
Late
Immediately
Most likely, least likely
Initial
After several days

Last
What is the issue in the question?
The specific problem or subject which the
question is ASKING

Drug
Problem
Toxic Effect
Behavior
Disorder Procedure

After Reading the Question


o
o
o
o
o

Cover up the answers


Read each answer individually
Write out beside why that question
Mark out the ones that are for sure incorrect
Question mark the maybes

Pitfalls
Reading into the
question
Asking well what
if.

Reading into the Question


based on REALITY
A client is admitted to the
hospital for an exploratory
laparotomy. The clients daughter
says to the nurse, I wish I could
stay with my father, but I need to
go home to see how my children
are doing. I really hate to leave
my father alone at this time. The
best nursing response is:

Answers
1. Your father needs opportunities to be
independent. This will help him become
self-sufficient.
2. Your father is capable of taking care of
himself. Try allowing him more
independence.
3. Stress is not good for your father at this
time. Perhaps you could call your
children.
4. You are feeling concern for both your
father and your children. Let me know
when you are leaving, and Ill stay with
him.

Eliminating Incorrect Options


Distracters are incorrect options that are
designed to resemble the correct answer.
They are intended to DISTRACT you from
answering correctly.
Read your answers
Cross out the nos
Question mark the maybes

Misreading Test Questions

Incorrectly analyze what is being asked


Overlook key words
Read into the question
Incorrectly interpret a disorder

Helpful Tips
To avoid reading into the question
Restate in your own words
Eliminate options that includes new
information
Eliminate options that require you to make
assumptions

Problem
oMy problem is I get
narrowed down to 2
answers and I always
pick the wrong one!

Guidelines
If you are left with two questions
marks and cant make a decision
go with your gut instinct!
Using a selection procedure allows
you to make educated guesses.
When you narrow to 2, you have a
50% chance of guessing correctly!

How to Choose the between


the best 2 options?

Use testing strategies


Global

Response
Similar Distractors
Similar words or phrases

Remember

Testing is like playing a


game! When you want to
win, you need to strategize.
The following are some of
your strategies!

Global Response
A global response is one that is a general
statement and may include the ideas of
other options within it.
This option is often the correct answer
when 2 or 3 more specific options appear
equally correct.

Practice Using Global


Response

The nurse assigned to care for a child with


cerebral palsy should obtain information
concerning the childs abilities, limitations,
interests, and habits, because the aim of therapy
is to:

1.

Assess the childs assets and potentialities and capitalize on


these in the rehabilitative process, while overlooking
limitations.
Reverse abnormal functioning and restore the brain function
through rehabilitation.
Provide a therapeutic program that avoids subjecting the
child to frustrating experiences that decrease achievement.
Develop an individualized therapeutic program that uses
the childs assets and abilities to achieve success as well as
develops the childs ability to cope with frustration and
failure.

2.
3.
4.

Answer

4- This is an APPROPRIATE

goal for CP therapy. This is also


a global option, since it
includes recognizing the
childs assets and helping the
child to cope with frustrations
and failures due to limitations.

Similar Distracters
Always remember there is only 1 correct
answer.
If 2 options say the same thing or include
the same idea, they cant be correct.
Answer is the option that is different.

Practice using Similar


Distracters

A newly diagnosed adult diabetic is


demonstrating of the proper
technique for insulin injection. The
client draws the correct dose of
insulin using the proper technique,
but when ready to inject the needle,
hesitates and says, I am not sure I
can do this. Which response by the
nurse would be best initially?

Answers
1.
2.
3.
4.

I will show you how to


inject the needle.
I will inject the needle for
you this time.
You are doing fine so far.
Give it a try.
Why are you so nervous?
Do you need help?

Answer

3- This is the correct


answer because it focuses
on the client being
encouraged to do the
procedure.

Similar Words

First use Global Response


Second use Similar Distracters
If still no hope, try similar words, phrases.
If you find a word, feeling, or behavior used in the
stem or the case scenario that is repeated in one of
the options, that option MAY be the correct
answer.
Not the most reliable strategy

Using Similar Words

A client has sustained a fracture


of the tibia and fibula. In
providing nursing care for this
client, who has a newly applied
long-leg cast, which
consideration is vital?

Answers
1.
2.

3.
4.

Elevation of the leg in the cast on


a pillow will minimize edema.
Healing of a fractured bone
requires an extended period of
time.
A long period of immobility may
lead to atrophy of the muscle.
Analgesics may be needed for
pain associated with the fracture.

Answer
!. When caring for a client with
a newly applied cast, it is
IMPORTANT to keep the
affected extremity above the
level of the heart to reduce
swelling.
Key words are leg and cast

Levels of Cognitive Ability Practice

Knowledge Questions
Knowledge questions require you
to recall or remember
information. To answer a question
you need to commit facts to
memory.

Knowledge Question
The first step of the procedure for
making unoccupied bed is

A. Pulling the curtain


B. Washing your hands
C. Collecting the linen
D. Placing the bottom sheet

Answer
B- because you need to know the
sequence of steps in the procedure
of making an unoccupied bed or
the basic principles that your
hands must be washed before ALL
procedures.

Comprehension Questions
Require you to understand
information. To answer a
comprehension question, you must
commit facts to memory as well as
translate, interpret, and determine
the implications of that information.

Comprehension Question
To evaluate the therapeutic effect of
a cathartic, the nurse should asses
the patient for:
A. Increased urinary output
B. A decrease un anxiety
C. A bowel movement
D. Pain Relief

Answer
C- to answer this question you have
to know not only that a cathartic is a
potent laxative that stimulates the
bowel but also that the increase in
peristalsis will result in bowel
movement.

Difference
The difference between knowledge
questions and comprehension
questions is: to answer knowledge
questions you must know facts. To
answer comprehension questions you
must understand the significance of
the facts.

Application Questions
Application questions require the
learner to show solve, modify,
change, use, or manipulate
information in a real situation or
presented scenario. To answer,
you must apply concept you
learned previously to concrete
situations.

Application Question

1.
2.
3.
4.

A client is experiencing a
hypoglycemic reaction. The
nurse should administer which
of the following items to best
treat the reaction?
Water
Diet soda
Milk
One sugar-free cookie

Answer
3- In intervention questions you are
asked about an intervention, a nursing
action, a decision, or a problem that
needs to be solved. Here you are asked
to select the best item for treating a
hypoglycemic reaction. Remember, if
a hypoglycemic reaction occurs, the
client should be given an item that
contains 10 to 15 g carbohydrate.

Analysis Questions
Require you to interpret a
variety of data and recognize
the commonalities,
differences, and
interrelationships among
presented ideas. Make the
assumption that you know,
understand, and can apply
information.

Analysis Question

1.
2.
3.
4.

The nurse administers 10 units of


Regular insulin at 0700 to a client
with type I diabetes mellitus. The
nurse monitors the client closely for
a hypoglycemic reaction during
which time frame?
0900 to 1000
1300 to 1900
0900 to 1500
1100 to 1200

Answer
1- For analysis you are required to
consider and examine possibly
several concepts in the question to
answer it correctly. In this
question, it is necessary to know
that Regular insulin is short acting
insulin (i.e. it peaks in 2 to 3
hours) and that a hypoglycemic
reaction is most likely to occur
during peak time.

Differences
Analysis questions require an
ability to examine information,
which is a higher thought
process than knowing,
understanding, or applying
information.

Example
Studying Blood Pressure
First memorize the parameters of a normal
blood pressure (Knowledge)
Then develop an understanding of what factors
influence and produce a normal blood pressure
(Comprehension)
Identify a particular patient situation that
would necessitate obtaining a BP (Application)
Differentiate among a variety of situations and
determine which has the highest priority for
assessing the BP (Analysis)

Client Needs Questions

Categories/Subcategories

Safe, Effective Care Environment

Management of Care
Safety and Infection Control

Health Promotion & Maintenance


Psychosocial Integrity
Physiological Integrity

Basic Care and Comfort


Pharmacological & Parental Therapies
Reduction of Risk Potential
Physiological Adaptation

Safe, Effective Care


Environment
Management of Care

A client scheduled for surgery tells the nurse


that he signed an informed consent but was
never told about the risks or the surgery. The
nurse serves as the clients advocate by

1. Writing a note on the front of the clients record so


that the surgeon will see it when the client arrives to
the OR.
2. Documenting in the clients record that the client
was not told about the risks of surgery.
3. Contacting the surgeon and asking the surgeon to
explain the surgical risks to the client.
4. Reassuring the client that the risks are minimal and
unlikely to occur.

Answer

3- Use therapeutic communication


techniques to eliminate option 4.
Focus on never told about the
risks of surgery. A nurse serves as
a client advocate by protecting the
rights of clients to be informed and
to participate in decisions
regarding their own care.

Safe, Effective Care


Environment
Safety and Infection Control

An emergency room nurse receives a telephone call from the


police department and is told that several victims involved in a
train accident will be brought to the emergency department.
The nurses immediate action is to:
1.
2.
3.
4.

Call as many nurses as possible at home to have them come to the


hospital to care for the victims.
Follow the directions outlined in the hospitals disaster prepardedness
plan (emergency response plan)
Ask the housekeeping and laundry department to deliver an extra cart
of linen that contains several blankets.
Call the operating room and inform the staff that they may be receiving
numerous victims that require surgery.

Answer
2- If the ED nurse is notified that several victims
of a disaster will be arriving to the ED, the nurse
would immediately activate the emergency
response plan by notifying the supervisor and by
following the directions in the plan.
Test Taking hint- Option 2 is the global
response- once this action is taken the others
will follow

Health Promotion &


Maintenance
A nurse is preparing to care for a
hospitalized female teenager who is in
skeletal traction. The nurse plans care
knowing that the most likely primary
concern of the teenager is:
1. Obtaining adequate nutrition
2. Body Image
3. Keeping up with school work
4. Obtaining adequate rest and sleep

Answer
2- note keyword primary. Focus
on the client who is a teenager.
Thinking about psychosocial
development of a teenager, will
direct you to option 2.

Psychosocial Integrity

A boy is brought to the school nurses office


with reports of abdominal pain. On
assessment, the nurse notes the presence of
several bruises on the childs abdomen and
back and several cigarette burn marks. The
nurse suspects child abuse and plans for
which priority action?
1. Calling the parents to ask them how the
childs bruises and burn marks occurred.
2. Removing the child from the abusive
situation to prevent further injury.
3. Documenting about the bruises noted on
the child.
4. Asking the child how long his parents
have been abusing him.

Answer
2- Maslows hierarchy of needs.
Physiological needs are the priority,
and if a physiological need does not
exist, then safety is priority.

Physiological Integrity
Basic Care & Comfort

A nurse has provided information to a client


about measures that will promote normal
urination patterns and prevent urinary tract
infections. Which statements by the client
indicates a need for further information?
1.
2.

3.
4.

I should eat foods that will make my urine acidic


I should try to hold my urine as long as I can
rather than expelling it when I feel the urge.
I should drink plenty of fluids during the day.
I should take my furosemide (Lasix) in the
morning.

Answer

2- Use the process of elimination


and note the words a need for
further teaching. Focusing on the
issue (prevent urinary tract
infections) and recalling that
urinary stasis can lead to infection
will direct you to option 2.

Physiological Integrity
Pharmacological & Parental Therapies
Cyclosporine (Sandimmune) oral solution
is prescribed for a client who had a kidney
transplant. The nurse provides information
to the client about the medication and tells
the client that which of the following is most
important to monitor?
1. Apical heart rate
2. Peripheral pulses
3. Platelet count
4. Temperature

Answer
4- Use the process of elimination.
Eliminate options 1 and 2 first
because they are similar. From the
remaining options, note the
keywords most important. Recalling
that infection is an adverse effect will
direct you to option 4.

Physiological Integrity
Reduction of Risk Potential
The nurse assists a physician in

performing a liver biopsy on a client.


After the procedure, the nurse assists the
client to which position?
1.
2.
3.
4.

Prone
On the right side
On the left side
Left Sims position

Answer
2- Use knowledge regarding anatomy and

the anatomic location of the liver to answer


the question. Recalling that the liver is
located on the right side of the upper
abdomen will direct you to option 2.

Physiological Integrity
Physiological Adaptation
A nurse is reviewing the medical records of the four

clients she will be caring for. The nurse determines that


which client is at risk for fluid volume deficit?
1. The client receiving long-term corticosteriod therapy.
2. The client with congestive heart failure.
3. The client with a syndrome of inappropriate
antidiuretic hormone.
4. The client with a nasogastric tube attached to suction.

Answer
4- Focus on the issue! The client at risk for

fluid volume deficit. Think about the


pathophysiology associated with each
condition identified in the options. The
only client that loses fluid is the client with
a nasogastric tube attached to suction.

Integrated Processes
Caring
Communication &
Documentation
Nursing Process
Teaching/Learning

Integrated Processes
Caring
An infant is brought to the ED by EMS with

suspected sudden infant death syndrome. The


infants parents have accompanied EMS and are
present when the infant is pronounced dead. The
most important aspect of compassionate care for
the parents is to:
1. Explain to the parents that the death was not
their fault.
2. Allow the parents to say goodbye to the infant.
3. Gather data about the events that occurred
before the infant was found.
4. Encourage the parents to attend a support
group.

Answer
2-Focuse on the issuecompassionate care. This
directs you to option 2,
because it is the only option
that addresses this issue. The
other answers are not
specifically related to
compassionate care.

Integrated Processes
Communication Questions
Thought is If you cannot communicate
therapeutically, it is difficult to practice
safely.
Identify the Client in the Question
Identify the issue
Use the Communication Tools and Blocks
Tools (enhance)
Blocks (interfere)

Communication Tools
Being Silent
Sitting quietly

Offering Self
Let me sit with you.

Showing Empathy
You are upset.

Focusing
You say that..

Restatement
You feel anxious?

Validation/clarification
What you are saying is

Giving information
Your room is 423.

Dealing with the here and


now
At this time, the problem
is.

Communication Blocks
Giving advice
If I were you, I would

Showing approval/disapproval
You did the right thing

Using clichs and false


assurances
Dont worry, it will be okay

Requesting an explanation
Why did you do that?

Devaluing client feelings


Dont be concerned.Its not a
problem.

Being Defensive
Every nurse on this unit is
exceptional.

Focusing on Inappropriate
issues or person
Have I said something wrong

Placing the clients issues on


hold
Talk to your doctor about that.

Cheating on Communication
Questions
NEVER answer I
Always focus on feelings, thoughts, and
behaviors.
Usually the answer with you feel is
correct.
Always remember it is about the client

Integrated Processes
Communication

A client says to the nurse,


Im scared about my
surgery that I am having
tomorrow. The nurse should
make which appropriate
response to the client?

Answers
1.
2.
3.
4.

There is no reason to be
scared.
You have plenty of reasons to be
scared. Surgery is a scary thing.
Scared?
Most people who have to have
surgery are scared.

Answer

3- Therapeutic
communication
techniques. In option 3,
you are using reflection.
Options 1,2, & 4 are
nontherapeutic.

Integrated Process
Documentation

A nurse discovers that she


needs to make a correction
to a written entry in a clients
chart. Which of the following
is the most appropriate
action?

Answers
1.
2.

3.

4.

Contact the nursing supervisor to


cosign the correction.
Remove the page, recopy the data to
a new page, and add the correct
entry.
Draw a single line through the entry
that needs correction followed by his
or her (RNs) initials.
Erase the entry that needs correction
and add the correct entry.

Answer

3- Use guidelines and


principles related to
documentation. No useful
reasons for options 1 & 2.

Nursing Behaviors Associated


with the Assessment Phase of
the Nursing Process
Gathering objective and
subjective data
Identifying manifestations
Evaluating environments
Identifying the nurses
reaction
Verifying Data
Communicating Information

Integrated Process
Assessment
A client is eight hours
postoperative after a
transurethral resection of the
prostate gland (TURP). Which
nursing assessment would be
an early indication of a
postoperative complication?

A. Pain in the operative site


B. Pulse rate of 88
C. Output of bloody urine
D. Oral temperature of 101.8F

Answer
D- A temperature of 101.8F
eight hours post-op is
considered an early
indication of a post-op
complication.
C- is a possibility, but
bloody urine is expected
post TURP.

Nursing Behaviors Associated


with the Analysis Phase of the
nursing Process (Diagnosis)

Interpreting data
Validating data
Organizing related data
Identifying a nursing diagnosis
MOST DIFFICULT to answer
Require an understanding of the
principles of pathophysiology,
pharmacokinetics, and psychopathology,
as well as growth and development.
Be sure you have the correctly identified
the issue in the question

Integrated Process
Analysis/Diagnose
The nurse is performing a
developmental evaluation of a twoyear-old child. Which observation
would the nurse consider a good
indicator of normal development?

Answers
A. Having command of a
vocabulary of six words.
B. The ability to walk up and
down stairs without help.
C. The ability to dress and
undress.
D. The ability to point at
something that is wanted.

Answer
B- This is a good indicator of
normal psychomotor
development.

Behaviors Associated with the Planning


Phase of the Nursing Process

Developing and modifying nursing


care plans
Cooperating with other health
personnel for delivery of client care
Recording relevant information

Integrated Process
Planning

A nurse is caring for a patient


experiencing loss of appetite
(anorexia) and nausea. Which
statement includes an expected
outcome?

Answers

A. The patient will eat 50 percent of


every meal during the next week.
B. The patient has altered nutrition
less than body requirements.
C. The patients privacy will be
maintained when providing care.
D. The patients mouth will be
cleaned every 4 hours.

Answer

A- In this question you have to


recognize the differences among a
goal, an expected outcome, a
nursing diagnosis, and a nursing
intervention.

Behaviors Associated with the Implementation


Phase of the Nursing Process
Performing or assisting in performing activities of
daily living
Counseling and teaching clients or families
Using therapeutic communication skills
Providing care to achieve therapeutic goals
Providing care to optimize achievement of health
goals by the client
Supervising and checking the work of the staff

Integrated Process
Implementation

The registered nurse delegates


the implementation of a
nasogastric tube feeding to a
licensed practical nurse. Which
statement is accurate in terms
of the responsibility of the RN?

Answers
A. The RN should implement the

planned care and not delegate.


B. The LPN should respectfully refuse
to implement this care.
C. The LPN is accountable for his or
her own actions.
D. The RN is responsible for
delegated care.

Behaviors Associated with the


Evaluation Phase of the Nursing
Process
Comparing actual outcomes with
expected outcomes of therapy
Determining the impact of nursing
actions
Verifying that tests or measurements
were performed correctly
Evaluating client understanding of
information given

Integrated Process
Evaluation
A patient returns to the clinic
after taking a 7-day course of
antibiotic therapy and is still
exhibiting signs of a urinary
tract infection. What should be
the nurses initial action?

Answers
A. Arrange for the MD to order a
different antibiotic.
B. Obtain another urine specimen
for a culture and sensitivity.
C. Determine if the patient took
the medication as prescribed.
D. Make an appointment for the
patient to be seen by the MD.

Answer
C- This item is designed to teat
your ability to recognize that the
nurse must analyze the factors
that influence outcomes of care.
Options 1,2,4 can be eliminated
because these actions immediately
move to an intervention before
collecting more information.

Integrated Process
Teaching/Learning

If a test question addresses


client teaching, remember
that client motivation and
client readiness to learn is
the FIRST priority.

Teaching/Learning

A nurse has taught a clients spouse how to change the


clients colostomy bag. The nurse would best
determine that the spouse understands the procedure
by
1. Asking the spouse if she has any questions about
the procedure
2. Asking the spouse if she understands what items
are needed to perform the procedure.
3. Asking the spouse to perform the procedure and
observe her performing it.
4. Asking the spouse if she feels comfortable
performing the procedure.

Answer

3- Note the keyword best in the stem and


focus on the issue: the spouses ability to
perform a procedure. The nurse would best
evaluate learning by observing the
performance of the behavior. Although 1,2, &
4 are things the nurse would ask, they do
not evaluate.

Pharmacology Questions
Utilize the Five Medications Rights and your
knowledge on appropriate ways to give
medication.
Utilize the following assessment guidelines
Always assess

Allergies or hypersensitivity to a med


Existing medical disorders that are contraindicated
Potential interactions
Pertinent lab
VS (esp for cardiac and BP meds)
Intended effects, side effects, adverse effects, or toxic effects
Client response to medication

Pharmacology Question
The nurse notes that a physician has prescribed
cotrimoxazole (Bactrim) for a client with a urinary
tract infection. Which priority action will the nurse
take before administering this medication?
1. Call the pharmacy to order the med.
2. Ask the client about an allergy to
sulfonamides.
3. Check the medication supply room to find out
whether the medication needs to be ordered.
4. Inform the client about the need to increase
fluid intake.

Answer
2- Note the issue: the action that the nurse
will take
Note the keyword: priority
The steps of the nursing process help you
here, option 2 is the only option that
addresses client assesment.

Pharmacology Question

1.
2.
3.
4.

A client taking amitriptyline (Elavil) calls the


nurse at the physicians office and reports that
he has an upset stomach whenever he takes
the medication. The nurse most appropriately
tells the client to
Take the medication with an antacid.
Stop the med for 2 days, and then resume the
prescribed med schedule.
Take the med on an empty stomach.
Take the medication with food

Answer
4- Issue- upset stomach! Recall antacids
are not usually administered with
medication. Options 1 & 2, a nurse would
not tell a patient to stop taking a
medication.

Pharmacology Questions
Have to know the differences between
Intended effects: a desirable effect
Side effects: no desired, not usually lifethreatening, alleviated with specific measures
Adverse effects: more severe than a side
effect, always undesirable, always reports to
the health care provider
Toxic effects: medication level in the body
exceeds the therapeutic level.

Question

1.
2.
3.
4.

Erythromycin (E-Mycin) has been prescribed


for a client with a respiratory infection. The
nurse tells the client that which frequent side
effect can occur from this medication?
Yellow discoloration to the white part of the
eye.
Abdominal cramping
Severe diarrhea
Yellow colored skin

Answer
2- Issue- side effect. Eliminate options 1 &
4 first because they are similar and both
indicate the presence of hepatitis, and
adverse side effect of the medication.
Eliminate option 3 because of the word
severe, which indicates an adverse
effect.

Question

1.
2.
3.
4.

A client with congestive heart failure is


receiving furosemide (Lasix). The nurse
monitors the client for which adverse
effect of the medication?
Nausea
Increase in urinary output
Gastric upset
Muscle weakness

Answer
4- Issue- adverse effect. Eliminate 1 & 3
because they are similar and both relate to
the GI System. Eliminate option 2 because
it is an intended effect of the med.

Unfamiliar with the Medication


Tips
Note whether the question identifies the clients diagnosis. For
example: if the questions states: Cyclophosphamide (Cytoxan)
has been prescribed for a client with metastatic breast cancer,
focusing on the clients diagnosis will help you to determine that
cyclophosphamide is an anitneoplastic med.
Break down the name of the med into parts (trade or generic)
Ex: Terbutaline sulfate (Brethine) has been prescribed for a
client. Think about breath when you look at the medication
name Brethine to help you determine that it is respiratory med.
Note the letters in the med name and look for those letters that
identify a particular medication classification. (See handout)

Pharmacology Questions
Break the name down to help you

1.
2.
3.
4.

A clinic nurse is taking a health history on a


client seen at the health care clinic for the first
time. When the nurse asks the client about
current prescribed medications, the client tells
the nurse that indinavir (Crixivan) is taken
twice daily. Based on this finding, the nurse
suspects the presence of which condition?
Peptic ulcer disease
Inflammatory bowel disease
HIV
Diverticulitis

Answer
3- Keyword suspects the presence
Issue- nurses findings
Remember that many antiviral medication
names contain the letters vir will direct
you to option 3.
Note the similarity in options 1,2, & 4

Delegation
The Rules
1. Do not delegate functions of assessment,
evaluation, and nursing judgment.
2. This is not the read world
3. Delegate activities for stable patients with
predictable outcomes
4. Delegate activities that involved standard,
unchanging procedures.
5. Remember priorities!
Review your Nurse Practice Act

Who can do what?


Unlicensed Personnel

Ambulate
Bathe
Transport
Groom
Hygiene measures
Position
ROM
Skin care
Some specimen
collections, such as urine
or stool

LPN
Administer
Oral meds
IMs
Sub Qs

Change Dressings
Irrigate wounds
Monitor IV flow rates
Suction
Teach basic hygiene and
nutritional measures
Urinary cath
Use nursing process: data
collection, plan, implement,
evaluate

The RN
Administer IV meds
Leader others and manage client care
environment
Teach
Use nursing process: assess, analyze
data, plan, implement evaluate

Practice

1.
2.
3.
4.

A nurse is planning client assignments for the day and


needs to assign four clients. There is a RN, a LPN, and
2 CNAs on the nursing team. Which client would the
nurse most appropriately assign to the RN?
A client with a right leg amputation who requires a
dressing change.
A client requiring a bed bath.
A client who required frequent ambulation.
A client who was admitted to the hospital during the
night after experiencing an acute asthma attack.

Answer
4- Keywords are most appropriate and RN
assignment
1- the LPN can do
2- CNA
3- CNA

You HAVE GOT to Critically Think


A nurse is planning the client assignments
for the day and is reviewing client data
and the needs of the clients on the nursing
team. 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?

Answers
1.
2.
3.
4.

A client with a cervical radiation implant


A client with active TB
A client with herpes zoster (chickenpox)
A client recently diagnosed with
inoperable cancer

Answer
4- Issue- focus on continuity of care
Important are client needs and safe
environment
Options 1, 2, & 3 present a risk to the
healthcare provider
Option 4 is psychosocial needs that can be
met with continuity of care!

Other Helpful Hints and


Strategies

When do I select Call the MD?


This is not always clear cut! You must read
the question to determine what it is asking
you. Is it asking you for a nursing
intervention? Is the client situation life
threatening?

Practice

1.
2.
3.
4.

A nurse is caring for a postop client who


suddenly becomes restless. The nurse
would most appropriately:
Check the clients vital signs
Notify the MD
Medicate the client for pain
Talk to the client in a calm voice

Answer
1- Keyword: most appropriate
Option 3- nothing tells us the patient is in
pain
Option 4- pyschosocial issue
Down to 1 and 2.
First step in nursing process

Practice

1.
2.
3.
4.

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:
Call the surgeon
Continue with the assessment
Check the clients BP
Obtain a flashlight and gauze

Answer
1- Keywords- restless, pulse rate increased,
large amounts bright red blood,
immediate.
Options 2,3,4 would delay necessary
interventions needed in this life
threatening situation!

Eliminate Options that Contain


Absolute Words
Absolute Words
All
Always
Cant
Every
Must
Never
None
Not
Only
Wont
* May indicate an incorrect
option

Not So Absolute Words


Generally
May
Possibly
Usually
* May indicate a correct
option

Practice

1.
2.
3.
4.

A nurse is providing dietary instructions


to a client about a low-fat diet. The nurse
tells the client to:
Never use butter for cooking
Read the labels on food items to
determine the fat content
Eat only foods that have less than 1% fat
content
Drink fluids only if they are fat free

Practice

1.
2.
3.
4.

A client scheduled for a CT scan of the abdomen asks


the nurse when the results of the test will be available.
The nurse makes which most appropriate response to
the client?
The results wont be available for at least one week.
You must ask the CT tech for that information.
Your MD may have the results in about 3 days.
Every scan is read by a radiologist and this process
always takes one week.

Medical vs Nursing Options


Remember boards is testing YOUR
knowledge as an RN! The only time you
should give a medical intervention is if the
question states Which intervention does
the nurse anticipate the MD to prescribe?

Practice

1.
2.
3.
4.

A nurse is caring for a client with a diagnosis of


CHF who suddenly experiences severe
dyspnea; the nurse suspects that pulmonary
edema has developed. The nurse immediately:
Obtains a vial of Lasix and a syringe
Places the client in high Fowlers position
Obtains a dose of morphine sulfate from the
narcotic drawer
Inserts a Foley catheter

Answer
2- Options 1,3, & 4 all require MD orders!

Ensuring all parts of the option are


CORRECT

1.
2.
3.
4.

A nurse is performing an assessment on a


client diagnosed with a cataract of the right
eye. The nurse would expect to obtain which
data on assessment?
Reports of blurred vision and excessive
tearing of the eye.
A cloudy white pupil and reports of eye pain.
Reports of gradual loss of vision and
photophobia
Reports of a frontal headache and
photophobia.

Lab Values
How do I ever remember them all?
Identify whether the lab value is normal or
abnormal.
Note the disorder presented in the
question
Identify the body organ that is affected as
a result of the disorder

Practice

1.
2.
3.
4.

A client with a diagnosis of sepsis is


receiving antibiotics by the intravenous
route. The nurse assesses the
nephrotoxicity by monitoring which lab
value closely?
Blood urea nitrogen
White blood cell count
Platelet count
Lipase Level

Answer
1- Keyword most closely
Issue nephrotoxicity
Option 1 is the only one that relates to renal!
2- immune
3- hematological
4- panreatic

Last minute Pointers


Visualize the question
Only be concerned with the
client in the question
Remember the Glass House
Theory
Pace yourself, concentrate,
and focus

When you get Frustrated!


Stop
Deep breath
Positive self talk
DO NOT SECOND GUESS
YOURSELF !!!!!!
DO NOT CHANGE ANSWERS !!!!!!!!!!!

Practice Makes Perfect


Remember these are test taking skills,
like any skill you have to practice to get
good at it!

Last but not Least


A 3 hour lecture summarized in a few sentences
Read each case scenario carefully. It
contains the information you need to answer
the question.
Go with what you know! Formulate an
answer before you look at them!
Client safety is NUMBER 1 priority.

Last but not Least


A 3 hour lecture summarized in a few sentences
There is only 1 correct answer. If more than
one seems correct, look at your key words.
Dont focus on trick questions, there are
none! NCLEX and HESI want to know that
you are safe!
Go to the testing site

Last but not Least


A 3 hour lecture summarized in a few sentences
Students who study by answering as many
questions as possible are most likely to
succeed. At minimum, you should answer at
least 3,000 questions when preparing for the
NCLEX exam.

Last but not Least


A 3 hour lecture summarized in a few sentences
No substitute for baseline nursing
knowledge.
Dont panic! If you get to something you
dont know, use your test taking strategies.
Time flies, prepare for the marathon by
training yourself for the potential of getting
all 265 questions.

Resources

Websites
www.nscbn.org
http://caring4you.ne
t/tests.html
http://www.nclexinf
o.com/
www.learningext.c
om
http://www.testpre
preview.com/nclex_
practice.htm

Books
Kaplan (2005).
NCLEX-RN Exam
2005-2006 Edition.
Silvestri, L. (2005).
Strategies for
Success for the
NCLEX-RN
Examination