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NCLEX – RN TEST PLAN – Step 1

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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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How to prepare SMART for NCLEX – RN Exam?

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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!

References

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.

 

NCLEX Question of the Week #5

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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 # 1

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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.