2. 1 NCLEX-RN Review Course Test-TakingWorkshop

3. 2 Test taking Workshop

4. NCLEX-RN Measures Nursing Knowledge Testtaking Workshop 3 1 Normal Growth and Development (Integrated throughout your nursing education) 2 Basic Human Needs 3 Coping Mechanisms of Individuals 4 Actual Potential for Health Problems 5 Effects on Health Needs of Age, Sex, Culture, Ethnicity and Religion 6 Ways to Assist Clients by Teaching Them to: Maintain Health Cope with Health Problems

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6. 5 Integrated Process 1. Nursing Process 2. Caring 3. Communication and Documentation 4. Teaching/Learning

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8. 7 1. Assessment 2. Analysis 3. Planning 4. Intervention 5. Evaluation

9. 1. Identify the signs and symptoms most indicative of a deterioration of the client’s respiratory status. 8 A. Increased restlessness and changes in level of consciousness B. Bradycardia and increases in blood pressure C. Complaints of chest pain and shortness of breath D. Rapidly dropping PCO 2 and pH

10. 1. Identify the signs and symptoms most indicative of a deterioration of the client’s respiratory status. A. Increased restlessness and changes in level of consciousness B. Bradycardia and increases in blood pressure C. Complaints of chest pain and shortness of breath D. Rapidly dropping PCO 2 and pH A. The brain is one of the first organs to be affected by a decrease in oxygenation. Restlessness and changes in the level of consciousness indicate this decrease. All the other choices are assessments for other conditions. 9

11. Testtaking Workshop 10 1. Assessment 2. Analysis 3. Planning 4. Intervention 5. Evaluation

12. 2. A client is admitted to the unit with a diagnosis of bronchitis, heart failure and fever. The nurse assesses the client to be very nervous, have a temperature of 101.1 o F (38.4 o C), peripheral edema, dyspnea, and rhonchi. Which nursing diagnosis has the highest priority? 11 A. Anxiety related to fear of hospitalization B. Ineffective airway clearance related to retained secretions C. Fluid volume excess related to third spacing of fluid (edema) D. Ineffective thermoregulation related to fever

13. 2. A client is admitted to the unit with a diagnosis of bronchitis, heart failure and fever. The nurse assesses the client to be very nervous, have a temperature of 101.1 o F (38.4 o C), peripheral edema, dyspnea, and rhonchi. Which nursing diagnosis has the highest priority? A. Anxiety related to fear of hospitalization B. Ineffective airway clearance related to retained secretions C. Fluid volume excess related to third spacing of fluid (edema) D. Ineffective thermoregulation related to fever B. Nursing diagnoses that deal with the airway always have highest priority. 12

14. Testtaking Workshop 13 1. Assessment 2. Analysis 3. Planning 4. Intervention 5. Evaluation

15. 3. A client is diagnosed with respiratory failure and is placed on oxygen. Select the highest priority goal for this client. 14 A. Ambulate the client twice per shift down the length of the hall B. Complete a bath and morning care before breakfast C. Maintain an oxygen saturation of 90% throughout the shift D. Keep the head of the bed elevated to promote proper ventilation

16. 3. A client is diagnosed with respiratory failure and is placed on oxygen. Select the highest priority goal for this client. A. Ambulate the client twice per shift down the length of the hall B. Complete a bath and morning care before breakfast C. Maintain an oxygen saturation of 90% throughout the shift D. Keep the head of the bed elevated to promote proper ventilation C. Choice A is unrealistic for this client. Choice B is not client centered, and choice D is a nursing intervention, not a goal. Maintaining an oxygen saturation of 90% is realistic and within normal limits. 15

17. Testtaking Workshop 16 1. Assessment 2. Analysis 3. Planning 4. Intervention 5. Evaluation

18. 4. When the nurse ambulates a client who has been on bedrest for three days, the client suddenly becomes very restless, displays extreme dyspnea and complains of chest pain. Which is the appropriate immediate nursing action? 17 A. Call the physician about the change in the client’s condition B. Continue to ambulate the client, but at a slower rate C. Give the client an injection of ordered pain medication D. Return the client to bed, and evaluate vital signs and lung sounds

19. 4. When the nurse ambulates a client who has been on bedrest for three days, the client suddenly becomes very restless, displays extreme dyspnea and complains of chest pain. Which is the appropriate immediate nursing action? A. Call the physician about the change in the client’s condition B. Continue to ambulate the client, but at a slower rate C. Give the client an injection of ordered pain medication D. Return the client to bed, and evaluate vital signs and lung sounds D. These are symptoms of a pulmonary embolism which is a common complication of prolonged bedrest. 18

20. Testtaking Workshop 19 1. Assessment 2. Analysis 3. Planning 4. Intervention 5. Evaluation

21. 5. A client is being prepared for discharge and is to take a theophylline medication by mouth at home for his lung disease. Which client statement indicated that teaching concerning theophylline medications has been effective? 20 A. “I can stop taking this medication when I feel better.” B. “If I have difficulty swallowing the time-released capsules, I can crush or chew them.” C. “If I have a lot of nausea and vomiting or become restless and can’t sleep, I need to call my physician.” D. “I need to drink more coffee and soft drinks while I am on this medication.”

22. 5. A client is being prepared for discharge and is to take a theophylline medication by mouth at home for his lung disease. Which client statement indicated that teaching concerning theophylline medications has been effective? A. “I can stop taking this medication when I feel better.” B. “If I have difficulty swallowing the time-released capsules, I can crush or chew them.” C. “If I have a lot of nausea and vomiting or become restless and can’t sleep, I need to call my physician.” D. “I need to drink more coffee and soft drinks while I am on this medication.” C. Choice C lists some adverse effects of theophylline medications that may indicate the onset of toxicity. The physician needs to know about these so that the theophylline level can be determined and the dosage adjusted accordingly. Other factors that the client could be taught about theophylline medications include avoiding excessive amounts of caffeine, never suddenly stop taking the medication, take it with a full glass of water and a small amount of food, and watch for interactions with OTC medications. 21

23. Testtaking Workshop 22 Caring

24. Testtaking Workshop 23 Communication And Documentation

25. Testtaking Workshop 24 Teaching/ Learning

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27. Testtaking Workshop 26 Client Needs I. Safe,Effective Care Environment II. Health Promotion and Maintenance III. Psychosocial Integrity IV. Physiological Integrity

28. Testtaking Workshop Client Needs 27 Safe, Effective Care Environment Management of Care Safety & Infection Control Health Promotion and Maintenance Psychosocial Integrity Physiological Integrity Basic Care and Comfort Pharmacological & Parenteral Therapy Reduction of Risk Potential Physiological Adaptation 13-19% 8-14% 6-12% 13-19% 11-17%

29. Testtaking Workshop 28 Client Needs I.Safe, Effective Care Environment

30. Testtaking Workshop 29 Client Needs II. Health Promotion and Maintenance

31. Testtaking Workshop 30 Client Needs III. Psychosocial Integrity

32. Testtaking Workshop 31 Client Needs IV. Physiological Integrity

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35. 6. A client is admitted to the medical unit with respiratory failure. What is the normal range for PO 2 ? 34 A. 10-30 mm Hg B. 35-55 mm Hg C. 10-20 cm H 2 O D. 80-100 mm Hg

36. 6. A client is admitted to the medical unit with respiratory failure. What is the normal range for PO 2 ? A. 10-30 mm Hg B. 35-55 mm Hg C. 10-20 cm H 2 O D. 80-100 mm Hg D. You either have or do not have the knowledge for this particular laboratory test. 35

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38. 7. A client is becoming progressively short of breath and the ABGs are: pH- 7.13; PO 2 -48; PCO 2 -53; HCO 3 -26. What is indicated by these values? 37 A. Uncompensated metabolic acidosis with moderate hypoxia B. Respiratory alkalosis with hypoxia C. Uncompensated respiratory acidosis with severe hypoxia D. Compensated respiratory acidosis with normal oxygen

39. 7. A client is becoming progressively short of breath and the ABGs are: pH- 7.13; PO 2 -48; PCO 2 -53; HCO 3 -26. What is indicated by these values? A. Uncompensated metabolic acidosis with moderate hypoxia B. Respiratory alkalosis with hypoxia C. Uncompensated respiratory acidosis with severe hypoxia D. Compensated respiratory acidosis with normal oxygen C. Not only do you have to know the normal values for each of the blood gas components given, you also have to be able to use that information in determining the underlying condition. 38

40. 8. A client has become cyanotic and is having Cheyne-Stokes respirations. What is the best action for the nurse to take at this time? 39 A. Call a code blue and begin CPR B. Call the physician and report the condition C. Make sure the client’s airway is open and begin supplemental oxygen D. Give the ordered dose of 200 mg aminophylline IVPB now

41. 8. A client has become cyanotic and is having Cheyne-Stokes respirations. What is the best action for the nurse to take at this time? A. Call a code blue and begin CPR B. Call the physician and report the condition C. Make sure the client’s airway is open and begin supplemental oxygen D. Give the ordered dose of 200 mg aminophylline IVPB now C. Answers B and D are also actions that should be carried out, but at this time, opening the airway and oxygenating the client must receive highest priority. Not only does this question require that the nurse know some specific facts (definitions of “cyanotic” and “Cheyne-Stokes respirations), but also requires a decision be made about the seriousness of the condition (analysis) and a selection of the care to be given from several correct options (judgment). 40

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43. Testtaking Workshop 42 Multiple Choice Items

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45. Testtaking Workshop 44 CAT changes difficulty level for next question based on response to previous question.

46. 9. The nurse is instructing a client on how to obtain a 24-hour urine sample for creatinine clearance. Which measure is appropriate for the nurse to include in the teaching plan? 45 A. Keep the urine in a glass container only B. Drink extra fluid to increase the amount C. Save all the urine for a full 24 hours D. Save only enough urine to fill the container

47. 9. The nurse is instructing a client on how to obtain a 24-hour urine sample for creatinine clearance. Which measure is appropriate for the nurse to include in the teaching plan? A. Keep the urine in a glass container only B. Drink extra fluid to increase the amount C. Save all the urine for a full 24 hours D. Save only enough urine to fill the container C. All urine needs to be saved, or the results would be inaccurate. This material should be covered in one of the introductory courses and is considered to have a low difficulty level. 46

48. 10. A client has been diagnosed as having Wolff-Parkinson-White (WPW) syndrome, Type A. In evaluating the electrocardiogram, the nurse notes which characteristics for this condition? 47 A. PR interval less than 0.12 second and wide QRS complex B. PR interval greater than 0.20 second and normal QRS complex C. Delta wave present in a positively deflected QRS complex in lead V1 and PR interval less than 0.12 second D. Delta wave present in a positively deflected QRS complex in lead V6 and PR interval greater than 0.20 second

49. 10. A client has been diagnosed as having Wolff-Parkinson-White (WPW) syndrome, Type A. In evaluating the electrocardiogram, the nurse notes which characteristics for this condition? A. PR interval less than 0.12 second and wide QRS complex B. PR interval greater than 0.20 second and normal QRS complex C. Delta wave present in a positively deflected QRS complex in lead V1 and PR interval less than 0.12 second D. Delta wave present in a positively deflected QRS complex in lead V6 and PR interval greater than 0.20 second C. These are the criteria for WPW. This material is much more difficult and usually covered, if at all, toward the end of the educational program. 48

50. Testtaking Workshop 49 Alternate Format Items 1.Fill-in-the-blank 2.Select more than one option 3.Identification of an Area/Location within an Image or Graphic 4.Ranking or Ordered response 5.Charts and Tables

51. Fill-in-the-Blank 50 For breakfast, a client consumed the following food and fluids. 1 cup of milk10 oz. of water 4 oz. of gelatin1 scrambled egg 1 crisp piece of bacon2 biscuits with jelly How many milliliters should the nurse document for the breakfast intake? Answer:______________mL.

52. Fill-in-the-Blank For breakfast, a client consumed the following food and fluids. 1 cup of milk10 oz. of water 4 oz. of gelatin1 scrambled egg 1 crisp piece of bacon2 biscuits with jelly How many milliliters should the nurse document for the breakfast intake? Answer:_____660 or 670 mL. Correct answer: 660 mL or 670 mL 1 cup = 8 fluid ounces (240 or 250 mL, depending on source) 10 oz = 300 mL 4 oz = 120 mL 51

53. 52 Select more than One Option In which situation(s) does the staff demonstrate adherence to infection control procedures? Select all that apply. ___1. Transfers a client who has just been diagnosed with active pulmonary tuberculosis from a semi-private room to a private ___2. Initiates airborne precautions, as well as standard precautions, for the client with scabies ___3. Utilizes droplet precautions, in addition to standard precautions, with a client who has meningococcal pneumonia ___4. Transfers a client with a staphylococcus wound infection to a private room ___5. Transfers a client with chicken pox (varicella) from a semi-private room with a postoperative roommate to a semi-private room with a roommate who has rubella ___6. In addition to standard precautions, institutes contact precautions for the client whit shigellosis

54. Select more than One Option In which situation(s) does the staff demonstrate adherence to infection control procedures? Select all that apply. _X__1. Transfers a client who has just been diagnosed with active pulmonary tuberculosis from a semi-private room to a private ___2. Initiates airborne precautions, as well as standard precautions, for the client with scabies _X__3. Utilizes droplet precautions, in addition to standard precautions, with a client who has meningococcal pneumonia ___4. Transfers a client with a staphylococcus wound infection to a private room ___5. Transfers a client with chicken pox (varicella) from a semi-private room with a postoperative roommate to a semi-private room with a roommate who has rubella _X__6. In addition to standard precautions, institutes contact precautions for the client whit shigellosis Correct answer: 1, 3 and 6 For the client with pulmonary tuberculosis, a private room, airborne and standard precautions are required. For scabies, contact and standard precautions are required. For pneumonia, droplet and standard precautions are required. A client with a staph wound infection may be in a private room or with a client with the same organism. Chickenpox should be in a private room. Shigellosis needs contact and standard precautions. 53

55. Identification of an Area/Location within an Image or Graphic 54 The nurse is auscultating a client’s breath sounds. Identify the area where the stethoscope should be placed by the nurse to best auscultate bronchovesicular breath sounds. For this item there would be an image of the thorax and the candidate would indicate the position for auscultation by positioning the mouse or cursor on a specific location within the image of the thorax and clicking.

56. Identification of an Area/Location within an Image or Graphic 55

57. Ranking or Ordered Response 56 Prioritize nursing actions for a client with a history of generalized seizures who is beginning to experience a tonic-clonic seizure. 1. Protect client from injury 2. Document the time of seizure occurrence 3. Determine airway patency 4. Explain to significant others what is occurring 5. Reassure and reorient the client Type the correct order by number in the box below without spaces between numbers.

58. Ranking or Ordered Response Prioritize nursing actions for a client with a history of generalized seizures who is beginning to experience a tonic-clonic seizure. 1. Protect client from injury 2. Document the time of seizure occurrence 3. Determine airway patency 4. Explain to significant others what is occurring 5. Reassure and reorient the client Type the correct order by number in the box below without spaces between numbers. Correct answer: 31245 57

59. Charts and Tables 58 You will be asked a question. You will then click on the exhibit button at the bottom and a chart or table with tabs will appear. You will need to click on the appropriate portion to obtain the information you need to answer the question.

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64. Testtaking Workshop 63 Licensure Examination Tests Minimum Standards to Guarantee Public Safety, Not Maximum Ability

65. Guidelines to Testtaking 64

66. Guidelines to Testtaking 65 Look for key words such as age, sex, who client is, any significant others involved, time frame

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68. Guidelines to Testtaking 67 Treat each question individually. There is no reference from one question to another question.

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71. Guidelines to Testtaking 70 Use the process of elimination in selecting the correct answer

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73. 11. The nurse suspects that a client is having an anaphylactic-type allergic reaction to an IV antibiotic just received. Which symptoms manifested by the client would most likely lead the nurse to this conclusion? 72 A. Nausea and vomiting B. Itchy rash and hives C. Hypertension and tachycardia D. Sudden wheezing and urticaria

74. 11. The nurse suspects that a client is having an anaphylactic-type allergic reaction to an IV antibiotic just received. Which symptoms manifested by the client would most likely lead the nurse to this conclusion? A. Nausea and vomiting B. Itchy rash and hives C. Hypertension and tachycardia D. Sudden wheezing and urticaria D. Anaphylactic reactions cause bronchial spasms/constriction and rashes. Nausea and vomiting are adverse side effects and hypertension is not associated with anaphylactic shock. The graduate may have chosen B if he/she did not read the whole question carefully, but D (urticaria) includes B. 73

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76. Guidelines to Testtaking 75 Maslow’s Hierarchy of Needs Self-actualizing Self-esteem Love and Belonging Safety Needs Physiologic Needs

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79. 12. A 62-year-old client has a history of coronary heart disease and is brought into the ER complaining of chest pain. What initial action should be taken by the nurse? 78 A. Give the client nitroglycerin 0.3 mg SL now B. Call the client’s cardiologist about admission C. Place the client in a high-Fowler’s position after loosening the shirt D. Check B/P and note the location and degree of the chest pain

80. 12. A 62-year-old client has a history of coronary heart disease and is brought into the ER complaining of chest pain. What initial action should be taken by the nurse? A. Give the client nitroglycerin 0.3 mg SL now B. Call the client’s cardiologist about admission C. Place the client in a high-Fowler’s position after loosening the shirt D. Check B/P and note the location and degree of the chest pain D. It is important to remember that when asked for an “initial” or “first” action, think of the nursing process. The first step in the nursing process is always assessment. If there is not an assessment choice, then look for a planning choice and so forth. The other three answers provided for this question are also correct and should be done at some point; but in this particular situation, the first need is to assess the chest pain to determine if it is indeed cardiac in nature. Many other conditions also cause chest pain. 79

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82. 13. Select the medication that is inappropriate for the relief of chest pain. 81 A. Diltiazem (Cardizem) B. Propranolol (Inderal) C. Digoxin (Lanoxin) D. Meperidine (Demerol)

83. 13. Select the medication that is inappropriate for the relief of chest pain. A. Diltiazem (Cardizem) B. Propranolol (Inderal) C. Digoxin (Lanoxin) D. Meperidine (Demerol) C. Digoxin is a positive inotropic medication and increases contractility and the oxygen demands of the heart. It is likely it would actually increase chest pain in this client. The other three medications all relieve chest pain by somewhat different mechanisms. But notice that if the question was not read carefully and the reader missed the “in” prefix of inappropriate then certainly choice C would not have been selected. 82

84. Guidelines to Testtaking 83

85. 14. When assessing the chest pain of a client with cardiovascular disease, what may be considered? 84 A. This pain is always caused by constriction or blockage of the coronary arteries by fat plaques or blood clots B. True cardiac pain is never relieved without treatment C. This type of pain is only relieved by nitroglycerin D. Clients often attribute the pain to indigestion

86. 14. When assessing the chest pain of a client with cardiovascular disease, what may be considered? A. This pain is always caused by constriction or blockage of the coronary arteries by fat plaques or blood clots B. True cardiac pain is never relieved without treatment C. This type of pain is only relieved by nitroglycerin D. Clients often attribute the pain to indigestion D. The answers to this question are very obvious in the demonstration of the “avoid the absolute” strategy. Coronary type chest pain can also be caused by spasms of the coronary arteries as a variant angina (choice A). Chest pain sometimes can go away by itself, although it will probably return later (choice B). There are a number of medications that will also relieve chest pain besides nitroglycerin (e.g. morphine and narcotics, calcium-channel blockers and beta blockers) (choice C). 85

87. Guidelines to Testtaking 86

88. Guidelines to Testtaking 87

89. 15. A client has developed heart failure. Identify the correct loading dose of digoxin (Lanoxin) for an adult client. 88 A. 0.75 mg divided into three doses q 8 hours B. 0.75 Gm divided into four doses q 8 hours C. 10 mg due to the fact the client is a very large person, with a Native American background, which causes slow absorption of the medication D. 0.25 mg

90. 15. A client has developed heart failure. Identify the correct loading dose of digoxin (Lanoxin) for an adult client. A. 0.75 mg divided into three doses q 8 hours B. 0.75 Gm divided into four doses q 8 hours C. 10 mg due to the fact the client is a very large person, with a Native American background, which causes slow absorption of the medication D. 0.25 mg A. The loading dose for digoxin is usually three times the maintenance dose (0.25 mg) divided over 24 hours. Choice B is in a different measurement form (grams instead of milligrams); choice C demonstrates the longer than average answer with rationale; and D is much shorter than any of the others. 89

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92. Guidelines to Testtaking 91 Avoid looking for a pattern in the selection of answers

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94. 16. A 33-year-old client has been diagnosed as having a pheochromocytoma. Select the appropriate initial nursing activity. 93 A. Administer large doses of xylometrazoline (Otrivin) to help control the symptoms of the disease B. Monitor the client’s vital signs closely, particularly the blood pressure C. Prepare the client and family for imminent death D. Have the family discuss the condition with the physician before informing the client about the disease because of the protracted recovery period after treatment.

95. 16. A 33-year-old client has been diagnosed as having a pheochromocytoma. Select the appropriate initial nursing activity. A. Administer large doses of xylometrazoline (Otrivin) to help control the symptoms of the disease B. Monitor the client’s vital signs closely, particularly the blood pressure C. Prepare the client and family for imminent death D. Have the family discuss the condition with the physician before informing the client about the disease because of the protracted recovery period after treatment. B. A pheochromocytoma is a tumor of the adrenal medulla that causes an increase in the secretion of epinephrine and/or norepinephrine. One important result of having this type of tumor is that a hypertensive crisis may occur in some individuals. Monitoring B/P would be an important nursing care measure. Also, assessment is the first step of the nursing process and would fit well with the qualifying word “initial”, used in the question stem. (xylometrazoline [Otrivin} is similar to Neosynephrine) 94

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99. Guidelines to Testtaking 98 Choose answers that acknowledge the client, communicate acceptance, are open-ended and encourage discussion and expression of feelings

100. Guidelines to Testtaking 99 If two or three answers say the same thing in different words, none are right

101. Guidelines to Testtaking 100 Look for the type of answer required (assessment data, nursing intervention, prioritizing, etc.)

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104. Guidelines to Testtaking 103 Review Thoroughly 1.Names of Common Medications 2.Lethal and Therapeutic Doses and Antidotes 3.Common Side Effects of Medications 4.Lab Values and Implications 5.Growth and Development 6.Diet Therapy 7.Basic Anatomy and Physiology 8.Stages of the Nursing Process

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106. Guidelines to Testtaking 105 Group Study Rules Set time limits Divide responsibilities of review Divide responsibilities of review Prepare your own questions Prepare your own questions Make decisions on participants Make decisions on participants Stop at scheduled end Stop at scheduled end

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113. Guidelines to Testtaking 112 Avoid Stimulants and Alcohol

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115. Guidelines to Testtaking 114 Day of Exam Avoid excess oral intake of your special diuretics: Coffee, Cigarettes, Tea, Soft Drinks. Do increase intake of foods high in quality glucose and protein. Arrive 15 to 30 minutes early. Relaxation Technique

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