NCLEX

1. NCLEX What is it? How should I study? How do I pass??

2. What is the NCLEX? • National Council Licensure Examination • Administered by the boards of nursing of all 50 states • Mandate to protect the public from unsafe and ineffective nursing care

3. Why must you take the NCLEX? • Each state requires you to pass the NCLEX to get a license • Once you get a license, you will get a title of Registered Nurse (RN)

4. CAT – Computer Adaptive Testing • Each test is assembled interactively based on the accuracy of the candidate’s response to the questions. • First question will be relatively easy, below the level of minimum competency. • If you answer that question correctly, the computer selects a slightly more difficult question. • If you answer it incorrectly, the computer selects a slightly easier question • By continuing to do this, the computer can calculate your level of competence.

5. Taking the Exam • No time limit for each individual question • Maximum of 6 hours to complete the exam. Optional 10 min break after the first 2 hours. Optional break after additional 90 min of testing • Minimum 75 questions, maximum 265 questions • 15 experimental questions, indistinguishable, do not count for or against you

6. Test ends when: • You have demonstrated competency and answered the minimum number of questions (75) • You have demonstrated a lack of minimum competency and answered the minimum number of questions (75) • You have answered the maximum number of questions (265) • You have used the maximum time allowed (six hours)

7. Length of test • Try not to be concerned with the length of the test • Plan on testing for 6 hours and seeing 265 questions • No warm-up time so it is important to be ready to answer every question from the beginning • Concentration is key!!!

8. Content

9. Management of Care 13-19% • A client arrives at the emergency department complaining of acute right lower quadrant abdominal pain. Laboratory tests are performed and the nurse notes that the client’s white blood cell (WBC) count is elevated. The nurse reviews the physician’s orders and contacts the physician to question which order, if noted, in the client’s record? • Maintain an NPO status • Apply a cold pack to the abdomen • Administer 30 mL of Milk of Magnesia (MOM) • Initiate an intravenous (IV) line for the administration of IV fluids

10. Safety and Infection Control 8-14% • A hospitalized client is diagnosed with urethritis caused by a chlamydial infection. The nurse instructs the nursing assistant about which measure to prevent contracting the infection during care? • Contact isolation • Enteric precautions • Standard precautions • Use of gloves and mask

11. Health Promotion and Maintenance 6-12% • A 7-year-old child is hospitalized with a fracture of the femur and is placed in traction. In meeting the developmental needs of the child, the nurse selects which of the following play activities for the child? • A board game • A large puzzle • A finger painting set • A coloring book with crayons The school age child becomes occupied with activities such as collections, drawing, construction, dolls, pets, guessing games, board games, riddles, etc. Option 2 is appropriate for a toddler. 3 and 4 are for preschooler.

12. Psychosocial Integrity 6-12% • A client with ovarian cancer says to the nurse, “If I can just live long enough to attend my daughter’s graduation, I’ll be ready to die.” The nurse determines that the client is experiencing which phase of coping? • Isolation • Bargaining • Depression • Acceptance

13. Basic Care and Comfort 6-12% • A nurse provides instructions to a client about the use of a cane and watches as the client uses it. Which observation by the nurse indicates the need to provide additional instructions to the client? • The client holds the cane on the strong side. • The client holds the cane about 6 inches to the side of the foot. • The client flexes the elbow at a 15- to 30-degree angle when holding the cane in place. • The client moves the cane and the stronger leg forward first and then moves the weaker leg forward.

14. Pharmacological and Parenteral Therapies 13-19% • A nurse caring for a client with hypertension receiving torsemide (Demadex) 5 mg orally daily. Which laboratory finding indicates to the nurse that the client might be experiencing an adverse reaction related to the medication? • A chloride level of 98 mEq/L • A sodium level of 135 mEq/L • A potassium level of 3.1 mEq/L • A blood urea nitrogen level (BUN) of 15 mg/dL Torsemide (Demadex) is a loop diuretic. It can produce water loss and electrolyte depletion. Normal K+ level 3.5-5.0 mEq/L.

15. Reduction of Risk Potential 13-19% • A magnetic resonance imaging (MRI) procedure is prescribed for a client with a suspected brain tumor. The nurse implements which action to prepare the client for this test? • Keeps the client NPO for 6 hours prior to the test • Shaves the groin for insertion of a femoral catheter • Removes all metal-containing objects from the client • Instructs the client in inhalation techniques for the administration of the radioisotope

16. Physiological Adaptation 11-17% • A nurse reviews the blood gas results of a client with pneumonia and determines that the client is experiencing respiratory acidosis. Which of the following validates the nurse’s findings? • pH 7.45, PCO2 52 mm Hg • pH 7.35, PCO2 40 mm Hg • pH 7.25, PCO2 50 mm Hg • pH 7.50, PCO2 30 mm Hg

17. The Nursing Process • Assessment • Analysis • Nursing Diagnosis • Planning • Implementation • Evaluation

18. Critical Thinking • Level’s of Questions in Nursing Tests – Bloom’s Taxonomy

19. The following is an example of a knowledge based question you might have seen in school. This question is at the knowledge level. • Which of the following is a complication that occurs during the first 24 hours after a percutaneous liver biopsy? • Nausea and vomiting • Constipation • Hemorrhage • Pain at the biopsy site

20. Questions at the comprehension level require you to understand the meaning of the material. Let’s look at the same question written at the comprehension level. • The nurse understands that hemorrhage is a complication of a liver biopsy because: • There are several large blood vessels near the liver • The liver cells are bathed with a mixture of venous and arterial blood • The test is performed on clients with elevated enzymes • The procedure requires a large piece of tissue to be removed

21. Minimum competency NCLEX questions are written at the application or analysis level. Your ability to solve problems is not tested with recall/recognition or comprehension level 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 a procedure? • Anorexia, nausea, and vomiting • Abdominal distention and discomfort • Pulse 112, blood pressure 100/60, respirations 20 • Pain at the biopsy site

22. The question is: What is a complication of a liver biopsy? • In order to begin to analyze this question, you must know that hemorrhage is the major complication. • But it’s not listed as an answer

23. So let’s look at the choices… • Anorexia, nausea, and vomiting. Does this indicate that the client is hemorrhaging? No, these are not symptoms of hemorrhage. • Abdominal distention and discomfort. Does this indicate that the client is hemorrhaging? Perhaps. Abdominal distention could indicate abdominal bleeding. • Pulse 112, blood pressure 100/60, respirations 20. Does this indicate the client is hemorrhaging? Yes. An increased pulse, decreased BP, and increased respirations indicate shock. Shock is the result of hemorrhage • Pain at the biopsy site. Does this indicate the client is hemorrhaging? No, pain is expected with this procedure.

24. How about an analysis level question… • The nurse is caring for a 56-year old man receiving Haldol 2 mg PO BID. The nurse assists the client to choose which of the following menus? • 3 oz. roast beef, baked potato, salad with dressing, dill pickle, baked apple pie, and milk • 3 oz. baked chicken, green peas, steamed rice, 1 slice of bread, banana, and milk • Cheeseburger on a bun, french fries with catsup, chocolate chip cookies, apple, milk • 3 oz. baked fish, 1 slice of bread, broccoli, ice cream, and pineapple drink taken ½ - 1 hour after the meal

25. Don’t panic!!! • What type of diet do you chose for a patient taking Haldol? • Haldol is antipsychotic med • There are no diet restrictions for Haldol • This question is really a diet question • Which of the choices is the most balanced regular diet??

26. Answers • 3 oz. roast beef, baked potato, salad with dressing, dill pickle, baked apple pie, and milk. Is this a balanced diet? Yes, it’s possible • 3 oz. baked chicken, green peas, steamed rice, 1 slice of bread, banana, and milk. Yes, it is also a good answer because it contains food from each of the food groups. • Cheeseburger on a bun, french fries with catsucp, chocolate chip cookies, apple, milk. No, this diet is high in fat and does not contain food groups. Eliminate. • 3 oz. baked fish, 1 slice of bread, broccoli, ice cream, and pineapple drink taken ½ - 1 hour after the meal. The choice isn’t bad, but why would the intake of fluids be delayed? Eliminate Which is the better answer? 1 or 2? Dill pickles are high in sodium, so the correct answer is 2.

27. Strategies that DON’T work! • “Cramming” in hundreds of facts about disease process and nursing care. • Recognizing and recalling facts rather than understanding the pathophysiology and the needs of a client with an illness. • Knowing who wrote the question and what is important to that instructor. • Selecting the response that is a different length compared to the other choices. • Selecting the answer choice that is grammatically correct. • When in doubt, choosing C.

28. To be successful on the NCLEX, you must… • Read the question • Decide what the question is asking • Evaluate the answer choices • Select the correct answer