2. Delegation of work and knowing the responsibilities of aides, LPNs and RNs. Now that there are more and more types of caregivers, nurses need to know what kinds of care are appropriate for each type.

3. Age-related changes and emotions. LPNs often care for the elderly, and they need to be aware of what they should expect.

4. The signs and symptoms of serious complications, such as hypoglycemia as a result of poor glucose control, which could easily occur in a hospital or nursing care facility.

5. Know the signs and symptoms of toxicity of common drugs that have serious side effects. Examples are digoxin or lithium.

6. Know the antidotes of common drugs such as magnesium sulfate (calcium gluconate), heparin (protamine sulfate), and Coumadin (vitamin K or aquamephyton).

7. It is necessary to memorize certain laboratory values, such as hemoglobin (12–18g/dl), white blood count (5,000–10,000 mm3), and platelets (150,000–400,000). Also learn sodium, potassium, calcium, blood gases, and glucose levels. Know the implications of high or low values and what diseases they are associated with.

8. Pain management is also a frequent topic today. Remember that addiction is not a concern when giving narcotics in almost all situations, and that pain is determined by the patient. A nurse cannot decide whether or not a complaint is valid.

Scores on tests are greatly affected by reading ability. In answering a test item, you

should begin by carefully reading the stem and then asking yourself the following

questions:

• What is the question really asking?

• Are there any key words?

• What information relevant to answering this question is included in the stem?

• How would I ask this question in my own words?

• How would I answer this question in my own words?

After you have answered these questions, carefully read the options and then ask yourself the following questions:

• Is there an option that is similar to my answer?

• Is this option the best, most complete answer to the question?

Deal with the question as it is stated, without reading anything into it, or making

assumptions about it. Answer the question asked, not the one you would like to answer.

For simple recall items the self-questioning process usually will be completed quickly.

For more complex items the self-questioning process may take longer, but it should assist

you in clarifying the item and selecting the best response.

2.      Identify Key Words

Certain key words in the stem, the options, or both should alert you to the need for

caution in choosing your answer. Because few things are absolute without exception, avoid selecting answers that include words such as always, never, all, every, only, must,

no, except, and none. Answers containing these key word are rarely correct because they

place special limitations and qualifications on potentially correct answers.

For example:

All of the following are services of the National Kidney Foundation except:

1. Public education programs

2. Research about kidney disease

3. Fund-raising affairs for research activities

4. Identification of potential transplant recipients

This stem contains two key words: all and except. They limit the correct answer choice to

the one option that does not represent a service of the National Kidney Foundation. When

except, not, or a phrase such as all but one of the following appears in the stem, the

inappropriate option is the correct answer—in this instance, option 4.

If the options in an item do not seem to make sense because more than one option is

correct, reread the question; you may have missed one of the key words in the stem. Also

be on guard when you see one of the key words in an option; it may limit the context in

which such an option would be correct.

3.      Pay Attention to Specific Details

The well-written multiple-choice question is precisely stated, providing you with only the

information needed to make the question or problem clear and specific. Careful reading

of details in the stem can provide important clues to the correct option. For example:

A male client is told that he will no longer be able to ingest alcohol if he wants to

live. To effect a change in his behavior while he is in the hospital, the nurse should

attempt to:

1. Help the client set short-term dietary goals

2. Discuss his hopes and dreams for the future

3. Discuss the pathophysiology of the liver with him

4. Withhold approval until he agrees to stop drinking

The specific clause to effect a change in his behavior while he is in the hospital is critical.

Option 2 is not really related to his alcoholism. Option 3 may be part of educating the

alcoholic, but you would not expect a behavioral change observable in the hospital to

emerge from this discussion. Option 4 rejects the client as well as his behavior instead of

only his behavior. Option 1, the correct answer, could result in an observable behavioral

change while the client is hospitalized; for example, he could define ways to achieve

short-term goals relating to diet and alcohol while in the hospital.

4.      Eliminate Clearly Wrong or Incorrect Answers

Eliminate clearly incorrect, inappropriate, and unlikely answers to the question asked in

the stem. By systematically eliminating distractors that are unlikely in the context of a

given question, you increase the probability of selecting the correct answer. Eliminating

obvious distractors also allows you more time to focus on the options that appear to be

potentially sound answers to the question. For example:

The four levels of cognitive ability are:

1. Assessing, analyzing, applying, evaluating

2. Knowledge, analysis, assessing, comprehension

3. Knowledge, comprehension, application, analysis

4. Medical-surgical nursing, obstetric nursing, psychiatric nursing

Option 1 contains both cognitive levels and nursing behaviors, thus eliminating it from

consideration. Option 4 is clearly inappropriate since the choices are all clinical areas.

Both options 2 and 3 contain levels of cognitive ability; however, option 2 includes

assessing, which is a nursing behavior. Therefore option 3 is correct. By reducing the

plausible options, you reduce the material to consider and increase the probability of

selecting the correct option.

5.      Identify Similar Options

When an item contains two or more options that are similar in meaning, the successful

test taker knows that all are correct, in which case it is a poor question, or that none is

correct, which is more likely to be the case. The correct option usually will either include

all the similar options or exclude them entirely. For example:

When teaching newly diagnosed diabetic clients about their condition, it is

important for the nurse to focus on:

1. Dietary modifications

2. Use of sugar substitutes

3. Their present understanding of diabetes

4. Use of diabetic nutritional exchange lists

Options 1, 2, and 4 deal only with the diabetic diet, involving no other aspect of diabetic

teaching; it is impossible to select the most correct option because each represents

equally plausible, though limited, answers to the question. Option 3 is the best choice

because it is most complete and allows the other three options to be excluded.

As another example:

A child’s intelligence is influenced by:

1. A variety of factors

2. Socioeconomic factors

3. Heredity and environment

4. Environment and experience

The most correct answer is option 1. It includes the material covered by the other options,

eliminating the need for an impossible choice, since each of the other options is only

partially correct.

6.      Identify Answer (Option) Components

When an answer contains two or more parts, you can reduce the number of potentially

correct answers by identifying one part as incorrect. For example:

After a cholecystectomy the postoperative diet is usually:

1. High fat, low calorie

2. High fat, low protein

3. Low fat, high calorie

4. Low fat, high protein

If you know, for instance, that the diet after a cholecystectomy is usually low or moderate

in fat, you can eliminate options 1 and 2 from consideration. If you know that the

cholecystectomy client usually is overweight, you can eliminate option 3 from

consideration. Therefore option 4 is correct.

7.      Identify Specific Determiners

When the options of a test item contain words that are identical or similar to words in the

stem, the alert test taker recognizes the similarities as clues about the likely answer to the

question. The stem word that clues you to a similar word in the option or that limits

potential options is known as a specific determiner. For example:

The government agency responsible for administering the nursing practice act in

each state is the:

1. Board of regents

2. Board of nursing

3. State nurses’ association

4. State hospital association

Options 2 and 3 contain the closely related words nurse and nursing. The word nursing,

used both in the stem and in option 2, is a clue to the correct answer.

8.      Identify Words in the Options That Are Closely Associated With Words in the Stem

Be alert to words in the options that may be closely associated with but not identical to a

word or words in the stem. For example:

When a person develops symptoms of physical illness for which psychogenic

factors act as causative agents, the resulting illness is classified as:

1. Dissociative

2. Compensatory

3. Psychophysiologic

4. Reaction formation

Option 3 should strike you as a likely answer since it combines physical and psychologic

factors, like those referred to in the stem.

9.      Watch for Grammatical Inconsistencies

If one or more of the options are not grammatically consistent with the stem, the alert test

taker usually can eliminate these distractors. The correct option must be consistent with

the form of the question. If the question demands a response in the singular, plural

options usually can be safely eliminated. When the stem is in the form of an incomplete

sentence, each option should complete the sentence in a grammatically correct way. For

example:

Communicating with a male client who is deaf will be facilitated by:

1. Use gestures

2. Speaking loudly

3. Find out if he has a hearing aid

4. Facing the client while speaking

Options 1 and 3 do not complete the sentence in a grammatically correct way and can

therefore be eliminated. Option 2 would be of no assistance with a deaf client, so option 4

is the correct answer.

10.  Be Alert to Relevant Information From Earlier Questions

Occasionally, remembering information from one question may provide you with a clue

for answering a later question. For example:

A client has an intestinal tube inserted for treatment of intestinal obstruction.

Intestinal suction can result in excessive loss of:

1. Protein enzymes

2. Energy carbohydrates

3. Water and electrolytes

4. Vitamins and minerals

If you determined that the correct answer to this question was option 3, it may help you to

answer a later question. For example:

Critical assessment of a client with intestinal suction should include observation

for:

1. Edema

2. Nausea

3. Belching

4. Dehydration

The correct answer is option 4. If you knew that excessive loss of water and electrolytes

may lead to dehydration, you could have used the clue provided in the earlier question to

assist you in answering the later question.

11.  Make Educated Guesses

When you are unsure about the correct answer to a question, it is better to make an

educated guess than not to answer the question. You generally can eliminate one or more

of the distractors by using partial knowledge and the methods just listed. The elimination

process increases your chances of selecting the correct option from those remaining.

Elimination of two distractors on a four-option multiple-choice item increases your

probability of selecting the correct answer from 25% to 50%.

1. Read every question carefully.
2. Ask yourself what the question is asking you.
3. What type of question is? Is this a true response question? True response questions ask you to select the answer that is most correct/accurate.
4. If this is a false response question. False response questions ask you to select the answer that is incorrect or so wrong that it can cause injury to the client.
5. Look for key words. Key words will drive your answer. Key words determine the correct answer.
6. Use key words to answer your questions. Keywords such as: early, best, now, later, most, appropriate, least appropriate, etc. These key words are like warning signs it tell you which direction you must take. More key words.
7. Implement the process of elimination. Eliminate the two choices that make the least sense or make no sense. Then reread the question before you select the final answer. Before you make the final selection, use ABC to answer your questions.
8. Use ABC to answer your questions. Airway is always first; if there are no airway choices, then go to breathing, if no breathing choices, then go circulation choices. Use this simple step by step process to get on the right path to success.
9. If there are no ABC choices then implement the nursing process. The nursing process starts with A- for assessment. Assess, assess, and assess before you anything else. Step 1. Assessment- Airway, breathing circulation, data collection, and inspection, etc. Assessment choices.
10. Step 2. D, diagnosis- nursing diagnosis. It is also call analysis which is assessing the data collected. Analysis questions ask you to select an answer that involves further nursing assessment. Never stop assessing, assess, assess. Analysis choices.
11. Planning. Before you can plan you must assess. Planning questions ask you to select an answer about plan or what you intent to do. Sample Planning choices.
12. Implementation. Implementation questions ask you to select an answer that involves an action, doing something for the client.
13. Evaluation. Evaluation questions ask you to select an answer that has to do with evaluating the outcome. Here are some evaluations keys words such as further, teaching, revaluation and doesn’t understand.

You may also want to read our Test Taking Tips and Strategy to help you Pass NCLEX, Important Tips to Pass NCLEX and Nursing Board Exam and What You Need to Know About NCLEX.

Try to study with a classical music playing in the background! Find a nice cozy, quiet corner where you feel comfortable and there are no distractions, turn on your classical music and begin to study! It really does help to retain information!

Another tip: Try to get up EARLY in the morning to study when your refreshed from a good night of sleep. It will help you tremendously. After studying for a bit, take break or take a walk!

Being test smart is also a help. By being test smart, I mean being able to pick out the KEY words. What are they asking for? Sometimes they will give you tons of information but in reality it is NOT important to the answer. Make sure you re-read a question if you are not sure! Look for those keys, they are usually there and many questions will have them highlighted! Also, there are some words that are DEADLY to an answer. Words that are definite, like MUST, ALWAYS, EVERY. These words in an answer should be triggers that that response is not right! Inevitably, you get down to two answers that could be correct, re-read the question. I look for part of the question in the answer, usually that is the right one!

Try to answer some NCLEX Practice test, NCLEX Quiz and sample NCLEX questions. It really helps. It is not as comfortable as you think!! So practice on a computer too!

The night BEFORE the test…DON’T STUDY!!!! Yes, you heard me! If you have been taking the time to study up to that point, give yourself a little break! RELAX!! Get a good night’s sleep so you are refreshed in the morning.

The Parts of a Question
The question contains several parts:

• the case (sometimes called scenario) – the description of the client and what is happening to him/her
• the stem – the part of the question that asks the question
• the correct response
• distracters – incorrect but feasible choices

Key Words
The most important skill for the test taker is the ability to read the question carefully and determine the key elements in each question. Each question has key words. Key words relate to the client; to the problem; and to specific aspects of the problem.

Client
Factors such as age, sex, and marital status may be relevant. When a child’s age is given it often is very relevant to the answer. Vital signs vary with age. Preoperative teaching methods vary with age. Appropriate toys and diversional activities vary with age. Always pay special attention to the age of a client when it is given. Also consider who is the client for this question. That is, who is the focus of the question. The client may be the identified sick person, or it might be a relative of the identified sick person, or even a staff member.

Problem/Behavior
The problem may be a disease, a symptom or a behavior.

Details of the Problem

• Is the question asking for nursing actions or client symptoms or family responses?
• Does the question ask about a specific aspect of nursing care assessment, planning, implementation, evaluation?
• Does the question ask details relevant to a specific symptom or behavior the client exhibits?
• Is there additional information about the client or the problem that is important?

Priority Setting 

• "What action takes priority?"
• "What should the nurse do first?"
• "What should the nurse do initially?"
• "What is essential for the nurse to do?"

Physiologic needs are first, followed by safety needs, then love and belonging, self-esteem and self-actualization.

The first step of the nursing process is assessment! When the stem of a question asks for the initial nursing action always look to see if there is a relevant assessment answer. The nurse will take an action only when there is enough data to act. Call the physician only when there is not a nursing action that should be taken first. The stem of the question may ask for a nursing action and the correct answer may be to assess.

When the stem of the question asks what is essential for the nurse to do, think safety. Remember many of the test questions are safety questions.

What is the Time Frame?
Whenever a specific time frame is indicated in a question it is very important. Pay attention to it. Time related words may be like early or late in relation in symptoms, pre operative or post operative, care on the day of surgery or later postoperative care.

Repeated Words
Words from the question are repeated in the answer. Frequently the same word or a synonym will be in both the question and the answer.

Opposites
When two answers are opposite such as high blood pressure and low blood pressure or increase the drip rate and stop the IV, or turn on the right side and turn on the left side, the answer is usually one of the two.

Same Answer
If two or three answers say the same thing in different words none can be correct. If the answers are too alike, then neither one is correct.

Odd Answer Wins
The answer that is different from the others is apt to be the correct answer. It may be the longest or the shortest or simply very different in content or style.

Umbrella Answer
One answer includes the others. There may be more than one correct answer. One answer is better than all the others because it includes them.

Test Item Check List
Use this handy list to check yourself every time you answer a test question.

Say to yourself, DID I CAREFULLY…

• Read the stem?
• Read all of the options?
• Read the stem again?
• Look for key words?
• Eliminate obviously incorrect options?

Absolutes
Answers containing universal or absolute words are very apt to be incorrect. Very little in life or nursing is always correct or incorrect. Answers stated in absolute terms should be looked at with great caution.

source: Drexel University

Purpose

1. To determine if you are a safe and effective nurse.

2. To safeguard the public.

3. To test for minimum competency.

Test Content

4. Based on the knowledge and activities of an entry-level nurse.

5. Written by nursing faculty and clinical specialists.

6. Presented as multiple-choice questions with four possible answer choices.

7. Based on integrated nursing content – not on the medical model of medical, surgical, obstetrics,

pediatrics, and psychiatric nursing.

8. Includes 15 experimental questions.

Test Administration

9. The computer adaptive test adapts to your knowledge, skills, and ability level.

10. The question sequence is determined interactively.

11. Questions are selected based on the item difficulty and the test plan.

12. Test dates and times are individually scheduled through a Sylvan Learning Center.

13. Tests are administered at individual computer stations.

Taking the Exam

14. Computer knowledge is not required.

15. 2 keys are used: the space bar to move the cursor and enter/return to highlight and lock in your answer.

16. All other computer keys are disconnected.

17. You receive instructions and a practice exercise before beginning the exam.

18. Any necessary background information appears on the screen with the question.

19. The computer selects a relatively easy first question.

20. The next question is selected by the computer based on your response to the first question.

21. If your answer is correct, the next question is slightly more difficult.

22. If your answer is incorrect, the next question is slightly easier.

23. Questions are selected to precisely measure your ability in each area of the test plan.

Timing

24. There is no time limit for each individual question.

25. You will answer a minimum of 75 questions to a maximum of 265 questions.

26. The maximum time for the exam is 5 hours, including the practice exercise and all breaks.

27. There is a mandatory 10-minute break after 2 hours of testing.

28. There is an optional 10-minute break after 1 1/2 hours additional test time.

This Exam Will End…

29. When the computer has determined your ability, or

30. When a maximum of 5 hours of testing is reached, or

31. When a maximum of 265 questions have been answered.

Scoring

32. It is a pass/fail exam.

33. There is no penalty for guessing.

34. The 15 experimental questions are not counted.

Concerns

35. No answer changes. Questions are selected by the computer based on your previous responses.

36. No scrolling back.

37. No skipping questions. You must answer the question to go on.

Advantages

38. Testing is available year-round, 15 hours a day, six days a week, in five-hour time slots.

39. Results are released by individual state boards.

40. If you fail, you can retest in 3 months.

• Internet
• Saunders NCLEX study cards
• Saunders NCLEX Comprehensive Study Guide
• Sandra Smith NCLEX Review

This method worked for me. – I’m not guaranteeing it will work for you. But it’s worth a try. I took my exam in Aug. 2008 and the computer shut off at the minimum amount of questions. Good Luck!

1. Saunders Nclex Study Cards – Perfect to start at any time. I bought a sturdy plastic container and just flipped through them anytime I felt like it… stress free. Some days you’ll pick up 1, other days you’ll do 10. No pressure no stress, your just reading a couple of cards in your spare time.
2. Saunders NCLEX comprehensive study guide. – Great preparation for subject test while you’re in school, and great for the NCLEX too. No stress method – do the end of questions like you would and open book test. You’d be surprised at how much you’ll learn when you have to search for the answer. It sticks with you.
3. NCBSN – www.learningext.com – They create the NCLEX. They offer study subscriptions as low as (3-week) $49. Trust me, money well spent. I suggest signing up for this right before you take the NCLEX. If you don’t get a chance to read everything (lengthy), make sure you answer all the questions in the Q/A bank. and the Questions and the end of the lessons.
4. Allnurses.com – Fact throwing session – lot’s of random important facts with easy ways to remember them. Go to www.allnurses.com – click on NCLEX discussion – Click on random fact throwing sticky. Direct Url – http://allnurses.com/forums/f197/anyoone-up-random-fact-throwing-308584.html
5. Sandra Smith NCLEX study guide – Great questions and Rationales. list ways to answer certain types of question. Key words, Key sentences, tricky formats. – I suggest highlighting this section and reviewing it the night before you take the test.

NCLEX Preparation Tips:

• Always keep a set of flashcards (whether bought or self-made) on hand in order to make use of traveling/commuting time.
• Set up a feasible study schedule early and plan to stick to it. There is nothing worse than wasting time feeling guilty for not adhering to an impossible schedule. When doing problems, read all of the answers, not just those you get right. This will reinforce your understanding as well as ensure that your original mode of thinking was correct.
• As you go through problems, mark the ones you miss. That way, you will be able to review those questions you had trouble with at a later date.
• Do not plan to spend every free moment studying. You need to reward yourself for your hard work once in a while. Make plans to see a movie with a friend, cook dinner, or take a trip to the gym.
• Bring energy food to the exam. A full day of testing can take a lot out of anyone. Raisins, chocolate, and nuts are great snacks.
• The night before the exam, pull out all of your paperwork and make sure you know where you have to be and at what time. Confirm any lodging and/or travel arrangements you have made. And try to relax. You have studied hard up to the test – passing is just a matter of calming down and facing the exam in an objective manner.
• Make plans to celebrate after your exam. You will have earned it!

by: luvxoni, ehow member