1. NCLEX Testing Strategies
Whitney Gallagher, RN

2. First...
Try to pick out what information given in the stem is important
What options do we know are incorrect? What factors can be dismissed?
What is the stem asking us to answer?

3. The nurse is instructing George, an 85 year old gentleman who lives alone on the importance of choosing foods low in sodium. The nurse should teach George to limit intake of which food?
Apples
Bananas
Smoked Sausage
Steamed Vegetables

4. The correct answer is C: Smoked Sausage
The patients age and living situation are irrelevant to what is being asked
We can certainly eliminate the fruit options, narrowing the options down to 2 choices
Review what the stem is asking

5. Absolutely DO NOT: Leave the patient Do nothing Pass the buck
Delay treatment

6. Do not “what if...”
When attempting to choose “the best answer”, do not overanalyze.
The information that you KNOW is the information that is provided in the question

7. 2. A nurse is planning care for a post partum client who had a vaginal delivery 2 hours ago. The client has a midline episiotomy. What is the priority nursing consideration?
Client’s pain level
Inadequate urinary output
Client’s perception of body changes
Potential for imbalanced body fluid volume

8. The correct answer is A: Client’s pain level -Don’t jump to irrational, panicked thinking -Don’t assume the client’s feelings -Review the stem for KNOWN facts

9. The Umbrella Principal
Sometimes, one option is the “all of the above” answer
If all options seem correct, look for the one that includes all of the choices

10. 3. A nurse from the ED receives a phone call from EMT’s to report victims of a plane crash suffering from cold exposure being transported to the hospital. What should the nurse’s initial action be?
Supply trauma room with normal saline
Call housekeeping to send as many warm blankets as possible
Call the emergency nursing supervisor to activate the disaster plan
Call the ICU to request nurses be sent to the ED

11. The correct answer is C: Call the emergency nursing supervisor to activate the disaster plan -This is the umbrella option -YES, we want to do all of the other things, however, by choosing C, this ensures that the other options will occur

12. Faced with opposite answers
If given a list of options and two of the answer are complete opposites of each other, it’s a good chance ONE OF THESE IS THE CORRECT ANSWER

13. 4. A client in the cardiac step down unit requires suctioning for excess mucous secretions. The nurse should monitor for which issue during the procedure?
Bradycardia
Tachycardia
Premature ventricular beats
Heart block

14. The correct answer is A: Bradycardia.
All of these options CAN occur
Using our “opposite answer” principal, we should narrow the options to either A or B
However, tachycardia is unlikely, and not the priority

15. Faced with same answers
On the other hand, if two of the options are describing the same action, chances are you can ELIMINATE BOTH OF THE CHOICES

16. 5. A two year old is hospitalized with lymphoma
5. A two year old is hospitalized with lymphoma. Which nursing observation poses the greatest risk, and requires action by the nurse?
Coloring book and crayons left in crib
Dolls placed in the crib
Hanging a mobile over the crib
Leaving the crib rail halfway down

17. The correct answer is D: Leaving the crib rail halfway down -Yes, the other options pose safety threats -Using the “like answers” principal, we should eliminate A and B - Two year olds are VERY mobile and active

18. Prioritization 1. Airway 2. Breathing 3. Circulation
Cardiac (undiagnosed chest pain) and Breathing (shortness of breath, tightness) components take PRIORITY
Maslow’s Hierarchy of Needs: Physical needs over everything

19. 6. Which of the following patients should the nurse go see first. A
6. Which of the following patients should the nurse go see first? A. 55 year old female requesting antacid, complaining of chest pain after eating a spicy meal, feeling sweaty B. 60 year old male 8 hours post cardiac cath C. 28 year old female diagnosed with asthma, just received a breathing treatment by respiratory therapy D. 70 year old male, blood glucose was 120 two hours ago

20. The correct answer is A: patient requesting antacid, feeling sweaty after eating spicy meal, feeling sweaty -Yes, we want to see all of the patients -Use ABC’s to prioritize -Although the patient may feel that their symptoms are due to the meal, undiagnosed chest pain is the absolute priority -ASSUME THE WORST: this could be an MI

21. Pick the safest activity option
If given a choice of toys/activities for a child, pick the lamest, most safe option
Even if you think a child would no way want to do this option, it is SAFE

22. 7. You are teaching a mother about caring for her 7 year old boy with risk of bleeding. Which activity is the best option?
Playing tag with friends from school
Suggesting a game of hide and seek
Signing him up for the junior football team
Painting with his sister

23. The correct answer is D: Painting with his sister
I KNOW this is the lamest option
- However, it is the SAFEST option

24. Patient over everything
Forget about the nurse’s convenience, the patient is the priority
This can include: one on one supervision and patient focused responses
Also, remember that the patient comes before any piece of equipment in the room

25. Who do I go see first?
Who is at IMMEDIATE risk if not made the priority?
Respiratory compromise
Unstable conditions (abnormal vital signs)
Sudden changes
Developing complications post-op

26. 8. You are the nurse on a general medical floor, assigned to four cases. Which of your patients would you want to go see first?
30 year old female, 8 hours post op hip replacement complaining of 5/10 pain
90 year old male, requesting his dose of Guaifenesen
14 year old female, complaining her room was too cold last night
55 year old male, who is diabetic, scheduled for a fasting blood sugar, complaining of dizziness

27. The correct answer is D: 55 year old, fasting glucose and dizzy -Pain is important, but it never KILLED anyone -Guaifenesen sounds VERY important, but its simply mucinex -Being cold never killed anyone, although we are concerned about patient comfort -A FASTING DIABETIC patient is very important, especially if he’s reporting dizziness. Low blood glucose can result in coma and seizure

28. Even if you have no idea...
You will more than likely be asked a question that you feel you know NOTHING about
Look for what you do know, don’t focus on what you don’t
Patient Safety is always the priority

29. Holding SI sessions in the library
Holding SI sessions in the library. or text me with questions or concerns (412)