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NCLEX-RN Exam Preparation

Oct 03, 202410 min read

I: Clinical Judgment and the Next Generation NCLEX (NGN)-RN Examination

II: Self-Efficacy and Pathways to Success

III: The NCLEX-RN Examination from a Graduate’s Perspective

IV: Clinical Judgment and Test-Taking Strategies

  1. Focus on the data in the case study or question, read every word, and make a decision about what the question is asking.
  2. Note the subject and determine what content is being tested. Visualize the event and recognize cues; note if an abnormality exists in the data and analyze or interpret the data provided.
  3. Look for strategic words; keywords that point towards what the question is about.
    • “Immediate”, “Initial”, “First”, “Priority”, “Best”, “Need for”, “Follow-up”, “Need for further teaching”, etc. create a difference in the question’s desired answer.
  4. Determine if the question contains a positive or negative event query.
    • A positive event query uses strategic words that ask you to select a correct option, e.g., “Which statement by a client indicates an understanding of the side effects of the prescribed medication?”
    • A negative event query uses strategic words that ask you to select an option that is an incorrect item or statement, e.g., “Which statement by a client indicates a need for further teaching about the side effects of the prescribed medication?”
  5. Avoid reading into the question. Never think “Well, what if…?” scenarios. However, this is useful for Next-Generation NCLEX (NGN) items that contain scenarios that unfurl in different ways depending on your answers. You will need to consider all existing and potential concerns, such as complications that can occur. Focus on what the question is asking to assist in determining what you need to consider.
  6. Apply to NCSBN Clinical Judgment Measurement Model (NCJMM) and the six cognitive skills/processes alongside other test-taking strategies.
  7. Determine the “Ingredients of a Question”: the event, which is a client or clinical situation; the event query, which asks for something specific about the content of the event; and the options or answers. Options and answers can be: multiple-choice, multiple-response, ordered-response, fill-in-the-blank, chart/exhibit question, or NGN-type/case study approach questions.

Prioritizing Strategies

Many questions require the test-taker to prioritize. While this can require specific knowledge of the disease process or situation that is implicated in the question, the nurse can utilize the ABCs of Life, Maslow’s Hierarchy of Needs, the Nursing Process (ADPIE), and NCJMM to determine priority needs and actions.

  1. ABCs: Airway is always the first priority. Note that an exception occurs when cardiopulmonary resuscitation (CPR) is performed; in this situation, CAB (Compression, Airway, Breathing) guidelines are followed.
  2. Maslow’s Hierarchy of Needs Theory: physiological needs are the priority, followed by safety and security needs, love and belonging needs, self-esteem needs, and finally, self-actualization needs. When a physiological need is not addressed in the question or noted in one of the options, continue to use Maslow’s Hierarchy of Needs theory sequentially as a guide and look for the option that addresses safety.
    • Physiological needs include breathing, food, water, shelter, clothing, sleep
    • Safety and Security needs include health, employment, property, family, and social ability.
    • Love and Belonging needs include friendship, family, intimacy, and sense of connection.
    • Self-Esteem needs include confidence, achievement, respect, and uniqueness.
    • Self-Actualization needs include morality, creativity, spontaneity, acceptance, purpose, meaning, and inner potential.
  3. Nursing Process: assessment, analysis, planning, interpretation, and evaluation; and NCJMM Cognitive Skills: recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.
    • Assessment/Recognizing Cues: the nurse recognizes cues by identifying significant data from many sources.
      • Questions under this process involve the process of gathering subjective and objective data relative to the client, confirming the data, and communicating and documenting the data.
      • Remember that assessment/recognizing cues is the first step. It is the option when asked what the “first”, “immediate”, or “initial” nursing action.
      • An exception exists when in an emergency situation; a nursing action may be better than gathering more data.
    • Analysis/Analyze Cues and Prioritize Hypotheses: connect significant data to the client’s clinical presentation and determine if the data is expected, unexpected, or concerning. From this, determine client needs (hypotheses) and prioritize the hypotheses from highest to lowest.
      • This process contains the most difficult questions because they require understanding various principles of physiological responses and requires interpretation of assessment data. Critical thinking, decision-making, and prioritization are all required. Communication and documentation may also be included.
      • These types of questions may require examining a broad concept and breaking it down into smaller parts and assimilation of the information and application to a client scenario.
    • Planning/Generating Solutions: using the hypotheses, determine interventions for expected client outcomes.
      • These types of questions require prioritizing client problems, determining goals and outcome criteria for goals of care, developing the plan of care, and communicating and documenting the plan of care.
      • Most questions focus on actual client problems rather than potential future problems.
    • Implementation/Taking Action: the implementation of generated solutions addressing the highest priorities or hypotheses. Focus on nursing actions rather than medical actions when answering, except if the questions asks for what prescribed medical action is expected and necessary.
      • These questions address further assessment or analyzing, organizing, and managing care, counseling and teaching, providing care to achieve established goals, supervising and coordinating care, and communicating and documenting nursing interventions.
      • Remember that the only client you need to worry about is the one presented in the question; do not read into the question. Answer it from a textbook and ideal point of view, and think about and visualize the data in the question as a real clinical situation, where all requisite supplies are present at bedside.
    • Evaluation/Evaluate Outcomes: the nurse compares observed outcomes with expected ones. Negative event queries (“Which of the following is not…”, “All are… except…”).
      • These questions focus on comparing the actual outcomes of care with the generated solutions and expected outcomes and on communicating and documenting findings. They also focus on assisting in determining the client’s response to care and identifying factors that may interfere with achieving expected outcomes.
  4. Determine if an abnormality exists: in the question, the client scenario will be described. Determine any abnormalities present in present information using nursing knowledge. If abnormalities are present, either further nursing assessment and analysis or further nursing action will be required. Therefore, continuing to monitor or documenting will not likely be a correct answer, if presented as options.
  5. Focus on the data in the question and recognize cues: data in the question and/or options is important in answering the question correctly. When placed to indicate an abnormality, assessment cues are not likely to be borderline, and will be clearly beyond normal range. If the data is borderline, then another event in the scenario may cause that assessment cue to become fully abnormal.
  6. Ensure client safety: always consider client safety when choosing options. If adverse effects or heightened risk is produced by an option, eliminate it as a valid answer.
  7. Eliminating Alike or Comparable Options, Options that use Close-Ended Words: when reading the options in multiple-choice questions, look for options that are comparable or alike; words like “all”, “always”, “every”, and “must” are examples of absolute words that are often found in wrong answers.
  8. Look for Umbrella Options: an umbrella option is one that is a broad, comprehensive, or universal statement that usually contains the concepts of the other options within it. Often, this option will be the correct answer.
  9. Use Guidelines for Delegating and Assignment-Making

Questions on Client Needs

More information can be found at the NCSBN website

Physiological Integrity

These questions test the concepts of nursing care as they relate to comfort and assistance in the client’s performance of ADLs, as well as care related to the administration of medications and parenteral therapies. These address the nurse’s ability to reduce the client’s potential for developing complications or health problems related to treatments, procedures, or existing conditions and to provide care to clients with acute, chronic, or life-threatening physical health conditions.

  • Focus on Maslow’s Hierarchy of Needs theory in these types of questions, and remember that physiological needs are a priority and are addressed first.
  • Use the ABCs, Nursing Process, and NCJMM when selecting an option addressing Physiological Integrity. Note that circulation supplants the airway (ABC becomes CAB) in cases of CPR.

Safe and Effective Care Environment

These questions test the concepts of providing safe nursing care and collaborating with interprofessional team members to facilitate effective client care; these also focus on the protection of clients, significant others, and health care personnel from environmental hazards.

  • Focus on safety with these types of questions. Remember the importance of hand washing, the nurse call system, bed positioning, side rails, asepsis, standard (and other) precautions, triage, environmental safety, and emergency response planning.

Health Promotion and Maintenance

These questions test the concepts that the nurse provides and assists with in directing nursing care to promote and maintain health. Content addressed in these questions relates to assisting the client and significant others during the normal expected stages of growth and development, and providing client care related to the prevention and early detection of health problems.

  • Use teaching and learning theory if the question addresses client teaching, remembering that the client’s willingness, desire, and readiness to learn is the first priority. Watch out for negative event queries, as they are frequently used for this category.

Psychosocial Integrity

These questions test the concepts of nursing care that promote and support the emotional, mental, and social well-being of the client and significant others. Content addressed in these questions relates to supporting and promoting the client’s or significant others’ ability to cope, adapt, or problem-solve in situations such as illnesses; disabilities; or stressful events, including abuse, neglect, or violence. You may be asked communication-type questions that relate to how you would respond to a client, a client’s family member or significant other, or other health care team members.

  • Use therapeutic communication techniques to answer communication questions because of their effectiveness in the communication process. Remember to identify the client of the question and to select the option that focuses on the thoughts, feelings, concerns, anxieties, or fears of the client, client’s family member, or significant other.

Pharmacology Questions

If you are familiar with the medication, use your nursing knowledge to answer the question. Remember that the question will identify the generic name of the medication only (but still be familiar for commonly recommended brands). If a medical diagnosis is presented, try to form a relationship between the medical diagnosis and the medicine. For example, you can determine that cyclophosphamide, when used for a client with breast cancer, is likely an antineoplastic medication. Diagnoses are not always presented in questions.

  • Try to determine the classification of the medication being addressed to assist in answering the question. Knowing a drug’s classification can aid in determining its action or side/adverse effects or both. Learn medications that belong to a classification by commonalities in their medication names. For example, medications that act as beta blockers end with “-lol”, e.g. atenolol, propranolol.
  • Determine if the question is asking for the drug’s side intended effect, side effect, adverse effect, or toxic effect. Side effects, adverse effects, and toxic effects often appear as exacerbations of the intended effect. For example, an antihypertensive drug may cause hypotension.
  • Nursing intervention related to medications is usually related to the drug’s action; for example, if a drug’s side effect is hypertension, the associated nursing intervention would be to monitor the patient’s blood pressure.

Pyramid Points:

  1. In general, the client would not take antacids with medication because it affects its absorption.
  2. Enteric-coated and sustained-released tablets should not be crushed; capsules should not be opened.
  3. The client would never adjust, change, or abruptly discontinue a medication or its dosage.
  4. The nurse needs to avoid taking any over-the-counter medications or any other medications, such as herbal preparations, unless they are approved for use by the primary health care provider.
  5. The client avoids consuming alcohol.
  6. Medications are never administered if its prescription is difficult to read, unclear, or shows an abnormal dosage.

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