Posted in Tips and Advice

Nothing, and I mean, NOTHING gets a nursing student more worked up than NCLEX questions. I have very clear memories of sitting in the testing room making my best “WTF is this” face as I worked my way through the questions. And yes, that’s the exact same face I made the entire time I was taking the actual NCLEX and my CCRN exam…so if you think these style of questions are ever going to go away…you are sadly so very very wrong.

The good news is that you CAN conquer them….and you will! NCLEX questions are designed to get you to think critically as they test your ability to use solid reasoning and prioritize appropriately. Often, there will be FOUR CORRECT ANSWERS with one answer that is “the most correct.” Other times you’ll find yourself saying, “I wouldn’t do ANY of those things,” yet there is ONE thing you’d be more likely to do than the others. It can be a bear…but I am here to help! (pause here while the clouds part and the sun shines through).

What is this “NCLEX” you keep talking about?

If you are just starting out in nursing school, let’s chat a bit about what NCLEX questions actually are. The NCLEX is the licensing exam you will take after graduation, so the idea is to set you up with lots and lots of practice while you’re in your program. This style of question uses applied knowledge. So, instead of a test question saying “what are the signs and symptoms of pancreatitis,”  you’ll have a question such as this:

Your patient is complaining of abdominal tenderness, abdominal pain that is worse after eating,  vomiting and nausea. You check her chart and see that her WBC are 15,000; amylase and lipase are significantly elevated. You will anticipate:

A) inserting a nasogastric tube and explaining to the patient that she will be NPO for a few days
B) placing the patient on fluid restriction of 1500ml per day
C) obtaining an abdominal x-ray to assess for free air
D) medicating the pt for pain and starting her on a low-fat diet

So, as you can see…while you won’t be asked to list the symptoms of pancreatitis, you do have to know what they are in order to recognize that the entire question is actually about pancreatitis AND which treatment modality you will use. From the choices provided, the correct answer is A. For you to know that the answer is A…you have to know the signs/symptoms of pancreatitis AND the treatment (which includes NG tube, NPO, fluids by IV and usually antibiotics). You’d know that B is wrong because a patient who is NPO still needs fluids, especially if they have been vomiting a lot. And, you’d know C is wrong, because further workup for pancreatitis would be an abdominal ultrasound, not an x-ray. And lastly, you’d know D is wrong because even though you’d give her pain medicine, you would not start her on a diet…pancreatitis patients are NPO for at least a day or two to let everything rest as we work to get the inflammation down. See how you have to know A LOT about pancreatitis in order to answer one teeny tiny test question? Now, imagine doing 75 of those. Good times!

NCLEX question themes

NCLEX questions mainly focus on the following themes. By keeping these themes in mind, you can more easily understand HOW to answer them. They are:

Life or death situations: These type of questions are asking you to focus on actions that will save a patient’s life…think ABCs. Airway, breathing, circulation. What do you do FIRST?

Patient safety: What action will you do that will keep the patient safe? For example, you wouldn’t give a tachypneic pt anything to eat/drink because the risk of aspiration is too high. If they’re writhing in bed, breathing 32 times a minute and complaining of severe pain, you’d give IV pain meds for sure…but pills and water? No way, Jose!

The nursing process: These questions want to make sure you understand the Nursing Process. For a review, check out this post here! The big thing with the nursing process is ASSESSING before you do anything, and then RE-ASSESSING once you’ve done it.

Nursing interventions for specific diseases: These questions test your knowledge of pathophysiology AND the appropriate interventions, like the pancreatitis example above. This means you gotta know your stuff, so pay attention in your Med/Surg lectures, and if you need extra love in this area, check out my notes!

Infection control: Sometimes you’ll come across a question about infection control….knowing what bugs require hand washing vs. alcohol foam, understanding the different types of precautions (airborne comes up a LOT, as does droplet), and knowing which types of patients who could share a room…for example, you wouldn’t want a fresh surgical patient to be roomed with someone who has a raging infection.

Appropriate delegation: As RNs, you have the power to delegate to CNAs, Patient Care Techs and the like. However, you HAVE to understand what items can be delegated and (here’s the big one), you have to EVALUATE their work. For the most part, only RNs assess the patient…others can do vital signs, but you have to ASSESS the patient.

Prioritizing: You’ll get a lot of questions about prioritizing. In these questions, all of the answers will be things you would actually do…but there’s only ONE thing you would do first. Have fun with these 🙂

Acute vs. chronic problems: One of the ways you can approach a prioritizing question is to see if you’re dealing with an “acute vs. chronic” situation. If you are, the acute situation is what needs to be addressed first. If your patient comes in with chronic renal disease, are you going to freak out about their decreased urine output, or are you going to address their elevated potassium brought about by an “acute exacerbation” of their illness? Since their urine output is probably always low, you’ll address the more dangerous and acute problem first…the high potassium level.

Teaching/learning: Some questions will focus on teaching your patients…a lot of these want you to understand that teaching is patient-centered. Meaning, you will not teach at at ime when the patient isn’t ready (during an acute episode, or when in a lot of pain)….and that you will also assess their understanding of the topic FIRST.

The patient’s developmental stage: The nursing gods really want all of us to understand everyone’s life stage and how this relates to their care. Review Erickson’s and Freud’s theories and you’ll do great with these questions! This will come into HUGE play with pediatrics!

Maslow’s hierarchy: Another common theme focuses on Maslow…physiology and safety are going to come before esteem and self actualization. These are usually pretty easy questions since you’ve likely had Maslow drilled into your brain since you took human development as a pre-req, right?

Your test-day strategy

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If you follow my study methods outlined all over this website and in my book “Nursing School Thrive Guide,” you’ll have a solid handle on the concepts you need to know before you walk into your exam. (#ad) If you’ve been following my methods, you will not be up half the night studying…EVER. The morning of your exam, you will resist (with every fiber of your being) the urge to cram. Don’t do it! It just gets your brain in a tizzy and you want your brain to be beautifully relaxed as you take your test. Deep breath in….deep breath out. You can do this.

When you get to the testing room, guess what you’ll see? Most (if not all) of your classmates hanging out in the hallway, frantically cramming and quizzing each other…freaking out about things they aren’t sure of and speculating about their grades. Do not participate! Go somewhere quiet or put in your ear buds and listen to some relaxing music, watch totally irrelevant YouTube videos (like this one) or play a game of Sudoku as a “warm-up.”  This way, when you walk into your exam, your mind is relaxed and open. Everything you need to know is already in there…and being relaxed and open helps you access the information. Trust me…been there, done that, bought the T-shirt. DO NOT CRAM ON THE DAY OF THE TEST…just in case I forgot to mention it 🙂

Take your time as you go through each question. I always used a piece of scratch paper and wrote out A B C D for each question and methodically crossed off each wrong choice as I went. I could usually get it down to two to choose from, making the whole test-taking experience a lot less daunting. Make sure you know in advance if your exam (which will be computer-based) allows you to go back to do questions that you’ve skipped. If it does, skip those that are taking too much time but make sure you mark the numbers down on your scratch paper! You don’t want to miss points for simply forgetting a question or two! Note that some exams WILL NOT let you go back…the idea is that the exam mimics the NCLEX as much as possible…so ask your professor before you start!

Another helpful way to study is to actually study by doing NCLEX questions. I highly recommend investing in a few NCLEX test books. I loved the ones by  Mosbys and Saunders…just make sure any that you choose have the questions broken out by body system and provide rationales for the wrong AND right answers. Clicky on the linky below and check ’em out on Amazon (which just happens to help support this website!) #ad

As you do these practice questions, don’t just read the rationales for the correct choices….read WHY the wrong ones are wrong as well. You’ll learn a TON from doing this, and get a lot of exposure to NCLEX-logic (which you’ll need to master this very specific style of question!).

I hope this helps you feel more confident as you prepare for your exams! Got a great NCLEX question tip? Share it below and share the love with your fellow nurses!

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