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Testing Strategies for the
NCLEX-PN
Examination
Not only do content experts and item reviewers create new items, they are also involved in the continual review of items in the NCLEX test pool to ensure all items reflect the current practice of practical nursing.^1 So, what does this all mean? It means that nurses in current practice and nursing faculty work together to identify the con- tent and to develop questions for the NCLEX-PN. The purpose of the examination is to assure the public that each candidate who passes the examination can practice safely and effectively as a newly licensed, entry-level PN. The NCLEX-PN is used by every U.S. state to determine en- try into nursing practice as a PN. Each state is responsible for the testing requirements, retesting procedures, and entry into practice within that state. Each state requires the same com- petency level or passing standard on the NCLEX; there is no variation in the passing standard from state to state.
TEST PLAN
The test plan is based on research conducted by the NCSBN every 3 years. The purpose of this research is to determine the most important and frequent activities of practical nurses who were successful on the NCLEX and who have been working after successful completion of the NCLEX. The current re- search indicates that the majority of graduate practical nurses are working in long term care facilities or in hospitals and are caring for clients ages 65 to over 85 years old.^1 Each question will reflect a level of the nursing process or an area of client needs, and each question will be categorized according to a validated level of difficulty. The exam consists of questions that are designed to test the candidate’s ability to apply the nursing process and to determine appropriate nursing respons- es and interventions to provide safe nursing care.
Integrated Processes
Integrated throughout the test plan are principles that are fun- damental to the practice of practical nursing.
Nursing Process
The nursing process is a scientific approach to problem solving; it has been a common thread in your nursing curriculum since the beginning of school. There is nothing new about the nursing process on the NCLEX. Data collection, planning, implementation and evaluation are all integral steps in the One of the first steps to be being successful on the NCLEX® (National Council Licensure Examination) for practical nurs- ing is to understand how the test is developed. An important step in preparing for the examination is to find out as much as possible about the test; this will help reduce stress and anxi- ety. During school there were course objectives and faculty class presentations to guide you through the information that would be included on the next examination. In most academic settings, the nursing faculty responsible for teaching a course was also responsible for the development and construction of the course examinations. As you begin to prepare for the NCLEX-PN, it is important to consider who determines the content of the test plan and constructs the questions based on the test plan. The term practical nurse (PN) is used in this text. There are several states that refer to the practical nurse as a licensed vo- cational nurse (LVN). There is no difference between these two titles, but the National Council consistently uses the term practical nurse. The National Council of State Boards of Nursing (NCSBN) is responsible for the development of the content and the con- struction of questions or items for the NCLEX -PN examina- tion. A practice analysis is conducted by the NCSBN every 3 years to validate the test plan and to determine currency of nursing practice. Content experts are consulted to assist in the creation of the practice analysis. The activity performances and knowledge identified by the content experts are analyzed with consideration given to frequency of performance, impact on client safety, and variety of client care settings. This analy- sis provides the basis for development of the content to be in- cluded in the NCLEX Test Plan. The content experts are practicing nurses who work with or supervise new graduates in the practice setting. These content experts represent geographical areas across the United States and are selected according to their area of practice; therefore all areas in the practice of practical nursing are addressed in the development of the test plan. Item writers are selected to create questions based on the content identified in the test plan. Item writers are nurses currently licensed in their jurisdiction who are responsible for supervision and teaching of practical nursing students in the clinical area, or who are currently em- ployed in clinical nursing practice working with new gradu- ate practical nurses. An additional panel of practicing nurses reviews all new test items or questions to ensure that each question or item reflects entry level practical nursing practice.
nursing process. It is important to keep the steps of the nursing process in mind when you are critically evaluating an NCLEX question, data must be obtained and analyzed before an action can be determined. (Box 1-1)
Caring
The interaction of the client and the nurse occurs in an at- mosphere of mutual respect and trust. To achieve the desired outcome, the nurse provides hope, support, and compassion to the client.
Communication and Documentation
Events and activities—both verbal and nonverbal—that in- volve the client, the client’s significant others, and the health care team are documented in handwritten or electronic re- cords. These records reflect quality and accountability in the provision of client care. Principles of documentation and pro- vision of client confidentiality are important considerations in any area of nursing practice.
Teaching and Learning
Nurses provide or facilitate knowledge, skills, and attitudes that promote a change in clients’ behavior through teaching and learning. Nurses provide education to clients and to their significant others in a variety of settings. 2
Areas of Client Needs
The National Council Examination Committee has identified four primary areas of client needs, which provide a structure to define nursing actions and competencies across all practice settings and for all clients. These areas reflect an integrated approach to the testing content; no predetermined number of questions or percentage of questions pertain to any particular area of practice (e.g., medical-surgical, pediatric, obstetrical). Table 1-1 lists the areas of client needs, with the subcategories and the specific weight associated with each subcategory. The range of percentages for each category reflects how important that area is on the test plan. Physiological Adaptation, Basic Care and Comfort, and Coordinated Care are the subcatego- ries with the highest emphasis.^2 When you are studying for the NCLEX, these are concepts that should be identified across the scope of nursing practice. This table has been adapted and summarized; it does not reflect the entire test plan content. The National Council Detailed Test Plan for the NCLEX-PN may be obtained from the NCSBN, Inc. ( www.ncsbn.org ). New information or new practices must be established as a standard of practice across the nation before being included on the NCLEX. Throughout this book are TESTING ALERT boxes that call your attention to areas of the test plan. Pay at- tention to these boxes and think about how each concept or principle can apply to different types of clients. As client conditions or nursing principles are presented, the NURSING PRIORITY boxes call your attention to critical in- formation regarding a client with a specific condition or situa- tion being presented. ✔ NURSING PRIORITY: This is critical information to consider in providing safe nursing care for a client with a specific problem.
Classification of Questions
The majority of questions on the NCLEX are written at the level of application or higher level of cognitive ability. This means a candidate must have the knowledge and understand concepts to be able to apply the nursing process to the cli- ent situation presented in the question. NCLEX questions are not fact, recall, or memory-level questions. The questions are based on critical thinking concepts that demonstrate a candi- date’s ability to make decisions and solve problems. Nurses who have taken the NCLEX have stated that the NCLEX ques- tions were not like any questions they had on nursing school examinations; however, the nursing content and principles needed to determine the answer were provided in their nurs- ing school curriculum. The questions and answers have been thoroughly researched and validated. The standardization of information is important because the NCLEX is administered nationwide to determine entry level into nursing practice. This ensures that regional differences in nursing care will not be a factor in the exam. All questions presented to a candidate taking the NCLEX-PN have been developed according to the NCLEX-PN Test Plan. The questions have been researched and documented as per- taining to entry-level nursing behaviors.2, The following words are often interchangeable and have the same meaning:
- Assessment: collect date, determine, observe, identify findings, recognize changes, notice, detect, find data, gather information, describe status, assess client - Planning: include goals, plan interventions, create plan, generate goals, arrange priorities and interventions, formulate short-term goal or long-term goals, prepare list of client outcomes - Implementation: implement nursing interventions, offer alternatives, teach, give, administer, chart, document, explain, inform, encourage, advise, provide, prepare - Evaluation: evaluate nursing care, question results, monitor findings, repeat assessment, re-establish, consider alternatives, determine changes and response, appraise findings
BOX 1-1 Key WOrds fOr IdeNtIfyINg
the NursINg PrOCess
to present questions that are based on the test plan and on the level of ability of the candidate until a level of competency has been established (see Figure 1-1)^3.
TAKING THE NCLEX®^ EXAMINATION
Application
An application must be submitted to the state board of nursing in the state in which the candidate wants to be licensed. The contact information for the state boards of nursing is available on the National Council website. After the candidate’s appli- cation and registration fees have been received and approved by the state, the candidate will receive an authorization to test (ATT) from the NCSBN. After the examination fee has been paid, it will not be refunded, regardless of how the candidate registered.^3 The candidate may register for the NCLEX at the NCLEX Candidate website or by regular mail or by telephone. All the contact information is listed in the ATT. The Candi- date Bulletin (CB) is available on the National Council web- site—be sure to print this bulletin for future reference. The CB provides critical information, including addresses and phone numbers for registration and specific details regarding the reg- istration process.
scheduling the examination
After a candidate has been declared eligible to take the NCLEX and has received an ATT, the candidate may schedule an examination date. A candidate must have an ATT before they can schedule their examination. The CB lists the phone number to call to schedule the examination. Once the ATT has been issued, the state stipulates a period of time within which the candidate must take the examination. This ranges from 60 to 365 days, with the average being 90 days; this period cannot be extended. You must test within the validity dates noted on your ATT. The ATT must be presented at the testing site before you can be admitted to take the examination. You are encouraged to call and schedule the appointment to take the examination as soon as possible after receiving the ATT, even if you do not plan to take the test immediately. This will increase the probability of getting the testing date you want. Early in the last semester, students should begin planning for when they want to take the examination. Students should plan on taking the examination within 2-6 weeks of graduation. If a review course is considered, then that should be factored into the schedule. The month after graduation is not a good time to plan a vacation or any life-changing events. Complete the NCLEX and then move on with your life. Do not procrastinate about scheduling the examination, the longer after graduation and review course that the examination is taken, the colder the knowledge. Take the examination when the nursing content is most current in your mind and you are still in the testing mode from school.^3 Pearson Vue is the company that provides the testing facility and computers for the examination. A tutorial on how to use the computer on NCLEX is available at www.vue.com/nclex/. Go to the site and review the tutorial. It should be very familiar to you when you see it on NCLEX; this same tutorial will be presented to you at the beginning of your examination.
testing Center Identification
Photo identification with a signature and the ATT will be re- quired at the testing site. The name printed on the ATT must match the identification presented at the course site. Identifi- cation must be in English and cannot be expired. Acceptable forms of identification are a U.S.driver’s license, a passport, or a U.S. state-issued identification, or a U.S. military issued identification. At the testing site before testing, each candidate will be digitally fingerprinted, a photo will be taken, and a signature will be required.
day of the examination
You should plan on arriving at the center about 30 minutes before scheduled testing time. If you arrive more than 30 min- utes late, the scheduled testing time will be canceled and you will have to reapply and repay the examination fee. An eras- able note board will be available at your computer terminal. You will not be allowed to take any type of books, personal belongings, hats, coats, blank tablets, or scratch paper into the **Decision: Fail Passing level of difficulty 0 10 20 30 40 50 60 70 75
of questions
Decision: Pass Passing level of difficulty 0 10 20 30 40 50 60 70 75
of questions
FIGURE 1-1 Plateau to Establish Pass or Fail.**
testing area. A fingerprint scan will be required to reenter the testing area after each break.
testing
You will have a maximum of 5 hours to complete the examina- tion. After 2 hours of testing, you have an optional 10-minute break; another optional break occurs after 3^1 / 2 hours of testing. If you need a break before that time, notify one of the atten- dants at the testing center. The computer will automatically signal when a scheduled break begins. All of the break times and the tutorial are considered part of the total 5 hours of test- ing time. The examination will stop when one of the following occurs:
- 85 questions have been answered, and a minimum level of competency has been established; or a lack of mini- mum competency has been established (see Figure 1-1).
- The candidate has answered the maximum number of 205 questions.
- The candidate has been testing for 5 hours, regardless of the number of questions answered. Each candidate will receive between 85-205 questions. The number of questions on the NCLEX is not indicative of the level of competency. The majority of candidates who complete all 205 questions will have demonstrated a level of minimum competency and therefore pass the NCLEX. A mouse will be used for selecting answers, so candidates should not worry about different computer keyboard function keys. An onscreen calculator will also be available to use for math problems. If any problems occur with the environment or with the equip- ment, someone will be available to provide assistance. In each candidate’s examination, there will be 25 pretest or unscored items or questions. The statistics on these items will be evaluated in order to determine whether the item is a valid test item to be included in future NCLEX test banks. All of the items that are scored, or counted, on a candidate’s examina- tion have been pretested and validated. It is impossible to de- termine which questions or items are scored items and which are pretest items. It is important to treat each question as a scored item. The CB from the NCSBN is very important; read it carefully and keep it until the results from NCLEX have been received. This bulletin will provide directions and will answer more of your questions regarding the NCLEX. The CB is available on- line (from the NCSBN at www.ncsbn.org or from Pearson Vue at www.vue.com/nclex ).
test results
Each examination is scored twice, once at the testing center and again at the testing service. The test results are electroni- cally transferred to the state boards of nursing. Test results are not available at the testing center, from Pearson Vue, or from the NCSBN. Check the information received from the appro- priate state board of nursing to determine how and when your results will be available. Test results may be available online. In some states, results may be available within 2 to 3 days; in others, the results will be mailed, which will require a longer notification period. Do not call the Pearson Professional Cen- ter, NCLEX Candidate Services, the National Council, or the individual state board of nursing for test results. Follow the procedure found in the information from the state board of nursing where the license will be issued.^3
SUCCESSFUL TEST TAKING ON THE
NCLEX®^ EXAM
TESTING ALERT: Practicing test-taking skills is critical if you are going to be able to effectively use them on the NCLEX. Practice test taking should be a component of your NCLEX preparation. Being able to effectively apply test-taking strategies on an ex- amination is almost as important as having the basic knowl- edge required to answer the questions correctly. Everyone has taken an examination only to find, on review of the exam, that questions were missed because of poor test-taking skills. Nursing education provides the graduate with a comprehen- sive base of knowledge; how effectively the graduate can dem- onstrate the use of this knowledge will be a major factor in the successful completion of the examination. The NCLEX-PN is designed to evaluate a minimum level of competency. The purpose of the examination is to determine whether a candidate has the knowledge, skills, and ability re- quired for safe and effective entry-level nursing practice as a practical nurse. Throughout the examination, questions are described as being based on clinical situations common in nursing; uncommon situations are not emphasized. NCLEX questions are not fact, recall, or memory-level questions; they are questions that require critical thinking to determine the correct answer. Critical thinking will require an evaluation and interpretation of client data, an understanding of the cli- ent’s condition or disease, and the ability to determine the best action that will most effectively meet the client’s needs. Practice testing is an excellent method of studying for the NCLEX. After taking a practice test, use the results to deter- mine whether you need additional review in certain areas or whether you are missing questions because of poor test-taking strategies.
NCLEX®^ TEST-TAKING STRATEGIES
The NCLEX questions are different from those found on nurs- ing school exams. One of the biggest problems candidates encounter is that there appears to be two or more correct an- swers. Sometimes a candidate believes that more information is necessary to answer the question. However, the answer must be determined from the information provided; no one will
may require contacting the RN or the physician. This judg- ment could be tested in a question where the LPN cannot meet the client needs and needs to obtain further assistance and or direction.
- Client Care Assignments: Nursing care assignments should take into consideration the caregiver who is educa- tionally prepared, experienced, and most capable of caring for the client. Unlicensed assistive personnel (UAP), patient care attendants (PCA), and/or nursing assistants must be di- rectly supervised in the provision of safe nursing care. Pay close attention to the person to whom the nurse is assigning the care or nursing activity: Is it to another LPN, or is a spe- cific activity (bathing, ambulating, etc.) being delegated to an unlicensed nursing assistant?
establishing Nursing Priorities
Almost all nurses will agree that the NCLEX has a lot of pri- ority questions. These questions may be worded in a variety of ways: “What is the priority nursing action?” “What should the nurse do first?” “What is the initial nursing action?” In other words, the NCLEX wants to know if the PN can iden- tify the most important nursing action to be taken in order to provide safe care for the client in the situation presented. This may be found in questions where three of four of the options are correct; however, one of the options or actions needs to be performed before the others. This is where critical think- ing is necessary— think like a nurse! There are three areas to consider when determining priority nursing actions: Maslow’s hierarchy of needs, the nursing process, and client safety.
- Maslow’s Hierarchy of Needs: And you thought this was just for fundamentals! Always consider Maslow’s hierarchy of needs and remember that physiological needs must come first. (Figure 3-1) When evaluating options, identify client needs that are physiological and those that are psychoso- cial. Physiological needs are a higher priority than psycho- social needs. A client’s physical needs must be met before considering his or her psychosocial needs. Also remember that the ABCs (airway, breathing, and circulation) are the critical physiological needs because these are at the base of Maslow’s pyramid. However, be cautious— don’t always se- lect “airway” as the best answer. Sometimes the client does not have an airway problem, so don’t read that into the ques- tion and give the client an airway problem! If a client is in pain, it is difficult to determine what is contributing to his/ her psychosocial problem. Maslow’s hierarchy of needs also applies to the client with psychosocial problems – take care of the physiological needs, then focus on the psychosocial needs. (see the section in this chapter regarding answering psychosocial questions). - Nursing Process: The first step in the nursing process for
Management of Client Care
As the role of the licensed practical nurse (LPN) has expand- ed, management of client care has become increasingly im- portant. A large percentage of graduates surveyed on the last job analysis reported they had “charge nurse” responsibilities. The majority of the management responsibilities were in the long term care facilities.^1 LPN’s may direct the care of the nursing assistants as well as other LPN’s. However, LPNs are under the supervision of a registered nurse. There is a director of nurses, or an administrator that is an RN and is ultimately responsible for nursing care delivered in that facility. Do not panic: pay close attention to what nursing action the question is focusing on and to whom the nurse is assigning the care or nursing activity – is it to another LPN, or is it to a less quali- fied person?
- Keep in mind the NCLEX Hospital. Adequate staff is available to provide safe client care; don’t worry about staff shortages. Focus on the needs of the client in the question - the activities on the rest of the unit are not pertinent to answering the question. The only client to consider in each question is the one involved in that question, not the other clients the practical nurse may have been assigned. - Identify the most stable client. The most stable client is the one who has the most predictable outcome and is least likely to have abrupt changes in condition that would require criti- cal nursing judgments. When determining the stability of clients, Maslow’s hierarchy of needs should be considered (see Chapter 2, Figure 2-1). The most stable client is often the one for which nursing activities can be delegated to a nursing assistant. - Assign tasks that have specific guidelines. Those tasks that have specific guidelines that are unchanging and are used in the care of a stable client can often be assigned to the nursing assistant. Bathing, collecting urine samples, feed- ing, providing personal hygiene, and assisting with ambula- tion are just a few examples of these activities. - Identify your priority client. The priority client is the one who is most likely to experience problems or ill effects if they are not taken care of first. Priority clients include those with conditions that are unstable and changing, and those who are at an increased risk for developing complications. NCLEX questions may present a typical nursing care as- signment and ask which client the nurse would care for first; or a situation with a client may be presented, and you will be asked to select the first nursing action. Review the test- ing strategies regarding priority questions. It is important to identify the most unstable client, to see him or her first, and then to determine what is necessary to do first for this client. - Carefully read the question and determine which clients are in a changing unstable situation, these are clients that
the practical nurse is data collection. When evaluating a question, it is important to determine if the question pro- vides adequate data for the nurse to make a decision regard- ing nursing interventions. Obtaining more information (data collection) may be the first nursing action. However, do not automatically select an option that involves data collection. If client data are provided in the stem of the question, then it will be important to consider Maslow’s hierarchy of needs when planning or selecting the best nursing action or imple- mentation. If a nursing action has been implemented, then the question may focus on evaluating the effectiveness of the nursing action. Read the question carefully and deter- mine what is being asked. (Box 1-1).
- Safety Issues: This may include situations in the hospital, in a long term care facility, or in the client’s home envi- ronment. The first issue to consider is meeting basic needs of survival: oxygen, nutrition, elimination. Reduction of environmental hazards is also a concern and may include prevention of falls, accidents, and medication errors. Envi- ronmental safety also includes the prevention and spread of disease. This may include how to avoid contagious diseases or even activities such as hand hygiene. When you are criti- cally evaluating questions that involve a client’s safety and multiple options appear to be correct, determine what activ- ity will be of most benefit to the client.
Example Questions for Management
and Priority Setting
The LPN is making assignments on a nursing care unit. What tasks could be assigned to the experienced nursing assistant? 1 Evaluate the skin in the sacral area for a client on bed rest. 2 Report on the quantity and characteristics of a client’s urine output. 3 Assist a client to obtain a clean-catch urine specimen 4 Evaluate the tolerance of client on tube feedings. Answer: Option 3 The nursing assistant can be assigned activities that involve standard, unchanging procedures such as helping to obtain a clean-catch urine specimen from a client. The LPN should evaluate the skin on the sacral area for any evidence of a break in skin integrity. The characteristics of the urine should be evaluated by the LPN, however the nursing assistance can empty and measure the amount of urinary output. Dietary in- take for client’s who do not have a problem with nutrition can be reported by the nursing assistant, however the LPN needs to determine the tolerance of the tube feedings. The LPN is in charge of the nursing unit on the afternoon shift in an ambulatory care center. After receiving a hand off report on the clients, who would the nurse evaluate first? 1 A client who had a laparoscopic cholecystectomy, has been in the unit for 4 hours, and is complaining of left shoulder pain. 2 A client who had a prostate biopsy about 6 hours ago and is beginning to complain of perineal discomfort, chills, and feeling flushed. 3 A young adult who complains of being nauseated and refuses to take his first dose of the oral postoperative antibiotic. 4 An older adult who experienced gastric distention and required placement of a nasogastric tube. Answer: Option 2 The client who is post-biopsy of the prostate should be evalu- ated first, because he could be developing a sepsis secondary to the biopsy. The client who is postcholecystectomy is expe- riencing referred shoulder pain, which is common after this procedure. The young adult client and the older adult client can be evaluated after the cholecystectomy client. The practical nurse is working on a step down nursing telem- etry unit. A client tells the nurse he is beginning to have mid- sternum chest pain. What is the first nursing action? 1 Begin oxygen at 4L/min per nasal cannula. 2 Request the charge nurse evaluate the cardiac rhythm. 3 Auscultate breath sounds and maintain airway. 4 Determine client activities prior to onset of chest pain. Answer: Option 1 When a client complains of chest pain, oxygen should be start- ed immediately, and then the status of the vital signs should be determined. The client is on a telemetry unit and is experienc- ing chest pain – this is enough information for a nursing action. Data collection will determine the status of the vital signs and further action can be evaluated. If the vital signs are unstable or if the client is experiencing an untoward dysrhythmia, then oxygen administration would still be the most important first nursing action. Activity prior to the chest pain can be evalu- ated after the current physical status is determined. Option 3 assumes the client has airway problems, there is no indication in the question stem that airway is a problem. The LPN received a shift handoff report for a group of assigned clients. Which client should the practical nurse see first? 1 A client who underwent a thoracotomy 3 days ago, his vital signs are stable and he is complaining of chest pain when he coughs. 2 An 85-year-old client who has a fractured hip, she is in Buck’s traction and is complaining of pain; she is scheduled for surgery in 4 hours. 3 An adult male client admitted 3 hours ago for dehydra- tion; the vital signs are temperature 99° F, pulse 100 beats/min and irregular, and BP 118/80 mm Hg.
Options
There are four options from which to choose an answer.
- Three options are distracters; they are designed to create a distraction from the correct answer. - One option correctly answers the question asked in the stem. - There is only one correct response; no partial credit is given for another answer.
specific strategies and examples of
Multiple-Choice Questions
- Read the question carefully before ever looking at or considering the options. If you glance through the options before understanding the question, you may pick up key words that will affect the way you perceive the question. Make sure you understand the question and do not formu- late an opinion about the answer before you have read and understand the question. On a paper-and-pencil test, cover the answers with your hand or a note card. If you practice this strategy before taking the NCLEX, you will be able to focus on the question without physically covering the an- swers when taking a test on the computer.
- Do not read extra meaning into the question. The ques- tion is asking for specific information; if it appears to be simple “common sense,” then assume it is simple. Do not look for a hidden meaning in a question. Avoid asking your- self “what if... ?” or the client might…” Don’t make the client any sicker then he or she already is! Example: A bronchoscopy was performed on a client at 7:00 am. The client returns to his room, and the nurse plans to assist him with his morning care. The client refuses the morning care. What is the best nursing action regarding the morning care for this client?
- Perform all of his morning care to prevent him from be- coming short of breath.
- Avoid morning care and continue to monitor vital signs and assess swallowing reflexes.
- Postpone the morning care until client is more comfort- able and can participate.
- Cancel all of the morning care because it is not necessary to perform it after a bronchoscopy. The correct answer is #3. The question is asking for a nurs- ing judgment regarding morning care. Do not read into the question and make it more difficult by trying to put in infor- mation relating to respiratory care, such as checking for gag and swallowing reflexes.
- Read the stem correctly. Make sure you understand ex- actly what information the question is asking. Determine whether the question is stated in a positive (true) or negative (false) format. Watch for words that provide direction to the question. A positive or true stem may include the following: “indicates the client understands,” “the best nursing action is,” “the preoperative teaching would include,” or “the best nursing assignment is.” Also watch for words in the stem that have a negative meaning so that the question is asking for a re- sponse that is not accurate or is false. Phrases such as “is contraindicated,” “the client should avoid,” “indicate the cli- ent does not understand,” “does not occur,” and “indicates [medication, equipment, nursing action] is not working” are negative indicators. The question is asking for infor- mation that is not accurate or actions the nurse would not take. The following words or phrases change the direction of the question: except, never, avoid, least, contraindicated, would not occur. It may help to rephrase the question in your own words to better understand what information is being requested. Example: The nurse is discussing body mechanics with a client who has had back surgery. What nursing observations would indicate the client did not understand the principles discussed? The client: 1. Bends at the knees to pick up an object from the floor. 2. Carries the object close to his body. 3. Places his fee apart when bending ot ppick pu an object. 4. Bends from the waist to pick up an object on the floor. The correct answer is #4 Rephrase the question: I need to identify what the client is doing wrong regarding body me- chanics. Bending from the waist does not represent good body mechanics; the client should bend with the knees (squatting), not from the waist. All other options represent good body mechanics.
- Pay attention to where the client is in their disease process or condition. Examples of this are terms such as “imme- diately postoperatively,” “the first postoperative day,” and “experienced a myocardial infarction this morning.” Example: A client had a cardiac catheterization through the left femoral artery. During the first few hours after the car- diac catheterization procedure, which nursing action would be most important? Rewording: What is the most important nursing care in the first few hours after a cardiac catheterization?
- Check his temperature every 2 hours and monitor cath- eter insertion site for inflammation.
- Elevate the head of his bed 90 degrees and keep affect- ed extremity straight.
- Evaluate his blood pressure and respiratory status every 15 minutes for 4-6 hours.
- Check his pedal and femoral pulses every 15 minutes for first hour, and then every 30 minutes. The correct answer is #4. The phrase, “during the first few hours after the procedure,” is important in answering this
question correctly. The danger of hemorrhage and hema- toma at the puncture site is greatest during this time. The question also asks for the most important nursing care. Op- tion 3, it is important to evaluate vital signs, but does not re- quire them to be done every 15 minute for 4-6 hours if client is stable. Option 4 is critical in the first few hours following a cardiac catheterization.
- Before considering the options, think about the charac- teristics of the condition and critical nursing concepts. What are the nursing priorities in caring for a client with this condition/procedure/medication/problem? Example: A woman who is 3 days postpartum returns to the clinic with complaints of soreness and fullness in her breasts and states that she wants to stop breast-feeding her infant until her breasts feel better. What is the best nursing response? This is a positive question. The answer will be a true state- ment. Think about breast-feeding and the common discom- forts and problems the client encounters. Don’t look at the options yet. Think, “Is it normal to have fullness and sore- ness in the breasts during the first 3 days of lactation, and what happens if she stops breast-feeding the infant?” Now evaluate the options:
- Show the client how to apply a breast binder to decrease the discomfort and the production of milk.
- Tell the client that breast fullness may be a sign of in- fection and she will not be able to continue breast- feeding.
- Suggest to the client that she decrease her fluid intake for the next 24 hours to temporarily suppress lactation.
- Explain to the client that the breast discomfort is nor- mal and that the infant’s sucking will promote the flow of milk. In this question, option #4 is correct. Initially, breast sore- ness may occur for about 2 to 3 minutes at the beginning of each feeding until the let-down reflex is established. Op- tions 1, 2, and 3 would decrease her milk production; the question did not state that she wanted to quit breast-feeding permanently.
- Identify the step in the nursing process being tested. Remember, you must have adequate client data before you move through the steps of the nursing process. Is there ad- equate information presented in the stem of the question to determine appropriate nursing planning or intervention? Is the correct nursing action to obtain further assessment data? Look for key words that can assist you in determining what type of information is being requested. Example: An 85-year-old client is a resident in a long-term care facility. The nurse assigned to the client for morning care observes numerous bruises and abrasions in various stages of healing on the client’s back and torso. The nurse from the previous shift explains that the client fell down. What is the best nursing action? 1. Review the chart for details regarding the client’s fall. 2. Cover the abrasions with a protective dressing.. 3. Notify the supervisor regarding the possibility of an abusive situation. 4. Further evaluate the client to determine presence of other injuries. The correct answer is #4, to determine or assess the ex- tent of injuries. The stem of the question did not present adequate information with which to make a nursing judg- ment, and the client’s physiological needs are the priority. Option 1 does not immediately alleviate any client problem or provide any assistance to the client. Options 2 and 3 re- late to nursing actions that may be done after the immediate injuries and needs have been assessed. Focus on the client; priority setting and physiological needs must be addressed first.
- Confused at this point? What if, after reading the ques- tion, you do not know what the question is even asking? Take a deep breath, reread the question, and ask yourself, “What is the main topic of the question?” Now read the op- tion choices, not to eliminate options or select a correct an- swer, but to get a clue as to the direction of the question. It might be helpful to read the options from the bottom up (start with option 4, rather than option 1) to help your brain focus on the options. Example: The nurse is caring for a client who is scheduled for a thoracotomy at noon. The nurse is evaluating the client at 10am. Which client finding would be most important for the practical nurse to report to the nursing supervisor? Is the question asking for problems regarding the surgical preparation, or the current status of the client’s conditions, or maybe even preoperative teaching? Check out the op- tions.
- Vital signs are: pulse rate 100 beats/min, respirations 20 breaths/minute, oral temperature 99° F.
- Surgical consent form is not signed and on the chart.
- The client states that he is anxious about the surgery.
- Lab reports indicate the hemoglobin level is 12.5g/dl and the hematocrit level is 36%. After checking the options, it appears the question is ask- ing for the preoperative or surgical preparation of the client. Now that you have determined what you need to identify, you can begin the process of elimination of the options until you have found the correct answer. The correct option is #2. The surgical consent should be on the chart and the client should not be given any preoperative narcotics before the consent form is signed. This needs to be taken care of im- mediately. The vital signs are within acceptable limits (op- tion 1), anxiety is normal before surgery (option 3), and the hemoglobin and hematocrit levels are within normal lim-
Systematically evaluate the options: Option 1 – no, the outer labia should be cleansed before the inner labia. Option 2 – no, cleansing should be performed from front to back. Option 3 – yes, each cotton ball should only be used one time, and then discarded. Option 4 – no, it does not affect the procedure even if the client is menstruating. After a systematic evaluation of the options, option #3 is the correct answer. Always evaluate every option; do not stop with what you think is the first correct answer.
- Identify similarities in the options. Frequently, the op- tions will contain similar information, and sometimes you can eliminate similar options. If three options are similar, the different one may be the correct answer. When two of the options are very similar and one of those options is not any better than the other, both of them are probably wrong, so start looking for another answer. Sometimes three of the options have very similar characteristics; the option that is different may be the correct answer. Example: The nurse is assisting a client to identify foods that would meet the requirements for a high-protein, low- residue diet. Which foods would represent correct choices for this diet?
- Roast beef, slice of white bread.
- Fried chicken, green peas.
- Broiled fish, green beans.
- Cottage cheese, tomatoes. Options 1, 2, and 3 all contain a meat or fish that would be needed for a high-protein diet; therefore option 4 can be eliminated. Options 2, 3, and 4 all contain a vegetable that has a skin, making these high-residue choices. The correct answer is option #1 , for both high-protein and low-residue qualities. Note that the NCLEX will not focus on dishes that contain a mixture of foods in which you would need to know the recipe to answer correctly. Also, unless speci- fied, do not attribute special characteristics to a food; if a food has a special characteristic, it will be stated (e.g., “low sodium” soup or “low fat” yogurt).
- Identify words in the options that are “qualifiers.” Every, none, all, always, never, and only are examples of words that have no exceptions. Options containing these words are frequently incorrect. Seldom in health care is anything absolute with no exceptions; thus you can often eliminate these options. In some situations the qualifiers can be cor- rect, especially when a principle or policy is described. For example, the nurse always establishes positive client iden- tification before administering medications. This would be a correct statement. Carefully evaluate qualifiers; they are clues to the correct answer. Example: The nurse is obtaining a specimen from a client’s incisional area for a wound culture and sensitivity. What client information will the sensitivity part of the procedure reflect?
- Presence and characteristics of all bacteria present in the client’s wound
- Which antibiotics will effectively treat the bacteria present
- Differentiation of the bacteria and viruses present in the wound
- All the treatments to which the bacteria are responsive Options 1 and 4 contain the word “all.” If you did not know the answer, you could eliminate options 1 and 4. Identify- ing all the bacteria and all the treatments is not feasible from a culture and sensitivity. This would give you a 50% chance of finding the right answer, which is option #.
- Select the most comprehensive answer. All of the options may be correct, but one option may include the other three options or need to be considered first. Example: The nurse is planning to teach a client with diabe- tes about his condition. Before the nurse provides instruc- tion, what is most important to evaluate? The client’s:
- Required dietary modifications.
- Understanding of the exchange list.
- Ability to administer insulin.
- Present understanding of diabetes. Options 1, 2, and 3 are certainly important considerations in diabetic education. However, they cannot be initiated until the nurse evaluates the client’s knowledge of his or her disease state. When two options appear to say the same thing, only in different words, then look for another an- swer; that is, eliminate the options that you know are incor- rect. Options 1 and 2 both refer to the client’s understand- ing of nutrition.
- Some questions may have options that contain several items to consider. After you are sure you understand what information the question is requesting, evaluate each part of the option. Is the option appropriate to what the question is asking? If an option contains one incorrect item, the en- tire option is incorrect. All of the items must be correct if that option is to be the correct answer to the question. Example: The practical nurse is preparing a client’s 8am medications. The client has the following medications or- dered: digoxin ( Lanoxin ) 0.125mg, PO; furosemide ( Lasix ) 20mg, PO, captopril ( Capoten ) 25mg, PO. The client’s cur- rent vital signs are: blood pressure 110/86, pulse 78, respi- rations 18, and temperature 99° F orally. What would be the best nursing action?
- Administer all of the medications, chart them as given, and document the client’s apical heart rate.
- Hold the digoxin and the captopril; recheck the heart rate and blood pressure in 30 minutes.
- Hold the captopril, administer the other medications and notify the nursing supervisor.
- Hold the furosemide until the intake and output can be evaluated, administer all other medications. In the methodical evaluation of the items in the options, you can eliminate items. Option 2: there is no reason to hold the digoxin or the captopril. Option 3, there is not rea- son to hold the captopril or to notify the nursing supervi- sor. Option 4, there is no reason to hold the furosemide. Therefore, option #1 is correct.
- After you have selected an answer, reread the question. Does the answer you chose give the information the ques- tion is asking for? Sometimes the options are correct but do not answer the question. Example: A client is 88 years old and has previously been alert, oriented, and active. The nursing assistant reports that on awakening this morning, the client was disoriented and confused. What initial action would the nurse take to determine the possible cause of this change in the client’s behavior?
- Review the history for any previous episodes of this type of behavior.
- Call the health care provider and discuss the changes in the client’s behavior.
- Do a thorough neurological evaluation to evaluate the specific changes in behavior.
- Evaluate for the presence of a urinary tract infection and for adequate hydration. Option #4 is the only answer that supplies what the ques- tion asked for (“determine the possible cause of this change”). The most common cause of a sudden change in the behavior of a geriatric client is a significant physiologi- cal change, often an infection (commonly in the urinary tract), dehydration, or hypoxia. Options 1 and 3 relate more to the gradual behavior changes seen in the progres- sion of dementia and do nothing “to determine the possible cause.. .” Option 2 also does not provide any assistance in determining the cause of the behavior change; further nursing assessment needs to be conducted before calling for assistance.
Alternate format Questions
In an effort to improve and more effectively assess the en- try-level nurse, the NCSBN has introduced “alternate format questions” to the examination. These questions were included on the NCLEX beginning in April 2003. There is no estab- lished percentage of alternate format items a candidate will receive. The alternate format questions that have been previ- ously validated are placed in the test item pools and are ran- domly selected to meet the items on the test plan and the es- tablished level of difficulty. The NCSBN has not specified a number of alternate format questions that will be included in a candidate’s test bank. A candidate should expect several al- ternate format questions. It is important to consider that there will be 25 pretest or unscored items in the first 85 questions on every candidate’s examination. Within those 25 items, there may be several unscored alternate format items. It is important to answer all the questions to the very best of your ability be- cause you do not know which questions are scored items and which are unscored items.3, Figure 1-3 Alternate format question—multiple response. Answer : The answer is based on standard precautions, plus respiratory precautions for the pneumonia. Nothing should be removed from the room and the gown should be removed prior to leaving the room, not outside the room. Select the best response. Click the Next button or the Enter key to confirm answer and proceed. Item 21 ✓ ✓ ✓ [NCLeX-PN] (^) time remaining: 3:15. Next ➜ Calculator the nurse is caring for an 85-year old client who has a diagnosis of Mycoplasma pneumoniae. What precautions will the nurse implement in assisting the client with morning care? select all that apply:
**1. Wear clean gloves.
- remove all extra suctioning supplies from the room.
- dispose of the gown and mask in container outside client’s door.
- Wear face mask when working within 3 feet of the client.
- Put on a gown before entering the room.
- remove the stethoscope from the room if it did not come in contact with** the client.
Hot Spot Questions
In a hot spot question, you will be presented with a graphic and asked to identify a specific item, area, or location on the graphic. Look at Figure 1-5. Identify the area on the graphic and then you would click on it with the mouse. Answer: The “hot spot” (in this case, the correct area to assess the apical heart rate) is at the PMI, or point of maximum impulse, which is located at the fifth intercostal space, just to the left of the sternal border. In this situation, you would place the mouse over the area and click on that area.
Drag and Drop
In a drag-and-drop question, several steps or actions are listed, and you will need to place them in a correct sequence (Figure 1-6). All of the options will be used, but you must place them in the correct order. The first thing to do is to decide in what order you want to place the options or rank the actions. After you have determined your answer, click on the option you want to place first, “drag” that option over, and place it in the first box. Then select the option you want to place second, drag that option over, and place it in the next box. Continue this process until you have used all of the options present. Practice by considering how you would answer the question in Figure 1-6. Figure 1-5 Alternate format question—hot spot. ✜ Answer: To evaluate the apical pulse the stethoscope should be placed on the area of the PMI - left midclavicular line, 5th intercostal space. To answer this questions, you would simply click the area on the graphic. Select the best response. Click the Next button or the Enter key to confirm answer and proceed. Item 22 [NCLeX-PN tutorial] (^) time remaining: 3:15. Next ➜ the nurse is caring for a client who is receiving 0.25 mg digoxin each morning. On the graphic, identify the correct location where the nurse should place the stethoscope to determine the client’s pulse. Calculator Figure 1-6 Alternate format question—ordered response (drag and drop). Need to know: Review each of the items in the list. Determine what is the most important action to take first, then second, etc. This question is asking you to provide care for a client who is experiencing difficulty breathing and has chest pain. The dyspnea and chest pain are most likely a result of the client’s pneumonia. Position is the first thing that you can do that will benefit the client the most, then begin the oxygen, administer the antipyretic medication, encourage clear liquids, and teaching is last. Remember Maslow when setting priorities. Select the best response. Click the Next button or the Enter key to confirm answer and proceed. Item 23 [NCLeX-PN tutorial] the nurse is caring for a client with pneumonia. he is dyspneic, his temperature is 102˚f orally, and he is complaining of chest pain. In what order would the nurse provide care for this client? Place all of the actions below in the order of priority for nursing care. use all of the options. Encourage clear fluids Administer humidfied oxygen Place in Semi-Flower’s position Administer antipyretic medication Instruct client regarding risk factors Place in Semi-Flower’s position Administer humidfied oxygen Next ➜ time remaining: 2:15. Calculator
Answer: The client should be placed in a semi-Fowler’s position before oxygen administration is started; an antipyretic medication should then be given. This ac- tion addresses current needs. Next, encourage intake of clear liquids to decrease viscosity of secretions. Fi- nally, provide instruction regarding risk factors (psy- chosocial need).
Chart or Exhibit Items
In this type of question, a client situation or problem and cli- ent information are provided in a chart or an exhibit (Figures 1-7 through 1-10). First, read the information presented and understand what information the question is asking for. Then click on the tabs within the exhibit to find the information needed to answer the question. There may be several tabs to click on, check the information included within each tab and determine if it is pertinent to the situation. The question is asking you to identify what would be the best pain medication to administer to this client. On reviewing the information, you will find that all an- swers are feasible. Check the tabs or exhibit informa- tion. Check the nurses notes, the medication adminis- tration record (MAR) and the doctor’s orders. What you should find within these tabs is that the client received morphine 10 mg IM at 11:00 am; became lethargic and slept for the next 5 hours. He received hydrocodone PO at 4:00 pm and was comfortable for the next 4 hours. The doctor’s orders are current for both the IM and the PO medication for pain. Answer: 4. Give the hydrocodone, PO, for pain at this time. It is preferable to give a client a PO pain medica- tion than a parenteral pain medication. The hydroco- done provided effective pain relief for 4 hours when it was administered the last time, and the doctor’s order is current. Figure 1-7 Alternate format question—exhibit item. Need to know: Click on the first exhibit and evaluate the information. Select the best response. Click the Next button or the Enter key to confirm answer and proceed. Item 24 [NCLeX-PN] A postoperative client complains of pain, the nurse assesses the client and determines the pain is in the abdomen around the area of the incision, pain level is 6. It is 8 pm in the evening, and the nurse is determining what can be done regarding the client’s pain. select the best answer based on the information in the chart.
**1. give Morphine sulfate 15 mg, IM now.
- Medication cannot be administered.
- give Morphine sulfate 10 mg, IM now.
- give hydrocodone (Vicodan) 10 mg PO.** exhibit Next ➜ time remaining: 3:20. Calculator Figure 1-8 Alternate format question—first tab on exhibit item. Select the best response. Click the Next button or the Enter key to confirm answer and proceed. Item 24 **[NCLeX-PN] A postoperative client complains of pain, the nurse assesses the client and determines the pain is in the abdomen around the area of the incision, pain level is 6. It is 8 pm in the evening, and the nurse is determining what can be done regarding the client’s pain. select the best answer based on the information in the chart.
- give Morphine sulfate 10 mg, IM now.
- Medication cannot be administered.
- give Morphine sulfate 15 mg, IM now.
- give hydrocodone (Vicodan) 10 mg PO. Close tile (t) Administration**^ Medication^ 1 of 3 records doctor’s Orders Nursing Notes
- Nursing notes: Need to know: How well did the pain medication hold the client the last time he received it? Information 8 am Complains of abdominal pain around area of incision; pain level 7; pain medication administered. 11am Sleeps throughout the day; lethargic but easily aroused. 4 pm Complains of abdominal pain around incision area, pain level 5, pain medication administered, free of pain and resting comfortably within 30 minutes. 6 pm Remains comfortable. 8 pm Begins to complain of abdominal incisional pain. time remaining: 3:20. Calculator exhibit Next ➜
- Situations requiring use of therapeutic communication are not always centered around a psychiatric client. Frequently, these questions are centered on the client experiencing stress and anxiety. There may be questions relating to therapeutic communication in the care of clients experiencing stress, anxiety related to a specific client situation, or a change in body image as a result of physiological problems. - Look for responses that focus on the concerns of the client. Do not focus on the concerns of the nurse, hospital, or physician. Determine whether the client is the central focus of the question or whether the question pertains to a spouse or significant other. - Watch for responses that are open-ended and encourage the client to express how he or she feels. Clients frequently experience difficulty in expressing their feelings. Focus on responses that encourage a client to describe how he or she feels. These are frequently open-ended statements made by the nurse. - Eliminate responses that are not honest and direct. In order to build trust and promote a positive relationship, it is important to be honest with the client. Options that include telling the client “don’t worry,” or “everything is going to be all right,” or “your doctor knows best” will most likely be wrong answers. - Look for responses that indicate an acceptance of the client. Regardless of whether you agree with the client’s views or moral values, it is important to respect his or her views and beliefs. Carefully evaluate responses that involve telling clients what they should or should not be doing, these are often wrong answers (e.g., telling an alcoholic that she should quit drinking or telling a depressed client that he should not feel that way). - Be careful about responses that give opinions or advice on the client's situation. Do not assume an authoritarian position. You should not insist that the client follow your advice (e.g., quit drinking, exercise more, quit smoking). - Look for responses that reflect, restate, or paraphrase feelings the client expressed. Do not tell the client how he or she should or should not feel. Look for responses that encourage the client to describe how he or she feels— responses that reflect, restate, or paraphrase feelings the client expresses. An option such as “You should not feel that way” would be a wrong answer; it would be better to ask “How did that make you feel?” - Do not ask “why” a client feels the way he or she does. If a client understood why he or she felt a certain way, the client would most likely be able to do something about it. The most common answer when a nurse asks a client why he or she feels a certain way is “I don’t know,” which does provide any information. - Do not use coercion to achieve a desired response. Do not tell clients that they can’t have their lunch until they get out of bed or bribe children to take their medicine with a promise of candy. - See examples of therapeutic and nontherapeutic com- munication in Chapter 6 (Table 6-1).
TIPS FOR TEST-TAKING SUCCESS
- Do not indiscriminately change answers. On a paper- and-pencil test, if you go back and change an answer, you should have a specific reason for doing so. Sometimes you do remember information and realize you answered the question incorrectly. However, students often “talk them- selves out” of the correct answer and change it to the incor- rect one. The good news - you cannot go back to previ- ously answered questions on the NCLEX. Before leaving the question, review the strategies you used to answer the question. When you press the enter bar, or select Next, an- other question will be presented and you cannot go back to the previous question. - Watch your timing. Do not spend too much time on one question. It is very important to evaluate your timing on practice exams. This will help you be more comfortable with timing on computer testing. The NCLEX will allow you a total of 5 hours to complete the examination. When you are taking a practice test, plan to spend about a minute on each question. Some questions you will answer quickly; others may take some time. Do not spend more than 2 min- utes deliberating the answer to a question. If you do not have a good direction for the right answer in 2 minutes, then you probably don’t know the answer. Eliminate all of the options you can, pick the best one, and move on. (Remember, you are not supposed to know all of the right answers.) - The NCLEX is a nursing competency examination, and the correct answer will focus on nursing knowledge and the provision of nursing care. Medical management or identifying a diagnosis based on symptoms are not the fo- cus of the examination. - Eliminate distracters that assume the client “would not understand” or would be ignorant of the situation and those distracters that indicate the nurse needs to pro- tect clients from worry. For example, “The client should not be told she has cancer because it would upset her too much” would most likely be an incorrect answer. - There is no pattern of correct answers. The exam is com- piled by a computer, and the position of the correct answers is selected at random. There is no validity in the rumor to select option 3 when you are guessing.
STUDY HABITS
study effectively
- Use memory aids, mindmapping, and mnemonics. Memory aids and mind mapping are tools that assist you in drawing associations from other ideas with the use of vi- sual images (Figure l-11). Mnemonics are words, phrases, or other techniques that help you remember information. Images, pictures, and mnemonics will stay with you longer than written text information.
- Develop 3 × 5 cards with critical information. Do not overload the card; put a statement or question on one side and answers or follow-up information on the other side. For example, on one side you might write “low potassium,” and on the other side you would list the relevant values. Another card might say “nursing care for hypokalemia” on the front, and on the back, you could list the nursing care. These cards are much easier for you to carry than a load of books or class notes. When you have developed and stud- ied your set of cards with priority information, trade them with friends, and see what they have put on their cards. Sets of cards can be used whenever you have only 15 to 20 minutes of study time. Take 20 cards with you to soc- cer practice, the doctor’s office, or anywhere you are going where you will to have to sit and wait for a few minutes. This is quick, easy, and a very effective way to study.
- Review class notes the next day. A very effective study habit to develop during school is to review your class notes the day after the class. Set aside about an hour on the day after the class and spend about 30 to 45 minutes reviewing the notes from class. Do the notes make sense to you, or are you unclear on the meaning of some of the areas? Correlate the notes and the visuals the instructor presented with the information in the textbook. It is important to take the time now to understand the information presented the previous day because it is fresher in your mind and you are more receptive to learning.
- Plan your study time when you are most receptive to learning. Do not wait until the end of the day when you have finished everything else. It is difficult to get up at 6: am, work all day, deal with family activities, and finally decide at 10:30pm that you are just too tired to study. You may feel guilty that you were not able to study for the in- tended 2 hours that evening. Schedule your study time – it may be easier for you to study for 2 hours prior to leaving school than it will be to study for 2 hours when you get home.
- Set a schedule and let everyone know the schedule. For example, when you set aside 1 hour for review on the day after your class, make sure everyone knows this is your study time. Do not expect your family to leave you alone while you study; this is frequently too much to ask, especially of children or a spouse. Go to the library, nursing school, or someone’s house where there are no disturbances. 6. Start planning your NCLEX preparation at the begin- ning of your last semester in school or 2 to 3 months before you will take the NCLEX. Do not wait until the week before the exam to start preparing. Even if you were an A student, you still need to review. Information that was presented at the beginning of school, last year, or even last semester may not be current in your knowledge base.
set a study goal
- Decide on a study method.
- Divide the review material into segments.
- Prioritize the segments; review first the areas in which you feel you are deficient or weak. Leave those areas you are the most comfortable with and most knowledgeable about for last.
- Practice testing, or an end of the semester assessment exam will assist you to identify areas in which you need additional review.
- Establish a realistic schedule and follow it. Planning for 8 hours of studying on your day off does not work. Instead, plan for 2 to 4 hours each day (in 20- to 30-minute chunks of time) and maybe 3 to 4 hours on your days off. Let ev- eryone know when you are planning on studying and how important it is for you to study.
- Plan on achieving your study goal several days before the examination.
group study
- Limit the group to four or five people.
- Group members should be mature and serious about studying.
- The group should agree on the planned study schedule. FIGURE 1-11 Peritonitis: “Hot Belly.” (From Zerwekh J, Claborn J, Miller CJ: Memory notebook of nursing, vol 1 , ed 4, Dallas, 2008, Nursing Education Consultants.)
