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.

How to prepare SMART for NCLEX – RN Exam?

How to Equip yourself for NCLEX-RN Examination

The most common reasons for delaying or not taking the National Council Licensure Examination for Registered Nurses (NCLEX-RN) include: lack of confidence in one’s ability to pass the examination, test anxiety, no adequate time to prepare for the examination, and expiration of registration or authority-to-test (ATT) letter. In the study conducted by Woo, Wendt, and Liu (2009), among 28 US-educated RN candidates, 25% expressed that they were not confident in their ability to pass the examination while among 243 internationally-educated RN candidates, 18% expressed that they did not have enough time to prepare for the NCLEX-RN examination.

Perhaps you feel the same right now. You want to delay taking the NCLEX-RN examination because you feel that you lack preparation. If this is the main reason, then you might just find this article very helpful.

  1. Obtain review materials for NCLEX-RN examination.

A study investigating the relationship between NCLEX-RN passing rate and lag time in taking NCLEX showed that NCLEX-RN candidates do delay taking the examination because of lack of preparation. The very first thing you need to do to equip yourself is to get the materials that will assist you in the preparation process. This can be in the form of books, journal articles, NCLEX-related blog posts (from credible sources), electronic resources, practice questions study guides, etc.


  1. Choose a mentor you can trust.

A mentor walks with you all the way from the very beginning until the time you finally receive your US-RN license. Your mentor can help you overcome your test anxiety and lack of confidence through constant and consistent encouragement and practice. Your mentor however, must remind you that delaying in taking the NCLEX-RN examination does not cause you to fail the examination.


  1. Improve your weakness, and develop your strengths.

According to the study of McGahee, Gramling, and Reid (2010), nursing schools give priority to the success of first-time NCLEX-RNs and that they recommend nursing schools to look for trends in student success and failure and help RN candidates to pass NCLEX-RN examination by adequately preparing them. In their literature review, they identified the most significant predictor of NCLEX-RN failure: lower grades in nursing theory courses. Additionally, NCLEX-RN success was related to higher grades in other major nursing courses or subjects and high grades in pathophysiology!

So, go back to your Transcript of Records. Which nursing courses or subjects were you weak? Which were your strengths? Grades may be predictors of failure or success in NCLEX-RN examination but that does not mean you cannot do anything about them. How then will you improve on areas where you are weak? Practice answering questions related to the subject area. That’s it. For those concepts where you are strong, do not neglect them altogether. Practice answering questions related to those strengths still but spend more time answering questions on those concepts that you are weak.


  1. Empower yourself through self-assessment and individualized plan of interventions.

According to Stark, Feikema, and Wyngarden (2002), this strategy of self-empowerment can lead you to lifelong achievement of your goals. This strategy can help you build your self-confidence that will help you prepare for your NCLEX-RN examination. The plan that you will make for yourself based on your own needs will give you confidence that success can be objectively attained. The following guidelines is adapted from the study of Stark, Feikema, and Wyngarden (2002):

Guide to Self-assessment
For each of the four areas, answer the following questions:


What are your strengths in this area? What needs further development in this area?

I.                    Content areas: Consider your work in nursing courses, assessment test results, work & life experiences.

II.                  Test-taking skills: Consider your previous experiences reading and understanding multiple choice questions and previous experience with computerized testing.

III.                Managing anxiety: Consider your responses at other stressful occasions. Have you ever had difficulty thinking clearly or panicked while taking a test?

IV.                Preparation for day of testing: Consider your schedule in the days before testing.

Consider family and work responsibilities, available support systems. Consider whether you have sufficient information about the testing process.


A Guide to Possible Interventions
I.                    Improving in content areas:

a.       Target specific areas of content: What content?

b.      How do you study best?

Study groups, independent study, tutoring, sit in on classes, computer    programs Select a review course or book.

Prepare a schedule: When and where will you study?

II.                  Improving test-taking skills:

a.       Learn strategies for taking multiple choice questions— Academic Student Services counseling or classes, NCLEX-RN® review courses and books, Web sites

b.      Develop strategies for taking computerized tests Practice taking NCLEX-RN®-style computer testing programs

III.                Managing test anxiety:

a.       Reduce stresses related to testing Prepare in advance—follow your plan and do not cram.

b.      Gain relaxation/coping skills

Select and practice mind/body techniques that are effective for you (eg, relaxation, meditation, visualization, deep breathing)

c.       Have a quiet spirit Nourish your own spirit, spiritual care for self (eg, prayer, scripture reading), accept spiritual care from others.

d.      Think positive! Surround yourself with positive people, practice positive self-talk.

IV.                Preparing for the day of testing:

a.       Practice self-care prior to testing.

Include adequate sleep, proper nutrition and hydration.

Locate testing site, know the rules for testing

Know what supplies will be required for testing

b.      Have balance in your life prior to testing

Study vs. work vs. recreation; Solitude vs. social support

c.       Clear your mind

Reduce demands on your attention, spend time in a natural environment daily.


Remember, delaying the time you will take the NCLEX-RN examination will only prolong your agony of wondering, waiting, and asking “what if” and thinking, “if only.” Delay in taking the NCLEX-RN examination does not imply failure, but it is better to just get it over with and jumpstart your career as US-RN with adequate preparation. You need to equip yourself for the examination. No one else can equip you holistically. Not even your mentor. Your mentor is there only to provide you with encouragement and boost your motivation. Every energy and enthusiasm must come from within you.

Start now. Gather review materials for the NCLEX-RN examination, choose a mentor you can trust, improve your weaknesses and develop your strengths, and empower yourself through self-assessment and implement your individualized plan of interventions for NCLEX-RN success!


Ada Woo, A. W. (2009). NCLEX Pass Rates: An Investigation Into the Effect of Lag Time and Retake Attempts. JONA’S Healthcare Law, Ethics, and Regulation, 23-26.

Mary Ann Stark, B. F. (2002). Empowering Students for NCLEX Success. NURSE EDUCATOR, 103-105.

Thayer W. McGahee, L. G. (2010). NCLEX-RN® Success: Are There Predictors. Southern Online Journal of Nursing Research.


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 #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

Question of the Week#3

Q3 A patient who takes zolpidem has a new additional prescription for tramadol. The teaching plan for this patient should include which information?
A Tramadol should be taken in the morning, with food.
B There is no risk for addiction related to tramadol.
C Avoid or limit the use of alcohol.
D Seek medical attention if constipation or diarrhea occur.

Top 5 smart strategies for Passing NCLEX

Sometimes, it is not all about how high your academic ratings were in college and how much you have retained in nursing classes when you take board examinations. Mostly, it is about the strategies when taking a big exam that will define the course of your career. All it takes is a lot of practice with the many test strategies out there. This article highlights five smart strategies ( referred to as “STAPE”) when taking the NCLEX (National Council Licensure Examination). NCLEX is a board examination for nurses who need to be licensed to practice nursing in the United States and Canada since 1994 and 2015, respectively. Here are 5 strategies you can use to jump-start your career in nursing practice either in Canada or the US

1.S- Start on something now.

“The secret of getting started is breaking your complex overwhelming tasks into small manageable tasks, and then starting on the first one” – Mark Twain

This strategy is most applicable when preparing to take the NCLEX-RN. There will come a time when you begin to feel so overwhelmed that you do not know anymore where to begin and what to focus on. Start by getting familiar with the NCLEX-RN Test Plan. Not knowing what you are getting yourself into, adds to your anxiety which can only add up to your feeling of being overwhelmed. It helps a lot to know the format and general content of the NCLEX because this will help you come up with better strategies when taking the test and can help alleviate your anxiety.

Start by understanding the Test Plan Structure. The NCLEX-RN Test Plan is organized into four major Client Needs Categories: Safe and Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity. The Safe and Effective Care Environment category is divided into 2 subcategories: Management of Care, and Safety and Infection Control. The Physiological Integrity category is divided into 4 subcategories: Basic Care and Comfort, Pharmacological and Parenteral Therapies, Reduction of Risk Potential, and Physiological Adaptation. More elaboration of this Test Plan Structure is found in this blog article, “Step One: Familiarizing the NCLEX-RN Test Plan.”

2. T – remember Textbook, not real world.

When taking the NCLEX, read and understand the situation and the question as best as you can. When choosing from the options, choose the most ideal option that appropriately answers the question. Eliminate the options that seem realistic but not ideal. Most of the time, all the options are correct but only one will best answer the question. Remember to choose the universal standards; the most patient-centered approach; the nursing care measures over the medical measures; and the most therapeutic communication or approach.

3. A- Avoid “Absolutes”.

When looking for the best answer, examine the options’ statements. When you find absolute words such as always, all, never, everything, everyone, none, only, must, every time, and every, take this as a clue that the option may be a distractor. Distractors are usually incorrect options.


A nurse is providing discharge instruction to the mother of a 3-year-old child with hemophilia and tells the mother to do which of the following to promote a safe environment for the child at home?

  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.

Answer: A

Test-Taking Strategy: Avoid options that has absolute words. Options B and D contain the absolute word, ONLY. Option C contains the absolute word, EVERY. This leaves you with option A. Remember that absolute words usually tend to make an option incorrect. Avoid absolutes


4. P – Prioritize the top task.

Prioritize what is asked for in the situation. When the question contains the keywords initial, first, priority, or best, it is usually assessing your prioritizing skills. How good are you at prioritizing nursing actions? How good are you at prioritizing patient’s needs? The options you will be considering are usually all correct but there should only be one nursing action that must be done first or there should be only one top priority. How then do you prioritize?

You can use the ABCs technique, Maslow’s hierarchy of needs, or the nursing process.

ABC – means Airway, Breathing, and Circulation. Identify what the question is asking for. Next, examine the options. Is there an option that talks about a patient with an airway problem? Is there an option that contains an intervention that is associated with providing airway management? If yes, then this is considered top priority.

Maslow’s Hierarchy of Needs– Does the situation or case scenario describe a patient or patients with multiple problems to be addressed? If this is the case, then the Maslow’s Hierarchy of Needs where the physiologic needs such as air, water, food, diet, nutrition, sleep, pain management are prioritized more than safety and security needs. Safety and security needs are also prioritized more than psychosocial needs of the patient or patients.

Nursing Process– This refers to assessment, diagnosis, planning, intervention, and evaluation as steps in the nursing process that can be used as prioritization technique. Read carefully the question. What is being asked? Is there a need to assess first or was assessment already done and now you need to choose the next action and the best option after assessment? Follow the sequence when prioritizing. Planning should be done after assessment and before performing the intervention. You can also ask yourself if there is a need for you to collect more assessment data on the patient before performing an intervention or even calling the physician.

5. E- Eliminate the “inappropriates.”

Use the “Elimination” technique. Options that are obviously incorrect and do not address the situation or the question should be eliminated. This process most often will narrow down your choices to two out of the four options. When you are left with two options, you need to read the question again and the remaining two options.  Remember, time is running and you do not need to spend too much time deciding which one is the best option.  Follow these simple steps when you try to decide which one between the two remaining options you should choose as the appropriate answer.

  1. Focus on the case event.
  2. Identify the question query.
  3. Look for strategic or key words.
  4. Ask yourself, “What is the question asking?”
  5. Read the two remaining options again.
  6. Use your nursing knowledge, prioritization techniques, avoid absolutes or choose the most “textbook” or ideal and most therapeutic, patient-centered, most compassionate and humanistic answer.
  7. Finally decide & stick to that answer.

This elimination technique requires practice and you will only master this when you answer hundreds of NCLEX questions.

If you want to pass NCLEX-RN, you have got to master the test taking strategies. There are so many strategies out there but these top 5 strategies are easier to recall and apply. Remember STAPE: start on something now, “textbook, not real world,” avoid absolutes, prioritize the top priority, and eliminate inappropriate options.


Resources/ References:

NCLEX Test Taking Strategy. (2008). Retrieved from

NCSBN. (2016). NCLEX-RN Examination: Test Plan for the National Council Licensure Examination for Registered Nurses. Retrieved from

Nurse Journal. (2016). How to Master NCLEX-Style Test Questions. Retrieved from

Test-Taking Strategies. (n.d.). Retrieved from

Test-Taking Tips for NCLEX. (n.d.). Retrieved from

The University of Arizona College of Nursing. (n.d.). Test Taking Strategies Workshop. Retrieved from

Ultimate Guide: 60 NCLEX Strategies to Use in Answering Questions. (2015). Retrieved from


Question of the Week # 1

1.A patient has completed a living will stating that he does not want intubation, mechanical ventilation or artificial nutrition and hydration carried out should he become unable to communicate his preferences related to medical care. However, the patient’s adult children have expressed their opposition to the patient’s wishes. Which are appropriate nursing actions? Choose all that apply

A. Notify the patient’s physician, the nursing supervisor, and the risk manager

B. Explain to the patient’s family that the living will cannot be changed at this point

C. Encourage the family to discuss their feelings to try to resolve this issue

D. Request a consult with the facility ethics committee if needed

E. Advise the patient to just go along with the wishes of his adult children.