NCLEX Question of the Week #11

Many documents fall under the category of an advanced directive. One of the most common legal documents is called “Durable Power of Attorney for Health Care” and works to:

  1. Review a person’s personal preferences for medical care in the future.
  2. Authorize another person to make medical decisions for a person, should they themselves be unable.
  3. Assign a legal authority in making medical decisions while honoring the spoken word of the family.
  4. Define what care should be administered or withheld by health care professionals, no matter which medical facility the patient finds themselves in.

NCLEX Question of the Week #10

A 30-year old patient is in the Emergency Department suffering from seizures related to alcohol withdrawal. They will soon be admitting this patient to the non-medical psychiatric care unit. The psychiatric nurse knows that, in order to keep this patient safe, he must perform which priority nursing action?

A. Ask the physician for a prescription for clonazepam, an anxiolytic that may help with the withdrawal symptoms

B. Ensure that a working IV pump is set up and ready to work at the patient’s bedside.

C. Order a STAT arterial blood gas lab.

D. Pad the side rails of the patient’s assigned bed.

 

NCLEX – RN TEST PLAN – Step 1

Step One: Familiarizing the NCLEX-RN Test Plan

As a newly-licensed, entry-level registered nurse, you will need to practice nursing care safely and effectively. In order for you to perform safe and effective nursing care, you need to meet the competencies expected of you and this can be measured through the NCLEX-RN or the National Council Licensure Examination for Registered Nurses. How then will you be able to obtain this license to practice? You will need to pass the NCLEX-RN.  For you to ensure that you will pass NCLEX-RN, you need adequate preparation.

You have got to take at least one step to get to where you want to go. This one small step marks your initial preparation: familiarizing the NCLEX-RN Test Plan. The NCLEX-RN Test Plan serves as a guide for your preparation. It summarizes the content and scope of the examination. It will also tell you what cognitive abilities in you will be tested and explains the components that are organized into four major Client Needs categories: safe and effective care environment, health promotion and maintenance, psychosocial integrity, and physiological integrity. The NCLEX-RN Test Plan also describes the integrated processes such as the nursing process, caring, communication, documentation, teaching/learning, culture, and spirituality.

 

What are the Cognitive Abilities being measured?

Nursing as a practice discipline requires application of your knowledge, skills, and abilities. Majority of the test items in the NCLEX-RN measure your higher levels of cognitive ability as a nurse. The levels of cognitive ability that will be measured are: knowledge, comprehension, application, and analysis. Since nursing practice requires critical thinking skills when making decisions, most of the NCLEX questions are application and analysis type of questions.

 

Here are two sample NCLEX questions taken from Silvestri (2005) that measure the application and analysis levels of cognitive ability:

Sample Question 1

Level of Cognitive Ability: Application

A client is experiencing a hypoglycemic reaction. The nurse should administer which of the following items to best treat the reaction?

  1. Water
  2. Diet soda
  3. Milk
  4. One sugar-free cookie

 

Answer: 3

When answering an application type of NCLEX question, the question usually asks for a nursing action, or intervention, a decision, or a problem that needs a solution. In the question above, you are asked to select the best treatment for hypoglycemia. You will be able to answer this correctly when you recall that a client with hypoglycemic reaction needs to take in drinks that contains 10 to 15 grams of carbohydrate.

 

Sample Question 2

Level of Cognitive Ability: Analysis

The nurse administers 10 units of Regular Insulin at 7:00 AM to a client with Type 1 diabetes mellitus. The nurse monitors the client most closely for a hypoglycemic reaction during which time frame?

  1. 9:00 AM to 10:00 AM
  2. 1:00 PM to 7:00 PM
  3. 9:00 AM to 3:00 PM
  4. 11:00 AM to 12:00 PM

 

Answer: 1

When answering correctly an analysis type of question, you need to integrate several concepts covered in the question. In the question above, recall that Regular insulin is a short-acting insulin that peaks in 2 to 3 hours. Recall also that hypoglycemic reactions most likely occur during peak time of drug action. Thus, the peak time of the short-acting insulin is most likely the time for a hypoglycemic reaction to occur.

 

There are also knowledge and comprehension type of questions in the NCLEX-RN, but majority of the questions are application and analysis types. You need to practice answering sample questions so that you will get used to the strategy or the techniques of answering these application and analysis types of questions.

 

What composes the Client Needs categories?

 

The Test Plan Framework of the NCLEX-RN is based on Client Needs. The Client Needs categories and subcategories identified by the (NCSBN) include:

 

  1. Safe and Effective Care Environment
  2. Management of Care

Questions under this subcategory may include the following content:

  1. Advance directives
  2. Case management
  3. Client advocacy
  4. Client rights (confidentiality and informed consent)
  5. Collaboration and consultation with interdisciplinary team
  6. Continuity of care
  7. Delegation, supervision, and management concepts
  8. Establishing priorities
  9. Ethical Practice
  10. Information Technology
  11. Legal rights and responsibilities
  12. Organ donation
  13. Performance improvement (quality improvement)
  14. referrals

 

  1. Safety and Infection Control

Questions under this subcategory may include the following content:

 

  1. Accident/error/injury prevention
  2. disaster planning and emergency response
  3. ergonomic principles
  4. handling hazardous and infectious materials
  5. home safety
  6. reporting of incident/event/irregular occurrence/variance
  7. use of restraints and safety devices
  8. safe use of equipment
  9. security plan
  10. standard precaution, transmission-based precaution, and surgical asepsis

 

  1. Health Promotion and Maintenance

Questions under this Client Need category may include the following content:

  1. Disease prevention
  2. Health promotion
  3. Aging process
  4. Maternal care and newborn care
  5. Developmental stages and transitions
  6. Health screening
  7. High risk behaviors
  8. Lifestyle choices
  9. Self-care
  10. Techniques of physical assessment

 

  1. Psychosocial Integrity

Questions under this Client Need category may include the following content:

  1. Abuse or neglect
  2. Behavioral interventions
  3. Chemical and other dependencies/substance use disorder
  4. Coping mechanisms
  5. Crisis intervention
  6. Cultural awareness/cultural influences on health
  7. End-of-life care
  8. Family dynamics
  9. Grief and loss
  10. Mental health concepts
  11. Religious and spiritual influences on health
  12. Sensory/perceptual alterations
  13. Stress management
  14. Support systems
  15. Therapeutic communication
  16. Therapeutic environment

 

  1. Physiological Integrity
  2. Basic Care and Comfort

Questions under this subcategory may include the following content:

  1. Assistive devices
  2. Elimination
  3. Personal Hygiene
  4. Mobility and immobility
  5. Nonpharmacological comfort interventions
  6. Nutrition and oral hydration
  7. Rest and sleep

 

  1. Pharmacological and Parenteral Therapies

Questions under this subcategory may include the following content:

  1. Blood and blood products
  2. Central venous access devices
  3. Dosage calculation
  4. Expected actions and outcomes
  5. Intravenous therapy and parenteral fluids
  6. Medication administration
  7. Pharmacological agents, actions, contraindications, interactions, side effects, and adverse effects
  8. Pharmacological pain management
  9. Total parenteral nutrition

 

  1. Reduction of Risk Potential

Questions under this subcategory may include the following content:

  1. Diagnostic tests and laboratory values
  2. Potential for alterations in body systems
  3. Potential for complications of diagnostic tests, treatments and procedures
  4. System specific assessments
  5. Therapeutic procedures
  6. Changes or abnormalities in Vital signs
  7. Potential for complications from surgical procedures and health alterations

 

  1. Physiological Adaptation

Questions under this subcategory may include the following content:

  1. Alterations in body systems
  2. Fluid and electrolyte imbalances
  3. Hemodynamics and illness management
  4. Medical emergencies
  5. Pathophysiology
  6. Unexpected responses to therapy

 

The Table below shows the Client Needs categories, subcategories, and the percentage of test questions.

 

Client Needs categories, subcategories, & percentage (%) of Questions
Categories/Subcategories Questions (%)
Safe, Effective Care Environment

Management of Care

Safety and Infection Control

 

17% – 23%

9% – 15%

Health Promotion and Maintenance 6% – 12%
Psychosocial Integrity 6% – 12%
Physiological Integrity

     Basic Care and Comfort

Pharmacological and Parenteral Therapies

Reduction of Risk Potential

Physiological Adaptation

 

6% – 12%

12% – 18%

13% – 19%

11% – 17%

 

What are the Integrated Processes?

 

Fundamental to the practice of nursing are four processes identified by NCSBN as: Caring, Communication and Documentation, Nursing Process, and Teaching/Learning. These integrated processes are a component of the NCLEX-RN Test Plan. They are integrated throughout the four Client Needs categories: Safe Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, and Physiologic Integrity.

 

  1. Nursing Process
  2. Caring
  3. Communication and Documentation
  4. Teaching/Learning
  5. Culture and Spirituality

 

References:

NCSBN. (2016). NCLEX-RN Examination: Test Plan for the National Council Licensure Examination for Registered Nurses. Retrieved from ncsbn.org: https://www.ncsbn.org/RN_Test_Plan_2016_Final.pdf

Silvestri, L. A. (2005). Strategies for Success for the NCLEX-RN Examination. Philadelphia, Pennsylvania, USA: W.B. Saunders Company.

#NCLEX #ARCHERNCLEX #allnurses #nurses #nursesrock

Stress Management Strategies for Passing NCLEX-RN Exam

Stress Management Strategies for Passing NCLEX-RN Exam

Preparing to take the NCLEX-RN exam is stressful. The process of registering and applying for the examination is stressful. Not knowing the outcome of the examination is stressful. Although you know you are going to experience stress, you still need to face the challenge and deal with the stressful experience the healthy way. You need to manage your stress for you to achieve your goal of passing the NCLEX-RN examination. Here are some tried and tested strategies you can apply in managing your NCLEX associated stress.

  1. Manage yourself.

Yes, everything in this world begins with the self. All the other strategies for managing stress are futile if you cannot manage yourself. To manage yourself, you need some time to reflect on your strengths and weaknesses. What are you good at? What do you need to improve on? Are you a procrastinator? Are you optimistic or pessimistic? How do you respond to a stressful situation? What are your coping habits? Look within you and find that strength to begin facing the stressful preparation for the NCLEX-RN examination.

 

  1. Exercise regularly.

Increasing your physical activities allows for the body to improve its blood circulation and its toxins are released through the sweat. There is that rejuvenated feeling after exercising. This wonderful energy and vitality gives you the boost to fight the effects of stress. Find time for at least 30 minutes of exercise, three times a week or at least 10 minutes of daily exercise. Aerobic exercise helps release tension and stress. Walking helps you maintain a healthy weight, prevents heart disease, manages your blood pressure, strengthens your bones and muscles, improves your balance and coordination, and most especially improves your mood. It therefore makes you feel good while reviewing for the NCLEX-RN exam.

 

  1. Do not be a perfectionist.

Perfectionism is one source of avoidable stress. Set realistic standards for yourself and others, and learn to feel just fine with “good enough.” Start with something like reading a chapter of your review book or answering 50 questions in a day for a week without the urge of perfectly cleaning up your room or study area before you begin. Just start reviewing without the need to be perfectly clean, organized and tidy. After answering 50 questions and the result is not what you expected, do not be discouraged. It’s perfectly alright not to get an impressive score initially. What is important is that you are consistent in your review and practice questions and that you are persistent, not perfect.

 

  1. Improve your attitude.

Positive attitude is the key to success. Optimism fuels you to take small steps to get to where you want to go inspite of difficulties. Positivity allows you to reflect on the good things in your life and keeping a positive perspective drives you to do things you need to do in preparation for your NCLEX-RN examination. As a stress management strategy, a positive attitude helps you cope with stress in healthy ways. Positive attitude also makes it easier for you to accept things you cannot change. It is therefore necessary that you improve on your attitude by turning negativities to positivity. How do you do this? One way is to stop comparing yourself to others. Convince yourself that no matter what you will pass the NCLEX-RN exam whether it is your first time to take it, the second time, or the third. Regardless of how many attempts you made, you will make it this time. Do not dwell on your inadequacies, instead focus on improving your attitude. Focus on your strength and wonderful self. Perform positive affirmations and self-talk. Say, “I will pass the NCLEX-RN exam.” Remember “hakuna matata,” it means no worries. All is well.

 

  1. Time Management

Time management is only effective when you are able to manage yourself. When you do planning about the things you need to do daily, as much as possible be disciplined enough to stick to your planned schedule. If there are things that are out of your own control, learn to be flexible. Adjust your tasks and schedule. One important thing to remember when managing your time is the ability to determine which tasks are necessary, urgent, and not that important. Do those tasks that are really urgent first and then those that are necessary but not so urgent and last in the list should be those that can wait. When you are in dilemma which activity to prioritize, use Maslows Hierarchy of Needs. Activities that address physiological needs can be top in your list. Safety needs, love and belongingness, esteem, and self-actualization needs can follow in this order. Your NCLEX-RN examination preparation is one of your esteem needs as it relates to achievement and career. When you are in dilemma whether to attend the birthday party of your family member or practice answering NCLEX test questions, don’t feel so stressed out trying to squeeze in your NCLEX practice questions activity into your daily tasks. Go and enjoy your day with your family. Perhaps it can even uplift your spirit and make you do better on your practice test the next day. Don’t stress yourself trying to cram up activities all in one day. Take it one day at a time.

 

  1. Adequate sleep.

Not getting enough sleep will make you feel tired and you end up becoming unproductive with your time. Insufficient sleep is associated with heart disease, diabetes, and obesity. You don’t want to experience health problems while preparing for your NCLEX-RN exam, do you? With adequate sleep, you’ll have a better mood. With better mood, you’ll feel good studying or reviewing for your NCLEX-RN examination.

  1. Try to relax and recharge.

Relaxation decreases muscle tension, improves blood circulation, slows your breathing which in turn reduces oxygen demand, normalizes blood pressure, and heart rate. When you are relaxed, you’ll have more energy to study and practice answering questions for your NCLEX-RN examination. You will also have better sleep and enhanced immunity. When you are relaxed, you will have better concentration and focus. You can think better and critically. Most importantly, you will have better problem-solving abilities which are necessary when answering NCLEX test questions.

 

Go for a walk. Spend time with nature. Call your best friend. Have a good workout. Write in your journal or blog. Bake cookies and cake. Savor a cup of coffee or tea. Play with your pet or your baby. Water the plants in your garden. Curl up on the sofa with a good book. Light scented candles. Take a long bath. Listen to your favorite music. Watch a comedy movie. Get a massage.

 

  1. Express your feelings.

Talk to a friend who had been through the whole process of NCLEX-RN examination from registration, to application, to actually taking it.  It is very cathartic when you express your thoughts and feelings of anxiety. The friend who had been through NCLEX can empathize with you. Expressing your feelings can also help alleviate your stress related anxiety.

Remember to MEDITATE when dealing with stress associated with your NCLEX-RN examination preparation. Manage yourself, Exercise regularly, Do not be a perfectionist, Improve your attitude, Time management, Adequate sleep, Try to relax and recharge, and Express your feelings

#NCLEX #ArcherNCLEX #nursingschool #nurselife #nursingstudent #allnurses #nursesrock 

NCLEX Question of the Week #9

9. Fundal height generally increases gradually throughout pregnancy. What explanation would the nurse give the pregnant mother whose fundal height has decreased from 36 to 40 weeks’ gestation?

  1. Fetal engagement
  2. Intrauterine Growth Restriction
  3. Possible premature labor
  4. Evidence of substance abuse

 

Topic: Health Promotion and Maintenance, Intrapartum Care

NCLEX Question of the Week #8

8. A 30-year old patient is in the Emergency Department suffering from seizures related to alcohol withdrawal. They will soon be admitting this patient to the non-medical psychiatric care unit. The psychiatric nurse knows that, in order to keep this patient safe, he must perform which priority nursing action?

  1. Ask the physician for a prescription for clonazepam, an anxiolytic that may help with the withdrawal symptoms.
  2. Ensure that a working IV pump is set up and ready to work at the patient’s bedside.
  3. Order a STAT arterial blood gas lab.
  4. Pad the side rails of the patient’s assigned bed.

 

Topic: Safety and Infection Control, Injury Prevention

NCLEX Question of the Week #7

7. A 63 year-old male is being seen in the clinic for his annual exam. Before performing a digital rectal exam, which of the following questions should the nurse ask?

  1. “Are you exercising regularly?”
  2. “Has your diet changed dramatically in the past year?”
  3. “Have you had any difficulty starting a stream of urine with you attempt to use the toilet?”
  4. “Are you currently experiencing constipation?”

 

Topic: Health Promotion and Maintenance/Aging Process

NCLEX Question of the Week #6

6. What is the nurse doing in the picture below?

NURSE PIC

A. Testing the neurological triceps reflex

B. Performing a nutritional assessment

C. Performing a musculoskeletal assessment

D. Testing the neurological biceps reflex

NCLEX Question of the Week #5

5. You are caring for a client who is 5 foot 6 inches tall and has a BMI of 28. This client is now on a regular diet. You would most likely recommend:

A. Continuing their diet as it is

B. A weight reduction diet and exercise.

C. A high caloric diet to gain weight

D. Nothing at all, this client is normal.

Question of the Week # 4

4. A nurse is caring for a woman that just had a Normal delivery in the Delivery room an hour ago. The nurse understands that the patient is still at risk for Uterine atony at this stage. All of the following interventions should be included in the care plan of patient for detection of uterine atony except:

A. Checking for saturated perinel pads every shift

B. Palpating the fundus at frequent interval.

C. Weighing perineal pads once they are changed, noting the time it was changed and the saturation.

D. Checking vital signs frequently for signs of shock

 

Topic:              Physiological Adaptation/ Reduction of Risk Potential

Subtopic:         Alterations in Body Systems/ Potential for Alterations in Body System