The purpose of the NCLEX RN exam is to determine that a candidate is prepared to safely practice entry-level nursing. The exam is designed to test essential nursing knowledge and a candidate’s ability to apply that knowledge to clinical situations. It is recommended that as soon as nursing students enter nursing school, they begin getting ready for NCLEX by doing at least 100 questions per week if they are an A or B student and 120 questions per week if they are a C student.
The key to passing NCLEX is to master NCLEX-style questions. NCLEX questions are application-type questions with an emphasis on critical thinking and clinical competency. The questions now consist of multiple choices, fill in the blank, all that apply, hot spot, drag and drop, and exhibit items.
How does one prepare? The key is practice, practice, practice. Practicing will teach your brain how to tackle and dissect these application-style questions. Soon, by practicing, you will begin to master how to eliminate distractors/options. Certain words will become apparent in making a distractor either true or false. Words such as “never,” “always,” “demand,” “insist,” “cure,” etc., are words that make distractors false. Practicing questions and then reading all the rationales associated with the answers is the key to success. Utilizing the 11 guidelines listed in this article can also assist with preparation.
1. Get to know the NCLEX RN Exam blueprint (available on www.ncsbn.org). Become familiar with the categories of questions, as well as the percent of questions asked per category. Remember, there are no penalties for guessing. You have a 25% chance of getting questions correct through guessing, so do not leave any questions unanswered.
2. When answering any question, ask yourself, “What is the story or situation? Is the client 1 day post-op or 3 days? Does the patient demonstrate he or she understands or needs additional teaching? Where is the patient? Acute-care, long-term care, or home?” Remember, in the NCLEX world, all clinical settings are “Utopia,” i.e., there is no nursing shortage, no equipment shortage, plenty of mechanical lifts, etc.
Unfortunately, you need to avoid remembering what you saw in your clinical experiences and instead recall what you were taught and what you read in your textbooks. In this Utopia world, infection control practices are always priority as well as your A, B, Cs.
3. Priority questions are not always about airway, the presence of breathing, or a heart beating. Your patient could be breathing but have “ineffective airway clearance” or “impaired gas exchange.” Think of your priority action. Clearing the airway by coughing, deep breathing, suctioning, or proper positioning is key. For impaired gas exchange, administering oxygen and positioning are key. If circulation is the issue, you always need to administer fluids first for fluid deficit-regardless of the reason for the deficit. Remember that an increased heart rate and decreased blood pressure are always signs of fluid deficit. Try to use major concepts of nursing when answering the questions.
4. Don’t look at the answers to the question until you really know what the story or situation is. Then try to think of the answer before looking at your options. If the answer you thought of is there, pick it and move on. Don’t talk yourself out of it.
5. “All That Apply” questions will never be all of them and usually are more than one.
6. Prior to the NCLEX exam, put together a binder with the following sections: Medical/Surgical, Pharmacology, Behavioral Health, Maternity, Pediatrics, Infection Control, and Delegation. Make charts and outlines that briefly describe important concepts. Add to your binder important notes as you practice questions and read all rationales.
Make a sheet with information you need to memorize, such as labs, drug levels, math conversions, and formulas. Use this binder as your chief resource when studying.
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7. Set a date to take the NCLEX as soon as you feel confident, but wait no longer than 3 months. Research has shown that the sooner you take the exam, the better the outcome. Your chance of passing drops to 80% after 3 months and to 70% after 6 months.
8. Do not cram or stay up all night studying the day before your test. Rest, try to relax, and casually look over your binder.
9. Get familiar with the Pearson Vue website (http://home.pearsonvue.com/Home.aspx) and the tutorial on the website explaining the exam.
10. Do a practice drive to your test site. On the day of the exam, arrive at least 30 minutes early. Review your sheet for key memorized knowledge facts.
11. Think positive. You can do this! During the exam, don’t let yourself become distracted. Focus on answering one question at a time.
Organized, structured preparation is the key to passing the exam. There are many tools, apps and websites available to use. Do not over-purchase or collect too many resources, since they can make you feel overwhelmed.
The use of an organized binder with key concepts is the best way to prepare, in combination with doing at least 100 questions per day for 2 to 3 weeks prior to the exam.
Patricia Brown-O’Hara is an associate professor of nursing at Gwynedd Mercy University and has served as an adjunct faculty member at the University of Pennsylvania and Villanova University.