NCLEX-RN
Review Course
Test-Taking
Workshop
1
Test taking Workshop
2
Testtaking Workshop
NCLEX-RN Measures Nursing Knowledge
1 Normal Growth and Development
throughout your nursing education)
(Integrated
2 Basic Human Needs
3 Coping Mechanisms of Individuals
4 Actual Potential for Health Problems
5 Effects on Health Needs of Age, Sex, Culture,
Religion
6 Ways to Assist Clients by Teaching Them to:
Maintain Health
Cope with Health Problems
3
Ethnicity and
Testtaking Workshop
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Testtaking Workshop
Integrated Process
1. Nursing Process
2. Caring
3. Communication and
Documentation
4. Teaching/Learning
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Testtaking Workshop
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Testtaking Workshop
1. Assessment
2. Analysis
3. Planning
4. Intervention
5. Evaluation
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1. Identify the signs and symptoms most indicative of a deterioration
of the client’s respiratory status.
A. Increased restlessness and changes in level of consciousness
B. Bradycardia and increases in blood pressure
C. Complaints of chest pain and shortness of breath
D. Rapidly dropping PCO2 and pH
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1. Identify the signs and symptoms most indicative of a deterioration
of the client’s respiratory status.
A. Increased restlessness and changes in level of consciousness
B. Bradycardia and increases in blood pressure
C. Complaints of chest pain and shortness of breath
D. Rapidly dropping PCO2 and pH
A. The brain is one of the first organs to be affected by a decrease in
oxygenation. Restlessness and changes in the level of consciousness
indicate this decrease. All the other choices are assessments for other
conditions.
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Testtaking Workshop
1. Assessment
2. Analysis
3. Planning
4. Intervention
5. Evaluation
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2. A client is admitted to the unit with a diagnosis of bronchitis, heart
failure and fever. The nurse assesses the client to be very nervous,
have a temperature of 101.1oF (38.4oC), peripheral edema, dyspnea,
and rhonchi. Which nursing diagnosis has the highest priority?
A. Anxiety related to fear of hospitalization
B. Ineffective airway clearance related to retained secretions
C. Fluid volume excess related to third spacing of fluid (edema)
D. Ineffective thermoregulation related to fever
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2. A client is admitted to the unit with a diagnosis of bronchitis, heart
failure and fever. The nurse assesses the client to be very nervous,
have a temperature of 101.1oF (38.4oC), peripheral edema, dyspnea,
and rhonchi. Which nursing diagnosis has the highest priority?
A. Anxiety related to fear of hospitalization
B. Ineffective airway clearance related to retained secretions
C. Fluid volume excess related to third spacing of fluid (edema)
D. Ineffective thermoregulation related to fever
B. Nursing diagnoses that deal with the airway always have highest priority.
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Testtaking Workshop
1. Assessment
2. Analysis
3. Planning
4. Intervention
5. Evaluation
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3. A client is diagnosed with respiratory failure and is placed on
oxygen. Select the highest priority goal for this client.
A. Ambulate the client twice per shift down the length of the hall
B. Complete a bath and morning care before breakfast
C. Maintain an oxygen saturation of 90% throughout the shift
D. Keep the head of the bed elevated to promote proper ventilation
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3. A client is diagnosed with respiratory failure and is placed on
oxygen. Select the highest priority goal for this client.
A. Ambulate the client twice per shift down the length of the hall
B. Complete a bath and morning care before breakfast
C. Maintain an oxygen saturation of 90% throughout the shift
D. Keep the head of the bed elevated to promote proper ventilation
C. Choice A is unrealistic for this client. Choice B is not client centered, and
choice D is a nursing intervention, not a goal. Maintaining an oxygen
saturation of 90% is realistic and within normal limits.
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Testtaking Workshop
1. Assessment
2. Analysis
3. Planning
4. Intervention
5. Evaluation
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4. When the nurse ambulates a client who has been on bedrest for
three days, the client suddenly becomes very restless, displays
extreme dyspnea and complains of chest pain. Which is the
appropriate immediate nursing action?
A. Call the physician about the change in the client’s condition
B. Continue to ambulate the client, but at a slower rate
C. Give the client an injection of ordered pain medication
D. Return the client to bed, and evaluate vital signs and lung sounds
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4. When the nurse ambulates a client who has been on bedrest for three
days, the client suddenly becomes very restless, displays extreme
dyspnea and complains of chest pain. Which is the appropriate
immediate nursing action?
A. Call the physician about the change in the client’s condition
B. Continue to ambulate the client, but at a slower rate
C. Give the client an injection of ordered pain medication
D. Return the client to bed, and evaluate vital signs and lung sounds
D. These are symptoms of a pulmonary embolism which is a common
complication of prolonged bedrest.
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Testtaking Workshop
1. Assessment
2. Analysis
3. Planning
4. Intervention
5. Evaluation
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5. A client is being prepared for discharge and is to take a theophylline medication
by mouth at home for his lung disease. Which client statement indicated that
teaching concerning theophylline medications has been effective?
A.
B.
C.
D.
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“I can stop taking this medication when I feel better.”
“If I have difficulty swallowing the time-released capsules, I can crush or chew them.”
“If I have a lot of nausea and vomiting or become restless and can’t sleep, I need to call
my physician.”
“I need to drink more coffee and soft drinks while I am on this medication.”
5. A client is being prepared for discharge and is to take a theophylline medication
by mouth at home for his lung disease. Which client statement indicated that
teaching concerning theophylline medications has been effective?
A.
B.
C.
D.
“I can stop taking this medication when I feel better.”
“If I have difficulty swallowing the time-released capsules, I can crush or chew them.”
“If I have a lot of nausea and vomiting or become restless and can’t sleep, I need to call
my physician.”
“I need to drink more coffee and soft drinks while I am on this medication.”
C. Choice C lists some adverse effects of theophylline medications that may indicate the
onset of toxicity. The physician needs to know about these so that the theophylline level
can be determined and the dosage adjusted accordingly. Other factors that the client
could be taught about theophylline medications include avoiding excessive amounts of
caffeine, never suddenly stop taking the medication, take it with a full glass of water and a
small amount of food, and watch for interactions with OTC medications.
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Testtaking Workshop
Caring
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Testtaking Workshop
Communication
And
Documentation
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Testtaking Workshop
Teaching/
Learning
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Testtaking Workshop
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Testtaking Workshop
Client Needs
I. Safe,Effective Care Environment
II. Health Promotion and Maintenance
III. Psychosocial Integrity
IV. Physiological Integrity
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Testtaking Workshop
Client Needs
Safe, Effective Care Environment
Management of Care
Safety & Infection Control
Health Promotion and Maintenance
Psychosocial Integrity
Physiological Integrity
Basic Care and Comfort
Pharmacological & Parenteral Therapy
Reduction of Risk Potential
Physiological Adaptation
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13-19%
8-14%
6-12%
6-12%
6-12%
13-19%
13-19%
11-17%
Testtaking Workshop
Client Needs
I.Safe, Effective Care Environment
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Testtaking Workshop
Client Needs
II. Health Promotion and Maintenance
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Testtaking Workshop
Client Needs
III. Psychosocial Integrity
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Testtaking Workshop
Client Needs
IV. Physiological Integrity
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Testtaking Workshop
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Testtaking Workshop
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6. A client is admitted to the medical unit with respiratory failure.
What is the normal range for PO2?
A. 10-30 mm Hg
B. 35-55 mm Hg
C. 10-20 cm H2O
D. 80-100 mm Hg
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6. A client is admitted to the medical unit with respiratory failure.
What is the normal range for PO2?
A. 10-30 mm Hg
B. 35-55 mm Hg
C. 10-20 cm H2O
D. 80-100 mm Hg
D. You either have or do not have the knowledge for this particular
laboratory test.
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Testtaking Workshop
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7. A client is becoming progressively short of breath and the ABGs are: pH7.13; PO2-48; PCO2-53; HCO3-26. What is indicated by these values?
A. Uncompensated metabolic acidosis with moderate hypoxia
B. Respiratory alkalosis with hypoxia
C. Uncompensated respiratory acidosis with severe hypoxia
D. Compensated respiratory acidosis with normal oxygen
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7. A client is becoming progressively short of breath and the ABGs are: pH7.13; PO2-48; PCO2-53; HCO3-26. What is indicated by these values?
A. Uncompensated metabolic acidosis with moderate hypoxia
B. Respiratory alkalosis with hypoxia
C. Uncompensated respiratory acidosis with severe hypoxia
D. Compensated respiratory acidosis with normal oxygen
C. Not only do you have to know the normal values for each of the blood gas
components given, you also have to be able to use that information in
determining the underlying condition.
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8. A client has become cyanotic and is having Cheyne-Stokes respirations.
What is the best action for the nurse to take at this time?
A. Call a code blue and begin CPR
B. Call the physician and report the condition
C. Make sure the client’s airway is open and begin supplemental oxygen
D. Give the ordered dose of 200 mg aminophylline IVPB now
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8. A client has become cyanotic and is having Cheyne-Stokes respirations.
What is the best action for the nurse to take at this time?
Call a code blue and begin CPR
B. Call the physician and report the condition
C. Make sure the client’s airway is open and begin supplemental oxygen
D. Give the ordered dose of 200 mg aminophylline IVPB now
A.
C. Answers B and D are also actions that should be carried out, but at this time,
opening the airway and oxygenating the client must receive highest priority. Not
only does this question require that the nurse know some specific facts
(definitions of “cyanotic” and “Cheyne-Stokes respirations), but also requires a
decision be made about the seriousness of the condition (analysis) and a selection
of the care to be given from several correct options (judgment).
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Testtaking Workshop
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Testtaking Workshop
Multiple Choice
Items
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Testtaking Workshop
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Testtaking Workshop
CAT changes difficulty level for
next question based on response
to previous question.
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9. The nurse is instructing a client on how to obtain a 24-hour urine
sample for creatinine clearance. Which measure is appropriate for the
nurse to include in the teaching plan?
A. Keep the urine in a glass container only
B. Drink extra fluid to increase the amount
C. Save all the urine for a full 24 hours
D. Save only enough urine to fill the container
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9. The nurse is instructing a client on how to obtain a 24-hour urine
sample for creatinine clearance. Which measure is appropriate for the
nurse to include in the teaching plan?
A. Keep the urine in a glass container only
B. Drink extra fluid to increase the amount
C. Save all the urine for a full 24 hours
D. Save only enough urine to fill the container
C. All urine needs to be saved, or the results would be inaccurate. This
material should be covered in one of the introductory courses and is
considered to have a low difficulty level.
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10. A client has been diagnosed as having Wolff-Parkinson-White (WPW)
syndrome, Type A. In evaluating the electrocardiogram, the nurse notes
which characteristics for this condition?
A. PR interval less than 0.12 second and wide QRS complex
B. PR interval greater than 0.20 second and normal QRS complex
C. Delta wave present in a positively deflected QRS complex in lead V1 and
PR interval less than 0.12 second
D. Delta wave present in a positively deflected QRS complex in lead V6 and
PR interval greater than 0.20 second
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10. A client has been diagnosed as having Wolff-Parkinson-White (WPW)
syndrome, Type A. In evaluating the electrocardiogram, the nurse notes
which characteristics for this condition?
A. PR interval less than 0.12 second and wide QRS complex
B. PR interval greater than 0.20 second and normal QRS complex
C. Delta wave present in a positively deflected QRS complex in lead V1 and
PR interval less than 0.12 second
D. Delta wave present in a positively deflected QRS complex in lead V6 and
PR interval greater than 0.20 second
C. These are the criteria for WPW. This material is much more difficult and
usually covered, if at all, toward the end of the educational program.
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Testtaking Workshop
Alternate Format Items
1.
2.
3.
4.
5.
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Fill-in-the-blank
Select more than one option
Identification of an Area/Location within an Image or Graphic
Ranking or Ordered response
Charts and Tables
Fill-in-the-Blank
For breakfast, a client consumed the following food and fluids.
1 cup of milk
10 oz. of water
4 oz. of gelatin
1 scrambled egg
1 crisp piece of bacon 2 biscuits with jelly
How many milliliters should the nurse document for the breakfast intake?
Answer:______________mL.
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Fill-in-the-Blank
For breakfast, a client consumed the following food and fluids.
1 cup of milk
10 oz. of water
4 oz. of gelatin
1 scrambled egg
1 crisp piece of bacon 2 biscuits with jelly
How many milliliters should the nurse document for the breakfast intake?
Answer:_____660 or 670 mL.
Correct answer: 660 mL or 670 mL
1 cup = 8 fluid ounces (240 or 250 mL, depending on source)
10 oz = 300 mL
4 oz = 120 mL
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Select more than One Option
In which situation(s) does the staff demonstrate adherence to infection
control procedures? Select all that apply.
___1. Transfers a client who has just been diagnosed with active
pulmonary tuberculosis from a semi-private room to a private
___2. Initiates airborne precautions, as well as standard
precautions, for the client with scabies
___3. Utilizes droplet precautions, in addition to standard
precautions, with a client who has meningococcal pneumonia
___4. Transfers a client with a staphylococcus wound infection to a
private room
___5. Transfers a client with chicken pox (varicella) from a semi-private
room with a postoperative roommate to a semi-private room with a
roommate who has rubella
___6. In addition to standard precautions, institutes contact precautions for
the client whit shigellosis
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Select more than One Option
In which situation(s) does the staff demonstrate adherence to infection
control procedures? Select all that apply.
_X__1. Transfers a client who has just been diagnosed with active
pulmonary tuberculosis from a semi-private room to a private
___2. Initiates airborne precautions, as well as standard
precautions, for the client with scabies
_X__3. Utilizes droplet precautions, in addition to standard
precautions, with a client who has meningococcal pneumonia
___4. Transfers a client with a staphylococcus wound infection to a
private room
___5. Transfers a client with chicken pox (varicella) from a semi-private
room with a postoperative roommate to a semi-private room with a
roommate who has rubella
_X__6. In addition to standard precautions, institutes contact precautions for
the client whit shigellosis
Correct answer: 1, 3 and 6
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For the client with pulmonary tuberculosis, a private room, airborne and standard precautions are required.
For scabies, contact and standard precautions are required. For pneumonia, droplet and standard
precautions are required. A client with a staph wound infection may be in a private room or with a client
with the same organism. Chickenpox should be in a private room. Shigellosis needs contact and
standard precautions.
Identification of an Area/Location within an
Image or Graphic
The nurse is auscultating a client’s breath sounds. Identify the area where
the stethoscope should be placed by the nurse to best auscultate
bronchovesicular breath sounds.
For this item there would be an image of the thorax and the candidate
would indicate the position for auscultation by positioning the mouse or
cursor on a specific location within the image of the thorax and clicking.
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Identification of an Area/Location within an
Image or Graphic
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Ranking or Ordered Response
Prioritize nursing actions for a client with a history of generalized seizures who is beginning
to experience a tonic-clonic seizure.
1.
2.
3.
4.
5.
Protect client from injury
Document the time of seizure occurrence
Determine airway patency
Explain to significant others what is occurring
Reassure and reorient the client
Type the correct order by number in the box below without spaces
between numbers.
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Ranking or Ordered Response
Prioritize nursing actions for a client with a history of generalized seizures who is beginning to
experience a tonic-clonic seizure.
1.
2.
3.
4.
5.
Protect client from injury
Document the time of seizure occurrence
Determine airway patency
Explain to significant others what is occurring
Reassure and reorient the client
Type the correct order by number in the box below without spaces
between numbers.
Correct answer: 31245
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Charts and Tables
You will be asked a question. You will then click on the exhibit button
at the bottom and a chart or table with tabs will appear. You will
need to click on the appropriate portion to obtain the information
you need to answer the question.
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Testtaking Workshop
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Testtaking Workshop
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Testtaking Workshop
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Testtaking Workshop
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Testtaking Workshop
Licensure Examination Tests
Minimum Standards to Guarantee
Public Safety, Not Maximum Ability
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Guidelines to Testtaking
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Guidelines to Testtaking
Look for key words such as age, sex,
who client is, any significant others
involved, time frame
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Guidelines to Testtaking
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Guidelines to Testtaking
Treat each question individually.
There is no reference from one
question to another question.
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Guidelines to Testtaking
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Guidelines to Testtaking
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Guidelines to Testtaking
Use the process of elimination in
selecting the correct answer
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Guidelines to Testtaking
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11. The nurse suspects that a client is having an anaphylactic-type allergic
reaction to an IV antibiotic just received. Which symptoms manifested
by the client would most likely lead the nurse to this conclusion?
A. Nausea and vomiting
B. Itchy rash and hives
C. Hypertension and tachycardia
D. Sudden wheezing and urticaria
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11. The nurse suspects that a client is having an anaphylactic-type allergic
reaction to an IV antibiotic just received. Which symptoms manifested
by the client would most likely lead the nurse to this conclusion?
A. Nausea and vomiting
B. Itchy rash and hives
C. Hypertension and tachycardia
D. Sudden wheezing and urticaria
D. Anaphylactic reactions cause bronchial spasms/constriction and rashes.
Nausea and vomiting are adverse side effects and hypertension is not
associated with anaphylactic shock. The graduate may have chosen B if
he/she did not read the whole question carefully, but D (urticaria)
includes B.
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Guidelines to Testtaking
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Guidelines to Testtaking
Maslow’s Hierarchy of Needs
Self-actualizing
Self-esteem
Love and Belonging
Safety Needs
Physiologic Needs
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Guidelines to Testtaking
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Guidelines to Testtaking
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12. A 62-year-old client has a history of coronary heart disease and is
brought into the ER complaining of chest pain. What initial action
should be taken by the nurse?
A. Give the client nitroglycerin 0.3 mg SL now
B. Call the client’s cardiologist about admission
C. Place the client in a high-Fowler’s position after loosening the shirt
D. Check B/P and note the location and degree of the chest pain
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12. A 62-year-old client has a history of coronary heart disease and is
brought into the ER complaining of chest pain. What initial action
should be taken by the nurse?
A. Give the client nitroglycerin 0.3 mg SL now
B. Call the client’s cardiologist about admission
C. Place the client in a high-Fowler’s position after loosening the shirt
D. Check B/P and note the location and degree of the chest pain
D. It is important to remember that when asked for an “initial” or “first” action, think of the
nursing process. The first step in the nursing process is always assessment. If there is not
an assessment choice, then look for a planning choice and so forth. The other three
answers provided for this question are also correct and should be done at some point; but
in this particular situation, the first need is to assess the chest pain to determine if it is
indeed cardiac in nature. Many other conditions also cause chest pain.
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Guidelines to Testtaking
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13. Select the medication that is inappropriate for the relief of chest
pain.
A. Diltiazem (Cardizem)
B. Propranolol (Inderal)
C. Digoxin (Lanoxin)
D. Meperidine (Demerol)
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13. Select the medication that is inappropriate for the relief of chest
pain.
A. Diltiazem (Cardizem)
B. Propranolol (Inderal)
C. Digoxin (Lanoxin)
D. Meperidine (Demerol)
C. Digoxin is a positive inotropic medication and increases contractility and the
oxygen demands of the heart. It is likely it would actually increase chest pain in
this client. The other three medications all relieve chest pain by somewhat
different mechanisms. But notice that if the question was not read carefully and
the reader missed the “in” prefix of inappropriate then certainly choice C would
not have been selected.
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Guidelines to Testtaking
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14. When assessing the chest pain of a client with cardiovascular
disease, what may be considered?
A. This pain is always caused by constriction or blockage of the coronary
arteries by fat plaques or blood clots
B. True cardiac pain is never relieved without treatment
C. This type of pain is only relieved by nitroglycerin
D. Clients often attribute the pain to indigestion
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14. When assessing the chest pain of a client with cardiovascular
disease, what may be considered?
A. This pain is always caused by constriction or blockage of the coronary
arteries by fat plaques or blood clots
B. True cardiac pain is never relieved without treatment
C. This type of pain is only relieved by nitroglycerin
D. Clients often attribute the pain to indigestion
D. The answers to this question are very obvious in the demonstration of the “avoid the absolute” strategy. Coronary type chest pain can also be
caused by spasms of the coronary arteries as a variant angina (choice A). Chest pain sometimes can go away by itself, although it will
probably return later (choice B). There are a number of medications that will also relieve chest pain besides nitroglycerin (e.g. morphine
and narcotics, calcium-channel blockers and beta blockers) (choice C).
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Guidelines to Testtaking
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Guidelines to Testtaking
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15. A client has developed heart failure. Identify the correct loading
dose of digoxin (Lanoxin) for an adult client.
A. 0.75 mg divided into three doses q 8 hours
B. 0.75 Gm divided into four doses q 8 hours
C. 10 mg due to the fact the client is a very large person, with a Native
American background, which causes slow absorption of the medication
D. 0.25 mg
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15. A client has developed heart failure. Identify the correct loading
dose of digoxin (Lanoxin) for an adult client.
A. 0.75 mg divided into three doses q 8 hours
B. 0.75 Gm divided into four doses q 8 hours
C. 10 mg due to the fact the client is a very large person, with a Native
American background, which causes slow absorption of the medication
D. 0.25 mg
A. The loading dose for digoxin is usually three times the maintenance dose
(0.25 mg) divided over 24 hours. Choice B is in a different measurement
form (grams instead of milligrams); choice C demonstrates the longer
than average answer with rationale; and D is much shorter than any of
the others.
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Guidelines to Testtaking
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Guidelines to Testtaking
Avoid looking for a pattern
in the selection of answers
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Guidelines to Testtaking
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16. A 33-year-old client has been diagnosed as having a pheochromocytoma.
Select the appropriate initial nursing activity.
A. Administer large doses of xylometrazoline (Otrivin) to help control the symptoms
of the disease
B. Monitor the client’s vital signs closely, particularly the blood pressure
C. Prepare the client and family for imminent death
D. Have the family discuss the condition with the physician before informing the client
about the disease because of the protracted recovery period after treatment.
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16. A 33-year-old client has been diagnosed as having a pheochromocytoma.
Select the appropriate initial nursing activity.
A. Administer large doses of xylometrazoline (Otrivin) to help control the symptoms
of the disease
B. Monitor the client’s vital signs closely, particularly the blood pressure
C. Prepare the client and family for imminent death
D. Have the family discuss the condition with the physician before informing the client
about the disease because of the protracted recovery period after treatment.
B. A pheochromocytoma is a tumor of the adrenal medulla that causes an increase in the secretion
of epinephrine and/or norepinephrine. One important result of having this type of tumor is
that a hypertensive crisis may occur in some individuals. Monitoring B/P would be an
important nursing care measure. Also, assessment is the first step of the nursing process and
would fit well with the qualifying word “initial”, used in the question stem.
(xylometrazoline [Otrivin} is similar to Neosynephrine)
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Guidelines to Testtaking
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Guidelines to Testtaking
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Guidelines to Testtaking
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Guidelines to Testtaking
Choose answers that acknowledge the
client, communicate acceptance, are
open-ended and encourage
discussion and expression of feelings
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Guidelines to Testtaking
If two or three answers say the
same thing in different words,
none are right
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Guidelines to Testtaking
Look for the type of answer
required (assessment data,
nursing intervention,
prioritizing, etc.)
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Guidelines to Testtaking
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Guidelines to Testtaking
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Guidelines to Testtaking
Review Thoroughly
1. Names of Common Medications
2. Lethal and Therapeutic Doses and Antidotes
3. Common Side Effects of Medications
4. Lab Values and Implications
5. Growth and Development
6. Diet Therapy
7. Basic Anatomy and Physiology
8. Stages of the Nursing Process
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Guidelines to Testtaking
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Guidelines to Testtaking
Group Study Rules
• Set time limits
• Divide responsibilities of review
• Prepare your own questions
• Make decisions on participants
• Stop at scheduled end
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Guidelines to Testtaking
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Guidelines to Testtaking
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Guidelines to Testtaking
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Guidelines to Testtaking
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Guidelines to Testtaking
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Guidelines to Testtaking
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Guidelines to Testtaking
Avoid Stimulants and
Alcohol
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Guidelines to Testtaking
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Guidelines to Testtaking
Day of Exam
• Avoid excess oral intake of your special
diuretics: Coffee, Cigarettes, Tea, Soft
Drinks.
• Do increase intake of foods high in quality
glucose and protein.
• Arrive 15 to 30 minutes early.
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• Relaxation Technique
Guidelines to Testtaking
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