NCLEX Test Taking Strategy

ANSWERING PHARMACOLOGY QUESTIONS

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A. If you are familiar with the medication, use nursing knowledge to answer the question.

B. Remember that the question will identify the generic name and trade name of the medication.

C. If the question identifies a medical diagnosis.

D. Then try to make a relationship between the medication and the diagnosis; for example, you can determine that cyclophosphamide (Cytoxan) is an antineoplastic medication if the question refers to a client with breast cancer who is taking this medication.

E. Recognize the common side effects associated with each medication classification and then relate the appropriate nursing interventions to each side effect; for example, if the side effect is hypertension, then the associated nursing intervention would be to monitor the blood pressure.

F. Learn medications that belong to a classification by commonalities on their medication names; for example, medications that are xanthine bronchodilators end with “line” (theophylline) .

G. Look at the medication name and use medical terminology to assist in determining the medication action; for example, Lopressor lowers (lo) the blood pressure (pressor).

H. If the question requires a medication calculation, remember that a calculator is available on the computer; talk yourself through each step to be sure the answer makes sense, and recheck the calculation before answering the question, particularly if the answer seems like an unusual dosage.

I. Points to remember
1. Generally, the client should not take an antacid with medication because the antacid will affect the absorption of the medication.

2. Enteric-coated and sustained-release tablets should be crushed; additionally, capsules should not be opened.

3. The client should never adjust or change a medication dose or abruptly stop taking a medication.

4. The nurse never adjusts or changes the client’s medication dosage and never discontinues a medication.

5. The client needs to avoid taking any over-the-counter medications or any other medications such as herbal preparations unless they are approved for use by health care provider.

6. The client needs to avoid alcohol and smoking.

7. Medications are never administered if the order is difficult to read, is unclear, or identifies a medication dose that is not a normal one.

Practice Question: Answering Pharmacology Questions
Orally administered levothyroxine (Synthroid) 50 ug daily is prescribed for a client with hypothyroidism. The nurse provides medication instructions to the client and tells the client to take the medication

1. Just after breakfast.
2. With a snack at 3 pm.
3. In the morning on an empty stomach.
4. With food.

Answer: 3
Test-Taking Strategy: Note that a medical diagnosis is presented in the question. This will assist you in determining that the medication is used to treat this condition. Additionally, most thyroid replacement medications contain “thy” in their names. Also use the strategy of eliminating similar options. Note that options 1, 2, and 4 are similar and indicate that the medication should be taken with food. Remember with pharmacology questions, focus on the information in the question and the classification of the medication.

USE THE GUIDELINES FOR DELEGATING AND ASSIGNMENT MAKING

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A. You may be asked a question that will require you to decide how you will delegate a task or assigned clients to other health care providers.
B. Focus on the information in the question and what task or assignment is to be delegated.
C. Once you have determined what task or assignment is to be delegated, consider the client’s needs and match the client’s needs to the scope of practice of the health care providers identified in the question.
D. The nurse practice act and any practice limitations define which aspects of care can be delegated and which must be performed by the registered nurse.
E. Generally, noninvasive interventions such as skincare, range of motion exercises, ambulation, grooming, and hygiene measures can be assigned to a nursing assistant.
F. A licensed practical nurse can perform the tasks that a nursing assistant can perform and additionally can perform certain invasive tasks such as dressings, suctioning, urinary catheterization, and administering medications orally or by subcutaneous or intramuscular injections.
G. The registered nurse can perform the tasks that a licensed practical nurse can perform and is responsible for assessment and planning care, supervising care, initiating teaching, and administering medications intravenously.

Practice Question: Use the Guidelines for Delegating and Assignment Making
A nurse is planning the client assignment for the day and has a licensed practical nurse (LPN) and a nursing assistant on the team. Which client would the nurse most appropriately assign to the LPN?
1. A client with stable congestive heart failure who has early stage Alzheimer’s disease
2. A client who was treated for dehydration and is weak and needs assistance with bathing.
3. A client with emphysema who is receiving oxygen at 2 L nasal cannula and becomes dyspneic on exertion.
4. A client who is scheduled for an electrocardiogram and a chest x-ray.

Answer: 3
Test-Taking Strategy: The nurse would most appropriately assign the client with emphysema to the LPN. This client has an airway problem and has the highest priority needs from the clients presented in the options. The clients described in option 1, 2, and 4 can be cared for appropriately by the nursing assistant. Remember to match the client’s needs with the scope of practice of the health care provider.

LOOK FOR THE UMBRELLA OPTION

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A. When answering a question, if you note that more than one option appears to be correct, look for the umbrella option (also known as global option or comprehensive option) .
B. The umbrella option is one that is a general statement and may contain the ideas of the other options within it.
C. The umbrella option will be the correct answer.

Practice Question: Look for the Umbrella Option
A nurse from the emergency room receives s telephone call from the 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 of the emergency nurse is which of the following?
1. Supply the trauma room with bottles of sterile water and normal saline.
2. Call the laundry department and ask the department to send as many warm blankets as possible to the emergency room.
3. Call the nursing supervisor to activate the agency disaster plan.
4. Call the intensive care unit to request that nurses be sent to the emergency room.

Answer: 3
Test-Taking Strategy: Option 3 is the umbrella option. Activating the agency disaster plan will ensure that the interventions in options 1, 2, and 4 will occur. Remember the umbrella option embraces the ideas of the other options within it.

ELIMINATE OPTIONS THAT CONTAIN ABSOLUTE WORDS

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A. As you read each option, look for absolute words.
B. Absolute words tend to make an option incorrect, and if you note an absolute word in an option, eliminate that option.
C. Some of these absolute words include all, always, every, must, none, never, and only.

Practice Question: Eliminate Options That Contain Absolute Words
A nurse is providing safety instruction to the mother of a child with hemophilia and tells the mother to do which of the following to promote a safe environment for the child?
1. Remove toys with sharp edges from the child’s toy box.
2. Allow the child to play with toys only of a parent is present.
3. Place a helmet and elbow pads on the child every day.
4. Allow the child to play indoors only.
Answer: 1
Test-Taking Strategy: Eliminate options that contain absolute words. Options 2 and 4 contain the absolute word only. Option 3 contains the absolute word every. Remember that absolute words tend to make an option incorrect.

ELIMINATING SIMILAR OPTIONS

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A. When answering the questions, use the process of elimination and look for similar options.
B. If any of the options include the same idea, then they are incorrect and can be eliminated.
C. Remember that there is only one correct option, and the answer to thje question is the option that is different.
Practice Question: Eliminate Similar Options
A nurse is assigned to care for a group of clients’ medical records, the nurse determines that which client is at risk for excess fluid volume?
1. The client with ileostomy
2. The client taking diuretics
3. The client who requires gastrointestinal sunctioning
4. The client with renal failure
Answer: 4
Test – Taking Strategy: Focus on what the question is asking: the client at risk for excess fluid volume. Think about the pathophysiology associated with each condition identified in the options. The only client that retains fluid is the client with renal failure. The client with an ileostomy, the client taking diuretics, and the client requiring gastrointestinal sunctioning all lose fluid. Remember eliminate similar options.

HEALTH PROMOTION AND MAINTENANCE

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1. These questions address the nurse’s role in providing and directing nursing care that prevents health problems, provide early detection of health problems, and provides and directs care that incorporates knowledge of expected growth and development principles.
2. Content addressed in these questions relates to assisting the client and significant other(s) through the normal stages of growth and development and assisting the client and significant other(s) to develop health practices that promote wellness and to recognize alterations in health care status.
3. Use the teaching/learning theory if the question addresses client education, remembering that client motivation and client readiness to learn is the first priority.
4. Be alert to false response a question that addresses health promotion and maintenance and client education.

CLIENT NEEDS – Psychosocial Integrity

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These questions address the nurse's role in providing nursing care that supports and promotes the emotional, mental, and social well-being of the client and significant others.
Content addressed in these questions relates to promoting the client's or significant other's ability to cope, adapt, or solve in situations such as illness or stressful events and to providing care to clients with maladaptive behaviour or acute or chronic mental illness.
In this Client Needs category you may be asked communication-type questions that relate to how you would respond to a client, a client's family member or significant other, or to other health care team members.
Use therapeutic communication techniques to answer communication questions because of their effectiveness in the communication process.
Remember to select the answer that focuses on the client's family members, or significant other's feelings, concerns, anxieties or fears.
Practice Question: Communication
A mother says to the nurse, "I am afraid that my child might have another seizure." Which response by the nurse is most therapeutic/
1. "Why worry about something that you cannot control?"
2. "Most children will never experience a second seizure."
3. "Tell me what frightens you the most about seizures."
4. "Acetaminophen (Tylenol) can prevent another seizure from occurring."
  Answer: 3
  Test-Taking Strategy: Option 3 is the only option that addresses the client's fears. Option 1 blocks communication because it states that he mother should not worry. Options 2 and 4 are incorrect because the nurse is giving false assurance that a seizure will not re occur or can be prevented in this child. Remember, focus on feelings, concerns, anxieties, or fears.

CLIENT NEEDS – Physiological Integrity

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These questions address the nurse's role in promoting physical health and well-being in the client by providing care and comfort, reducing client risk potential, and managing the client's health alterations.
Content addressed in these questions relates to basic care and comfort, pharmacological and parenteral therapies, reducing the risk of the development of complications, and managing and providing care to clients with acute, chronic, or life-threatening conditions.
Remember that physiological needs are a priority and are addressed first.
Use the ABCs airway, breathing, and circulation; Maslow's hierarchy of needs theory; and the steps of the nursing process when selecting an option addressing physiological integrity.

CLIENT NEEDS – Safe, Effective Care Environment

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These questions address the nurse's role in providing and directing care that will ensure an environment that promotes protecting the client, family or significant other(s), and other health care personnel.
Content addressed in these questions relates to the nursing role of coordinating and integrating cost-effective care, supervising and/or collaborating with members of the multidisciplinary health care team, and environmental safety.
Be alert to safety needs addressed in a question, and remember the importance of handwashing, call bells, bed positioning, the appropriate use of side rails, and standard precautions.

The Use Of Nursing Process to Prioritize

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The steps include assessment, analysis, planning, implementation, ad evaluation and are followed in this order.
Assessment
1. Remember that assessment is the first step in nursing process.
2. When you are asked to select your first and initial nursing action, follow the steps of the nursing process to prioritize when selecting the correct option.
3. Assessment questions address the process of gathering subjective and objective data relative to the client, confirming that data and communicating and documenting the data.
4. Look for key words in the options that reflect assessment.
  Assessment Key Words;

Ascertain
Assess
Check
Determine
Find out
Identify
Monitor
Observe
Obtain information

If an option contains the concept of assessment or the collection of client data, the best choice is to select that option.
Practice Question: The Nursing Process – Assessment

A nurse is teaching a client with coronary artery disease about dietary measures to follow. During the session, the client expresses frustration in learning the dietary regimen. The nurse would initially
1. Identify the cause of the frustration
2. Continue with the dietary teaching
3. Notify the physician
4. Tell the client that the diet needs to be followed
  Answer: 1
  Test-Taking Strategy: Use the steps of the nursing process. Assessment is the first step. Of the four options presented, the only assessment action is option 1. Options 2, 3, and 4 identify the implementation step of the nursing process. The initial action is to identify the cause of the frustration. Remember assessment is the first step of the nursing process.
If an assessment action is not one of the options, follow the steps of nursing process as your guide to select your initial or first action.
Possible exception to the guideline: If the question presents an emergency situation, read carefully; in an emergency situation, an intervention may be the priority.

Analysis
Practice Question: The Nursing Process – Analysis
A nurse is reviewing the laboratory results of an infant suspected of having hypertrophic pyloric stenosis. Which of the following laboratory findings would the nurse most likely to expect to note in this infant?
1. A blood pH of 7.50
2. A blood pH of 7.30
3. A blood bicarbonate of 22 mEq/L
4. A blood bicarbonate of 19 mEq/L
  Answer: 1
Test-Taking Strategy: An understanding of the physiology associated with hypertrophic pyloric stenosis and that metabolic alkalosis is likely to occur as a result of vomiting is necessary. Next, the nurse must know which laboratory findings would be noted in this acid-base condition. Analysis of this data will direct you to the correct option. Remember analysis is the second step of the nursing process.
1. Analysis question are the most difficult questions because they require understanding of the principles of physiological responses and require interpretation of the data based on assessment.
2. Analysis questions require critical thinking and determining the rationale for therapeutic interventions that may be addressed in the question.
3. Analysis questions may address the formulation of a nursing diagnosis and the communication and documentation of the results of the process of analysis.
Planning
1. Planning questions require prioritizing nursing diagnoses, determining goals and outcome criteria for goals of care, developing the plan of care, and communicating and documenting the plan of care.
2. Regarding nursing diagnoses, remember that actual client problems rather than potential or at-risk client problems will most likely be the priority.
3. Remember that this is a nursing examination and the answer to the question most likely involves something that is included in the nursing care plan, rather than the medical.
  Practice Question: The Nursing Process – Planning
  A nurse develops a plan of care for a client with a cataract. Which nursing diagnosis is the priority?
  1. Fear related to loss of eyesight
  2. Social isolation related to decreased ability to mobilize in the community
  3. Disturbed sensory Perception (Visual) related to ocular lens opacity
  4. Risk for injury related to decreased vision
    Answer: 3
    
    Test-Taking Strategy: This question relates to planning nursing care and asks you to identify the priority nursing diagnosis. Use Maslow's hierarchy of needs theory to answer the question. Remembering that physiological needs are the priority will direct you to option 3. Although Risk for Injury is a potential rather than an actual problem, according to Maslow's hierarchy of needs theory, safety is the second priority. Fear and social isolation are psychosocial needs. Remember planning is the third step of the nursing process.
Implementation
1. Implementation questions address the process of organizing and managing care, counselling and teaching, providing care to achieve established goals, supervising and coordinating care, and communicating and documenting nursing interventions.
2. This examination is about nursing, so focus on the nursing action rather than on the medical action; unless the question is asking you what prescription (medical order) is anticipated.
3. The only client whom you need to be concerned is the client in the question that you are answering; remember that this client is your only assigned client.
4. Answer the question as if the situations were textbook and ideal and the nurse had all the time and resources needed and readily available at the client's bedside.
  Practice Question: The Nursing Process – Implementation
  A nurse is caring for a client with angina pectoris who begins to experience chest pain. The nurse administers a sublingual nitroglycerin (Nitrostat) tablet sublingually as prescribed, but the pain is unrelieved. The nurse should take which of the following actions next?
  1. Contact the physician
  2. Call the client's family
  3. Administer another nitroglycerin tablet
  4. Reposition the client
    Answer: 3
    Test-Taking Strategy: Implementation questions address the process of organizing and managing care. This question also requires that you prioritize the nursing actions. Note that the keyword next. Recalling that the nurse would administer three nitroglycerin tablets 5 minutes apart from each other to relieve chest pain will assist in directing you to option 3. Remember implementation is the fourth step of the nursing process.
Evaluation
1. Evaluation questions focus on comparing the actual outcomes of care with the expected outcomes and focus on how the nurse should monitor or make a judgement concerning a client's response to therapy or to a nursing action.
2. These questions address evaluating the client's ability to implement care, and the process of communicating and documenting evaluation findings.
3. In an evaluation question, be alert to false response question because they are used frequently in evaluation-type questions, and the question may ask for a client statement that indicates accurate or inaccurate information related to the issue of the question.
  Practice Question: The Nursing Process – Evaluation
  
  A client with multiple sclerosis has been taking oxybutynin (Ditropan). The nurse determines the degree of the effectiveness of the medication by asking the client about changes in the following:
  1. Extent of muscle spasm
  2. Level of fatigue
  3. Bowel movements
  4. Patterns of urination
    Answer: 4
    
    Test-Taking Strategy: This is an evaluation question. Note the keywords determine the degree of effectiveness. Oxybutynin is an antispasmodic used to relieve symptoms of urinary urgency, frequency, nocturia, and incontinence in clients with uninhibited or reflex neurogenic bladder. Recalling that this medication is used to treat bladder dysfunction will direct you to option 4. Remember evaluation is the fifth step of the nursing process.

Use Maslow’s Hierarchy of Needs Theory as a Guide To Prioritize

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Use Maslow's hierarchy of needs theory as a guide to prioritize.
Physiological needs are the priority; therefore select an option or determine the order of priority by addressing physiological needs first.
When a physiological need is not addressed in the question or noted in one of the options, continue to use Maslow's hierarchy of needs theory as a guide and look for the option that addresses safety.

Practice Question: Maslow's Hierarchy of Needs Theory
A nurse is reviewing the plan of care for a pregnant client with a diagnosis of sickle cell anemia. Which nursing diagnosis, if stated on the plan of care, would the nurse select as receiving the highest priority?
1. Anxiety
2. Ineffective coping
3. Disturbed body image
4. Deficient fluid volume
  Answer: 4
  Test-Taking Strategy: Note the key words highest priority. Use Maslow's hierarchy of needs theory to prioritize, remembering that physiological needs comes first. Using this guideline will direct you to option 4. Deficient fluid volume is a physiological need and is the priority nursing diagnosis. Remember, physiological needs are the priority.

The ABCs in Prioritization

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Use the ABCs – airway, breathing, and circulation – when selecting an answer or determining the order of priority.
Remember the order of priority: airway, breathing, and circulation.
Airway is always the first priority.
Practice Question: Use of the ABCs
The client with a diagnosis of cancer is receiving a morphine sulphate 10 mg subcutaneously every 3-4 hours for pain. When preparing the plan of care for the client, the nurse includes which priority action?
1. Monitor stools.
2. Monitor the urine output.
3. Encourage the client to cough and deep breath.
4. Encourage fluid intake.
  Answer:3
  
  Test-Taking Strategy: Use the ABCs – airway, breathing, and circulation – as a guide to direct you to the correct option. Recall that morphine sulphate suppresses the cough reflex and the respiratory reflex. Although, options 1, 2, and 4 are components of the plan of care, the correct option addresses airway. Remember use the ABCs airway, breathing, and circulation to prioritize.

Questions That Require Prioritizing

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Questions in the examination may require you to use the skill of prioritizing nursing actions.
Look for the key words in the question that indicate the need to prioritize.
Common Key Words That Indicate the Need to Prioritize

Best
Essential
First
Highest priority
Immediate
Initial
Most important
Next
Primary
Vital

Remember, when a question requires prioritization, all options may be correct, and you need to determine the order of action.
Guidelines to use include the ABCs airway, breathing, and circulation; Maslow's hierarchy of needs theory; and the steps of the nursing process.

How To Look For Key Words

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Key words focus your attention on a specific or critical point to consider when answering the question.
Some key words may indicate that all of the options are correct, and that it will be necessary to prioritize in order to select the correct option.
As you read the question, look for the key words; key words will make a difference regarding how you will answer the question.

Common Key Words:

Early or late
Best
First
Initial
Immediately
Most likely or least likely
Most appropriate or least appropriate

True and False Response Question

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True response questions use key words that ask you to select an option that is accurate regarding the information in the question.
False response questions use key words that ask you to select an option that is not accurate regarding the information in the question.
Read every word in the question and be specifically alert in noting key words that ask you to select an option that is not accurate regarding the information in the question.
Practice question: True response
A client suspected of having meningitis is being scheduled for diagnostic tests. The nurse anticipates that which of the following diagnostic tests will most likely be prescribed to confirm the diagnosis?
1. Serum electrolytes
2. Electromyography
3. White blood cell count
4. Lumbar puncture
  Answer: 4
  
  Test-Taking Strategy: This question identifies an example of a true response question. Note the key words most likely and confirm. Focus on the diagnosis presented in the question and the associated pathophysiology to assist in directing you to option 4. Remember, meningitis is an acute or chronic inflammation of the meninges and the cerebrospinal fluid. The key diagnostic test used in meningitis is the lumbar puncture. A white blood cell count and serum electrolytes test may also be performed. Electromyography is not a key diagnostic test. Remember true response questions ask you to select an option that is accurate.

Practice question: False response

Cortisone (Cortone) is prescribed for a client with adrenal insufficiency, and the nurse provides instructions to the client regarding the medication. Which of the following statements if made by the client would indicate a need for further instruction?

"I will eat a good breakfast everyday.:
1. "I will avoid people with colds."
2. "I will limit my sodium intake."
3. "I will stop the medication when I feel better."
  Answer: 4
  Test-Taking Strategy: This question identifies a example of a false response question. Note the key words need for further instruction. These key words indicate that you should select an option that identifies an incorrect client statement. Glucocorticoids should not be abruptly discontinued to prevent acute adrenal insufficiency. You easily should be able to eliminate options 1, 2, and 3, remember that the client should not stop these medications or in fact any medication without physician approval. Remember false response questions ask you to select an option that is not accurate regarding the information in the question.

The issue of the question

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The issue of the question is the specific subject content about which the question is asking.
Identifying the issue of the question will assist in eliminating the incorrect options and direct you to selecting the correct option.
The issue of the question can include the following:
1. A medication or intravenous therapy
2. A side effect of a medication
3. An adverse or toxic effect of a medication
4. A treatment or procedure
5. A complication of a health care problem, treatment, or procedure
6. A specific nursing action
  Practice Question: The issue of the question
  Fat emulsion is prescribed for the client receiving total parenteral nutrition. The nurse is preparing to hang the fat emulsion and notes the presence of fat globules in the solution. The most appropriate nursing action is:
  1. Shake the solution to dissolve the globules
  2. Call the physician
  3. Return the solution to the pharmacy
  4. Place the solution in a bath of warm water until the globules dissolve
    Answer: 3
    
    Test-taking strategy: Focus on the issue, the presence of fat globules in the solution. Thinking about the significance of fat globules in the solution and the potential adverse side effect of fat globules entering the client's blood-stream will direct you to correct option.

How To Avoid Reading Into The Question

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Pyramid points
1. Read every word in the question and specifically determine what the question is asking.
2. Focus only on the information in the question and avoid asking yourself, "Well, what if...?"
3. Look for the key words in the question, such as early signs or late signs.
4. In multiple choice questions, multiple-response questions, or questions that require you to number in order of priority, read every choice or option presented.
5. Use the process of elimination when choices or options are presented; reread the question and what the question is asking specifically to assist you in determining your final choice or choices.
6. With questions that require you to fill in the blank, focus on the information in the question and determine what the question is asking; if the question requires you to calculate a medication dose or intake and output amounts, recheck your work in calculating to verify the answer.
7. Remember, focus on the information in the question is asking.
The parts of the question
1. The question will consist of a case situation, question stem, and the options (a fill in the blank question will not contain options).
2. The case situation provides you with the information about the client and the information that you need to consider in answering the question.
3. The question stem asks something specific about the case situation.
4. The options are all the answers.
5. A multiple-choice question will have four options, and you must select one; read every option carefully, and always use the process of elimination.
6. A multiple-response question will have several options, and you must select all options that apply to the situation in the question; read each option carefully, visualize the situation, and use your nursing knowledge to answer the question.
7. In a prioritizing (ordered response) question, you will be required to list in order of priority certain nursing interventions; visualize the situation, and use your nursing knowledge to answer the question.