Top Ten Test Taking Strategies for NCLEX-RN

1. Avoid Reading Into the Question

Read the question carefully, identify key words or phrases, and focus on the issue of the question.

What is the question asking?

Avoiding asking “Well, What if?”

A nurse is caring for a hospitalized client with a diagnosis of congestive heart failure who suddenly
complains of shortness of breath and dyspnea. The nurse takes which immediate action?

Prepares to administer furosemide (Lasix)

Calls the physician
Administers oxygen to the patient
Elevates the head of the bed

2. Look for key words

Some 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. As you read the question, look for the key words. Key words will make a
difference with regard to how you will answer the question.

Look for Key Words:

• Early or late
• Best
• First
• Initial
• Immediately
• Most likely or least likely
• Most appropriate or least appropriate

A nurse is caring for a client who just returned from the recovery room after undergoing abdominal surgery.
The nurse monitors the client for which early sign of hypovolemic shock?
1. Increased pulse rate
2. Increased depth of respiration
3. Lethargy
4. Decreased deep tendon reflexes
3. Use Guidelines for Prioritizing

When a question requires prioritization, all options may be correct and you need to determine the correct
order of action
• Best
• Essential
• First
• Highest priority
• Immediate
• Vital
• Most important
• Next
• Primary

Guidelines for Prioritizing!

1. ABCs (airway, breathing, and circulation)
2. Maslow’s Hierarchy of Needs theory
3. Steps of the nursing process
• ABC’s
• Remember the order of priority: airway, breathing, and circulation
• Airway is always the first priority!

The client with a diagnosis of cancer is receiving morphine sulfate for pain. When preparing the plan of care
for the client, the nurse includes which priority action?

1. Monitor stools
2. Monitor the urine output
3. Encourage the client to cough and deep breath
4. Encourage fluid intake

Second guideline to use for prioritizing:

Physiological needs are the priority. When a physiological need is not addressed in the question or noted in
one of the options, continue to use Maslow’s Hierarchy of Needs theory as a guide and look for the option
that addresses safety.

A nurse is reviewing the plan of care for a pregnant client with a diagnosis of sickle cell anemia. Which
nursing diagnosis, if stated on the plan of care, would the nurse select as receiving the highest priority?

1. Anxiety
2. Ineffective coping
3. Disturbed body image
4. Deficient Fluid volume

The Steps of the Nursing Process

• Remember that assessment is the first step
• If an option contains the concept of assessment or the collection of client data, it is best to select
that option.

ACCEPTION TO RULE

The Steps of the Nursing Process

• Possible exception to the guideline:
• If the question presents an emergency situation, read carefully; in an emergency situation, an
intervention may be the priority!

A hospitalized client with type 1 diabetes mellitus tells the nurse that she feels like she is having a
hypoglycemic reaction.

The nurse would first:

1. Obtain a blood glucose reading (assessment first)
2. Administer 50% dextrose intravenously
3. Give the client 4 oz of orange juice
4. Administer subcutaneous glucagon hydrochloride

4. Identify True or False Response Questions

True response questions use key words that ask you to select an option that is accurate regarding the
information in the question.

False response questions use key words that ask you to select an option that is not accurate regarding the
information in the question.

True response question:

A nurse is caring for a client with angina pectoris who begins to experience chest pain. (Focus on the issue!)
The nurse administers a sublingual nitroglycerin (Nitrostat) tablet as prescribed, but the pain is unrelieved.
Which action would the nurse take next?

1. Contact the physician

2. Call the client’s family
3. Administer another nitroglycerin tablet
4. Reposition the client

False response question:

A client treated for an episode of hyperthermia is being discharged to home from the emergency room. The
nurse determines that the client needs reinforcement of the discharge instructions if the client stated to:

1. Stay in a cool environment when possible

2. Increase fluid intake for the next 24 hours
3. Monitor voiding for adequacy o urine output
4. Resume full activity level immediately

5. Answering Communication Questions

Use therapeutic communication techniques to answer communication questions because of their

effectiveness in the communication process.

Select the answer that focuses on the client’s, client’s family member, or significant others’
feelings, concerns, anxieties, or fears

A mother says to the nurse:

“I am afraid that my child might have another seizure.” Which response by the nurse is most therapeutic?
1. “Why worry about something that you cannot control?”
2. “Most children will never experience a second seizure”.
3. “Tell me what frightens you the most about seizures.” (Addresses mother’s fears)
4. “Acetaminophen (Tylenol) can prevent another seizure from occurring.”

6. Eliminate Similar Options

Look at similar options. If any of the options include the same idea, then they are incorrect and can
be eliminated. Remember that there is only one correct option and the answer to the question is the option
that is different.

A nurse is assigned to care for a group of clients. On review of the clients’ medical records, the nurse
determines that which client is at risk for excess fluid volume?
1. The client with an ileostomy
2. The client on diuretics
3. The client on gastrointestinal suctioning
4. The client with renal failure
REMEMBER TO ELIMINATE SIMILAR OPTIONS!

Eliminate Options with Absolute Words!

If you note an absolute word in the question eliminate it!

• All
• Always
• Every
• Must
• None
• Never
• Only

A nurse provides safety instructions to the mother of a child with hemophilia and tells the mother to do
which of the following to promote a safe environment for the child?

1. Remove toys with sharp edges from the child’s toy box
2. Allow the child to play with toys only if a parent is present
3. Place a helmet and elbow pads on the child every day
4. Allow the child to play indoors only

8. Look for the Umbrella option .

If you note that more than one option appears to be correct look for the umbrella option.
The umbrella option is the one that is a general statement and may encompass the other ideas within it. The
umbrella option will be the right answer.

An emergency room nurse receives a telephone call from emergency medical services and is told that
several people who survived a plane crash will be transported to the hospital.

The nurse’s initial action is which of the following?

1. Supply the trauma rooms with bottles of sterile water and normal saline
2. Call the laundry department and ask the department to send as many warm blankets as possible to
the emergency room
3. Call the nursing supervisor to activate the agency disaster plan (umbrella option, ensures that option
1,2,&4 will be accomplished)
4. Call the intensive care unit to request that nurses be sent to the emergency room.

9. Use Guidelines for Delegating and Assignment-Making Questions .

You may be asked a question that will require you to decide how you will delegate a task or assign
clients to other health care providers.

Focus on the information in the question and what task or assignment is to be delegated and then
consider the client’s needs with the scope of practice of the health care providers identified in the
question.

The nurse practice act and any practice limitations define which aspects of care can be delegated and
which must be performed by the registered nurse.

Generally, noninvasive interventions such as skin care, range-of-motion exercises, ambulation, grooming,
and hygiene measures can be assigned to a nursing assistant.
 LVN can perform tasks that a nursing assistant performs. In addition they can perform invasive tasks
such as dressings, suctioning, urinary catheterization, administering oral, subcutaneous, and IM
medications.

The registered nurse can perform the tasks that the licensed practical or vocational nurse can perform
and is responsible for assessment and planning care, supervising care, initiating teaching, and
administering intravenous medications.

Which client would the nurse most appropriately assign to the LPN? A client

1. with stable congestive heart failure who has early stage Alzheimer’s disease
2. who was treated for dehydration and is weak and needs assistance with bathing
3. with emphysema who is receiving oxygen at 2 liters by nasal cannula and becomes dyspneic on
exertion
4. Who is scheduled for an electrocardiogram and a chest x-ray?

This client has the highest priority presented in the options. Remember Priority and ABCs - Airway! Patients
1, 2 & 4 can be cared for by a nursing assistant. Match the client’s needs with the scope of the healthcare
provider.

10. Guidelines for Answering Pharmacology Question .

If you are familiar with the medication identified in the question, use your nursing knowledge to answer the
question.

Remember the pharmacology questions will identify both the generic and Trade name of the drug.

If the question identifies a medical diagnosis, then try to 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 who is taking this medication, also, try to determine the
classification of the medication; identifying the classification will assist in determining a medication
action and / or side effects;

For example, diltiazem (Cardizem) is a cardiac medication.

Learn medications that belong to a classification by commonalities in their medication names;
Learn medications that belong to a classification by commonalities in their medication names;
For example, medication names that are xanthine bronchodilators end with “line” (theophyline)

Don’t try to memorize every side effect and nursing intervention related to a medication. Recognize the
common side effects associated with each medication classification and relate the appropriate nursing
intervention to that side effect.

For example, if a side effect is hypertension then the associated nursing intervention would be to monitor the
blood pressure.

Look at the medication name and use medical terminology to assist in determining the medication action.

For example, metoprolol (Lopressor_ lowers (lo) the blood pressure (pressor)

Some additional strategies are as follows:

• The client generally does not take an antacid with medication because the antacid will affect the
absorption of the medication.
 • Enteric-coated and sustained-release tablets should not be crushed; additionally, capsules should not
be opened.
• The client should never adjust or change a medication dose or abruptly stop taking a medication
• The client needs to avoid taking any over-the-counter medications or any other medications such as
herbal preparations unless they are approved for use by the health care provider
• The client needs to avoid alcohol and smoking
• Medications are never administered if the order is difficult to read, is unclear, or identifies a
medication dose that is not a normal one.

A client taking amitriptyline hydrochloride (Elavil) calls the nurse at the physician’s office and reports that he
develops an upset stomach whenever he takes the medication.

The nurse most appropriately tells the client to:

1. Take the medication with an antacid

2. Stop the medication for 2 days and then resume the prescribed medication schedule
3. Take the medication on an empty stomach
4. Take the medication with food.