2PEARLS 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
3OutcomesAfter 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
4NCLEX 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
6NCLEX is a computer adapted test (CAT). FYINCLEX is a computer adapted test (CAT).NCSBN CAT video: https://www.ncsbn.org/3761.htm
7Computer 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 – 26515 items are “test” questions & are not scored
8Zerwehk, 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.
10ˈTwas 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 youDo not drink alcohol or take mind-altering drugsSleep wellAvoid “negativity” and think positively. Decree and declare, “I will pass NCLEX the first time and become an excellent RN!”Dress comfortably
11Eat 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 needsYou 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)
12PASS- 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 practicingFAIL- 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.
13To learn more about NCLEX: NCSBN Websitehttps://www.ncsbn.org/nclex.htmSee “The 8 Steps of the NCLEX” at https://www.ncsbn.org/2013_Eight_Steps_of_NCLEX.pdf
14KEEP THIS IN MINDWhen 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?
15You betta check yo’ self! Remember ABCs or CABs (appropriately)Know how to care for prevalent health conditionsKnow normal lab levelsKnow principles of infection prevention and control & various precautionsPrioritizationBetter safe than sorry!
16TOPIC 1: Misreading Questions Misreading questions is a common reason why students answer question wrong.
17Misreading 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 youOverlook key wordsMisinterpret a disorderRead question too fast
18Misreading QuestionsThe 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.
19Misreading SentencesLook at this example…let’s read it aloud. Paris in the the spring time
20Misreading SentencesDid 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”
21Misreading SentencesHere’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.
22Misreading Sentences Did you count 7 Fs? Finished files are the result of years of scientific study combined with the experience of full years.
23Misreading SentencesRead this sentence aloud.Every 8 out of 10 hunans report they are unhappy with their career choice.
24Misreading SentencesNow how many of you read “Every 8 out of 10 HUMANS report they are unhappy with their career choice.”The word was HUNAN.
25Misreading SentencesMisreading sentences can cause you to miss key information.Take your time reading scenarios and understanding what the question is asking.
27RACE 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.
28RACE 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
29RACE ModelCRITICALLY 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 optionCritically compare and contrast the option in relation to the information in the stem and their relationships to one another
30RACE 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 wrongUsually the answer that is most different from the other answer options is correct
32Parts of a Question Each question has 3-4 parts: Introductory statementClinical Information Distracters (sometimes)StemFour answer options with 3 answers being distracters and 1 correct answer (unless it is select all that apply/multiple select)
34Introductory 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.
35Introductory 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:
36The Invisible Gorilla Challenge Closely count the number of passes made by basketball players in white shirts.
371. Did anyone see the gorilla that appeared halfway through the video? Distracters1. 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.
38DistractersDistracter 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.
39DistractersYou 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.
40Awareness 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).
41Contributing Factors of Inattentional Blindness Mental Capacity – how much your mind you “hold”; fatigue, stress, drugs and alcohol, sleep deprivation all decrease mental capacityConspicuity – 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 timeMental 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
42Distracters 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?
43Distracters 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?RectumAbdomenOral cavityPerineal area
44Stem of a QuestionThe 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.
45Types 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
46Stem 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?
47Stem of a QuestionExample 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:xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
51The 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.
52The SubjectExample: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 femaleIs she the patient, nurse, or family member?patient
53Step # 2 Identify the issue or the topic THEN determine Is further assessment needed?Is it appropriate to apply ABCs or CABs?
54The IssueThe 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.
55The 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 applyStrict isolationRespiratory precautionsUniversal precautionsEnteric precautionsWhat is the issue?Prevention of transmission of HIV and TB
57Key WordsKey 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).
58CAN YOU THINK OF SOME KEY WORDS YOU HAVE SEEN ON YOUR EXAMS?
59Examples of Key Words Positive Negative Urgent least unlikely except should domost likelyappropriateeffectivetrueinclude(d)indicatedconsistentrealisticcorrectnot neededsafebestleastunlikelyexceptinconsistentinappropriatecontraindicatedfalsenotincorrect/wrongunrealisticneed…unsafeLatePriority (high or low)firstinitial(ly)immediate(ly)most importantSTATnowearlypriorprimaryquicklyEssentialmandatory
60Examples of Key Words Always Never All Completely Only Directionality InexactAbsolute (Definite)MaximumMinimumHighLowPossible/yUsuallyMaySomeOftenMostManyMainlyThese terms often makes answers true.AlwaysNeverAllCompletelyOnlyThese terms usually make answers false!!
61Examples of Key Words for The Nursing Process AssessmentPlanningAssessAscertainGatherCollectDetermineIdentifyMonitorObserveObtain (information)RecognizeFind outCheckPlansGoalsDevelopsDetermine
62Examples of Key Words for The Nursing Process InterventionsEvaluation/OutcomesIntervenesApply(ies or ication)ImplementsExpectsDemonstratesDisplays understandingObservesAnticipatesEvaluateAchieveInterpret
63Key Words Example: When beginning an IV, the nurse should first: xxxxxxxxxxxxxxxxxxxx
64Identify appropriate or inappropriate nursing action Step # 4Identify appropriate or inappropriate nursing action
65Appropriate or Inappropriate Action Mentally create a pool of answersThen, examine each answer choice given and determine which outcome best answers the questionYour first answer may not be an option, so choose the 2nd best, safe answer.
66Make Mental AnswersAn 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?
67Answer Options Give warm herbal tea 15 minutes before bed Administer melatonin pillsPlay soothing music on a low volume and dim lightsTalk to the older gentleman for an hour
68Make Mental AnswersWhat should the nurse do immediately before performing any procedure for a patient?
69Answer Options Select all that apply Shut the door Wash hands Close the curtainExplain the procedureAsk for patient’s permission
70Putting 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.
71Putting 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 bedpanExplain to the man that he should use the call light if he needs to get upPlace 3 side rails in the up position and check on the client oftenInitiate proper use of restraintsPlace the bed in lowest position
74Answer Option TipsAfter 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.
75Answer Option TipsLook 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.
76Answer Option TipsDo not focus only on your experiences, which may be too narrow for a point of referenceFOCUS 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.
77Answer Option TipsSelect responses that are:Therapeutic and patient-centeredShow respectCommunicate acceptanceEliminate responses that are:Obviously wrongInappropriate and non-therapeuticPartially trueIn 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.”