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
Don’t study the day of!
MEMORY DUMP
Just a few facts…..
• Nursing exams are difficult because the
questions ask you to make judgments and
apply information-not 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. “I’ll 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
client’s 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.
2.
3.
4.
Your father needs opportunities to be
independent. This will help him become selfsufficient.”
“Your father is capable of taking care of
himself. Try allowing him more
independence.”
“Stress is not good for your father at this
time. Perhaps you could call your children.”
“You are feeling concern for both your father
and your children. Let me know when you
are leaving, and I’ll 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 no’s
– Question mark the maybe’s
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 can’t 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
child’s abilities, limitations, interests, and habits,
because the aim of therapy is to:
1.
Assess the child’s 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
child’s assets and abilities to achieve success as well as
develops the child’s 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 child’s 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 can’t 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
“I will show you how to inject
the needle.”
2. “I will inject the needle for you
this time.”
3. “You are doing fine so far. Give
it a try.”
4. “Why are you so nervous? Do
you need help?”
1.
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
client’s advocate by




1. Writing a note on the front of the client’s record so that
the surgeon will see it when the client arrives to the OR.
2. Documenting in the client’s 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 nurse’s 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 hospital’s 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 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?
1. Calling the parents to ask them how the
child’s 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- Maslow’s 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 infant’s 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 clichés and false
assurances
“Don’t worry, it will be okay”
• Requesting an explanation
“Why did you do that?”
• Devaluing client feelings
“Don’t be concerned.It’s 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 client’s 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, “I’m
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 client’s 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 (RN’s) 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 nurse’s
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 patient’s privacy will be maintained
when providing care.
D. The patient’s 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 nurse’s 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 client’s spouse how to change the client’s
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 spouse’s 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 physician’s 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 client’s diagnosis. For
example: if the questions states: Cyclophosphamide (Cytoxan)
has been prescribed for a client with metastatic breast cancer,
focusing on the client’s 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- nurse’s 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
• IM’s
• Sub Q’s
–
–
–
–
–
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 CNA’s 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 client’s 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 client’s 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
– Can’t
– Every
– Must
– Never
– None
– Not
– Only
– Won’t
* 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 won’t 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 Fowler’s 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.
Don’t 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.
Don’t panic! If you get to something you
don’t 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.n
et/tests.html
• http://www.nclexinf
o.com/
• www.learningext.co
m
• http://www.testprep
review.com/nclex_p
ractice.htm
• Books
• Kaplan (2005).
NCLEX-RN Exam
2005-2006 Edition.
• Silvestri, L. (2005).
Strategies for
Success for the
NCLEX-RN
Examination