Because the NCLEX-RN® exam is testing your critical thinking, the topic of the questions may be unstated. You may see a question that concerns a disease process or procedure with which you are unfamiliar. Most test takers who are “clueless” about a question will read the question and answer choices over and over again. They do this because they hope that:
- They will remember seeing the topic in their notes or on a textbook page.
- The light will dawn and they will remember something about the topic.
- They believe there is some clue in the question that will point them toward the correct
What usually happens? Absolutely nothing! The student then randomly selects an answer choice. When you randomly select an answer, you have 1 chance in 4 of getting it right. You can better those odds, and here’s how: When you encounter a question that deals with unfamiliar nursing content, look for clues in the answer choices instead of in the question stem.
If you find yourself “clueless” after you carefully read a question, follow these steps:
Practice Question 1
Step 1. Read the stem of the question. Can you identify the topic of the question? No, you can’t. The nurse is telling the client to do something, but about what topic? The topic is unstated in the question.
Step 2. Read the answer choices to obtain clues about the topic of the question. Each answer choice deals with ways to maintain a normal blood sugar.
Step 3. Reword the question: “What does the nurse tell the client about ‘sick day rules’?”
Answer and Explanation
(1) “Hold your regular dose of insulin.” This is an implementation that would increase the blood glucose level. The nurse should assess first. Eliminate.
(2) “Check your blood glucose level every 3–4 hours.” This is an assessment. Before you can advise the client, you must identify whether the client is hypoglycemic or hyperglycemic. Keep this answer for consideration.
(3) “Increase your consumption of foods containing simple sugars.” This is an implementation and would increase the client’s blood glucose level. The nurse should assess first. Eliminate.
(4) “Increase your activity level.” This is an implementation that would decrease the client’s blood glucose level. The nurse should assess first. Eliminate.
The nurse should always assess before implementing nursing care. The correct answer is (2).
No matter how much you prepare for the NCLEX-RN® exam, there may be topics you see on your test with which you are unfamiliar. Reading the answer choices for clues will increase your chances of selecting a correct answer. Remember, you do have a body of knowledge. You just have to be calm and access this knowledge.
Practice Question 2
In some questions, the NCLEX-RN® exam asks you to figure out the topic of the question. In those questions, you should follow this path:
In other questions you are required to use critical thinking skills to figure out what the answer choices really mean. The NCLEX-RN® exam can take a concept with which you are very familiar and make it difficult to recognize. The following question illustrates this point.
It is not difficult to identify the topic of this question, “What is a priority for a client with heart failure?” Many students get tripped up on this question by not thinking through the answers as carefully as they should. In some questions, you have to figure out the topic of the question. In this question, you have to figure out what the answer choices mean.
Step 1. Read the stem of the question.
Step 2. Reword the question in your own words.
Step 3. Read the answer choices.
Step 4. Think: “What nursing concept should I identify in the answer choices?”
The Reworded Question: What is a priority for a client with heart failure?
Answer and Explanation
(1) “Do your ankles swell at the end of the day?” Why would you ask a client this question? Because edema is a symptom of right-sided heart failure. Is right-sided failure your priority? No, left-sided failure takes priority because it affects the lungs. Eliminate this answer.
(2) “Where do you sleep at night?” Why would you ask a client this question? If he is sleeping in his bed, his breathing is not compromised. If he has to sleep in his recliner, he is having orthopnea. Orthopnea is a symptom of left-sided failure, and this would be a priority. Keep this answer for consideration.
(3) “How do you feel after you eat dinner?” Why would you ask a client this question? Bloating after meals is a symptom of right-sided failure. This is not as important as breathing problems. Eliminate this answer.
(4) “Do you have chest pain when you inhale?” Why would you ask a client this question? It does indicate a breathing problem. The student who reacts rather than thinks may select this answer. Pain on inspiration may indicate irritation of the parietal pleura of the lung, which is not associated with heart failure. Eliminate this answer.
The correct answer is (2). In order to select this answer, you must recognize that “Where do you sleep at night?” represents orthopnea. The NCLEX-RN® exam can take important concepts such as this, and “hide” the concept in some fairly simple behaviors.
These questions illustrate why knowing nursing content is not enough to answer application/analysis-level questions. You must be able to effectively use the information you learned in nursing school to answer NCLEX-RN® exam-style test questions. Here is a brief review of some of the lessons you have learned in this chapter:
Reword the question.
Eliminate answer choices you know to be incorrect.
Don’t predict answers.
Recognize expected outcomes.
Read answer choices to obtain clues.