NCLEX Test-Taking Strategies

Courtesy of: https://www.me.me

            Let’s face it!  Nursing school is hard.  It’s like boot camp for your brain.  It’ll make a former A+ student scream “Hallelujah” at the sight of a C+, a social butterfly lock herself in her room for the weekend in order to study, and even cause the best test-taker to break out in hives at the realization that the upcoming exam will have eight “Select All that Apply”!  We’ve all been there… cramming for a final or an ATI proctored exam only to glare at each test question in disgust thinking that this thing must’ve been handcrafted in the evil recesses of some professor’s mind. 

            Remember, you’re not alone. We’re here to help! 🙂

 At www.nursingsurvive.school.blog, we’ll show you some tips that can help demystify those pesky nursing questions that leave you scratching you’re head and changing perfectly right answers to wrong ones.  Be confident.  After all, you are one of the lucky ones who got into nursing school in the first place!  To all the future nurses of America, we’ve got your back! 

Question Type #1:

           Negative/Positive Event Query Questions

(Glasbergen, R. (n.d).  Cartoon ID: 949.  Retrieved from: https://www.glasbergen.com)

I particularly love this question type because it’s one of the most straightforward to answer, as long as you know the content area pretty well.  Positive/negative event query questions typically ask you to identify either a correct statement or discharge teaching (+), an incorrect statement or misunderstanding (-), or some information that relates to the data given in the question (i.e. pathophysiology, risk factors for a disease, steps in a procedure, etc.).

Let’s take a look at a sample question below:

Question:  A nurse is providing teaching for a client who has a new diagnosis of hypertension and a new prescription for Spironolactone 25 mg/day.  Which of the following statements by the client indicates an understanding of the teaching

a) “I should eat a lot of fruits and vegetables, especially bananas and potatoes.”

b) “I will report any changes in heart rate to my provider.”

c) “I should replace the salt shaker on my table with a salt substitute.”

d) “I will decrease the dose of medication when I no longer have headaches and facial redness.”

Ans. B 

Strategy:  Use the data in the question to look for the correct statement.  Knowing that Spironolactone is a Potassium-Sparing Diuretic will help you to understand that hyperkalemia is a potential side effect of this medication.  Hyperkalemia can cause cardiac dysrhythmias.   

Reference:

Assessment Technologies Institute. (2016).  Content mastery series review module: Rn adult medical surgical nursing (10th ed.), p.229-230.  Sitwell, Kansas. ATI Nursing Education.       

Tips to answering this question:  Read the data in the question and highlight or underline keywords.  Ask yourself: Is this a positive or a negative query event?

  • There’s nothing worse than getting it confused and looking for a positive answer when the question prompt is negative.  If this happens to you, put (+) sign next to the ones you don’t want and a (-) sign next to the answer choice you are seeking.   
  • Read all of the answer choices.  Is there an answer choice that is completely bogus, inappropriate, or doesn’t apply to the question at all?  Eliminate it.
  • Note that sometimes the correct answer is there, but it might not be worded so obviously.  Paraphrase or rework the statement in your head to see if it applies.
  • “Know your stuff!”  If they’re asking for a technique, and you don’t know what it is, “brush up” on the topic, and try again. 

Keywords: best, further teaching, most appropriate, understanding, inappropriate, requires further instruction, indicative, least likely, most likely, initial sign, late sign, greatest risk factor, indicates an understanding of this technique/procedure.

                                                             Question Type #2:  

The Nursing Process or “A.D.P.I.E.”

(picture credits: Bebolduc. Nurses Week Memes.  Retrieved from: https://www.someecards.com)
(Anonymous.  Not sure if getting better at the nursing processhttps://www.quickmemes.com)

Ever encounter one of these questions and wonder how to answer it?  We’re going to show you a simple way to increase your chances of getting this question right. 

Question:  A nurse discovers that a client was administered an anti-hypertensive medication in error.  Which of the following actions should the nurse perform first?

a) Call the provider.

b) Check the vital signs.

c) Notify the risk manager.

d) Inform the client of the error.

Ans. B.   While each of these answer choices is something that eventually the nurse will do, the first step in the Nursing Process is always to “Assess”.  After the client’s vital signs have been deemed to be within normal range, and the client is okay, then the nurse can complete the other actions. 

Strategy/Tip:  Look at the key action words in the answer choices again.

a) Call the provider.

b) Check the vital signs.

c) Notify the risk manager.

d) Inform the client of the error.

Reference:

Assessment Technologies Institute. (2016).  Content mastery series review module: Nursing leadership and management (7th ed.), pp. 76-77. Sitwell, Kansas. ATI Nursing Education.       

  • If the nurse hasn’t checked on the client’s condition, how can she document or inform the health care provider accurately about the patient’s reaction?  *Remember the nurse’s duty is always to the client first. 

Keywords:  Check, Determine, Assess, Observe, Measure, Collect & Gather Data, Clarify, Inspect, Verify.

            Huh?  What’s that I hear you say?  What about when the answer choice is not to assess?  You’re absolutely right!  Sometimes the question may ask you to deviate from the traditional nursing process for a reason; and that reason most likely is – SAFETY!

Let’s look at the following example:

Question: An 8 year-old boy is admitted to the emergency department with severe pain, swollen hands & joints, an O2 saturation of 86%, and weak, +1 thready pulses due to sickle cell anemia vaso-occlusive crisis.  Which of the following actions should the nurse do first

a) Recheck the O2 saturation

b) Obtain a “Type and Screen” for a possible blood transfusion.

c) Give the child fluids to drink.

d) Teach the child’s parents how to recognize the signs of a vaso-occlusive crisis.

Tip:  We already have an assessment & a diagnosis (INEFFECTIVE TISSUE PERFUSION), so what’s next?…

(picture credit: The fundamentals of the nursing process (n.d.). Retrieved from:
https://www.qdnurses.com/fundamentals/fundamentals-nursing-process/)

Ans. C.  (Intervention) -> Give the child fluids to drink. 

During a vaso-occlusive crisis, the sickled cells become viscous (often due to dehydration, cold stress, or illness) and occlude or block the microvasculature resulting in extreme pain.  In this question, it doesn’t make sense to recheck the O2 sats when we’ve already done so, and the reading is within normal limits.  Instead, the nurse should give the client fluids to help promote profusion and decrease blood viscosity.  Administering a blood transfusion might occur, however, this is not the priority.  Teaching will come later when the crisis has resolved. 

*Think:  If the nurse could do one thing that would promote safety and/or physiological integrity for the patient, what would he/she do?  This will guide you to the correct answer.

Key Concepts: The Nursing Process, Maslow’s Hierarchy of Needs, Prioritization, Intervention, Safety & Physiological Integrity, and Least Restrictive vs. More Restrictive. 

                                                            Question Type #3:

                                                The Dreaded… Select All that Apply

(Picture Credit: Howell, J. (2019). My thoughts during select all that apply. Retrieved from: https://www.imgflip.com)

Lastly, there’s the one that we all love the least… “Select all that apply” questions.  Answering these questions can feel like playing Russian Roulette or walking around in a mine field.  One little wrong step, and “Kaboom!!!” You’re done.  We know how you feel, but there’s hope while you’re in the trenches.  Here’s a few tips.  Look at the sample question below:

Question: You’re a newly licensed nurse working with a 52 year-old female client who recently received a radiation implant for cervical cancer therapy.  Which of the following actions would you include while caring for this patient?

a) Place the client in a private room.

b) Ensure that the door is closed at all times.

c) Wear a lead apron.

d) Limit visitors to 1 hour.

e) Keep a lead container in the room. 

Ans. A, C, E

Tips: 

1. Watch out for absolutes!

Keywords: all, only, always, never, every, etc.

2. Even if you could keep the door closed at all times, it seems as if this statement sounds more appropriate for “airborne” or TB precautions.

3. ATI loves this! Changes in “distance, rate, and time”.  What’s the standard?  Is 1 hour of exposure safe, or should the nurse limit visitors to 30 minutes?

Last, but not least… a lead container is used just in case the radioactive implant dislodges. 

*Remember: The nurse’s responsibility is to maintain safety and physiological integrity. If all else fails, and you’re stumped on this type of question – pray to a Higher Being!  Good luck! 🙂

      (Picture Credit:  Howell, J. (2019).  My brain throughout nursing school.  Retrieved from: https://www.imgflip.com)

                   

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