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.

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