Do Everything By the Book. Be careful about using your “real world” experience. All correct answers are based on textbook nursing practices.
The NCLEX-RN exam is a standardized exam administered by the National Council of State Boards of Nursing, Inc. Because the NCLEX-RN exam is a national exam, students should be aware that in some parts of the country, nursing is practiced slightly differently. But to ensure that the test is reflective of national trends, questions and answers are all carefully documented. The test makers make sure that the correct answers are documented in at least two standard nursing textbooks or one textbook or one nursing journal.
When you are unsure of an answer choice, don’t ask yourself, “What do they do on my floor?” but “What does the medical/surgical textbook writer Brunner say? Or “What do Potter and Perry say to do?” This test does not necessarily reflect what happens in the “real world,” but is based on textbook nursing.
Some examples to remember when taking the NCLEX-RN exam:
• You have all of the time and resources you need to provide appropriate care to your client. (Checking for bowel sounds for five minutes in all four quadrants, no problem!)
• You have all of the equipment you need. (Remember the bath thermometer you learned to use in the nursing lab? For the NCLEX-RN exam you will have one available to test the temperature of the bath water.)
• There are no staffing problems on the NCLEX-RN exam. You are caring only for the client described in the question, and that person is your only concern.
• All care given to clients is “by the book.” No shortcuts are used. (You would not turn off an IV solution, flush the line, give another IV solution, flush the line, and then restart the original IV solution that was ordered to be run continuously.)
Time Is On Your Side. On the NCLEX-RN exam, don’t worry about “real world” concerns, such as limited time and resources.
Yes, I Have It in Writing. The correct answer choices can be documented in at least two sources.
FIRST TAKE CARE OF THE CLIENT, THEN THE EQUIPMENT
The NCLEX-RN exam tests your ability to use critical thinking skills to make nursing judgments. It is very important that you remember to:
• Take care of the client first
• Take care of the equipment second
Put That Down and Help ME! Always take care of the patient first before the equipment.
LABORATORY VALUES
Answering questions about lab values is another example of how the “real world” does not work on the NCLEX-RN exam. In nursing school you learned lab values for a specific test and you may not have remembered them after the test. While you were in the clinical setting, the emphasis was on interpretation of lab values. Since most lab slips contained a listing of normal values, you were able to compare the client’s results to the normal levels. Questions on the NCLEX-RN exam will not provide you with a listing of normal lab values.
To answer questions on the NCLEX-RN exam you must:
• Know normal lab test result.
• Correctly interpret normal or abnormal lab test result.
Know What’s Normal. Memorize normal lab values and be able to interpret them.
MEDICATION ADMINISTRATION
An important function in providing safe and effective care to clients is the administration of medications. Because this is one of the responsibilities of a beginning practitioner, questions about medications are often an important part of the NCLEX-RN exam. The nurse who is minimally competent is knowledgeable about medications and uses the “five rights” when administering medication.
The NCLEX-RN exam does not give you any clues from the context of the question. The questions on this exam include the name of the medication, almost always identifying it by both trade and generic names. Most of the time you will not be given the reason the client is giving the medication.
Know Your Rights. Remember the “five rights” of medication administration.
Anything Out of the Ordinary? Know side effects and nursing implications of medications.
NOTIFY THE PHYSICIAN
Another behavior that commonly occurs in the real world is calling the physician. Be very careful how you handle this in the NCLEX-RN exam. More often than not, the answer choice that states, “call the physician, contact the social worker, or refer to the chaplain” is the WRONG answer. Usually there is something you need to do first before you make that call. The NCLEX-RN exam does not want you to know what the physician is going to do. The NCLEX-RN exam wants to know what you, the registered professional nurse, will do in a given situation.
The Buck Stops Here. Don’t pass the buck on the NCLEX-RN exam.
Before you want to choose the answer choice that involves “call the physician,” look at the other answer choices carefully. Make sure that there isn’t an answer that contains an assessment or action you should do before making the phone call.
Hold the Phone. Think before calling the physician in an NCLEX-RN exam answer. The test makers want to know what you would do in a situation, not what the doctor would do!
Expect to see real-world situations on your NCLEX-RN exam, but make sure that you do not choose real world answers! These strategies should help you use your previous nursing experience without encountering any pitfalls.
