1. TEST-TAKING STRATEGIES

2. PYRAMID POINTS
Read the question and every option thoroughly and carefully.
Ask yourself, “What is the question specifically asking?”
Be alert to key words and true and false response stems.
Eliminate the incorrect options.
Use all of your nursing knowledge, your clinical experiences, and your test-taking skills and strategies to answer the question.

3. HOW TO AVOID READING INTO THE QUESTION
Identify the case situation from the stem of the question.
Identify what the question is asking.
Look for the key words.
Read every option.
Use the process of elimination.
As you read the question, avoid asking yourself “What if...?”

4. THE CASE SITUATION
The case situation provides you with the information about a clinical health problem and the information that you need to consider in answering the question.
Read all of the information and every word in the case situation.

5. THE STEM OF THE QUESTION
The stem of the question follows the case situation and asks something specific about the case situation.
Read the stem carefully and specifically identify exactly what is being asked.

6. THE OPTIONS
The options are all of the answers and you must select one.
Read every option carefully and reread the stem of the question to be sure that you understand what is being asked.
Use the process of elimination.
Once you have eliminated two incorrect options, reread the stem of the question again to identify specifically what the question is asking, before selecting the correct option.

7. EXAMPLE: CASE SITUATION, STEM, OPTIONS
CASE SITUATION: A nurse is monitoring a child for bleeding following surgery for removal of a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing.
STEM: Which of the following would be the most appropriate nursing intervention?
OPTIONS:
Circle the area of drainage and continue to monitor.
Reinforce the dressing.
Notify the physician.
Document the findings.

8. KEY WORDS
Key words focus your attention on critical ideas in the case situation, stem, and in the options.
Key words are important to identify because they will assist in eliminating the incorrect options.
Some of the 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.

9. KEY WORDS Early or late Best First Initial Immediately
Most likely or least likely
Most appropriate or least appropriate
On the day of
After several days

10. THE CLIENT OF THE QUESTION
Identify the client of the question.
The client is the person who is the focus of the question.
It is important to remember that the client of the question may not necessarily be the person with the health problem; in the test question, the client may be a relative, friend, spouse, significant other, or another member of the health care team.
After identifying the client of the question, select the option that relates to and most directly addresses that client.

11. THE ISSUE OF THE QUESTION
Identify the issue of the question.
The issue of the question is the specific subject content that the question is asking about.
Identifying the issue of the question will assist in eliminating the incorrect options and direct you to selecting the correct option.

12. EXAMPLES: ISSUE OF THE QUESTION
A medication or intravenous (IV) therapy
A side effect of a medication
An adverse or toxic effect of a medication
A treatment or procedure
A complication of a health care problem, treatment, or procedure
A specific nursing action

13. TRUE RESPONSE STEMS
True response stems use key words that ask you to select an option that is true regarding the case situation in the question.
Key words used in a true response stem
Most or most appropriate
Most likely
Best
Best judgment
Initial or first
Chief
Immediate

14. FALSE RESPONSE STEMS
False response stems use key words that ask you to select an option that is NOT true regarding the case situation in the question.
Key words used in a false response stem
Avoids
Least likely
Need for further instructions or education
Lowest priority
Incorrect
Unsafe
Except or not

15. QUESTIONS REQUIRING PRIORITIZING
Identify the key words in the question that indicate the need to prioritize.
Key words
Initial or first
Essential
Vital
Immediate
Highest
Best
Most
Priority

16. QUESTIONS REQUIRING PRIORITIZING
Use Maslow's Hierarchy of Needs theory as a guide to prioritizing.
Physiological needs come FIRST. Select an option that addresses a physiological need.
When a physiological need is not addressed in the question or noted in one of the options, safety needs receive priority. Select an option that addresses safety.

17. MASLOW’S HIERARCHY OF NEEDS THEORY
Maslow’s Hierarchy of Human Needs from Maslow, AH: Motivation and Personality. Upper Saddle River, NJ, 1970, Prentice-Hall.

18. QUESTIONS REQUIRING PRIORITIZING
Use the ABCs when selecting an option.
Remember the order of priority
Airway
Breathing
Circulation

19. QUESTIONS REQUIRING PRIORITIZING
Assessment
Analysis
Planning
Implementation
Evaluation
Use the steps of the nursing process to answer questions.
Follow the steps of the nursing process to select an option.
The first step of the nursing process is assessment.
When the question asks you what the nurse’s initial, first, or most appropriate action is, select the option that relates to assessment of the client.

20. QUESTIONS REQUIRING PRIORITIZING
NURSING PROCESS: ASSESSMENT
Assessment questions address the process of gathering subjective and objective data relative to the client, confirming the data, and communicating and documenting the data.
Remember that assessment is the first step in the nursing process.
When you are asked a question regarding your initial or first nursing action, select the option that addresses an assessment action.

21. QUESTIONS REQUIRING PRIORITIZING
NURSING PROCESS: ASSESSMENT
If an assessment action is not one of the options, follow the steps of the nursing process as your guide to select your initial or first action.
When answering questions that focus on assessment, look for key words in the options that reflect assessment.

22. QUESTIONS REQUIRING PRIORITIZING
KEY WORDS: ASSESSMENT
Ascertain
Assess
Check
Determine
Find out
Identify
Monitor
Observe
Obtain information

23. QUESTIONS REQUIRING PRIORITIZING
NURSING PROCESS: ANALYSIS
Analysis questions are the most difficult questions because they require understanding of the principles of physiological responses and require interpretation of the data based on assessment.
Analysis questions require critical thinking and determining the rationale for therapeutic interventions that may be addressed in the case situation.
Analysis questions may address the formulation of a nursing diagnosis and the communication and documentation of the results of the process of analysis.

24. QUESTIONS REQUIRING PRIORITIZING
NURSING PROCESS: PLANNING
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.
Remember that this is a nursing examination and the answer to the question most likely involves something included in the nursing care plan, rather than the medical plan.

25. QUESTIONS REQUIRING PRIORITIZING
NURSING PROCESS: IMPLEMENTATION
This exam is about NURSING, so focus on the nursing action rather than on the medical action, unless the question is asking you what prescribed medical action is anticipated.
Implementation questions address the process of organizing and managing care, counseling and teaching, providing care to achieve established goals, supervising and coordinating care, and communicating and documenting nursing interventions.

26. QUESTIONS REQUIRING PRIORITIZING
NURSING PROCESS: IMPLEMENTATION
On NCLEX-RN, the only client that you need to be concerned about is the client in the question that you are answering.
When you are answering a question, remember that this client is your only assigned client.
Answer the question as if the situation were textbook and ideal and the nurse had all the time and resources needed and readily available at the client’s bedside.

27. QUESTIONS REQUIRING PRIORITIZING
NURSING PROCESS: EVALUATION
Evaluation questions focus on comparing the actual outcomes of care with the expected outcomes.
Evaluation questions address evaluating the client’s ability to implement self-care, health care team members’ ability to implement care, and the process of communicating and documenting evaluation findings.

28. QUESTIONS REQUIRING PRIORITIZING
NURSING PROCESS: EVALUATION
Evaluation questions also focus on how the nurse should monitor or make a judgment concerning a client's response to therapy or to a nursing action.
In an evaluation question, be alert to false response stems because they are frequently used in evaluation-type questions.
The question may ask for a client statement that indicates either accurate or inaccurate information related to the issue of the question.

29. CLIENT NEEDS SAFE, EFFECTIVE CARE ENVIRONMENT
These questions address the provision that the nurse provides and directs 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.

30. CLIENT NEEDS SAFE, EFFECTIVE CARE ENVIRONMENT
Be alert to safety needs addressed in a question and remember the importance of hand washing, call bells, bed positioning, and the appropriate use of side rails.

31. CLIENT NEEDS PHYSIOLOGICAL INTEGRITY
These questions address the provision that the nurse promotes 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.

32. CLIENT NEEDS PHYSIOLOGICAL INTEGRITY
Remember that physiological needs are a priority and are addressed first.
Use the ABCs (airway, breathing, and circulation) and the steps of the nursing process when selecting an option addressing physiological integrity.

33. CLIENT NEEDS PSYCHOSOCIAL INTEGRITY
These questions address the provision that the nurse provides nursing care that supports and promotes the emotional, mental, and social well-being of the client and significant other(s).
Content addressed in these questions relates to promoting the client or significant others’ ability to cope, adapt, or problem-solve in situations such as illness or stressful events, and providing care to clients with maladaptive behavior or acute or chronic mental illness.

34. CLIENT NEEDS HEALTH PROMOTION AND MAINTENANCE
These questions address the provision that the nurse provides and directs care that prevents health problems, provides early detection of health problems, and provides and directs care that incorporates knowledge of expected growth and development principles.
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 status.

35. CLIENT NEEDS HEALTH PROMOTION AND MAINTENANCE
Use the Teaching/Learning Theory if the question addresses client education, remembering that client motivation and client readiness to learn is the FIRST priority.
Be alert to false response stems with questions that address health promotion and maintenance.

36. COMMUNICATION QUESTIONS
Identify the use of therapeutic communication tools.
Use of communication tools indicates a CORRECT option.
Use of communication blocks indicates an INCORRECT option.
Always focus on the client’s feelings first; if an option reflects the client’s feelings, select that option as the answer to the question.

37. COMMUNICATION QUESTIONS
TOOLS
Being silent
Offering self for assistance
Showing empathy
Focusing
Restatement
Validation/clarification
Giving information
Dealing with the here and now

38. COMMUNICATION QUESTIONS
BLOCKS
Giving advice
Showing approval/disapproval
Using clichés and false reassurance
Requesting an explanation, “Why?”
Devaluing client feelings
Being defensive
Focusing on inappropriate issues or persons
Placing the client's issues on "hold"

39. UNFAMILIAR CONTENT
Answer questions using your nursing knowledge, clinical experiences, and test-taking skills and strategies.
If the content of the question is unfamiliar and you are unable to answer the question using your nursing knowledge, look for a global option, similar distracters, or similar words, behaviors, thoughts, or feelings in the question and in one of the options.

40. GLOBAL OPTION
When more than one option appears to be correct, look for a global option.
A global option is one that is a general statement and may include the ideas of the other options within it.

41. SIMILAR DISTRACTERS
If you don't know the answer, try looking for similar distracters.
Remember that there is only ONE correct option.
If two options say the same thing or include the same idea, then NEITHER of these options can be correct.
The answer to the question is the option that is different.

42. SIMILAR WORDS, BEHAVIORS, THOUGHTS, OR FEELINGS
If you do not know the answer, look for a similar word, behavior, thought, or feeling used in the case situation or the stem of the question, and in one of the options.
If you find a word, behavior, thought, or feeling used in the case situation or the stem of the question and it is repeated in one of the options, that option MAY be the correct one.

43. PHARMACOLOGY QUESTIONS
If you are familiar with the medication, use nursing knowledge to answer the question.
Remember that the question will identify both the generic name and trade name of the medication.
If the case situation identifies a diagnosis, then you can 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 taking this particular medication.

44. PHARMACOLOGY QUESTIONS
Try to determine the classification of the medication being addressed to assist in answering the question; identifying the classification will assist in determining a medication action and/or side effects (Cardizem is a cardiac medication).
Use medical terminology and break the name of the medication into parts; for example, Lopressor can be broken down into Lo and pressor meaning lowering the blood pressure.

45. PHARMACOLOGY QUESTIONS
Look at the prefix and/or suffix of the medication name
“-ase” indicates an enzyme
“-sone” indicates a steroid
“-line” indicates a bronchodilator
“-lol” indicates a beta blocker

46. PHARMACOLOGY QUESTIONS
GENERAL PRINCIPLES TO REMEMBER
Clients are instructed to avoid alcohol with medications.
Antacids are generally not administered with other medications.
Capsules and sustained-released medications are not to be crushed.
The nurse never adjusts or changes the client’s medication dosage or discontinues a medication.
Medications are never administered if the order is difficult to read, is unclear, or identifies a medication dose that is not a normal dosage.

47. ADDITIONAL PYRAMID STRATEGIES
If the question asks for an immediate action or response, all options may be correct; therefore, base your selection on priorities.
Reword a difficult question, but if you do so, be careful not to change the intent of the question.
Relate the situation to something familiar and try to visualize the client as you read through the case situation and the stem of the question.

48. ADDITIONAL PYRAMID STRATEGIES
If there are words in the case situation or stem of the question that are unfamiliar, try to figure out the meaning in terms of the context of the sentence or break down the word and use medical terminology skills.
If one option includes qualifiers such as GENERALLY, USUALLY, TENDS TO, POSSIBLY, or MAY, and other options do not, select that option.

49. ADDITIONAL PYRAMID STRATEGIES
Absolute terminology such as ALWAYS, NEVER, ALL, EVERY, NONE, MUST, and ONLY tend to make an option incorrect.
With medication calculations, talk yourself through each step and be sure the answer makes sense; recheck the calculation before selecting an option, particularly if the answer seems like an unusual dosage.

50. ADDITIONAL PYRAMID STRATEGIES
Remember, the only client you need to be concerned about is the one in the question you are answering and answer the question as if the situation were ideal and the nurse had all the time and resources readily available at the client’s bedside.
Pace yourself, concentrate, and focus on one item at a time; if you find yourself becoming distracted, take a few minutes to breathe deeply and then refocus.