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  NCLEX tests ones ability in the following areas:

  • Safe and Effective Care
  • Health Promotion and Maintenance
  • Basic Care and Comfort
  • Psychosocial Integrity
  • Physiological Adaptation
  • Reduction of Risk
  • Pharmacological and Parenteral Therapies

 

NCLEX will have a certain percentage of questionnaires from each of the above topics. Do not spend time on one topic alone knowing that NCLEX might ask more questions under that topic. Come exam time, you will not even know nor have the time to determine under which topic the question falls under.

 

General TIPS on how to prepare for the exam.

 

  1. Come prepared. Make sure you have all the proper identification and needed documents weeks before the exam. Always double check for the required documents. You definitely do not want to have the added stress of last minute gathering of important documents.
  2. Acknowledge the fact that you will always feel unprepared regardless of how much time you’ve spent reading and practicing on test questionnaires. Believe that you know your stuff and just go through each answer choice carefully.
  3. If given the opportunity, visit the testing area prior to your scheduled exam. This should give you an idea of any transportation issues. For those test takers that have to travel to another city for another center, please try to arrive a couple of days earlier to give yourself time to adjust to any time difference and to have time to scout the area.
  4. Come to the testing area early, preferably no less than 30-40 minutes earlier. This will give you time to register early; relax a bit and feel the testing area; know where the restrooms are. The testing sight might even allow you to take the test earlier. 

 

A few pointers on how to approach the test and choose the appropriate answer. Please note that all of these TIPS are generalizations and may not always apply depending the question. Most of the TIPS will be preceded with a question as an aid to better understand each TIP. Try answering the question before reading the TIP.

 

Question 1

A patient has esophageal varices and a doctor as ordered Amoxicillin, 500mg capsule BID. What can the nurse do to administer the medication?

 

            a. Give the medication as ordered.  

            b. Make sure to give orange juice when giving the medication.  

            c. Ask the doctor to have the medication to be given in an alternative form.  

            d. Open the capsule and give the contents with jello or apple sauce.  

 

TIP 1:  Don’t think of the answer when you read the question. The answers may not even be related to the medical issue posited in the situation.

            The correct answer is C, since the patient is experiencing esophageal varices, oral absorption of the medication will be difficult.

 

 

Question 2

A new RN graduate, was doing her patient rounds,  and observes a patient with a colostomy throwing colostomy supplies on the floor and loudly says, “I can’t stand this anymore!” What should be the best response of that new nurse graduate?

 

a. Ask the patient why he threw the supplies on the floor and explain that those supplies  

    are expensive.

            b. Stay with the patient and assist him in securing the colostomy.

            c. Tell the patient that you will quickly ask a more experienced nurse who can better

               assist.

            d. Ask the patient, “Are you upset?” Then tell the patient that you will come back when

    he is in a better mood. 

 

TIP 2:  Eliminate questions that ask WHY on any psychosocial issue.

            Avoid the option that requires a simple YES / NO answer.

            Never leave a patient alone. Always stay with the patient.               

            Thus, the correct answer for Question 2 is letter B.

           

Question 3

A nurse in the ER has been given the responsibility to quickly assess the patients that came in from an accident. Which if these patients should the nurse check first?

           

            a. The 15 yr old girl with laceration on the face and arms.

            b. The 40 yr old woman with a dislocated hip. 

            c. The 20 yr old man with bruises on the sternal area.

            d. The 60 yr old man with a broken elbow.

 

TIP 3:  Prioritizing Patients. NCLEX may use different words or phrases (i.e. check, assess first, immediately look into) that basically mean to prioritize. When encountering such a question, remember two important things:

            i.          Know at least the first two base levels of Maslowe’s hierarchy of needs:   Physiological and Safety needs 

            ii.          Know the ABC’s. (Airway, Breathing, and Circulation)

            Apply the Maslowe rule that a physical need must be a priority over a physiological need (NOTE: Under NCLEX, pain is considered physiological). If all of the options left are considered physical, apply the ABC rule, where airway takes priority. A patient having difficulty breathing or has a potential for breathing problem, that patient takes precedence over another person with an open cut wound or broken bones that may eventually affect the person’s circulation.

            The correct answer is C. This patient, though the youngest may have difficulty breathing since bruises are visible on the chest area.

 

Question 4

A nurse observes a post op male patient having a blood pressure of 90/54, respiration of 37, and pulse of 132.  What should the nurse do?

 

            a. Inform the doctor of the patient’s condition.

            b. Continue to monitor the vital signs.

            c. Make sure the patient is lying down and ask the patient how he feels.

            d. Make sure that PRN antiarrythmia medications are ready.

 

Question 5

A nurse observes a child with asthma with a saturation of 76%. What should the nurse do?

            a. Call the physician.

            b. Give the patient oxygen.

            c. Continue to monitor the patient’s vital signs.

            d. Low saturation is normal for patient’s suffering from asthma, thus, the nurse does not have to be alarmed.

 

TIP 4: No Passing the Buck.  When calling the doctor is one of the options, ask yourself if the doctor will be asking you questions related the patient’s condition.  In NCLEX, a nurse is supposed to be able to assess before calling the doctor. However, in question 4, although the nurse would continue to monitor the vital signs for any signs of deterioration and ask the patient’s feeling to determine the level of consciousness, it is important to call the doctor and inform the current condition of the patient. Monitoring the patient is important after informing the physician of the patient’s current status.

            Yet, in question 5, it is important to maintain the saturation to normal level of 92% – 100%. So, calling the doctor would possibly be detrimental for the child for not receiving enough oxygen. So, giving the oxygen to increase the saturation would be an appropriate thing to do. Then, one can call the physician of the patient’s condition.

 

Question 6

It is Wednesday and the hospital policy for each unit is to do a full count of the narcotics. During the count, the nurse noticed a discrepancy in the amount of Hydromorphone (Dilaudid) vials. The nurse should:

 

            a. Inform the nurse manager.

            b. Inform the hospital pharmacist.

            c. Inform the Nurse Director of the hospital.

            d. Inform a nurse colleague.

 

TIP 5: Follow the Chain of Command. Your direct superior is your immediate contact for any personnel, patient or any clinical issues that may arise.

            The correct answer is A.

 

Question 7

A nurse is caring for a patient with Down Syndrome. What are the characteristics that one ought to see with a patient with Down Syndrome?

           

            a. Cherry red macula of the eye, developmentally regressed.

            b. Short stature, webbed hands, low posterior hairline.

            c.  Broad hands, transpalmer creases, epicanthal folds

            d.  Fragile bones, brittle teeth, blue sclera.

 

TIP 6: Apply the “Comma, Comma” rule when appropriate. If the choices list several possible answer, if one of the choices is already incorrect, then eliminate that answer.

            The correct answer is C

 

Question 8

A nurse was floated to another unit where there is another RN, one LPN and a Nurse Aide. Which of the patients can be assigned to the floated Nurse Aide?

           

            a. A patient with exacerbation of multiple sclerosis.

            b. A patient with injury on the C3 and is on Crutchfield tongs for immobilization.

            c. A patient who is status post abdominal surgery, 1 hour ago.

            d. A hemiplegic patient and has urinary tract infection.

TIP 7: In some hospitals Nurse Aide are referred to as UAP (Unlicensed Assistant Personnel), PCA (Patient Care Assistant). Regardless of what they are referred to, when assigning patients, they should be given the most stable patient. In addition, LPNs are under the supervision of RNs. Again, when there are only RN and LPN in the unit, the most stable patient should be assigned to the LPN.  Moreover, a Registered Nurse that has been floated to another unit should be assigned the most stable patient, even if that floated RN has had more years of experience than another RN in the unit.

            Generally, the Registered Nurse (RN) is responsible for the following:

·         Must do all the Teaching.

·         Must do the Discharge.

·         Must do Assessment (TIPS: Vital Signs are part of assessment and RN’s must do the initial assessment).

·         Must do the Assessment on newly admitted patients in the hospital and in the unit.

·         KNOW the educational and personality of nurse aides / assistants not enough to just ask them to report back give them details.

 

            In essence, there is no need to really remember who does what. It is important, when an RN has a Nurse Aide and LPN to assist, assign the most stable patient to a Nurse Aide and the next most stable patient to the LPN. The RN should be responsible for the least stable patients.

            NCLEX will also put in the number of years of experience of each Nurse aides / LPNs and the years of number of experience do not have any relevance. For instance, the problem above may indicate the LPN and the Nurse aide having more years of experience than the nurse and those numbers will not matter.

            To further clarify, if given a problem indicates two nurses with two varying years of experiences, again, those years of experiences will not matter. If the one nurse with the most years of experience is floated to another floor/unit, that nurse will have to get the most stable patient.

            Thus, the correct answer for Question 8 is B, the most stable patient.

 

 

 Question 9

A patient admitted in the ER after being involved in a motor vehicular accident had a blood alcohol level of 460 mg/dL. The nurse should carefully assess for:

 

            a. Respiratory depression

            b. Loss of coordination

            c. Fever

            d. Visual disturbance

 

TIP 8: It is good to know your LAB VALUES (See section on summary of LAB VALUES). Except for a couple of lab values such as specific urine gravity and serum sodium level, majority of the books for  laboratory results will have differing absolute values. Most hospitals will even have different exact values. It is important to just have a general idea of where the normal range lies for that particular lab value in order to help you assess the situation in the NCLEX question.

            However, if you do not know the range of the lab value in question, choose the appropriate answer in relation to information provided.

            The correct answer is A.  One may not be aware of the range of the lab value for alcohol but it is not necessary. One can apply TIP 3, and choose answer A.

 

TIP 9: Any situation presented in NCLEX is IDEAL. For instance, a unit in a hospital may not be fully staffed but in the NCLEX world, always assume that there are enough LPNs, Nurse Assistants to assist the RN.

 

TIP 10: Know the meaning and significance of terms particularly the ones that may be confusing because they may might sound alike. Some examples of terms with their definitions are noted below.

 

·         Acrocyanosis – blue or purple discoloration of extremities especially the finger, toes or nose. Common in babies but a critical sign in adults.

·         Agranulocytosis – deficit or lack of granulocytic white blood cells

·         Aphasia – loss of ones ability to communicate. Difficulty forming words. Impairment of the power to use or comprehend words. Usually due to a brain damage.

·         Agnosia – loss of comprehension of auditory , visual or other sensations.

·         Apraxia -  can’t perform purposive movements even though there is no sensory or motor impairment.

·         Akathesiaextrapyramidal side effect caused by antipsychotic medications where the individual is unable to stand or sit still

·         Ataxia – loss of ability to coordinate voluntary muscular movements usually due to a nervous disorder

·         Asterixis – an involuntary jerky movement usually seen in the hands or flopping movements of the wrist when hands are extended. It can be seen also in the tongue and feet also. Often seen in patients with liver disease, history of alcohol    abuse. 

                  - a sign of liver failure

·         Endemic  - a disease that occurs in a given population, with a certain number of cases, and is expected for a given period.

·         Epidemic – a disease that occurs or attacks many people at the same time in the same geographical area.

·         Pandemic  - a disease that affect the majority of the population of a large region or different parts of the world.

·         Epistaxis – nose bleed

·         Polycythemia Vera – a chronic disorder that leads to the increase production of red blood cells occurring independently of erythropoietin stimulation.

 

 

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