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Slide1
Pearls
for NCLEX-RN® Success: Strategies to Correctly Answer Questions
Developed by: Staja “STAR” Booker, MS, RNReviewed and Approved by: Alumni Webpage Committee
© 2011-14
Originally
Developed for:
MACaN
@ Penn
State
Slide2PEARLS for NCLEX Success
PEARLS
P
ractice questions and
P
ray often
E
xamine the
E
ntire question and all answers
A
void reading into the question and
A
pply your knowledge and skills
R
eview everyday and
R
est often
L
isten to your “first mind”
S
tudy difficult concepts and keep
S
tress to a minimum
Slide3Outcomes
After completion of this presentation, learners will be able to:
--Appreciate and recognize importance of critical thinking, clinical judgment, clinical reasoning, and sound decision-making
--Identify the introductory statement, information distracters, and the stem of questions
--Identify the four elements in a question
--Demonstrate ways to isolate the correct answer(s)
--Gain confidence in answering NCLEX-style questions
--Recognize different types of
questions
Slide4NCLEX Readiness Assessment
Complete the “Readiness for NCLEX Assessment” provided on this page webpage. This will help you identify areas that you need to spend additional time studying and practicing
Slide52013 NCLEX Content Areas
Slide6NCLEX is a computer adapted test (CAT).
FYI
NCSBN
CAT video
:
https
://
www.ncsbn.org/3761.htm
Slide7Computer Adaptive Testing (CAT)
You can’t skip or review NCLEX questions on the computer. Once you click Next, the questions are GONE!!
There is a tutorial at the beginning of the NCLEX to make sure your computer is working correctly and to ensure that you understand the directions. You will be given a couple of sample questions.
Your computer will automatically shut down after you have or have not demonstrated minimal competency.
Minimum questions – 75 Maximum questions – 265
15 items are “test” questions & are not scored
Slide8Zerwehk, J., Claborn, J.C., & Miller, C.J. (2008). Memory notebook of nursing. (Volume 1, Ed. 4). Ingram, TX: Nursing Education Consultants.
Slide9Review NCLEX test planPearson VUE NCLEX tutorial http://www.pearsonvue.com/nclex/#tutorial
Slide10ˈTwas the night before NCLEX…
Do not study heavily. Use this day to relax, clear your mind, and reflect. If you must study, review core principles of nursing care.Gather the necessary materials you will need to take with youDo not drink alcohol or take mind-altering drugsSleep wellAvoid “negativity” and think positively. Decree and declare, “I will pass NCLEX the first time and become an excellent RN!”Dress comfortably
Slide11Eat a light meal before the test to prevent your blood sugar from dropping.Arrive to the testing site 30min – 1 hour early.Have acceptable form of ID!! Don’t bring family, friends, or kids.You will 1) be photographed, 2) fingerprinted, 3) have your palm veins scanned, and 3) provide your digital signature.A plastic bag for storage or a locker will be assigned to you to secure all possessions. NOTHING goes into the computer room but your body, exceptions for those with cultural or religious needsYou will be given a dry erase board if you need to write information or do calculations– but no purging of knowledge.Time Allotted – 6 hours (you can take breaks but the clock doesn’t stop)
Slide12Receive “unofficial” results 48 hours after the exam. This service is available for $7.95 on Pearson VUE website.PASS- YAY! get license number, a job, and begin practicingFAIL- Never give up. Can retake in 45 days. Will need to register, pay, etc. all over again.You'll receive an NCLEX Candidate Performance Report (CPR) which is an individualized document that shows how you performed in each of the test plan content areas.
Slide13https://www.ncsbn.org/nclex.htmSee “The 8 Steps of the NCLEX” at https://www.ncsbn.org/2013_Eight_Steps_of_NCLEX.pdf
NCSBN Website
To learn more about NCLEX:
Slide14KEEP THIS IN MIND
When answering NCLEX questions, keep these two statements in mind:
If I can only do one thing now….What will cause my patient least harm and most benefit?
Slide15You betta check yo’ self!
Remember ABCs or CABs (appropriately)Know how to care for prevalent health conditionsKnow normal lab levelsKnow principles of infection prevention and control & various precautionsPrioritizationBetter safe than sorry!
Slide16Misreading questions is a common reason why students answer question wrong.
TOPIC 1: Misreading Questions
Slide17Misreading Questions
Do not misread questions. This can occur if you:
Read into the question: if it doesn’t say it, then don’t add it to the scenario.
Incorrectly analyze what the question is really asking you
Overlook key words
Misinterpret a disorder
Read question too fast
Slide18Misreading Questions
The brain can read something that is not there, but it is important to take your time and analyze exactly what is presented.
If it doesn’t say it in the question, then don’t assume or add anything. Granted, there are things that you should know and/or gather from the situation presented.
For example
, if a question said that urine output per hour was below normal, then you can accurately conclude that output was less than 30ml/hr. But if it the question said that the urine was abnormally colored then you can’t assume that the urine was dark amber…it could be red, blue, orange, etc.
Slide19Misreading Sentences
Look at this example…let’s read it aloud.
Paris in the
the spring time
Slide20Misreading Sentences
Did
you catch that there are 2 “
the
s
” in the
phrase?
You most likely read the statement like this: “Paris in the spring time” when it really says “Paris in
the
the
spring time”
Slide21Misreading Sentences
Here’s
another example…count the number of
F
s
below
.
Finished files are the result of years of scientific study combined with the experience of full years.
Slide22Misreading Sentences
Did you count 7
F
s
?
F
inished
f
iles are the result o
f
years o
f
scienti
f
ic study combined with the experience o
f
f
ull years.
Slide23Misreading Sentences
Read this sentence aloud.
Every 8 out of 10
hunans
report they are unhappy with their career choice.
Slide24Misreading Sentences
Now how many of you read “
Every 8 out of 10
HU
M
ANS
report they are unhappy with their career choice.”
T
he word was
HU
N
AN
.
Slide25Misreading Sentences
Misreading sentences can cause you to miss key information.
Take your time reading scenarios and understanding what the question is asking.
Slide26RACE Model
Recognize
Ask
Critically analyze
Eliminate
Slide27RACE Model
RECOGNIZE
what kind of information in the stem.
Recognize key words in the stem.
Recognize who the client is in the stem.
Recognize what the topic is about.
Slide28RACE Model
ASK
what
is the question asking
?
Ask what are the key words in the stem that indicate the need for a response.
Ask what is the question is asking me to do
Slide29RACE Model
CRITICALLY
analyze the options in relation to the question asked in the stem.
Critically examine each answer option in relation to the information in the stem
(
do the answers even match the information in the stem?
)
Critically identify a rationale and risk/benefit for each option
Critically compare and contrast the option in relation to the information in the stem and their relationships to one another
Slide30RACE Model
ELIMINATE
as many answer options as possible
Eliminate one option at a time (determine if any answer options were in your “pool” of answers)
If any part of the answer is wrong, the entire answer is all wrong
Usually the answer that is most different from the other answer options is correct
Slide31TOPIC 2: Parts of a Question
Slide32Parts of a Question
Each question has 3-4 parts:
I
ntroductory statement
Clinical Information Distracters (
sometimes
)
Stem
Four answer options with 3 answers being distracters and 1 correct answer
(unless it is select all that apply/multiple select)
Slide33Parts of a Question
ITEM
Slide34Introductory Statement
The introductory statement tells you about the client’s situation, health problem, or clinical status that you should consider when answering the question.
The introductory statement sets up the scenario.
Slide35Introductory Statement
Example:
Mr. Wilson is prescribed an iron supplement and an increased intake of Vitamin C in his diet.
The nurse understands that the best rationale for increasing Vitamin C in the diet is to:
Slide36The Invisible Gorilla Challenge
http://www.theinvisiblegorilla.com/videos.html
Closely count the number of passes made by basketball players in white shirts.
Slide37Distracters
1.
Did anyone see the gorilla that appeared halfway through the video?
Well that gorilla appeared to distract you, and sometimes information in questions and answers are simply there to distract you.
If you saw the gorilla and it threw you off from counting, you have to be careful about allowing distractor information in questions throw you off.
Slide38Distracters
Distracter information in questions or answers is just that – it
distracts
,
detracts
, and
subtracts
from the main issue.
It is information that provides additional detail but does not necessarily help to answer the
question.
Slide39Distracters
You must keep
your
mind
on
what the question is asking and what the answer is answering.
Likewise,
in practice, you
should avoid allowing
non-emergent issues distract you
from critical tasks…
(medication administration,
receiving or reporting critical labs, charting
,
report
, etc.)
because this increases
risk of nursing errors.
Slide40Awareness of Distracters
On the flip side, failing to see the gorilla is reflective of inattentional blindness. Sometimes we overlook key points in the question (e.g. misread questions) and we read (or see) what we want to you read (see).
Slide41Contributing Factors of Inattentional Blindness
Mental Capacity – how much your mind you “hold”; fatigue, stress, drugs and alcohol, sleep deprivation all decrease mental capacityConspicuity – physical properties of an image; we notice things that are bright, flicker, and move, italicized, bolded, all caps, etc.; NCLEX does not provide any of these sensory hints.Expectation – seeing what we believe or know; If something was correct the first three times you checked you may miss that it is incorrect the fourth timeMental Workload – how much is on your mind; although we are expected to multitask, if your mind is overloaded and attention is diverted there is increased risk for errors; Example: You are talking to a NP on the phone and fail to hear the ventilator alarm
Slide42Distracters in Questions
Example:
Mrs. Jackson was admitted to the medical-surgical unit for a COPD exacerbation, but she is currently stable.
She is in normal sinus rhythm (NSR) and her blood glucose is 143.
Which rationale best explains why Mrs. Jackson is only prescribed 2L oxygen?
Slide43Distracters in Answers
Mr. Ron is a
thirty five year old
male in the trauma ICU post MVA. A nasogastric tube has been inserted for feeding and medication delivery. Which part of the body requires special hygiene for a patient with a nasogastric tube?
Rectum
Abdomen
Oral cavity
Perineal
area
Slide44Stem of a Question
The STEM is the portion of a question that “asks” the nurse to solve a specific problem by implementing a nursing action.
This is usually the actual “question.”
However, the stem may not be a separate sentence, but it may be a part of the introductory statement.
Slide45Types of Stem
2 types of Stem:
--Appropriate action
(what the nurse should do, or did correct)
(what the patient should do or did correct)
(what
is true) –
Positive polarity
--Inappropriate action
(what the nurse
shouldn’t
do, or did
incorrect
)
(what the patient
shouldn’t
do or did
incorrect)
(what
is false) –
Negative polarity
Slide46Stem of a Question
Example of STEM as a separate sentence:
During dinner, a client puts on her call light. When the RN enters the room, she notices that he is grabbing his chest and complaining of severe chest pain.
What action should the nurse take first?
Slide47Stem of a Question
Example of STEM as part of the introductory statement:
After inserting a nasogastric (NG) tube in a patient for nutritional tube feedings, it is important to:
x
xxxxxxxxxxxxxxxxxxxxx
x
xxxxxxxxxxxxxxxxxxxxx
x
xxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxx
Slide48TOPIC 3: Elements of a Question
Slide49Elements of a Question
There are four elements in each test question:
S
ubject
I
ssue or problem
K
ey words
Appropriate or Inappropriate Action (i.e. answers)
Slide50Step # 1
Identify the subject.
Slide51The Subject
The subject is the focus of the question.The subject can be a patient (or client), nurse, family member(s), or colleagues.REMEMBER the answer choice you select must relate to the subject.
Slide52The Subject
Example:A 23 year old female arrives at the ED after collapsing at home. She has no pulse or respirations. Which of the following accurately describes the cardio-pulmonary resuscitation process?So who is the subject? The 23 year old femaleIs she the patient, nurse, or family member? patient
Slide53Step # 2
Identify the issue or the topic
THEN determine
Is further assessment needed?
Is it appropriate to apply ABCs or CABs?
Slide54The Issue
The issue is the specific problem that the question is asking about.
Make sure you pay attention to what the question is
specifically
asking you about.
The issue is not necessarily the same as the patient’s admitting diagnosis. The question may tell you what the diagnosis is, but may not ask you anything about it.
Slide55The Issue
An HIV + patient is admitted to the hospital with a tuberculosis (TB). Which of the following isolation categories should be implemented in order to prevent transmission of the HIV virus and tuberculosis? Select all that applyStrict isolationRespiratory precautionsUniversal precautionsEnteric precautionsWhat is the issue?Prevention of transmission of HIV and TB
Slide56Step # 3
Identify Key Words
Slide57Key Words
Key words are the important words in a question that should focus your attention on critical ideas in the stem and answers.
Key words can be positive, negative, urgent or absolute (i.e. definite).
Slide58Key Words
CAN YOU THINK OF SOME KEY WORDS YOU HAVE SEEN ON YOUR EXAMS?
Slide59Examples of Key Words
should domost likelyappropriateeffectivetrueinclude(d)indicatedconsistentrealisticcorrectnot neededsafebest
leastunlikelyexceptinconsistentinappropriatecontraindicatedfalsenotincorrect/wrongunrealisticneed…unsafeLate
Positive
Negative
Urgent
Priority (high or low)
first
initial(
ly
)
immediate(
ly
)
most important
STAT
now
early
prior
primary
q
uickly
Essential
mandatory
Slide60Examples of Key Words
AlwaysNeverAllCompletelyOnlyThese terms usually make answers false!!
Absolute (Definite)
Inexact
Possible/y
UsuallyMaySomeOftenMost ManyMainlyThese terms often makes answers true.
Directionality
Maximum
Minimum
High
Low
Slide61Examples of Key Wordsfor The Nursing Process
PlansGoalsDevelopsDetermine
Planning
Assessment
Assess
Ascertain
Gather
Collect
Determine
Identify
Monitor
Observe
Obtain (information)
Recognize
Find out
Check
Slide62Examples of Key Wordsfor The Nursing Process
ExpectsDemonstratesDisplays understandingObservesAnticipatesEvaluateAchieveInterpret
Evaluation/Outcomes
Interventions
Intervenes
Apply(
ies
or
ication
)
Implements
Slide63Key Words
Example:
When beginning an IV, the nurse
s
hould
first:
x
xxxxxxxxxxxxxxxxxxx
x
xxxxxxxxxxxxxxxxxxx
x
xxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxx
Slide64Step # 4
Identify
appropriate or inappropriate
nursing action
Slide65Appropriate or Inappropriate Action
Mentally create a pool of answers
Then, examine each answer choice given and determine which outcome best answers the question
Your first answer may not be an option, so choose the 2
nd
best, safe answer.
Slide66Make Mental Answers
An older adult with heart failure, Parkinson’s disease,
Lewy
body dementia, sleep apnea, and peripheral vascular disease is having trouble sleeping at night. He already takes many medications, and his wife does not want to add any additional ones. What non-pharmacological strategies may be safe to implement to aid in sleep?
Slide67Answer Options
Give warm herbal tea 15 minutes before bed
Administer melatonin pills
Play soothing music on a low volume and dim lights
Talk to the older gentleman for an hour
Slide68Make Mental Answers
What should the nurse do immediately before performing any procedure for a patient?
Slide69Answer Options
Select all that apply
Shut the door
Wash hands
Close the curtain
Explain the procedure
Ask for patient’s permission
Slide70Putting It All Together
An elderly confused man is on bed rest due to a DVT in his right leg. Which intervention will not effectively provide for this patient’s safety?Who is the subject?Elderly manWhat is the issue?SafetyWhat are the key words?Will not effectivelyWhat are the distracters?NoneWhat would you do? (your pool of answers)Let’s examine each answer and determine which will effectively provide safety.
Slide71Putting It All Together
An elderly confused man is on bed rest due to a DVT in his right leg. Which intervention will not effectively provide for this patient’s safety
?
Provide regular toileting by bedpan
Explain to the man that he should use the call light if he needs to get up
Place 3 side rails in the up position and check on the client often
Initiate proper use of restraints
Place the bed in lowest position
Slide72QUESTIONS?
Slide73TOPIC 4: Answer Option Tips
Slide74Answer Option Tips
After reading the question, develop a pool of answers in your mind before looking at the actual answers provided.
Answer the question, as if the situation is ideal or “textbook perfect.”
Your first choice may not be there, so choose the next best answer.
Three of the answer options are there to distract you, so make a decision on each before continuing.
Make a yes/no decision on each answer choice before moving to the next answer choice.
Slide75Answer Option Tips
Look at how words or actions are grouped. Are all the answers physiological, intervention-centered, assessment, etc.?? There is only one best answer. No test question on NCLEX is keyed for two responses unless it is select all that apply.Go with your “first-mind”; never change your answer!!!If you do not know the answer, make your best educated guess and move on. Don’t spend more than 1-1.5 minutes/question.
Slide76Answer Option Tips
Do not focus only on your experiences, which may be too narrow for a point of reference
FOCUS
ON WHAT YOU KNOW AND NOT ON WHAT YOU DON’T KNOW
!!!
Scope
of practice - Be able to differentiate the need for nursing judgment from the need for physician judgment
.
Watch out for
answer choices that are factually correct on their own, but fail to answer the question, and so are actually wrong.
Slide77Answer Option Tips
Select
responses
that are:
Therapeutic and patient-centered
Show respect
Communicate
acceptance
Eliminate
responses that are:
Obviously wrong
Inappropriate and non-therapeutic
Partially true
In some instances, rule out an option if you know it is associated with something else. For example, you may not know about the laboratory values for warfarin therapy, but you do know the laboratory values for heparin and aspirin. Those values can be eliminated because you are “using what you know
.”
Slide78TOPIC 5: NCLEX Question Formats
Slide79NCLEX Question Formats
Multiple choice (one correct answer)
Alternate Item Formats
Multiple response (select all that apply)
Hot spots
Audio or Video
Drop-and-drag/ordered response
Chart exhibits
Fill-in-the
blank
(calculation
questions
)
Graphics (e.g. ECG rhythm)
Slide80Slide81Slide82Slide83Slide84Slide85Slide86Slide87NCLEX QUESTION
For a tutorial on alternate item NCLEX questions, click on the Alternate Test Item icon on the NCLEX resources webpage.
Slide88The End
Star’s 106 year old granny
Slide89ANY QUESTIONSANY COMMENTSANY CONCERNSUse Tiger Chat tool to contact us
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