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NCLEX PREPARATION
PROGRAM
MODULE 1
Overview, Assessment Testing
Preparing to be Successful on the
NCLEX-RN
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Philosophy of Learning
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Adult Learner
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Individual Responsibility
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Collaboration
The Adult Learner is Unique!
1. Like to determine their own learning
experiences
2. Enjoy small group interactions
3. Learn from others’ experiences as well as
their own
4. Hate to have their time wasted
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The Adult Learner is Unique!
5. Some adults will like some lectures but all
lectures won't be liked by all adults
6. Are motivated to learn when they identify
they have a need to learn
7. Are motivated to learn when societal or
professional pressures require a particular
learning need
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The Adult Learner is Unique!
8. Are motivated to learn when “others”
arrange a learning package in such a
manner that the attraction to learning
overcomes the resistance
9. Draw their knowledge from years of
experience and don’t change readily
10. Want practical answers for today’s
problems
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The Adult Learner is Unique!
11. Like physical comfort
12. Enjoy practical problem solving
13. Like tangible rewards
14. Refreshments and breaks establish a
relaxed atmosphere and convey respect
to the learner
Values
If you have identified values
and designated adequate time
and support, you are likely to
be successful at
attaining your goal
Skills the Successful RN
Candidate Will Need:
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Comfort with mathematics: Math Tutorial CD
Critical thinking skills and some memorization:
Critical Thinking Exam
Reading and reviewing many pages of nursing
content almost daily in preparation for class and the
NCLEX exam
Time and stress management
Self-confidence in one’s ability to be successful:
positive self talk
Computer Skills
Basic computer literacy and comfort
are very important!
 Competent working knowledge of
Windows programs.
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Study Time Required
• 8-12 hours per week classroom
• 5 hours/week computerized testing
practice
• 2 or more hours/week for
classroom preparation & homework
assignments
• Working more than 32 hours/week
is not recommended
*Commuters add 4-6 hours/week for travel
We Want You to Be Successful
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One day at a time!
Know your learning style
Organize and plan ahead
Assume responsibility for your learning
Practice first party communication
Be empowered
Strengthen skills
Practice balance
Practice “stress busters”!
What is Your Learning Style?
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Each of us has a unique way in which we
process information and learn the best.
Knowing your learning style preference allows
you to choose learning strategies that are most
effective for you.
Learning Style assessment results indicate
learning preferences rather than strengths.
Done right, learning can be fun!
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Major Learning Styles
Visual
draw, diagram,
outline, color
To learn more effectively remember to use:
Flow charts, graphs, labeled diagrams
Visual imagination
Written words
Pictures
Graphs
Timeline
Highlight text
Major Learning Styles
Aural /Auditory
To learn more effectively focus on:
Lectures in the classroom
Tape recording the lectures
Group discussions
Web chat; talk things through
Sort things out by speaking out loud
(to yourself and to others)
Major Learning Styles
Read/Write
To learn most effectively remember to:
• Read and reread
• Write and rewrite (take notes and use them for
study outside the classroom)
• Organize
• Use outlines
• Change graphs, etc. into statements or words
Major Learning Styles
Kinesthetic/tactile
Related to the use of experience and practice (simulated or real)
To learn most effectively, remember to:
 Be actively involved
 Touch, act
 Type notes
 Make flash cards,
 Use mind mapping (more information to follow)
 Watch videos depicting real-life scenarios
Major Learning Styles
Multimodal (a mix of learning styles)
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50 to 70% of the population
Choose among your preferences to suit the
occasion or situation
-or
Use strategies from each preference to learn
Mind Mapping
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What is it?
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Mind mapping is a technique for taking notes in
such as way that it produces strong visuals
How does it work?
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To make a mind map, one starts in the center of
the page with the main idea, and works outward in
all directions, producing a growing and organized
structure composed of key words and key images.
Case Study – Mind Mapping Sample
Mind Mapping
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Why does it work?
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Mind maps help organize information using the same
structure that our brain uses for making memories
By presenting your thoughts and perceptions in a
spatial manner and by using color and pictures, a
better overview is gained and new connections can be
made visible.
Mind maps allow you to use both sides of your brain
Struggling Student vs.
Successful Student
STRUGGLING:
SUCCESSFUL:
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Denial
Avoids problems
Blames others
Avoids Faculty
Disorganized
Tries Hard
Lucky
Realistic
Addresses problems
Accountable
Works with Faculty
Organized & Manages
Time
• Tries Hard and Produces
• Works Hard & is Prepared
At Risk Students:
Board of Registered Nursing (BRN) Task Force
defines “at risk” students as follows:
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English as a second language
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Works >20 hours / week
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Family responsibilities
If you fit any of these criteria: DEVELOP A
PLAN
Seven Steps to Reach Your Goals
1.
2.
3.
4.
5.
6.
Write them down.
Be specific, measurable.
Be certain they are YOUR goals
Be positive.
Establish a time frame.
Do goals conflict with goals in other
areas of your life?
7. Keep score!
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To Enhance Your Success:
• Utilize faculty
• Plan ahead
• Complete and turn
assignments in on
time
• Read study guides
prior to lecture
Study Skills Inventory
Complete the study skills inventory tool
located on page 13 of Module 1;
Study Guide #3
S.M.A.R.T. Outcomes
Specific
Measurable
Attainable
Realistic
Time-targeted
Plan and Prepare!
• Organize now
• Enlist help from family
(i.e. helping w/ meals)
• Assess finances
• Reduce work hours
• Schedule fun
• What works best for you
is unique
Student/Family Prep Activity
Complete the Student/Family Prep
Activity tool located on page 16 of
Module 1; Study Guide #3
Support is Available:
• Instructors
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Peers/Study Groups
Counseling
Family and Friends
Employer/Supervisor
“Return on Investment”
Return on Investment
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Why it’s OK to ask your employer for 4-8 hours
per week of paid time-off:
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Your success at becoming a RN is of benefit to
your employer!
Providing support to you during your NCLEX
review is a less expensive way for your employer
to gain a new RN than recruiting a new RN!
Preparation for classroom
lecture discussions
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A successful participant is a prepared
participant.
Read ahead.
Come to class with questions if portions of
the study guides were unclear.
Your questions in class will help someone else
understand the concept better as well.
Preparation for classroom
lecture discussions
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When completing your weekly NCLEX-RN
computerized testing practice, focus on the
same subject matter being covered in class that
week.
Prior to class, brush up on physiology,
terminology and the lab values one can expect
while caring for patients with the diseases
being discussed.
Preparation for classroom
lecture discussions
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Create flashcards of material that requires
memorization and that is new to you.
Write down your questions to ask in class.
Also take the opportunity to learn from your
workplace if working in the healthcare field.
Tying together what you observe in action and
what you learn in the classroom is a great
learning strategy.
Maslow’s Hierarchy of Needs
Theory
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What is Maslow’s Hierarchy of Needs Theory?
How will understanding the needs theory help
with prioritizing nursing interventions?
How does the hierarchy apply to a NCLEX
candidate's life?
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Maslow’s Hierarchy of Needs
in Descending Order
5th. Self-Actualization
4th. Self-Esteem
3rd. Love & Belonging
2nd Safety & Security
1st. Physiological Needs
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Maslow's Hierarchy of Needs
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Physiological Needs
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According to Maslow, physiologic needs are the
highest priority and must be met first.
Physiologic needs are necessary for survival.
Oxygen
Elimination
Fluid
Shelter
Nutrition
Rest
Temperature
Sex
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Safety and Security
Physical and Psychosocial
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Physical safety includes decreasing what is
threatening to the patient.
The threat could be an illness, accidents, or
environmental threats.
Psychological safety states that the client
must have adequate knowledge and an
understanding about what to expect from
others in his environment.
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Love & Belonging
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Client needs to feel loved by family and
accepted by others.
When a client feels self-confident and
useful, he will achieve the need of
esteem as described by Maslow.
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Self Esteem
How one feels about himself/herself
 Feelings of adequacy or inadequacy
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Self-Actualization
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This is the highest level of Maslow’s
hierarchy of needs.
To achieve this level, the client must
experience fulfilment and recognize his or
her potential.
In order for self-actualization to occur, all of
the lower level needs starting with
physiologic must first be met.
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How to Apply Maslow’s Needs to Establish Priorities of Care
Maslow’s
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First recognize that answer options include both
physical and psychosocial needs.
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Next eliminate the psychosocial answer.
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Ask yourself “Does this make sense in this case?”
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Finally apply the “ABCs” of care. Airway, Breathing,
Circulation
Answer
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Application of Maslow's
Hierarchy
A woman is admitted to the hospital with a
ruptured ectopic pregnancy. A laparotomy is
scheduled. Which preoperative nursing
intervention is most important for the nurse to
consider in this patient’s plan of care?
a.
b.
c.
d.
Fluid Replacement
Pain Relief
Emotional Support
Respiratory Therapy
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Physical Needs First
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The nurse obtains a diet history from a pregnant
16-year-old girl. The girl tells the nurse that her
typical daily diet includes cereal and milk for
breakfast, pizza and soda for lunch, and
cheeseburger, milkshake, fries and salad for dinner.
Which of the following is the most accurate
nursing diagnosis based on this data provided?
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Highest Priority Need
1. Altered nutrition: more than body
requirements related to high-fat intake.
2. Knowledge deficit: nutrition in pregnancy.
3. Altered nutrition: less than body requirements
related to increased nutritional demands of
pregnancy.
4. Risk for injury: fetal malnutrition related to poor
maternal diet.
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Prioritizing Care
The nurse plans care for a 14-year-old girl
admitted with an eating disorder. On admission,
the girl weighs 82 lbs. and is 5’4” tall. Lab test
indicate severe hypokalemia, anemia and
dehydration. The nurse should give which of the
following nursing diagnoses the highest priority?
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Physiological needs are most important.
Remember the “ABCs”!
1. Body image disturbance related to weight loss.
2. Self-esteem disturbance related to feelings of
inadequacy.
3. Altered nutrition: less than body requirements
related to decreased intake.
4. Decreased cardiac output related to the potential
for dysrhythmias.
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Computerized Adaptive
Testing (CAT)
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CAT is a method whereby the examination is
created as you answer each question. If you select
the correct answer, the computer selects a more
difficult question for your next question. If you
selected an incorrect answer, the computer will then
select an easier question.
This process continues until the computer has
established with 95% confidence that you have been
successful or unsuccessful.
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Computerized Adaptive
Testing
When a test question is presented, it must
be answered in order; move to the next
question.
 There is no penalty for guessing.
 A computer keyboard tutorial is offered at
the beginning of the examination in order
to orient you to the use of the keys, etc.
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Computerized Adaptive Testing
Time Considerations
The maximum testing time is 6 hours. This time
period includes:
The computer tutorial
 The sample items
 All breaks (restroom, stretching, etc.)
 The examination
 All breaks are optional!
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Computerized Adaptive
Testing
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The minimum number of questions that you
will need to answer is 75.
The maximum number of questions in the test
is 265.
Each exam has 15 “pilot testing” questions that
will not be added to your score.
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Computerized Adaptive Testing
(CAT)
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Each candidate’s exam is unique because it is
created interactively as the exam proceeds.
Computer technology selects items to administer
that match the candidate’s ability level.
All test items are stored in a large item pool.
Items have been classified by test plan area being
evaluated and level of difficulty.
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Scoring the Computerized
Adaptive Test
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After the candidate answers an item, the computer
calculates an ability estimate based on all of the previous
answers the candidate selected.
An item determined to measure the candidate’s ability is
selected and this process is repeated for each item, creating
an exam tailored to the candidate’s knowledge and skills
while fulfilling all NCLEX-RN Test Plan requirements.
The exam continues with items selected being
administered in this way until a pass or fail decision is
made.
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Computerized Adaptive Testing:
Pass or Fail?
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After 75 questions are answered the computer
compares the test-taker’s ability level to the
standard required for passing.
If the test-taker is above the passing standard,
then the test-taker has passed.
If the test-taker is below the passing standard,
then the test-taker fails.
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Computerized Adaptive Testing:
Pass or Fail? …cont
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If the computer is not able to determine whether
the test-taker has passed or failed, then the
computer continues asking questions.
The computer must be 95% certain before it
stops testing.
How is the NCLEX-RN Exam
Written?
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First data is collected to reflect the current
practice of the entry-level nurse.
Data analyzed regarding frequency of
performance, impact on maintaining client
safety and client care settings where
activities performed.
This guides the selection of content and
behaviors to be tested.
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NCLEX Definition of RN
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Provides a unique comprehensive assessment of the
health status of the client (individual, family or group).
Develops, then implements an explicit plan of care.
Assists clients in the promotion of health, in adapting
to and/or recovering from the effects of disease or
injury and in supporting the right to a dignified death.
Accountable for abiding by all applicable federal, state
and territorial statutes related to nursing practice.
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NCLEX-RN Detailed Test Plan
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Reviewed and approved by National Council of
State Boards of Nursing (NCSBN) every three
years.
Expert resources support changes that reflect
practice trends.
Comprehensive listing of content for each client
need category and sub category.
Test Plan Components
Questions are written to address:
Bloom’s Taxonomy Levels of cognitive ability
 Client Needs
 Integrated Processes
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Item writers are master’s-prepared nursing
educators.
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NCLEX Test Plan Framework
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Bloom’s taxonomy ranks levels of learning from
simple to complex, it is used as a basis for writing and
coding test items.
 Nursing practice requires the application of
knowledge, skills and abilities.
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The majority of items are written at the application or
higher levels of cognitive ability.
This requires more complex thought processing.
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Blooms Taxonomy and Test
Question Construction
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Levels of Cognitive Ability
Knowledge
Comprehension
Application
Analysis
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Bloom's Taxonomy of Questions with
Increasing Difficulty and Sophistication
Analysis
Application
Comprehension
Recall/Recognition
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Application Questions
Which of the following symptoms, if observed
by the nurse during the first 24 hours after a
percutaneous liver biopsy, would indicate a
complication from the procedure?
1. Anorexia, nausea and vomiting
2. Abdominal distension and discomfort
3. Pulse 112, BP - 100/60, R - 20
4. Pain at the biopsy site
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Application Questions
It’s the principle of the thing!
Application involves the utilization of basic facts
and principle to make nursing judgements.
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The NCLEX exam tests your ability to apply
nursing knowledge and principles in a variety of
clinical situations across the life span.
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Application Questions
One’s ability to solve problems, prioritize care,
draw conclusions, perform assessments and
synthesize information is not directly tested with
recall, recognition or comprehension level
questions.
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You must be able to answer questions at the application
level in order to prove your competence on the NCLEX.
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Analysis Type Question
A man is brought to the emergency room
complaining of chest pain. The nurse performs an
assessment of the patient. Which of the following
symptoms would be MOST characteristic of an
acute myocardial infarction?
1. Colic-like epigastric pain.
2. Sharp, well localized unilateral chest pain.
3. Severe substernal pain radiating down the left arm.
4. Sharp, burning chest pain moving from place to place.
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Comprehension Question
The nurse understands that hemorrhage is a
complication of a liver biopsy because:
a. There are several large blood vessels near the liver.
b. The liver cells are bathed with a mixture of venous
arterial blood.
c. The test is performed on patients with elevated
enzymes.
d. The procedure requires a large piece of tissue to be
removed.
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The NCLEX Test Plan
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The content of the NCLEX-RN test plan is
organized into four major Client Needs
categories.
Two of the four categories are further
divided into subcategories.
All content categories and subcategories
reflect client needs across the life span in a
variety of settings.
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NCLEX Test Plan Framework
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Client Needs categories include the following:
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Safe and Effective Care Environment
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Health Promotion and Maintenance
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Psychosocial Integrity
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Physiological Integrity.
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Client Needs Sample Question
The nurse is delivering external cardiac compressions to
a 63 year old woman while performing cardiopulmonary
resuscitation (CPR). It is most important for the nurse to:
 Maintain a position close to the client’s side with the nurse’s knees
apart.
 Maintain vertical pressure on the client’s chest through the heel of
the nurse’s hand.
 Recheck the nurse’s hand position after every 10 chest
compressions.
 Check for a return of the client’s pulse after every 8 breaths by the
nurse.
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Sample Recall and Recognition
Knowledge-based Question
Which of the following is a complication that
occurs during the first 24 hours after a
percutaneous liver biopsy?
a. Nausea and vomiting
b. Constipation
c. Hemorrhage
d. Pain at the biopsy site.
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NCLEX Test Plan Framework
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Woven within the client needs categories are
four Integrated Processes.
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Nursing process
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Caring
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Communication and Documentation
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Teaching and Learning
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A Closer Examination
Let’s examine each component in greater detail
including sample questions that will emphasize key
concepts.
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First Client Needs categories
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Next Bloom’s Taxonomy Cognitive Domain
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Finally Integrated Processes
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Client Need #1
Safe and Effective Care Environment
Subcategory: Management of Care: 13-19%
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Advance Directive
Advocacy
Case Management
Client rights
Collaboration with Interdisciplinary team
Concept of Management
Confidentiality/Information Security
Consultation
Continuity of Care
Delegation
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Client Need #1
Safe and Effective Care Environment
Subcategory: Management of Care: 13-19%
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Establishing Priorities
Ethical Practice
Informed Consent
Legal Rights and Responsibilities
Performance Improvement (Quality Assurance)
Referrals
Resource management
Staff Education
Supervision
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Client Needs
Sample Question
A client scheduled for surgery tells the
nurse that she signed an informed
consent but was never told about the
risks of the surgery.
The nurse serves as the client’s advocate
by performing which of the following
actions?
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Client Needs (cont’d)
a. Writing a note on the front of the client’s
record so that the surgeon will see it when the
client arrives in the operating room.
b. Documenting in the client’s record that the
client was not told about the risks of the surgery.
c. Contacting the surgeon and asking the surgeon
to explain the surgical risks to the client.
d. Reassuring the client that the risks are minimal
and unlikely to occur.
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Client Need #1
Safe and Effective Care Environment
Subcategory: Safety and Infection Control:
8 –14%
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Accident prevention
Disaster planning
Emergency Response Plan
Ergonomic Principles
Error prevention
Handling hazardous and infectious materials
Home Safety
Injury Prevention
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Client Need #1
Safe and Effective Care Environment
Subcategory: Safety and Infection Control:
8 –14%
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Medical and Surgical Asepsis
Reporting of Incident/Event/Irregular
Occurrence/Variance
Safe Use of Equipment
Security Plan
Standard/Transmission-Based/Other Precautions
Use of Restraints/Safety Devices
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Safety and Infection Control
Sample Question
The physician orders tobramycin sulfate (Nebcin) 3mg/kg
IV every 8 hours for a 3-year-old boy. The nurse enters the
patient’s room to administer the medication and discovers
that the boy does not have an identification bracelet. What
should the nurse do?
 Ask the parents at the child’s bedside to state their
child’s name.
 Ask the child to say his first and last name.
 Have a co-worker identify the child before giving the
medication.
 Hold the medication until an identification bracelet can
be obtained.
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Client Need #2:
Health Promotion and Maintenance:
6 – 12%
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The Aging Process
Ante/Intra/Postpartum and Newborn
Care
Developmental Stages and Transitions
Disease Prevention
Expected Body Image Changes
Family Planning
Family Systems
Growth and Development
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Client Need #2:
Health Promotion and Maintenance:
6 – 12%
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Health and Wellness
Health Promotion Programs
Health Screening
High Risk Behaviors
Human Sexuality
Immunizations
Life Style Choices
Principles of Teaching and Learning
Self-Care
Techniques of Physical Assessment
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Client Needs Sample Question
A nurse is preparing to care for a hospitalized
female teenager in skeletal traction. The nurse
plans patient care, knowing that the most likely
primary concern of the teenager is:
a.
b.
c.
d.
Body image
Keeping up with school work
Obtaining adequate nutrition
Obtaining adequate rest and sleep
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Client Need #3
Psychosocial Integrity: 6-12%
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Abuse/Neglect
Behavioral Interventions
Chemical Dependency
Coping Mechanisms
Crisis Intervention
Cultural Diversity
End of Life
Family Dynamics
Grief and Loss
Mental Health Concepts
Client Need #3
Psychosocial Integrity: 6-12%
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Psychopathology
Religious and Spiritual Influences on Health
Sensory/Perceptual Alterations
Situational Role Changes
Stress management
Support Systems
Therapeutic Communication
Therapeutic Environment
Unexpected body image
Client Needs Sample Question
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?
a. Documents the bruises noted on the child’s body.
b. Calls the parents to ask them how the child’s bruises and
burn marks occurred.
c. Notifys Child Protective Services to facilitate the removal of
the child from the abusive situation in order to prevent
further injury.
d. Asks the child how long his parents have been abusing him. 86
Client Needs Sample Question
A 50-year-old male patient comes to the nurses’ station
and asks the nurse if he could go to the cafeteria to get
something to eat. When told that his privileges do not
include visiting the cafeteria, the patient became verbally
abusive. Which of the following approaches by the nurse
would be most effective?
a. Tell the patient to lower his voice because he is disturbing the
other patients.
b. Ask the patient what he wants from the cafeteria and have it
delivered to his room.
c. Calmly but firmly escort the patient back to his room.
d. Assign a nursing assistant to accompany the patient to the
cafeteria.
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Client Need #4
Physiological Integrity
Basic Care and Comfort: 6-12%
Alternative and Complementary Therapies
 Assistive Devices
 Elimination
 Mobility and Immobility
 Non-Pharmacological Comfort Interventions
 Nutrition and Oral Hydration
 Palliative and Comfort Care
 Personal Hygiene
 Rest and Sleep

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Client Needs Sample Question
A nurse has provided information to a client about
measures that will promote normal urination
patterns and prevent urinary tract infections. Which
statement by the client indicates a need for further
information?
a. “I should take my furosemide (Lasix) in the morning.”
b. “I should drink plenty of fluids during the day.”
c. “I should try and hold my urine as long as I can rather
than expelling it when I feel the urge.”
d. “I should eat foods that will make my urine acidic.”
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Client Need #4
Physiological Integrity
Pharmacological and Parenteral Therapies:
13 – 19%
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Adverse effects/Contraindications
Blood and Blood Products
Central Venous Access Devices
Dosage Calculations
Expected Outcomes/Effects
Intravenous Therapy
Medication Administration
Parenteral Fluids
Pharmacological Agents/Actions
Pharmacological Interactions
Pharmacological Pain Management
Total Parenteral Nutrition
90
Client Needs Sample Question
Cyclosporine (Sandimmune) oral solution is
prescribed for a patient who had a kidney transplant.
The nurse provides information to the patient about
the medication and tells the patient that which of
the following is most important to monitor?
a.
b.
c.
d.
Temperature
Peripheral pulses
Platelet count
Apical heart rate
91
Client Need #4
Physiological Integrity
Reduction of Risk Potential: 13 –19%


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
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Diagnostic Tests
Laboratory Values
Monitoring Conscious Sedation
Potential for Alterations in Body Systems
Potential Complications of Diagnostic Tests/
Treatments/Procedures
Potential for Complications from Surgical
Procedures and Health Alterations
System Specific Assessments
Therapeutic Procedures
Vital Signs
92
Client Needs Sample Question
A 7-year-old girl with type I insulin dependent
diabetes mellitus (IDDM) has been home sick for
several days and is brought to the ER by her parents.
If the child is experiencing ketoacidosis, the nurse
would expect to see which of the following lab
results?
a.
b.
c.
d.
Serum glucose 140 mg./dl
Serum creatine 5.2 mg./dl
Blood pH 7.28
Hematocrit 38%
93
Client Need #4
Physiological Integrity
Physiological Adaptation: 11 – 17%

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
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Alteration in Body Systems
Fluid and Electrolyte Imbalances
Hemodynamics
Illness Management
Infectious Diseases
Medical Emergencies
Pathophysiology
Radiation Therapy
Respiratory Care
Unexpected Response to Therapies
94
Integrated Processes
These “threads” of knowledge are
fundamental to the practice of nursing
and are integrated throughout the Patient
Needs categories and subcategories.
95
Four Integrated
Processes Categories
1. Nursing Process is a scientific problem
solving approach to client care that includes
assessment, analysis, planning, implementation and
evaluation.
96
Four Integrated
Processes Categories
2. Caring is the interaction of the nurse and patient
in an atmosphere of mutual respect and trust. In this
collaborative environment, the nurse provides
encouragement, hope, support and compassion to help
achieve desired outcomes.
97
Four Integrated
Processes Categories
3. Communication/Documentation
Communication is the verbal and nonverbal interaction
between the nurse and the client, the client's significant others
and the other members of the health care team.
Documentation relates to events and activities associated
with client care which are validated in written and/or electronic
records that reflect standards of practice and accountability in
the provision of care.
98
Four Integrated
Processes Categories
4. Teaching/Learning is the facilitation of the
acquisition of knowledge, skills and attitudes promoting a
change in behavior. It is the distribution of content.
99
6 Types of Questions
on the NCLEX Exam






Multiple choice - one correct answer
Fill-in-the-Blank - type in the answer
Hot Spot - select a specific area on a diagram or
illustration
Exhibit - information needed for the answer is in the
form of an exhibit or spreadsheet.
Ordered response - select choice in the proper
sequence (prioritize)
Multiple response - more than one answer is correct;
select all that apply
100
Multiple Choice Questions
Most of the questions that you will be asked
to answer will be in the multiple choice
format.
 These questions will provide you with data
about a particular client situation, together
with four answers or options.

101
Fill-in-the Blank Questions
Follow the directions for each question.
 Use the on-screen calculator and verify
calculations a second time.
 Type in only the numeric component of the
answer as directed.
 Round the answer to the nearest whole number
if directed to do so.
 Do not use abbreviations if directions indicate
that they are not acceptable.

102
Hot Spot Questions
This type of question allows you to use the
mouse or arrow keys to identify a figure,
illustration or other item designated in the
stem of the question.
103
Exhibit Questions


In order to answer exhibit questions you will
need to click on the button that says, “Exhibit.”
This opens up a new smaller window with either
a list or a spreadsheet.
There may be more than one page to the exhibit.
If this is the case, there will be tabs at the top of
the exhibit. Be sure to look at all of the tabs
provided.
Multiple Response Questions



You must select all of the options that relate to
the information being asked in the question.
There is no partial credit given for correct
selections you have chosen.
You must select ALL that apply in order for the
question to be counted as correct.
105
Ordered Response Questions
Prioritizing questions ask you to select options
in the correct sequence or use the computer
mouse to drag and drop your nursing actions in
order of priority.
 Information will be presented and based on the
data you have been provided.
 You will need to determine what you would do
first, second, third and so forth.

106
Golden Rules for
NCLEX Success

Be prepared

Avoid negative people

Do not discuss the exam

Avoid distractions

Think positively
Golden Rules for
NCLEX Success

Eat well

Exercise

Sleep well


Eliminate alcohol and other mind-altering
drugs
Schedule study time
Tutorial Prior to NCLEX Exam



Each NCLEX candidate is given a tutorial at the
beginning of the exam in order to become familiar
with how to answer each question using a mouse,
arrow keys, and a calculator.
There is no partial credit given for an answer that is
only partially correct.
Updated information on the administration of the
test plan can be found at NCSBN web site:
www.ncsbn.org
109
Test Taking Strategies


If an option contains an absolute word, it is
usually an incorrect choice and can safely be
eliminated as an option.
If a tentative word is used in an option, then
it is more likely to be the correct answer.
110
Examples of Absolute Words
Always advise clients to eat low sodium foods.
Drink fluids only if they are fat-free.
Eat only foods that have less than 1% fat content
Never use butter for cooking.
111
Examples of Tentative Words
Nursing actions are usually in the clients’ best
interest.
It is sometimes necessary to call for an
emergency support team.
Hot liquids may cause skin damage if spilled.
Often times clients who break their legs need
instruction in crutch walking.
112
Questions Containing
Laboratory Values
 Laboratory values questions will first require you
identify whether the results are normal or
abnormal. You will need to memorize common
laboratory values.
 Next you will be asked to analyze the laboratory
value as it relates to the client situation being
presented.
 Finally you may be asked to make the appropriate
assessment, judgement and/or nursing action.
113
Laboratory Values Sample Question
A client with a diagnosis of sepsis
is receiving antibiotics by the intravenous
route. The nurse assesses for
nephrotoxicity by closely monitoring which
of the following laboratory values?
114
Laboratory Values Sample Question
Possible Answers
a.
b.
c.
d.
Lipase level
Platelet count
White blood cell count
Blood urea nitrogen
115
Nursing Interventions


Although sometimes appropriate, avoid jumping
immediately to an answer that recommends
immediate referral to the patient’s M.D.
NCLEX is examining your abilities as a nurse and
doesn’t usually want immediate referral to other
members of the health care team.
Key Words

Key words in NCLEX-RN test questions are
critical in defining the correct answer. Examples
of how key words are used include:

…is an early sign of…?

…is the most important…?

Identify the ___ with the highest priority…

Which ____ would the nurse do initially?
Sample Question –
Key Word in Stem
A nurse is caring for a patient with a diagnosis
of congestive heart failure who suddenly
experiences severe dyspnea. The nurse
suspects that pulmonary edema has developed.
The immediate nursing action is:
118
Sample Question Answer Options
a. Place the client in high-Fowler’s position.
b. Insert a Foley catheter STAT.
c. Obtain a dose of morphine sulfate from the
narcotic medication drawer.
d. Begin oxygen at 2 liters per minute.
119
Sample Question –
Key Word in Stem
A nurse in the emergency department receives a call
from emergency medical services and is told that
several victims who survived a plane crash and are
suffering from cold exposure will be transported to
the hospital. The initial nursing action for the
emergency department nurse is which of the
following?
120
Sample Question Answer Options
a. Call the laundry department and ask the department
to send as many warm blankets as possible to the
emergency room.
b. Call the intensive care unit to request that nurses be
sent to the emergency room.
c. Call the nursing supervisor to activate the agency
disaster plan.
d. Supply the trauma rooms with bottles of sterile
water and normal saline.
121
Visualization as a
Test-Taking Strategy

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Visualize the specific information in the case situation
in order to answer the question.
See yourself performing the procedure, assessing the
client, delegating the care, etc.
Remember that clinical practice can vary depending
upon where it is practiced and who is performing the
care.
Be certain that you draw upon knowledge and skills
which come from nursing textbooks.
122
Visualization Sample
Test Question
A nurse prepares to perform a sterile dressing
change on an abdominal incision. The nurse
explains the procedure to the patient, washes
her hands and sets up the sterile field. The
nurse takes which action next?
123
Visualization Sample - Answer Options
a. Assesses the integrity of the abdominal
incision.
b. Cleans the wound with Betadine solution as
prescribed.
c. Dons clean gloves and removes the old
dressing.
d. Dons sterile gloves and begins the procedure.
124
Response Options

“Odd man out”

Eliminate obvious wrong answers.


If two answers are opposites, chances are one of
them is the correct answer.
“Wordy” answers tend to be the correct answer
(only use this if two answers look correct but
one is more wordy than the other).
Additional Strategies



Read each question carefully and avoid reading
more into the question than is there.
Try not to answer a question based on what
you’ve seen in a clinical setting.
Reinforce your learning by:

testing your knowledge using NCLEX-RN
review resources
Additional Strategies

Reinforce your learning by:


Using NCLEX-RN review videos and computer
programs
Frequently asking yourself questions that reinforce
your learning such as, “If I had to do that procedure,
what would I need to know?” –or– “If I had to teach
a client about that particular diagnosis, how would I
explain it?”
Pacing Strategies When Testing

Once you’re allowed to begin, check the time.

Try to spend no more than 1 minute per test question

Don’t allow difficult questions to immobilize you. Make
your best selection and then move on.
While completing the NCLEX-RN computerized practice testing
during this course, aim to answer one answer correctly per minute.
Strategies – Day of Testing



Eat breakfast. Brains function optimally if
blood sugar levels are even.
Use scratch paper as a tool for helping to
answer future questions based on information in
older questions. Remember you can’t go back to
previous questions so this may be useful.
Don’t panic if someone finishes before you.
Anxiety
Anxiety is an individual’s negative response to
the stressor being confronted.
 Anxiety is defined as a state of varying degrees
of uneasiness or discomfort resulting in energy
that can be constructive or destructive.
 Learning how to prevent stress from becoming
anxiety is an important skill for everyone to
learn.

130
Tips to Reduce Test Anxiety


Sufficient preparation helps candidates feel
confident and that they can be successful.
Make a study schedule; cramming isn’t
associated with success and therefore
doesn’t work!
131
Tips to Reduce Test Anxiety




Decide what and when to study (study plan).
Use a study system or technique that works best
for you (study groups, flash cards, diagrams, etc.)
Take a second look at your study environment.
Have you provided for your physiological needs?
Tips to Reduce Test Anxiety




Rethink your attitude about test taking.
Read all test directions carefully.
Remember to breathe and relax your body.
Move along at a steady pace without
getting hung up on any one question.
133
Techniques for Reducing Stress
and Anxiety
 Reward yourself regularly for your efforts.
 Spend more time on your “weak” areas or on
those that create the most anxiety.
 Know that test anxiety is very common.
 Get help from classmates, faculty, counsellors
and family.
 It is a sign of strength to admit that you could
use some help.
 Stay focused on the tasks at hand.
134
Reducing Stress and Anxiety

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Turn to a comforting person
Rely on self-discipline
Talk it out
Think it through - introspection
Work it off - physical activity
Use symbolic substitutes
Religion and spirituality - prayer, meditation,
being with nature.
135
Stress



Stress can be a good thing or a bad thing!
Stress is defined as a broad class of experiences
which are demanding and tax an individual’s
resources and coping abilities.
The way a stressor is viewed by an individual
plays a big role in helping one cope, work
effectively for a solution and organize resources
in a productive way.
136
Stress
Stage 1: Alarm Reaction

Sympathetic nervous system initiates “fight or flight”

Adrenaline (AKA epinephrine) surges!



Hypothalamic-pituitary-adrenal axis releases cortisol,
norepinephrine & epinephrine
Heart pounds, breathing rapid, BP increases, mouth
dry, sweaty, pupils dilate, digestion slows, muscles
tense, hyper-alert
Cannot stay in alarm stage long
Stress
Stage 2: Resistance





Quickly follows alarm reaction
Body attempts to adapt to stressor
Parasympathetic nervous system opposes action of
sympathetic nervous system. Cortisol levels still
increased.
If adaptation occurs, individual will reestablish
homeostasis
If not, will enter exhaustion stage
Stress
Stage 3: Exhaustion




All energy for adaptation expended
Body cannot defend against stressor
Illness and/or death will occur if stress continues
and appropriate outside assistance is not given
Candidates perform at their highest level when
stress is at a minimal level
Final Tips for
Passing NCLEX

Set goals and manage your time to
accomplish these goals.

Face the challenges by taking small steps!

Think about your past accomplishments!
140
Final Tips for
Passing NCLEX



Think positive thoughts and use positive
self talk!
Maintain your self-confidence and control
anxiety!
Visualize yourself as an RN!
Positives that Perfect
Your Performance!
 Familiarity and repetition can help with
retention.
 You have assessed your strengths and
weaknesses.
 You have completed hundreds of similar
test questions.
142
Positives that Perfect
Your Performance!




You know what factors were considered
when the test was constructed.
You are familiar with the use of the
computer.
You are familiar with the testing procedures.
You have studied English and medical
terminology.
Positives that Perfect
Your Performance!
 You are aware of the content areas where
you believe little fine-tuning is necessary.
 You have reviewed several areas of nursing
content you believe are in need of more indepth concentrated study.
144
Positives that Perfect
Your Performance!
 You have reviewed test taking techniques
and learned how to more carefully
examine each test question so that it is
more easily understood.
Visualize!
Your Name
Photo Acknowledgement:
Unless noted otherwise, all photos and clip art
contained in this module were obtained from the
2003 Microsoft Office Clip Art Gallery.