PEARLS for NCLEX-RN® Success:
Strategies to Correctly Answer Questions
© 2011-14
Originally Developed for: MACaN
@ Penn State
Developed by: Staja “STAR” Booker, MS, RN
Reviewed and Approved by: Alumni Webpage Committee
PEARLS for NCLEX Success
P
Practice questions and Pray often
E
Examine the Entire question and all answers
A
Avoid reading into the question and Apply your
knowledge and skills
R
L
S
Review everyday and Rest often
Listen to your “first mind”
Study difficult concepts and keep Stress to a
minimum
Outcomes
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After completion of this presentation, learners will be able to:
--Appreciate and recognize importance of critical thinking, clinical judgment,
clinical reasoning, and sound decision-making
--Identify the introductory statement, information distracters, and the stem of
questions
--Identify the four elements in a question
--Demonstrate ways to isolate the correct answer(s)
--Gain confidence in answering NCLEX-style questions
--Recognize different types of questions
NCLEX Readiness Assessment
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Complete the “Readiness for NCLEX Assessment”
provided on this page webpage. This will help you
identify areas that you need to spend additional time
studying and practicing
2013 NCLEX Content Areas
F
Y
I
NCLEX is a computer adapted test (CAT).
NCSBN CAT video: https://www.ncsbn.org/3761.htm
Computer Adaptive Testing (CAT)
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You can’t skip or review NCLEX questions on the computer. Once
you click Next, the questions are GONE!!
There is a tutorial at the beginning of the NCLEX to make sure
your computer is working correctly and to ensure that you
understand the directions. You will be given a couple of sample
questions.
Your computer will automatically shut down after you have or
have not demonstrated minimal competency.
Minimum questions – 75 Maximum questions – 265
15 items are “test” questions & are not scored
Zerwehk, J., Claborn, J.C., & Miller, C.J. (2008). Memory notebook of nursing. (Volume 1, Ed. 4). Ingram, TX: Nursing Education Consultants.
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Review NCLEX test plan
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Pearson VUE NCLEX tutorial http://www.pearsonvue.com/nclex/#tutorial
ˈTwas the night before NCLEX…
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Do not study heavily. Use this day to relax, clear your
mind, and reflect. If you must study, review core
principles of nursing care.
Gather the necessary materials you will need to take
with you
Do not drink alcohol or take mind-altering drugs
Sleep well
Avoid “negativity” and think positively. Decree and
declare, “I will pass NCLEX the first time and become
an excellent RN!”
Dress comfortably
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Eat a light meal before the test to prevent your blood sugar from dropping.
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Arrive to the testing site 30min – 1 hour early.
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Have acceptable form of ID!! Don’t bring family, friends, or kids.
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You will 1) be photographed, 2) fingerprinted, 3) have your palm veins scanned,
and 3) provide your digital signature.
A plastic bag for storage or a locker will be assigned to you to secure all
possessions. NOTHING goes into the computer room but your body, exceptions for
those with cultural or religious needs
You will be given a dry erase board if you need to write information or do
calculations– but no purging of knowledge.
Time Allotted – 6 hours (you can take breaks but the clock doesn’t stop)
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Receive “unofficial” results 48 hours after the exam. This
service is available for $7.95 on Pearson VUE website.
PASS- YAY! get license number, a job, and begin practicing
FAIL- Never give up. Can retake in 45 days. Will need to
register, pay, etc. all over again.

You'll receive an NCLEX Candidate Performance Report (CPR)
which is an individualized document that shows how you
performed in each of the test plan content areas.
To learn more about NCLEX:
NCSBN Website
https://www.ncsbn.org/nclex.htm
See “The 8 Steps of the NCLEX” at
https://www.ncsbn.org/2013_Eight_Steps_of_NCLEX.pdf
KEEP THIS IN MIND
When answering NCLEX questions, keep
these two statements in mind:
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If I can only do one thing now….
What will cause my patient least harm
and most benefit?
You betta check yo’ self!
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Remember ABCs or CABs (appropriately)
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Know how to care for prevalent health conditions
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Know normal lab levels
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Know principles of infection prevention and control & various
precautions
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Prioritization
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Better safe than sorry!
TOPIC 1: Misreading Questions
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Misreading questions is a common reason why
students answer question wrong.
Misreading Questions
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Do not misread questions. This can occur if you:
Read into the question: if it doesn’t say it, then don’t
add it to the scenario.
Incorrectly analyze what the question is really asking
you
Overlook key words
Misinterpret a disorder
Read question too fast
Misreading Questions
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The brain can read something that is not there, but it is
important to take your time and analyze exactly what is
presented.
If it doesn’t say it in the question, then don’t assume or add
anything. Granted, there are things that you should know
and/or gather from the situation presented.
For example, if a question said that urine output per hour
was below normal, then you can accurately conclude that
output was less than 30ml/hr. But if it the question said
that the urine was abnormally colored then you can’t
assume that the urine was dark amber…it could be red,
blue, orange, etc.
Misreading Sentences
Look at this example…let’s read it aloud.
Paris in the
the spring time
Misreading Sentences
1.

Did you catch that there are 2 “thes” in
the phrase?
You most likely read the statement like this: “Paris in
the spring time” when it really says “Paris in the the
spring time”
Misreading Sentences
Here’s another example…count the number of Fs below.
Finished files are the result of years of scientific study
combined with the experience of full years.
Misreading Sentences
1.
Did you count 7 Fs?
Finished files are the result of years of scientific study
combined with the experience of full years.
Misreading Sentences
Read this sentence aloud.
Every 8 out of 10 hunans report they are unhappy
with their career choice.
Misreading Sentences
1.
2.
Now how many of you read “Every 8 out of 10
HUMANS report they are unhappy with their career
choice.”
The word was HUNAN.
Misreading Sentences
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Misreading sentences can cause you to miss key
information.
Take your time reading scenarios and
understanding what the question is asking.
RACE Model
Recognize
 Ask
 Critically analyze
 Eliminate
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RACE Model
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RECOGNIZE what kind of information in the
stem.
 Recognize
key words in the stem.
 Recognize who the client is in the stem.
 Recognize what the topic is about.
RACE Model
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ASK what is the question asking?
 Ask
what are the key words in the stem that
indicate the need for a response.
 Ask what is the question is asking me to do
RACE Model
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CRITICALLY analyze the options in relation to the
question asked in the stem.
 Critically
examine each answer option in relation to
the information in the stem (do the answers even match the
information in the stem?)
 Critically
identify a rationale and risk/benefit for
each option
 Critically compare and contrast the option in relation
to the information in the stem and their relationships
to one another
RACE Model
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ELIMINATE as many answer options as possible
 Eliminate
one option at a time (determine if any
answer options were in your “pool” of answers)
 If any part of the answer is wrong, the entire
answer is all wrong
 Usually the answer that is most different from the
other answer options is correct
TOPIC 2: Parts of a Question
Parts of a Question
Each question has 3-4 parts:
1.
2.
3.
4.
Introductory statement
Clinical Information Distracters (sometimes)
Stem
Four answer options with 3 answers being
distracters and 1 correct answer (unless it is select
all that apply/multiple select)
Parts of a Question
ITEM
Introductory Statement
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The introductory statement tells you about the
client’s situation, health problem, or clinical status
that you should consider when answering the
question.
The introductory statement sets up the scenario.
Introductory Statement
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Example:
Mr. Wilson is prescribed an iron supplement and an
increased intake of Vitamin C in his diet.
The nurse understands that the best rationale for
increasing Vitamin C in the diet is to:
The Invisible Gorilla Challenge
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http://www.theinvisiblegorilla.com/videos.html
Closely count the number of passes made by
basketball players in white shirts.
Distracters
1. Did
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anyone see the gorilla that appeared halfway
through the video?
Well that gorilla appeared to distract you, and
sometimes information in questions and answers are
simply there to distract you.
If you saw the gorilla and it threw you off from
counting, you have to be careful about allowing
distractor information in questions throw you off.
Distracters
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Distracter information in questions or answers is just that
– it distracts, detracts, and subtracts from the main
issue.
It is information that provides additional detail but does
not necessarily help to answer the question.
Distracters
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You must keep your mind on what the question is asking
and what the answer is answering.
Likewise, in practice, you should avoid allowing nonemergent issues distract you from critical tasks…
(medication administration, receiving or reporting
critical labs, charting, report, etc.) because this
increases risk of nursing errors.
Awareness of Distracters
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On the flip side, failing to see the gorilla is
reflective of inattentional blindness.
Sometimes we overlook key points in the question
(e.g. misread questions) and we read (or see) what
we want to you read (see).
Contributing Factors of Inattentional
Blindness
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Mental Capacity – how much your mind you “hold”; fatigue, stress, drugs
and alcohol, sleep deprivation all decrease mental capacity
Conspicuity – physical properties of an image; we notice things that are
bright, flicker, and move, italicized, bolded, all caps, etc.; NCLEX does not
provide any of these sensory hints.
Expectation – seeing what we believe or know; If something was correct the
first three times you checked you may miss that it is incorrect the fourth time
Mental Workload – how much is on your mind; although we are expected to
multitask, if your mind is overloaded and attention is diverted there is
increased risk for errors; Example: You are talking to a NP on the phone and
fail to hear the ventilator alarm
Distracters in Questions
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Example:
Mrs. Jackson was admitted to the medical-surgical unit
for a COPD exacerbation, but she is currently stable.
She is in normal sinus rhythm (NSR) and her blood
glucose is 143.
Which rationale best explains why Mrs. Jackson is
only prescribed 2L oxygen?
Distracters in Answers
Mr. Ron is a thirty five year old male in the trauma ICU
post MVA. A nasogastric tube has been inserted for
feeding and medication delivery. Which part of the
body requires special hygiene for a patient with a
nasogastric tube?
a.
Rectum
b.
Abdomen
c.
Oral cavity
d.
Perineal area
Stem of a Question
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The STEM is the portion of a question that “asks” the
nurse to solve a specific problem by implementing a
nursing action.
This is usually the actual “question.”
However, the stem may not be a separate sentence,
but it may be a part of the introductory statement.
Types of Stem
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2 types of Stem:
--Appropriate action
(what the nurse should do, or did correct)
(what the patient should do or did correct)
(what is true) – Positive polarity
--Inappropriate action
(what the nurse shouldn’t do, or did incorrect)
(what the patient shouldn’t do or did incorrect)
(what is false) – Negative polarity
Stem of a Question
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Example of STEM as a separate sentence:
During dinner, a client puts on her call light. When the
RN enters the room, she notices that he is grabbing his
chest and complaining of severe chest pain.
What action should the nurse take first?
Stem of a Question
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Example of STEM as part of the introductory statement:
After inserting a nasogastric (NG) tube in a patient for
nutritional tube feedings, it is important to:
a.
xxxxxxxxxxxxxxxxxxxxxx
b.
xxxxxxxxxxxxxxxxxxxxxx
c.
xxxxxxxxxxxxxxxxxxxxxx
d.
xxxxxxxxxxxxxxxxxxxxxxx
TOPIC 3: Elements of a Question
Elements of a Question
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1.
2.
3.
4.
There are four elements in each test question:
Subject
Issue or problem
Key words
Appropriate or Inappropriate Action (i.e. answers)
Step # 1
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Identify the subject.
The Subject
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The subject is the focus of the question.
The subject can be a patient (or client), nurse, family
member(s), or colleagues.
REMEMBER the answer choice you select must relate
to the subject.
The Subject
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Example:
A 23 year old female arrives at the ED after collapsing at
home. She has no pulse or respirations. Which of the
following accurately describes the cardio-pulmonary
resuscitation process?
So who is the subject?
The 23 year old female
Is she the patient, nurse, or family member?
patient
Step # 2
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Identify the issue or the topic
THEN determine
 Is
further assessment needed?
 Is it appropriate to apply ABCs or CABs?
The Issue
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The issue is the specific problem that the question is
asking about.
Make sure you pay attention to what the question is
specifically asking you about.
The issue is not necessarily the same as the patient’s
admitting diagnosis. The question may tell you what the
diagnosis is, but may not ask you anything about it.
The Issue
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a.
b.
c.
d.
An HIV + patient is admitted to the hospital with a tuberculosis
(TB). Which of the following isolation categories should be
implemented in order to prevent transmission of the HIV virus
and tuberculosis? Select all that apply
Strict isolation
Respiratory precautions
Universal precautions
Enteric precautions
What is the issue?
Prevention of transmission of HIV and TB
Step # 3
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Identify Key Words
Key Words
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Key words are the important words in a question
that should focus your attention on critical ideas in
the stem and answers.
Key words can be positive, negative, urgent or
absolute (i.e. definite).
Key Words
CAN YOU THINK OF
SOME KEY WORDS
YOU HAVE SEEN ON
YOUR EXAMS?
Examples of Key Words
Positive
Negative
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should do
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most likely
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appropriate
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effective
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true
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include(d)
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indicated
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consistent
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realistic
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correct
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not needed
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safe
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best
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least
unlikely
except
inconsistent
inappropriate
contraindicated
false
not
incorrect/wrong
unrealistic
need…
unsafe
Late
Urgent
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Priority (high or low)
first
initial(ly)
immediate(ly)
most important
STAT
now
early
prior
primary
quickly
Essential
mandatory
Examples of Key Words
Directionality
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Maximum
Minimum
High
Low
Inexact
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Possible/y
Usually
May
Some
Often
Most
Many
Mainly
These terms often
makes answers true.
Absolute (Definite)
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Always
Never
All
Completely
Only
These terms usually
make answers
false!!
Examples of Key Words
for The Nursing Process
Assessment
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Assess
Ascertain
Gather
Collect
Determine
Identify
Monitor
Observe
Obtain (information)
Recognize
Find out
Check
Planning
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Plans
Goals
Develops
Determine
Examples of Key Words
for The Nursing Process
Interventions
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Intervenes
Apply(ies or ication)
Implements
Evaluation/Outcomes
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Expects
Demonstrates
Displays understanding
Observes
Anticipates
Evaluate
Achieve
Interpret
Key Words
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Example:
When beginning an IV, the nurse should
first:
a.
xxxxxxxxxxxxxxxxxxxx
b.
xxxxxxxxxxxxxxxxxxxx
c.
xxxxxxxxxxxxxxxxxxxx
d.
xxxxxxxxxxxxxxxxxxxx
Step # 4
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Identify appropriate or inappropriate nursing
action
Appropriate or Inappropriate Action
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Mentally create a pool of answers
 Then,
examine each answer choice given and determine
which outcome best answers the question
 Your first answer may not be an option, so choose the
2nd best, safe answer.
Make Mental Answers
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An older adult with heart failure, Parkinson’s
disease, Lewy body dementia, sleep apnea, and
peripheral vascular disease is having trouble
sleeping at night. He already takes many
medications, and his wife does not want to add any
additional ones. What non-pharmacological
strategies may be safe to implement to aid in
sleep?
Answer Options
a.
b.
c.
d.
Give warm herbal tea 15 minutes before bed
Administer melatonin pills
Play soothing music on a low volume and dim lights
Talk to the older gentleman for an hour
Make Mental Answers
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What should the nurse do immediately before
performing any procedure for a patient?
Answer Options

a.
b.
c.
d.
e.
Select all that apply
Shut the door
Wash hands
Close the curtain
Explain the procedure
Ask for patient’s permission
Putting It All Together
An elderly confused man is on bed rest
due to a DVT in his right leg. Which intervention will not effectively provide
for this patient’s safety?
Who is the subject?
Elderly man
What is the issue?
Safety
What are the key words?
Will not effectively
What are the distracters?
None
What would you do? (your pool of answers)
Let’s examine each answer and determine which will effectively provide
safety.
Putting It All Together
An elderly confused man is on bed rest due to a DVT
in his right leg. Which intervention will not effectively
provide for this patient’s safety?
a.
b.
c.
d.
e.
Provide regular toileting by bedpan
Explain to the man that he should use the call light if he
needs to get up
Place 3 side rails in the up position and check on the client
often
Initiate proper use of restraints
Place the bed in lowest position
QUESTIONS?
TOPIC 4: Answer Option Tips
Answer Option Tips
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After reading the question, develop a pool of answers in
your mind before looking at the actual answers provided.
Answer the question, as if the situation is ideal or
“textbook perfect.”
Your first choice may not be there, so choose the next best
answer.
Three of the answer options are there to distract you, so
make a decision on each before continuing.
Make a yes/no decision on each answer choice before
moving to the next answer choice.
Answer Option Tips
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Look at how words or actions are grouped. Are all the answers
physiological, intervention-centered, assessment, etc.?? There is
only one best answer.
No test question on NCLEX is keyed for two responses
unless it is select all that apply.
Go with your “first-mind”; never change your answer!!!
If you do not know the answer, make your best educated guess
and move on. Don’t spend more than 1-1.5 minutes/question.
Answer Option Tips
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Do not focus only on your experiences, which may be too
narrow for a point of reference
FOCUS ON WHAT YOU KNOW AND NOT ON WHAT YOU
DON’T KNOW!!!
Scope of practice - Be able to differentiate the need for
nursing judgment from the need for physician judgment.
Watch out for answer choices that are factually correct on their
own, but fail to answer the question, and so are actually wrong.
Answer Option Tips
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Select responses that are:
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Eliminate responses that are:
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Therapeutic and patient-centered
Show respect
Communicate acceptance
Obviously wrong
Inappropriate and non-therapeutic
Partially true
In some instances, rule out an option if you know it is associated
with something else. For example, you may not know about the
laboratory values for warfarin therapy, but you do know the
laboratory values for heparin and aspirin. Those values can be
eliminated because you are “using what you know.”
TOPIC 5: NCLEX Question Formats
NCLEX Question Formats

Multiple choice (one correct answer)
Alternate Item Formats
 Multiple response (select all that apply)
 Hot spots
 Audio or Video
 Drop-and-drag/ordered response
 Chart exhibits
 Fill-in-the blank (calculation questions)
 Graphics (e.g. ECG rhythm)
NCLEX QUESTION

For a tutorial on alternate item NCLEX questions,
click on the Alternate Test Item icon on the NCLEX
resources webpage.
The End
Star’s 106 year old granny
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 ANY COMMENTS
 ANY CONCERNS
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