Presentation on theme: "NCLEX PREPARATION PROGRAM"— Presentation transcript:
1NCLEX PREPARATION PROGRAM MODULE 1Overview, Assessment TestingPreparing to be Successful on the NCLEX-RN
2Philosophy of Learning Adult LearnerIndividual ResponsibilityCollaborationAdult learner – self pacedassertivewide range of experiencesIndividual respon.confidentialitywhat part are you resp forCollaborationdon’t grade on the curvedevelop group process
3The Adult Learner is Unique! 1. Like to determine their own learning experiences2. Enjoy small group interactions3. Learn from others’ experiences as well as their own4. Hate to have their time wasted
4The Adult Learner is Unique! 5. Some adults will like some lectures but all lectures won't be liked by all adults6. Are motivated to learn when they identifythey have a need to learn7. Are motivated to learn when societal or professional pressures require a particularlearning need
5The Adult Learner is Unique! 8. Are motivated to learn when “others”arrange a learning package in such amanner that the attraction to learningovercomes the resistance9. Draw their knowledge from years ofexperience and don’t change readily10. Want practical answers for today’sproblems
6The Adult Learner is Unique! 11. Like physical comfort12. Enjoy practical problem solving13. Like tangible rewards14. Refreshments and breaks establish arelaxed atmosphere and convey respectto the learner
7ValuesIf you have identified values and designated adequate time and support, you are likely to be successful at attaining your goal
8Skills the Successful RN Candidate Will Need: Comfort with mathematics: Math Tutorial CDCritical thinking skills and some memorization: Critical Thinking ExamReading and reviewing many pages of nursing content almost daily in preparation for class and the NCLEX examTime and stress managementSelf-confidence in one’s ability to be successful: positive self talk
9Computer SkillsBasic computer literacy and comfort are very important!Competent working knowledge of Windows programs.
10Study Time Required 8-12 hours per week classroom 5 hours/week computerized testing practice2 or more hours/week for classroom preparation & homework assignmentsWorking more than 32 hours/week is not recommended*Commuters add 4-6 hours/week for travel
11We Want You to Be Successful One day at a time!Know your learning styleOrganize and plan aheadAssume responsibility for your learningPractice first party communicationBe empoweredStrengthen skillsPractice balancePractice “stress busters”!
12What is Your Learning Style? Each of us has a unique way in which we process information and learn the best.Knowing your learning style preference allows you to choose learning strategies that are most effective for you.Learning Style assessment results indicate learning preferences rather than strengths.Done right, learning can be fun!
13draw, diagram, outline, color Major Learning StylesVisualdraw, diagram, outline, colorTo learn more effectively remember to use:Flow charts, graphs, labeled diagramsVisual imaginationWritten wordsPicturesGraphsTimelineHighlight text
14Major Learning Styles Aural /Auditory Lectures in the classroom To learn more effectively focus on:Lectures in the classroomTape recording the lecturesGroup discussionsWeb chat; talk things throughSort things out by speaking out loud (to yourself and to others)
15Major Learning Styles Read/Write To learn most effectively remember to:Read and rereadWrite and rewrite (take notes and use them forstudy outside the classroom)OrganizeUse outlinesChange graphs, etc. into statements or words
16Major Learning Styles Kinesthetic/tactile Related to the use of experience and practice (simulated or real)To learn most effectively, remember to:Be actively involvedTouch, actType notesMake flash cards,Use mind mapping (more information to follow)Watch videos depicting real-life scenarios
17Major Learning Styles Multimodal (a mix of learning styles) 50 to 70% of the populationChoose among your preferences to suit the occasion or situation-or-Use strategies from each preference to learn
18Mind Mapping What is it? How does it work? Mind mapping is a technique for taking notes in such as way that it produces strong visualsHow does it work?To make a mind map, one starts in the center of the page with the main idea, and works outward in all directions, producing a growing and organized structure composed of key words and key images.
20Mind Mapping Why does it work? Mind maps help organize information using the same structure that our brain uses for making memoriesBy presenting your thoughts and perceptions in a spatial manner and by using color and pictures, a better overview is gained and new connections can be made visible.Mind maps allow you to use both sides of your brain
21Struggling Student vs. Successful Student DenialAvoids problemsBlames othersAvoids FacultyDisorganizedTries HardLuckySUCCESSFUL:RealisticAddresses problemsAccountableWorks with FacultyOrganized & Manages TimeTries Hard and ProducesWorks Hard & is Prepared
22At Risk Students:Board of Registered Nursing (BRN) Task Force defines “at risk” students as follows:English as a second languageWorks >20 hours / weekFamily responsibilitiesIf you fit any of these criteria: DEVELOP A PLAN
23Seven Steps to Reach Your Goals 1. Write them down.2. Be specific, measurable.3. Be certain they are YOUR goals4. Be positive.5. Establish a time frame.6. Do goals conflict with goals in other areas of your life?7. Keep score!
24To Enhance Your Success: Utilize facultyPlan aheadComplete and turn assignments in on timeRead study guides prior to lecture
25Study Skills Inventory Complete the study skills inventory tool located on page 13 of Module 1;Study Guide #3
26S.M.A.R.T. Outcomes Specific Measurable Attainable Realistic Time-targeted26
27Plan and Prepare! Organize now Enlist help from family (i.e. helping w/ meals)Assess financesReduce work hoursSchedule funWhat works best for you is unique
28Student/Family Prep Activity Complete the Student/Family Prep Activity tool located on page 16 of Module 1; Study Guide #3
29Support is Available: Instructors Peers/Study Groups Counseling Family and FriendsEmployer/Supervisor“Return on Investment”
30Return on InvestmentWhy it’s OK to ask your employer for 4-8 hours per week of paid time-off:Your success at becoming a RN is of benefit to your employer!Providing support to you during your NCLEX review is a less expensive way for your employerto gain a new RN than recruiting a new RN!
31Preparation for classroom lecture discussions A successful participant is a prepared participant.Read ahead.Come to class with questions if portions of the study guides were unclear.Your questions in class will help someone else understand the concept better as well.
32Preparation for classroom lecture discussions When completing your weekly NCLEX-RN computerized testing practice, focus on the same subject matter being covered in class that week.Prior to class, brush up on physiology, terminology and the lab values one can expect while caring for patients with the diseases being discussed.
33Preparation for classroom lecture discussions Create flashcards of material that requires memorization and that is new to you.Write down your questions to ask in class.Also take the opportunity to learn from your workplace if working in the healthcare field. Tying together what you observe in action and what you learn in the classroom is a great learning strategy.
34Maslow’s Hierarchy of Needs Theory What is Maslow’s Hierarchy of Needs Theory?How will understanding the needs theory help with prioritizing nursing interventions?How does the hierarchy apply to a NCLEX candidate's life?Most questions are written at the application or higher levels of cognitive ability.
35Maslow’s Hierarchy of Needs in Descending Order 5th. Self-Actualization4th. Self-Esteem3rd. Love & Belonging2nd Safety & Security1st. Physiological NeedsMost questions are written at the application or higher levels of cognitive ability.
37Physiological NeedsAccording to Maslow, physiologic needs are the highest priority and must be met first.Physiologic needs are necessary for survival.Oxygen EliminationFluid ShelterNutrition RestTemperature SexMost questions are written at the application or higher levels of cognitive ability.
38Safety and Security Physical and Psychosocial Physical safety includes decreasing what is threatening to the patient.The threat could be an illness, accidents, or environmental threats.Psychological safety states that the client must have adequate knowledge and an understanding about what to expect from others in his environment.Most questions are written at the application or higher levels of cognitive ability.
39Love & BelongingClient needs to feel loved by family and accepted by others.When a client feels self-confident and useful, he will achieve the need of esteem as described by Maslow.Most questions are written at the application or higher levels of cognitive ability.
40Self Esteem How one feels about himself/herself Feelings of adequacy or inadequacy
41Self-ActualizationThis is the highest level of Maslow’s hierarchy of needs.To achieve this level, the client must experience fulfilment and recognize his or her potential.In order for self-actualization to occur, all of the lower level needs starting with physiologic must first be met.Most questions are written at the application or higher levels of cognitive ability.
42How to Apply Maslow’s Needs to Establish Priorities of Care First recognize that answer options include both physical and psychosocial needs.Next eliminate the psychosocial answer.Ask yourself “Does this make sense in this case?”Finally apply the “ABCs” of care. Airway, Breathing, CirculationAnswer
43Application of Maslow's Hierarchy A woman is admitted to the hospital with a ruptured ectopic pregnancy. A laparotomy is scheduled. Which preoperative nursing intervention is most important for the nurse to consider in this patient’s plan of care?a. Fluid Replacementb. Pain Reliefc. Emotional Supportd. Respiratory TherapyMost questions are written at the application or higher levels of cognitive ability.
44Physical Needs FirstThe nurse obtains a diet history from a pregnant 16-year-old girl. The girl tells the nurse that her typical daily diet includes cereal and milk for breakfast, pizza and soda for lunch, and cheeseburger, milkshake, fries and salad for dinner. Which of the following is the most accurate nursing diagnosis based on this data provided?
45Highest Priority Need1. Altered nutrition: more than body requirements related to high-fat intake.2. Knowledge deficit: nutrition in pregnancy.3. Altered nutrition: less than body requirements related to increased nutritional demands of pregnancy.4. Risk for injury: fetal malnutrition related to poormaternal diet.
46Prioritizing Care The nurse plans care for a 14-year-old girl admitted with an eating disorder. On admission,the girl weighs 82 lbs. and is 5’4” tall. Lab testindicate severe hypokalemia, anemia anddehydration. The nurse should give which of thefollowing nursing diagnoses the highest priority?
47Physiological needs are most important. Remember the “ABCs”! 1. Body image disturbance related to weight loss.2. Self-esteem disturbance related to feelings of inadequacy.3. Altered nutrition: less than body requirements related to decreased intake.4. Decreased cardiac output related to the potential for dysrhythmias.
48Computerized Adaptive Testing (CAT) CAT is a method whereby the examination is created as you answer each question. If you select the correct answer, the computer selects a more difficult question for your next question. If you selected an incorrect answer, the computer will then select an easier question.This process continues until the computer has established with 95% confidence that you have been successful or unsuccessful.Knowing what you will encounter during the process of testing will assist in alleviating your fear and anxiety. CAT stands for “computerized adaptive testing.”
49Computerized Adaptive Testing When a test question is presented, it must be answered in order; move to the next question.There is no penalty for guessing.A computer keyboard tutorial is offered at the beginning of the examination in order to orient you to the use of the keys, etc.A proctor always is present to assist in explaining the use of the computer to ensure your full understanding of how to proceed.
50Computerized Adaptive Testing Time ConsiderationsThe maximum testing time is 6 hours. This time period includes:The computer tutorialThe sample itemsAll breaks (restroom, stretching, etc.)The examinationAll breaks are optional!The first preprogrammed optional break takes place after 2 hours of testing; the second preprogrammed optional break is after 3.5 hours of testing. The computer screen will notify you of the time for these breaks. You must leave the testing room during breaks;
51Computerized Adaptive Testing The minimum number of questions that you will need to answer is 75.The maximum number of questions in the test is 265.Each exam has 15 “pilot testing” questions that will not be added to your score.Fifteen of the total number of questions that you need to answer will be pretest (unscored) questions.The pretest questions are questions that may be presented as scored questions on future examinations. These pretest questions are not identified as such; that is, you will not know which questions are the pretest (unscored) questions. Therefore, it is important to answer every question as if it were being scored.
52Computerized Adaptive Testing (CAT) Each candidate’s exam is unique because it is created interactively as the exam proceeds.Computer technology selects items to administer that match the candidate’s ability level.All test items are stored in a large item pool.Items have been classified by test plan area being evaluated and level of difficulty.Most questions are written at the application or higher levels of cognitive ability.
53Scoring the Computerized Adaptive Test After the candidate answers an item, the computer calculates an ability estimate based on all of the previous answers the candidate selected.An item determined to measure the candidate’s ability is selected and this process is repeated for each item, creating an exam tailored to the candidate’s knowledge and skills while fulfilling all NCLEX-RN Test Plan requirements.The exam continues with items selected being administered in this way until a pass or fail decision is made.Most questions are written at the application or higher levels of cognitive ability.
54Computerized Adaptive Testing: Pass or Fail? After 75 questions are answered the computer compares the test-taker’s ability level to the standard required for passing.If the test-taker is above the passing standard, then the test-taker has passed.If the test-taker is below the passing standard, then the test-taker fails.The standard required for passing is set based on the expert judgment of several individuals appointed by the National Council of State Boards of Nursing. Do not get anxious if your computer does not stop at 75 questions!
55Computerized Adaptive Testing: Pass or Fail? …cont If the computer is not able to determine whether the test-taker has passed or failed, then the computer continues asking questions.The computer must be 95% certain before it stops testing.
56How is the NCLEX-RN Exam Written? First data is collected to reflect the current practice of the entry-level nurse.Data analyzed regarding frequency of performance, impact on maintaining client safety and client care settings where activities performed.This guides the selection of content and behaviors to be tested.Question writers voluntarily submit an application to become a writer and must meet specific established criteria designated by the NCSBN. However, a nurse currently employed in clinical nursing practice and working directly with nurses who have entered practice within the last 12 months may be selected to participate
57NCLEX Definition of RNProvides a unique comprehensive assessment of the health status of the client (individual, family or group).Develops, then implements an explicit plan of care.Assists clients in the promotion of health, in adapting to and/or recovering from the effects of disease or injury and in supporting the right to a dignified death.Accountable for abiding by all applicable federal, state and territorial statutes related to nursing practice.
58NCLEX-RN Detailed Test Plan Reviewed and approved by National Council of State Boards of Nursing (NCSBN) every three years.Expert resources support changes that reflect practice trends.Comprehensive listing of content for each client need category and sub category.
59Test Plan Components Questions are written to address: Bloom’s Taxonomy Levels of cognitive abilityClient NeedsIntegrated ProcessesItem writers are master’s-prepared nursing educators.The content of NCLEX-RN reflects the activities that a newly licensed, entry- level, registered nurse must be able to perform to provide clients with safe and effective nursing care.
60NCLEX Test Plan Framework Bloom’s taxonomy ranks levels of learning from simple to complex, it is used as a basis for writing and coding test items.Nursing practice requires the application of knowledge, skills and abilities.The majority of items are written at the application or higher levels of cognitive ability.This requires more complex thought processing.
61Blooms Taxonomy and Test Question Construction Levels of Cognitive AbilityKnowledgeComprehensionApplicationAnalysisMost questions are written at the application or higher levels of cognitive ability.
62Analysis Application Bloom's Taxonomy of Questions with Increasing Difficulty and SophisticationAnalysisApplicationIn nursing school, you are also given test questions written at the comprehension level. These questions require you to understand the meaning of the material. Let’s look at this same question written at the comprehension level.ComprehensionRecall/Recognition62
63Application 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 the procedure?1. Anorexia, nausea and vomiting2. Abdominal distension and discomfort3. Pulse 112, BP - 100/60, R - 204. Pain at the biopsy siteCan you select an answer based on recall or recognition? No. Let’s analyze the question and answer choices. 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. Can you find hemorrhage in one of the answer choices? 1. Anorexia, nausea…. Does this indicate that the patient is hemorrhaging? No, these are not symptoms of hemorrhage Abdominal … Does this indicate that the patient is bleeding? Perhaps. Abdominal distention could indicate internal bleeding. 3. Pulse: 112… does this indicate that the patient is bleeding? Yes. And increased pulse, a decreased BP, and increased respiratory rate indicate shock. Shock is a result of hemorrhage. 4. Pain at the biopsy…. Does this indicate the patient is bleeding? No. Pain at the biopsy site is expected due to the procedure. This question tests you at the paplication level.63
64Application Questions It’s the principle of the thing!Application involves the utilization of basic facts and principle to make nursing judgements.The NCLEX exam tests your ability to apply nursing knowledge and principles in a variety of clinical situations across the life span.
65Application Questions One’s ability to solve problems, prioritize care, draw conclusions, perform assessments and synthesize information is not directly tested with recall, recognition or comprehension level questions.You must be able to answer questions at the application level in order to prove your competence on the NCLEX.
66Analysis Type Question A man is brought to the emergency room complaining of chest pain. The nurse performs an assessment of the patient. Which of the following symptoms would be MOST characteristic of an acute myocardial infarction?1. Colic-like epigastric pain.2. Sharp, well localized unilateral chest pain.3. Severe substernal pain radiating down the left arm.4. Sharp, burning chest pain moving from place to place.Many students panic when they read this question because they can’t immediately recall any diet restriction by a patient taking Haldol. Analysis questions are many times written so that a familiar piece of information is put in an unfamiliar setting. Let’s think about this question. Choosing the menu that best represents a balanced diet is not a difficult question to answer. The challenge lies in determining that a balanced diet is the topic of the question.Note that answer choices (1) and (2) are very similar. Because NCLEX is testing your discretion, you will be making decisions between answer choices that are ver close in meaning. Don’t expect obvious answer choices.These questions highlight the difference between the knowledge/comprehension=based questions that you may have seen in nursing school, and the application/analysis-based questions that you will see on the NCLEX.What type of diet do you choose for a patient receiving Haldol? In order to begin analyzing this question, you must first recall that Haldol is an antipsychotic medication used to treat psychotic disorders. There are no diet restrictions for clients taking Haldol. Since there are not diet restrictions, you must problem-solve to determine what this question is really asking. Based on the answer choices, it is obviously a diet question. What kind of diet should you choose for this patient/ Since you have been given no other information, there is only one type of diet that can be considered: a regular balanced diet. This is an example of taking the familiar (a regular balanced diet) and putting into the unfamiliar (a patient receiving Haldol). In this question, the critical thinking is deciding what this question is really asking. QUESTION: “What is the most balanced regular diet?”66
67Comprehension Question 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 arterial blood.The test is performed on patients with elevated enzymes.The procedure requires a large piece of tissue to be removed.The questions restated is, “Why does hemorrhage occur after a liver biopsy?” In order to answer this question, the nurse must understand that the liver is a highly vascular organ. The portal vein and the hepatic artery join in the liver to form the sinusoids that bathe the liver in a mixture of venous and arterial blood. NCLEX asks few minimum competency questions at the comprehension level. It assumes you know and understand the facts you learned in nursing school.67
68The NCLEX Test PlanThe content of the NCLEX-RN test plan is organized into four major Client Needs categories.Two of the four categories are further divided into subcategories.All content categories and subcategories reflect client needs across the life span in a variety of settings.
69NCLEX Test Plan Framework Client Needs categories include the following:Safe and Effective Care EnvironmentHealth Promotion and MaintenancePsychosocial IntegrityPhysiological Integrity.In the Test Plan implemented in April 2004, the National Council of State Boards of Nursing (NCSBN) has identified a test plan framework on Client Needs.
70Client Needs Sample Question The nurse is delivering external cardiac compressions to a 63 year old woman while performing cardiopulmonary resuscitation (CPR). It is most important for the nurse to:Maintain a position close to the client’s side with the nurse’s kneesapart.Maintain vertical pressure on the client’s chest through the heel ofthe nurse’s hand.Recheck the nurse’s hand position after every 10 chestcompressions.Check for a return of the client’s pulse after every 8 breaths by thenurse.The correct answer is (2). The nurse’s elbows should be locked, arms straight, with shoulders directly over hands. Incorrect pressure or improperly placed hands could cause injury to the client.70
71Sample Recall and Recognition Knowledge-based Question Which of the following is a complication that occurs during the first 24 hours after a percutaneous liver biopsy?a. Nausea and vomitingb. Constipationc. Hemorrhaged. Pain at the biopsy site.The question restated is, “What is a common complication of a liver biopsy?” You may or may not remember the answer. So, as you look at the answer choices, you hope to seen an item that looks familiar. You do see something that looks familiar: “Hemorrhage.” You selected the correct answer based on recall or recognition. NCLEX rarely asks passing questions at the recall/recognition level.71
72NCLEX Test Plan Framework Woven within the client needs categories are four Integrated Processes.Nursing processCaringCommunication and DocumentationTeaching and Learning
73A Closer ExaminationLet’s examine each component in greater detail including sample questions that will emphasize key concepts.First Client Needs categoriesNext Bloom’s Taxonomy Cognitive DomainFinally Integrated Processes
74Client Need #1 Safe and Effective Care Environment Subcategory: Management of Care: 13-19% Advance DirectiveAdvocacyCase ManagementClient rightsCollaboration with Interdisciplinary teamConcept of ManagementConfidentiality/Information SecurityConsultationContinuity of CareDelegation
75Client Need #1 Safe and Effective Care Environment Subcategory: Management of Care: 13-19% Establishing PrioritiesEthical PracticeInformed ConsentLegal Rights and ResponsibilitiesPerformance Improvement (Quality Assurance)ReferralsResource managementStaff EducationSupervision
76Client Needs Sample Question A client scheduled for surgery tells the nurse that she signed an informed consent but was never told about the risks of the surgery.The nurse serves as the client’s advocate by performing which of the following actions?
77Client Needs (cont’d)a. Writing a note on the front of the client’s record so that the surgeon will see it when the client arrives in the operating room.b. Documenting in the client’s record that the client was not told about the risks of the surgery.c. Contacting the surgeon and asking the surgeon to explain the surgical risks to the client.d. Reassuring the client that the risks are minimal and unlikely to occur.Answer: c
78Client Need #1 Safe and Effective Care Environment Subcategory: Safety and Infection Control: 8 –14% Accident preventionDisaster planningEmergency Response PlanErgonomic PrinciplesError preventionHandling hazardous and infectious materialsHome SafetyInjury Prevention
79Medical and Surgical Asepsis Client Need #1 Safe and Effective Care Environment Subcategory: Safety and Infection Control: 8 –14%Medical and Surgical AsepsisReporting of Incident/Event/Irregular Occurrence/VarianceSafe Use of EquipmentSecurity PlanStandard/Transmission-Based/Other PrecautionsUse of Restraints/Safety Devices
80Safety and Infection Control Sample Question The physician orders tobramycin sulfate (Nebcin) 3mg/kg IV every 8 hours for a 3-year-old boy. The nurse enters the patient’s room to administer the medication and discovers that the boy does not have an identification bracelet. What should the nurse do?Ask the parents at the child’s bedside to state their child’s name.Ask the child to say his first and last name.Have a co-worker identify the child before giving the medication.Hold the medication until an identification bracelet can be obtained.
81Client Need #2: Health Promotion and Maintenance: 6 – 12% The Aging ProcessAnte/Intra/Postpartum and Newborn CareDevelopmental Stages and TransitionsDisease PreventionExpected Body Image ChangesFamily PlanningFamily SystemsGrowth and DevelopmentIt is important to understand that not everyone described in the question will be sick or hospitalized. Some clients may be in a clinic or home-care setting. Some clients may not be sick at all. Wellness is an important concept on the NCLEX. It is necessary for a safe and effective nurse to know how to promote health and prevent disease.81
82Client Need #2: Health Promotion and Maintenance: 6 – 12% Health and WellnessHealth Promotion ProgramsHealth ScreeningHigh Risk BehaviorsHuman SexualityImmunizationsLife Style ChoicesPrinciples of Teaching and LearningSelf-CareTechniques of Physical Assessment
83Client Needs Sample Question A nurse is preparing to care for a hospitalizedfemale teenager in skeletal traction. The nurseplans patient care, knowing that the most likely primary concern of the teenager is:a. Body imageb. Keeping up with school workc. Obtaining adequate nutritiond. Obtaining adequate rest and sleep
84Client Need #3 Psychosocial Integrity: 6-12% Abuse/NeglectBehavioral InterventionsChemical DependencyCoping MechanismsCrisis InterventionCultural DiversityEnd of LifeFamily DynamicsGrief and LossMental Health Concepts
85Client Need #3 Psychosocial Integrity: 6-12% PsychopathologyReligious and Spiritual Influences on HealthSensory/Perceptual AlterationsSituational Role ChangesStress managementSupport SystemsTherapeutic CommunicationTherapeutic EnvironmentUnexpected body image
86Client Needs Sample Question A boy is brought to the school nurse’s office with reports of abdominal pain. On assessment, the nurse notes the presence of several bruises on the child’s abdomen and back and several cigarette burn marks. The nurse suspects child abuse and plans for which priority action?a. Documents the bruises noted on the child’s body.b. Calls the parents to ask them how the child’s bruises and burn marks occurred.c. Notifys Child Protective Services to facilitate the removal of the child from the abusive situation in order to prevent further injury.d. Asks the child how long his parents have been abusing him.
87Client Needs Sample Question A 50-year-old male patient comes to the nurses’ station and asks the nurse if he could go to the cafeteria to get something to eat. When told that his privileges do not include visiting the cafeteria, the patient became verbally abusive. Which of the following approaches by the nurse would be most effective?a. Tell the patient to lower his voice because he is disturbing the other patients.b. Ask the patient what he wants from the cafeteria and have it delivered to his room.c. Calmly but firmly escort the patient back to his room.d. Assign a nursing assistant to accompany the patient to the cafeteria.The correct answer is (3). The nurse should not reinforce abusive behavior. Patients need consistent and clearly defined expectations and limits.87
88Client Need #4 Physiological Integrity Basic Care and Comfort: 6-12% Alternative and Complementary TherapiesAssistive DevicesEliminationMobility and ImmobilityNon-Pharmacological Comfort InterventionsNutrition and Oral HydrationPalliative and Comfort CarePersonal HygieneRest and SleepKeep on moving. Hazards of immobility are frequently tested.88
89Client Needs Sample Question A nurse has provided information to a client about measures that will promote normal urination patterns and prevent urinary tract infections. Which statement by the client indicates a need for further information?a. “I should take my furosemide (Lasix) in the morning.”b. “I should drink plenty of fluids during the day.”c. “I should try and hold my urine as long as I can ratherthan expelling it when I feel the urge.”d. “I should eat foods that will make my urine acidic.”
90Client Need #4 Physiological Integrity Pharmacological and Parenteral Therapies: 13 – 19% Adverse effects/ContraindicationsBlood and Blood ProductsCentral Venous Access DevicesDosage CalculationsExpected Outcomes/EffectsIntravenous TherapyMedication AdministrationParenteral FluidsPharmacological Agents/ActionsPharmacological InteractionsPharmacological Pain ManagementTotal Parenteral NutritionKnow your medications. Actions, indications, side effects and nursing considerations.90
91Client Needs Sample Question Cyclosporine (Sandimmune) oral solution is prescribed for a patient who had a kidney transplant. The nurse provides information to the patient about the medication and tells the patient that which of the following is most important to monitor?a. Temperatureb. Peripheral pulsesc. Platelet countd. Apical heart rate
92Client Need #4 Physiological Integrity Reduction of Risk Potential: 13 –19% Diagnostic TestsLaboratory ValuesMonitoring Conscious SedationPotential for Alterations in Body SystemsPotential Complications of Diagnostic Tests/ Treatments/ProceduresPotential for Complications from Surgical Procedures and Health AlterationsSystem Specific AssessmentsTherapeutic ProceduresVital Signs
93Client Needs Sample Question A 7-year-old girl with type I insulin dependent diabetes mellitus (IDDM) has been home sick for several days and is brought to the ER by her parents. If the child is experiencing ketoacidosis, the nurse would expect to see which of the following lab results?a. Serum glucose 140 mg./dlb. Serum creatine 5.2 mg./dlc. Blood pH 7.28d. Hematocrit 38%The correct answer is (3) Normal pH is 7.35 – 7>45. This indicates DKA.93
94Client Need #4 Physiological Integrity Physiological Adaptation: 11 – 17% Alteration in Body SystemsFluid and Electrolyte ImbalancesHemodynamicsIllness ManagementInfectious DiseasesMedical EmergenciesPathophysiologyRadiation TherapyRespiratory CareUnexpected Response to TherapiesThink ER. Know what to do in an emergency.94
95Integrated ProcessesThese “threads” of knowledge are fundamental to the practice of nursing and are integrated throughout the Patient Needs categories and subcategories.
96Four Integrated Processes Categories 1. Nursing Process is a scientific problemsolving approach to client care that includesassessment, analysis, planning, implementation andevaluation.
97Four Integrated Processes Categories 2. Caring is the interaction of the nurse and patientin an atmosphere of mutual respect and trust. In thiscollaborative environment, the nurse providesencouragement, hope, support and compassion to helpachieve desired outcomes.
98Four Integrated Processes Categories 3. Communication/DocumentationCommunication is the verbal and nonverbal interaction between the nurse and the client, the client's significant others and the other members of the health care team.Documentation relates to events and activities associated with client care which are validated in written and/or electronic records that reflect standards of practice and accountability in the provision of care.Communication-type test questions are integrated throughout the NCLEX-RN Test Plan and may address a situation in any health care setting.
99Four Integrated Processes Categories 4. Teaching/Learning is the facilitation of the acquisition of knowledge, skills and attitudes promoting a change in behavior. It is the distribution of content.
1006 Types of Questions on the NCLEX Exam Multiple choice - one correct answerFill-in-the-Blank - type in the answerHot Spot - select a specific area on a diagram or illustrationExhibit - information needed for the answer is in the form of an exhibit or spreadsheet.Ordered response - select choice in the proper sequence (prioritize)Multiple response - more than one answer is correct; select all that applySome questions, such as those that present a figure or illustration, may require you to use the mouse component of the computer system; you may be asked to “point and click”.
101Multiple Choice Questions Most of the questions that you will be asked to answer will be in the multiple choice format.These questions will provide you with data about a particular client situation, together with four answers or options.
102Fill-in-the Blank Questions Follow the directions for each question.Use the on-screen calculator and verify calculations a second time.Type in only the numeric component of the answer as directed.Round the answer to the nearest whole number if directed to do so.Do not use abbreviations if directions indicate that they are not acceptable.
103Hot Spot QuestionsThis type of question allows you to use the mouse or arrow keys to identify a figure, illustration or other item designated in the stem of the question.
104Exhibit QuestionsIn order to answer exhibit questions you will need to click on the button that says, “Exhibit.” This opens up a new smaller window with either a list or a spreadsheet.There may be more than one page to the exhibit. If this is the case, there will be tabs at the top of the exhibit. Be sure to look at all of the tabs provided.
105Multiple Response Questions You must select all of the options that relate to the information being asked in the question.There is no partial credit given for correct selections you have chosen.You must select ALL that apply in order for the question to be counted as correct.
106Ordered Response Questions Prioritizing questions ask you to select options in the correct sequence or use the computer mouse to drag and drop your nursing actions in order of priority.Information will be presented and based on the data you have been provided.You will need to determine what you would do first, second, third and so forth.
107Golden Rules for NCLEX Success Be preparedAvoid negative peopleDo not discuss the examAvoid distractionsThink positively
108Golden Rules for NCLEX Success Eat wellExerciseSleep wellEliminate alcohol and other mind-altering drugsSchedule study time
109Tutorial Prior to NCLEX Exam Each NCLEX candidate is given a tutorial at the beginning of the exam in order to become familiar with how to answer each question using a mouse, arrow keys, and a calculator.There is no partial credit given for an answer that is only partially correct.Updated information on the administration of the test plan can be found at NCSBN web site:
110Test Taking Strategies If an option contains an absolute word, it is usually an incorrect choice and can safely be eliminated as an option.If a tentative word is used in an option, then it is more likely to be the correct answer.Absolute Words :All, always, can’t, never, must, only, won’t noneTentative words: generally, most often, may, possibly, usually
111Examples of Absolute Words Always advise clients to eat low sodium foods.Drink fluids only if they are fat-free.Eat only foods that have less than 1% fat contentNever use butter for cooking.
112Examples of Tentative Words Nursing actions are usually in the clients’ best interest.It is sometimes necessary to call for an emergency support team.Hot liquids may cause skin damage if spilled.Often times clients who break their legs need instruction in crutch walking.
113Questions Containing Laboratory Values Laboratory values questions will first require you identify whether the results are normal or abnormal. You will need to memorize common laboratory values.Next you will be asked to analyze the laboratory value as it relates to the client situation being presented.Finally you may be asked to make the appropriate assessment, judgement and/or nursing action.When a question is presented on the NCLEX-RN regarding a specific laboratory value, note the disorder presented in the question and the associated body organ that is affected as a result of the disorder.
114Laboratory Values Sample Question A client with a diagnosis of sepsisis receiving antibiotics by the intravenous route. The nurse assesses for nephrotoxicity by closely monitoring which of the following laboratory values?
115Laboratory Values Sample Question Possible Answers a. Lipase levelb. Platelet countc. White blood cell countd. Blood urea nitrogenAnswer d. – Note that the issue is nephrotoxicity. Read each option carefully and note that option d is the only option that relates to kidney function.
116Nursing Interventions Although sometimes appropriate, avoid jumping immediately to an answer that recommends immediate referral to the patient’s M.D.NCLEX is examining your abilities as a nurse and doesn’t usually want immediate referral to other members of the health care team.
117Key WordsKey words in NCLEX-RN test questions are critical in defining the correct answer. Examples of how key words are used include:…is an early sign of…?…is the most important…?Identify the ___ with the highest priority…Which ____ would the nurse do initially?
118Sample Question – Key Word in Stem A nurse is caring for a patient with a diagnosis of congestive heart failure who suddenly experiences severe dyspnea. The nurse suspects that pulmonary edema has developed. The immediate nursing action is:
119Sample Question Answer Options a. Place the client in high-Fowler’s position.b. Insert a Foley catheter STAT.c. Obtain a dose of morphine sulfate from the narcotic medication drawer.d. Begin oxygen at 2 liters per minute.Answer: Note keyword immediately and note the issue of the question: a nursing action. Option A is a nursing action that does not require a medical order. Remember the NCLEX is a nursing examination, not a medical examination.
120Sample Question – Key Word in Stem A nurse in the emergency department receives a call from emergency medical services and is told that several victims who survived a plane crash and are suffering from cold exposure will be transported to the hospital. The initial nursing action for the emergency department nurse is which of the following?
121Sample Question Answer Options a. Call the laundry department and ask the departmentto send as many warm blankets as possible to theemergency room.b. Call the intensive care unit to request that nurses besent to the emergency room.c. Call the nursing supervisor to activate the agencydisaster plan.d. Supply the trauma rooms with bottles of sterilewater and normal saline.Answer: Note the keyword initial and focus on the issue: the nursing action in the event of a disaster. As you read each option, you will note that all of the options are correct. In this type of question, look for the umbrella option. Option c is the umbrella option.
122Visualization as a Test-Taking Strategy Visualize the specific information in the case situation in order to answer the question.See yourself performing the procedure, assessing the client, delegating the care, etc.Remember that clinical practice can vary depending upon where it is practiced and who is performing the care.Be certain that you draw upon knowledge and skills which come from nursing textbooks.Forming a mental image of the situation places you as the nurse into the scenario. In addition, visualize each option as you read it.
123Visualization Sample Test Question A nurse prepares to perform a sterile dressing change on an abdominal incision. The nurse explains the procedure to the patient, washes her hands and sets up the sterile field. The nurse takes which action next?
124Visualization Sample - Answer Options a. Assesses the integrity of the abdominal incision.b. Cleans the wound with Betadine solution as prescribed.c. Dons clean gloves and removes the old dressing.d. Dons sterile gloves and begins the procedure.Answer: Note the word next. Form an image of this procedure and visualize the steps that you would take in this procedure. You cannot clean the wound or assess the wound unless you remove the old dressing; therefore, option c is correct.
125Response Options “Odd man out” Eliminate obvious wrong answers. If two answers are opposites, chances are one of them is the correct answer.“Wordy” answers tend to be the correct answer (only use this if two answers look correct but one is more wordy than the other).
126Additional Strategies Read each question carefully and avoid reading more into the question than is there.Try not to answer a question based on what you’ve seen in a clinical setting.Reinforce your learning by:testing your knowledge using NCLEX-RN review resources
127Additional Strategies Reinforce your learning by:Using NCLEX-RN review videos and computer programsFrequently asking yourself questions that reinforce your learning such as, “If I had to do that procedure, what would I need to know?” –or– “If I had to teach a client about that particular diagnosis, how would I explain it?”
128Pacing Strategies When Testing Once you’re allowed to begin, check the time.Try to spend no more than 1 minute per test questionDon’t allow difficult questions to immobilize you. Make your best selection and then move on.While completing the NCLEX-RN computerized practice testing during this course, aim to answer one answer correctly per minute.
129Strategies – Day of Testing Eat breakfast. Brains function optimally if blood sugar levels are even.Use scratch paper as a tool for helping to answer future questions based on information in older questions. Remember you can’t go back to previous questions so this may be useful.Don’t panic if someone finishes before you.
130AnxietyAnxiety is an individual’s negative response to the stressor being confronted.Anxiety is defined as a state of varying degrees of uneasiness or discomfort resulting in energy that can be constructive or destructive.Learning how to prevent stress from becoming anxiety is an important skill for everyone to learn.
131Tips to Reduce Test Anxiety Sufficient preparation helps candidates feelconfident and that they can be successful.Make a study schedule; cramming isn’tassociated with success and thereforedoesn’t work!
132Tips to Reduce Test Anxiety Decide what and when to study (study plan).Use a study system or technique that works best for you (study groups, flash cards, diagrams, etc.)Take a second look at your study environment.Have you provided for your physiological needs?
133Tips to Reduce Test Anxiety Rethink your attitude about test taking.Read all test directions carefully.Remember to breathe and relax your body.Move along at a steady pace withoutgetting hung up on any one question.
134Techniques for Reducing Stress and Anxiety Reward yourself regularly for your efforts.Spend more time on your “weak” areas or on those that create the most anxiety.Know that test anxiety is very common.Get help from classmates, faculty, counsellors and family.It is a sign of strength to admit that you could use some help.Stay focused on the tasks at hand.
135Reducing Stress and Anxiety Turn to a comforting personRely on self-disciplineTalk it outThink it through - introspectionWork it off - physical activityUse symbolic substitutesReligion and spirituality - prayer, meditation, being with nature.
136Stress Stress can be a good thing or a bad thing! Stress is defined as a broad class of experiences which are demanding and tax an individual’s resources and coping abilities.The way a stressor is viewed by an individual plays a big role in helping one cope, work effectively for a solution and organize resources in a productive way.
137Stress Stage 1: Alarm Reaction Sympathetic nervous system initiates “fight or flight”Adrenaline (AKA epinephrine) surges!Hypothalamic-pituitary-adrenal axis releases cortisol, norepinephrine & epinephrineHeart pounds, breathing rapid, BP increases, mouth dry, sweaty, pupils dilate, digestion slows, muscles tense, hyper-alertCannot stay in alarm stage longDuring the alarm stage, the sympathetic nervous system initiates the “fight or flight response and activates defense mechanisms.Adrenaline surges, the heart speeds and the body prepares for fighting or running away.This fight or flight response is sustained by the hypothalamic-pituitary-adrenal axis, which releases cortisone, norepinephrine and epinephrine into the blood.Body responses in the alarm reaction stage include: rapid, pounding heart, rapid breathing, increased BP, dry mouth, sweating & dilated pupils. Digestion slows, (nausea, anorexia) and muscles are tense & poised for action, awareness is hyper-alertThe alarm reaction is self-limited; living in a continuous state of alarm would result in death, so the person moves into the second stage, resistance137
138Stress Stage 2: Resistance Quickly follows alarm reactionBody attempts to adapt to stressorParasympathetic nervous system opposes action of sympathetic nervous system. Cortisol levels still increased.If adaptation occurs, individual will reestablish homeostasisIf not, will enter exhaustion stageDuring the alarm stage, the sympathetic nervous system initiates the “fight or flight response and activates defense mechanisms.Adrenaline surges, the heart speeds and the body prepares for fighting or running away.This fight or flight response is sustained by the hypothalamic-pituitary-adrenal axis, which releases cortisone, norepinephrine and epinephrine into the blood.Body responses in the alarm reaction stage include: rapid, pounding heart, rapid breathing, increased BP, dry mouth, sweating & dilated pupils. Digestion slows, (nausea, anorexia) and muscles are tense & poised for action, awareness is hyper-alertThe alarm reaction is self-limited; living in a continuous state of alarm would result in death, so the person moves into the second stage, resistance138
139Stress Stage 3: Exhaustion All energy for adaptation expendedBody cannot defend against stressorIllness and/or death will occur if stress continues and appropriate outside assistance is not givenCandidates perform at their highest level when stress is at a minimal levelDuring the alarm stage, the sympathetic nervous system initiates the “fight or flight response and activates defense mechanisms.Adrenaline surges, the heart speeds and the body prepares for fighting or running away.This fight or flight response is sustained by the hypothalamic-pituitary-adrenal axis, which releases cortisone, norepinephrine and epinephrine into the blood.Body responses in the alarm reaction stage include: rapid, pounding heart, rapid breathing, increased BP, dry mouth, sweating & dilated pupils. Digestion slows, (nausea, anorexia) and muscles are tense & poised for action, awareness is hyper-alertThe alarm reaction is self-limited; living in a continuous state of alarm would result in death, so the person moves into the second stage, resistance139
140Final Tips for Passing NCLEX Set goals and manage your time to accomplish these goals.Face the challenges by taking small steps!Think about your past accomplishments!
141Final Tips for Passing NCLEX Think positive thoughts and use positive self talk!Maintain your self-confidence and controlanxiety!Visualize yourself as an RN!
142Positives that Perfect Your Performance! Familiarity and repetition can help with retention.You have assessed your strengths and weaknesses.You have completed hundreds of similar test questions.
143Positives that Perfect Your Performance! You know what factors were considered when the test was constructed.You are familiar with the use of the computer.You are familiar with the testing procedures.You have studied English and medical terminology.
144Positives that Perfect Your Performance! You are aware of the content areas where you believe little fine-tuning is necessary.You have reviewed several areas of nursing content you believe are in need of more in- depth concentrated study.
145Positives that Perfect Your Performance! You have reviewed test taking techniques and learned how to more carefully examine each test question so that it is more easily understood.