1. Pearls for NCLEX-RN® Success: Strategies to Correctly Answer Questions
Developed by: Staja “STAR” Booker, MS, RN
Reviewed and Approved by: Alumni Webpage Committee ©
Originally Developed for: Penn State

2. PEARLS for NCLEX Success
Practice questions and Pray often Examine the Entire question and all answers Avoid reading into the question and Apply your knowledge and skills Review everyday and Rest often Listen to your “first mind” Study difficult concepts and keep Stress to a minimum

3. Outcomes
After completion of this presentation, learners will be able to:
--Appreciate and recognize importance of critical thinking, clinical judgment, clinical reasoning, and sound decision-making
--Identify the introductory statement, information distracters, and the stem of questions
--Identify the four elements in a question
--Demonstrate ways to isolate the correct answer(s)
--Gain confidence in answering NCLEX-style questions
--Recognize different types of questions

4. NCLEX Readiness Assessment
Complete the “Readiness for NCLEX Assessment” provided on this page webpage. This will help you identify areas that you need to spend additional time studying and practicing

5. 2013 NCLEX Content Areas

6. NCLEX is a computer adapted test (CAT).F Y I
NCLEX is a computer adapted test (CAT).
NCSBN CAT video:

7. Computer Adaptive Testing (CAT)
You can’t skip or review NCLEX questions on the computer. Once you click Next, the questions are GONE!!
There is a tutorial at the beginning of the NCLEX to make sure your computer is working correctly and to ensure that you understand the directions. You will be given a couple of sample questions.
Your computer will automatically shut down after you have or have not demonstrated minimal competency.
Minimum questions – Maximum questions – 265
15 items are “test” questions & are not scored

8. Zerwehk, J. , Claborn, J. C. , & Miller, C. J. (2008)
Zerwehk, J., Claborn, J.C., & Miller, C.J. (2008). Memory notebook of nursing. (Volume 1, Ed. 4). Ingram, TX: Nursing Education Consultants.

9. Review NCLEX test plan
Pearson VUE NCLEX tutorial

10. ˈTwas the night before NCLEX…
Do not study heavily. Use this day to relax, clear your mind, and reflect. If you must study, review core principles of nursing care.
Gather the necessary materials you will need to take with you
Do not drink alcohol or take mind-altering drugs
Sleep well
Avoid “negativity” and think positively. Decree and declare, “I will pass NCLEX the first time and become an excellent RN!”
Dress comfortably

11. Eat a light meal before the test to prevent your blood sugar from dropping.
Arrive to the testing site 30min – 1 hour early.
Have acceptable form of ID!! Don’t bring family, friends, or kids.
You will 1) be photographed, 2) fingerprinted, 3) have your palm veins scanned, and 3) provide your digital signature.
A plastic bag for storage or a locker will be assigned to you to secure all possessions. NOTHING goes into the computer room but your body, exceptions for those with cultural or religious needs
You will be given a dry erase board if you need to write information or do calculations– but no purging of knowledge.
Time Allotted – 6 hours (you can take breaks but the clock doesn’t stop)

12. PASS- YAY! get license number, a job, and begin practicing
Receive “unofficial” results 48 hours after the exam. This service is available for $7.95 on Pearson VUE website.
PASS- YAY! get license number, a job, and begin practicing
FAIL- Never give up. Can retake in 45 days. Will need to register, pay, etc. all over again.
You'll receive an NCLEX Candidate Performance Report (CPR) which is an individualized document that shows how you performed in each of the test plan content areas.

13. To learn more about NCLEX:
NCSBN Website
See “The 8 Steps of the NCLEX” at

14. KEEP THIS IN MIND
When answering NCLEX questions, keep these two statements in mind:
If I can only do one thing now….
What will cause my patient least harm and most benefit?

15. You betta check yo’ self!
Remember ABCs or CABs (appropriately)
Know how to care for prevalent health conditions
Know normal lab levels
Know principles of infection prevention and control & various precautions
Prioritization
Better safe than sorry!

16. TOPIC 1: Misreading Questions
Misreading questions is a common reason why students answer question wrong.

17. Misreading Questions Do not misread questions. This can occur if you:
Read into the question: if it doesn’t say it, then don’t add it to the scenario.
Incorrectly analyze what the question is really asking you
Overlook key words
Misinterpret a disorder
Read question too fast

18. Misreading Questions
The brain can read something that is not there, but it is important to take your time and analyze exactly what is presented.
If it doesn’t say it in the question, then don’t assume or add anything. Granted, there are things that you should know and/or gather from the situation presented.
For example, if a question said that urine output per hour was below normal, then you can accurately conclude that output was less than 30ml/hr. But if it the question said that the urine was abnormally colored then you can’t assume that the urine was dark amber…it could be red, blue, orange, etc.

19. Misreading Sentences
Look at this example…let’s read it aloud. Paris in the the spring time

20. Misreading Sentences
Did you catch that there are 2 “thes” in the phrase?
You most likely read the statement like this: “Paris in the spring time” when it really says “Paris in the the spring time”

21. Misreading Sentences
Here’s another example…count the number of Fs below.
Finished files are the result of years of scientific study combined with the experience of full years.

22. Misreading Sentences Did you count 7 Fs?
Finished files are the result of years of scientific study combined with the experience of full years.

23. Misreading Sentences
Read this sentence aloud.
Every 8 out of 10 hunans report they are unhappy with their career choice.

24. Misreading Sentences
Now how many of you read “Every 8 out of 10 HUMANS report they are unhappy with their career choice.”
The word was HUNAN.

25. Misreading Sentences
Misreading sentences can cause you to miss key information.
Take your time reading scenarios and understanding what the question is asking.

26. RACE Model
Recognize
Ask
Critically analyze
Eliminate

27. RACE Model RECOGNIZE what kind of information in the stem.
Recognize key words in the stem.
Recognize who the client is in the stem.
Recognize what the topic is about.

28. RACE Model ASK what is the question asking?
Ask what are the key words in the stem that indicate the need for a response.
Ask what is the question is asking me to do

29. RACE Model
CRITICALLY analyze the options in relation to the question asked in the stem.
Critically examine each answer option in relation to the information in the stem (do the answers even match the information in the stem?)
Critically identify a rationale and risk/benefit for each option
Critically compare and contrast the option in relation to the information in the stem and their relationships to one another

30. RACE Model ELIMINATE as many answer options as possible
Eliminate one option at a time (determine if any answer options were in your “pool” of answers)
If any part of the answer is wrong, the entire answer is all wrong
Usually the answer that is most different from the other answer options is correct

31. TOPIC 2: Parts of a Question

32. Parts of a Question Each question has 3-4 parts:
Introductory statement
Clinical Information Distracters (sometimes)
Stem
Four answer options with 3 answers being distracters and 1 correct answer (unless it is select all that apply/multiple select)

33. Parts of a Question
ITEM

34. Introductory Statement
The introductory statement tells you about the client’s situation, health problem, or clinical status that you should consider when answering the question.
The introductory statement sets up the scenario.

35. Introductory Statement
Example:
Mr. Wilson is prescribed an iron supplement and an increased intake of Vitamin C in his diet.
The nurse understands that the best rationale for increasing Vitamin C in the diet is to:

36. The Invisible Gorilla Challenge
Closely count the number of passes made by basketball players in white shirts.

37. 1. Did anyone see the gorilla that appeared halfway through the video?
Distracters
1. Did anyone see the gorilla that appeared halfway through the video?
Well that gorilla appeared to distract you, and sometimes information in questions and answers are simply there to distract you.
If you saw the gorilla and it threw you off from counting, you have to be careful about allowing distractor information in questions throw you off.

38. Distracters
Distracter information in questions or answers is just that – it distracts, detracts, and subtracts from the main issue.
It is information that provides additional detail but does not necessarily help to answer the question.

39. Distracters
You must keep your mind on what the question is asking and what the answer is answering.
Likewise, in practice, you should avoid allowing non- emergent issues distract you from critical tasks… (medication administration, receiving or reporting critical labs, charting, report, etc.) because this increases risk of nursing errors.

40. Awareness of Distracters
On the flip side, failing to see the gorilla is reflective of inattentional blindness.
Sometimes we overlook key points in the question (e.g. misread questions) and we read (or see) what we want to you read (see).

41. Contributing Factors of Inattentional Blindness
Mental Capacity – how much your mind you “hold”; fatigue, stress, drugs and alcohol, sleep deprivation all decrease mental capacity
Conspicuity – physical properties of an image; we notice things that are bright, flicker, and move, italicized, bolded, all caps, etc.; NCLEX does not provide any of these sensory hints.
Expectation – seeing what we believe or know; If something was correct the first three times you checked you may miss that it is incorrect the fourth time
Mental Workload – how much is on your mind; although we are expected to multitask, if your mind is overloaded and attention is diverted there is increased risk for errors; Example: You are talking to a NP on the phone and fail to hear the ventilator alarm

42. Distracters in Questions
Example:
Mrs. Jackson was admitted to the medical-surgical unit for a COPD exacerbation, but she is currently stable.
She is in normal sinus rhythm (NSR) and her blood glucose is 143.
Which rationale best explains why Mrs. Jackson is only prescribed 2L oxygen?

43. Distracters in Answers
Mr. Ron is a thirty five year old male in the trauma ICU post MVA. A nasogastric tube has been inserted for feeding and medication delivery. Which part of the body requires special hygiene for a patient with a nasogastric tube?
Rectum
Abdomen
Oral cavity
Perineal area

44. Stem of a Question
The STEM is the portion of a question that “asks” the nurse to solve a specific problem by implementing a nursing action.
This is usually the actual “question.”
However, the stem may not be a separate sentence, but it may be a part of the introductory statement.

45. Types of Stem 2 types of Stem: --Appropriate action
(what the nurse should do, or did correct)
(what the patient should do or did correct)
(what is true) – Positive polarity
--Inappropriate action
(what the nurse shouldn’t do, or did incorrect)
(what the patient shouldn’t do or did incorrect)
(what is false) – Negative polarity

46. Stem of a Question Example of STEM as a separate sentence:
During dinner, a client puts on her call light. When the RN enters the room, she notices that he is grabbing his chest and complaining of severe chest pain.
What action should the nurse take first?

47. Stem of a Question
Example of STEM as part of the introductory statement:
After inserting a nasogastric (NG) tube in a patient for nutritional tube feedings, it is important to:
xxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxx

48. TOPIC 3: Elements of a Question

49. Elements of a Question There are four elements in each test question:
Subject
Issue or problem
Key words
Appropriate or Inappropriate Action (i.e. answers)

50. Step # 1
Identify the subject.

51. The Subject The subject is the focus of the question.
The subject can be a patient (or client), nurse, family member(s), or colleagues.
REMEMBER the answer choice you select must relate to the subject.

52. The Subject
Example:
A 23 year old female arrives at the ED after collapsing at home. She has no pulse or respirations. Which of the following accurately describes the cardio-pulmonary resuscitation process?
So who is the subject?
The 23 year old female
Is she the patient, nurse, or family member?
patient

53. Step # 2 Identify the issue or the topic THEN determine
Is further assessment needed?
Is it appropriate to apply ABCs or CABs?

54. The Issue
The issue is the specific problem that the question is asking about.
Make sure you pay attention to what the question is specifically asking you about.
The issue is not necessarily the same as the patient’s admitting diagnosis. The question may tell you what the diagnosis is, but may not ask you anything about it.

55. The Issue What is the issue? Prevention of transmission of HIV and TB
An HIV + patient is admitted to the hospital with a tuberculosis (TB). Which of the following isolation categories should be implemented in order to prevent transmission of the HIV virus and tuberculosis? Select all that apply
Strict isolation
Respiratory precautions
Universal precautions
Enteric precautions
What is the issue?
Prevention of transmission of HIV and TB

56. Step # 3
Identify Key Words

57. Key Words
Key words are the important words in a question that should focus your attention on critical ideas in the stem and answers.
Key words can be positive, negative, urgent or absolute (i.e. definite).

58. CAN YOU THINK OF SOME KEY WORDS YOU HAVE SEEN ON YOUR EXAMS?

59. Examples of Key Words Positive Negative Urgent least unlikely except
should do
most likely
appropriate
effective
true
include(d)
indicated
consistent
realistic
correct
not needed
safe
best
least
unlikely
except
inconsistent
inappropriate
contraindicated
false
not
incorrect/wrong
unrealistic
need…
unsafe
Late
Priority (high or low)
first
initial(ly)
immediate(ly)
most important
STAT
now
early
prior
primary
quickly
Essential
mandatory

60. Examples of Key Words Always Never All Completely Only Directionality
Inexact
Absolute (Definite)
Maximum
Minimum
High
Low
Possible/y
Usually
May
Some
Often
Most
Many
Mainly
These terms often makes answers true.
Always
Never
All
Completely
Only
These terms usually make answers false!!

61. Examples of Key Words for The Nursing Process
Assessment
Planning
Assess
Ascertain
Gather
Collect
Determine
Identify
Monitor
Observe
Obtain (information)
Recognize
Find out
Check
Plans
Goals
Develops
Determine

62. Examples of Key Words for The Nursing Process
Interventions
Evaluation/Outcomes
Intervenes
Apply(ies or ication)
Implements
Expects
Demonstrates
Displays understanding
Observes
Anticipates
Evaluate
Achieve
Interpret

63. Key Words Example: When beginning an IV, the nurse should first:
xxxxxxxxxxxxxxxxxxxx

64. Identify appropriate or inappropriate nursing action
Step # 4
Identify appropriate or inappropriate nursing action

65. Appropriate or Inappropriate Action
Mentally create a pool of answers
Then, examine each answer choice given and determine which outcome best answers the question
Your first answer may not be an option, so choose the 2nd best, safe answer.

66. Make Mental Answers
An older adult with heart failure, Parkinson’s disease, Lewy body dementia, sleep apnea, and peripheral vascular disease is having trouble sleeping at night. He already takes many medications, and his wife does not want to add any additional ones. What non-pharmacological strategies may be safe to implement to aid in sleep?

67. Answer Options Give warm herbal tea 15 minutes before bed
Administer melatonin pills
Play soothing music on a low volume and dim lights
Talk to the older gentleman for an hour

68. Make Mental Answers
What should the nurse do immediately before performing any procedure for a patient?

69. Answer Options Select all that apply Shut the door Wash hands
Close the curtain
Explain the procedure
Ask for patient’s permission

70. Putting It All Together
An elderly confused man is on bed rest due to a DVT in his right leg. Which intervention will not effectively provide for this patient’s safety? Who is the subject? Elderly man What is the issue? Safety What are the key words? Will not effectively What are the distracters? None What would you do? (your pool of answers) Let’s examine each answer and determine which will effectively provide safety.

71. Putting It All Together
An elderly confused man is on bed rest due to a DVT in his right leg. Which intervention will not effectively provide for this patient’s safety?
Provide regular toileting by bedpan
Explain to the man that he should use the call light if he needs to get up
Place 3 side rails in the up position and check on the client often
Initiate proper use of restraints
Place the bed in lowest position

72. QUESTIONS?

73. TOPIC 4: Answer Option Tips

74. Answer Option Tips
After reading the question, develop a pool of answers in your mind before looking at the actual answers provided.
Answer the question, as if the situation is ideal or “textbook perfect.”
Your first choice may not be there, so choose the next best answer.
Three of the answer options are there to distract you, so make a decision on each before continuing.
Make a yes/no decision on each answer choice before moving to the next answer choice.

75. Answer Option Tips
Look at how words or actions are grouped. Are all the answers physiological, intervention-centered, assessment, etc.?? There is only one best answer.
No test question on NCLEX is keyed for two responses unless it is select all that apply.
Go with your “first-mind”; never change your answer!!!
If you do not know the answer, make your best educated guess and move on. Don’t spend more than minutes/question.

76. Answer Option Tips
Do not focus only on your experiences, which may be too narrow for a point of reference
FOCUS ON WHAT YOU KNOW AND NOT ON WHAT YOU DON’T KNOW!!!
Scope of practice - Be able to differentiate the need for nursing judgment from the need for physician judgment.
Watch out for answer choices that are factually correct on their own, but fail to answer the question, and so are actually wrong.

77. Answer Option Tips
Select responses that are:
Therapeutic and patient-centered
Show respect
Communicate acceptance
Eliminate responses that are:
Obviously wrong
Inappropriate and non-therapeutic
Partially true
In some instances, rule out an option if you know it is associated with something else. For example, you may not know about the laboratory values for warfarin therapy, but you do know the laboratory values for heparin and aspirin. Those values can be eliminated because you are “using what you know.”

78. TOPIC 5: NCLEX Question Formats

79. NCLEX Question Formats
Multiple choice (one correct answer)
Alternate Item Formats
Multiple response (select all that apply)
Hot spots
Audio or Video
Drop-and-drag/ordered response
Chart exhibits
Fill-in-the blank (calculation questions)
Graphics (e.g. ECG rhythm)

87. NCLEX QUESTION
For a tutorial on alternate item NCLEX questions, click on the Alternate Test Item icon on the NCLEX resources webpage.

88. The End
Star’s 106 year old granny

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