NCLEX-RN Review Made Incredibly Easy! 5th edition Lippincott eBook


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  • Published: 2012
  • ISBN-13: 978-1608313419
  • ISBN-10: 1608313417


NCLEX-RN Review Made Incredibly Easy! 5th edition Lippincott eBook

Part 1 Getting Ready

1 Preparing for the NCLEX

NCLEX basics

Passing the National Council Licensure

Examination (NCLEX®) is an important landmark

in your career as a nurse. The first step

on your way to passing the NCLEX is to understand

what it is and how it’s administered.

NCLEX structure

The NCLEX is a test written by nurses who,

like most of your nursing instructors, have

an advanced degree and clinical expertise in

a particular area. Only one small difference

distinguishes nurses who write NCLEX questions:

They’re trained to write questions in a

style particular to the NCLEX.

If you’ve completed an accredited nursing

program, you’ve already taken numerous

tests written by nurses with backgrounds and

experiences similar to those of the nurses

who write for the NCLEX. The test-taking

experience you’ve already gained will help

you pass the NCLEX. So your NCLEX review

should be just that — a review. (For eligibility

and immigration requirements for nurses

from outside of the United States, see Guidelines

for international nurses, page 4.)

What’s the point of it all?

The NCLEX is designed for one purpose:

namely, to determine whether it’s appropriate

for you to receive a license to practice as a

nurse. By passing the NCLEX, you demonstrate

that you possess the minimum level of

knowledge necessary to practice nursing safely.

Mix ’em up

In nursing school, you probably took courses

that were separated into such subjects as

pharmacology, nursing leadership, health

assessment, adult health, pediatric, maternalneonatal,

and psychiatric nursing. In contrast,

the NCLEX is integrated, meaning that different

subjects are mixed together.

As you answer NCLEX questions, you

may encounter clients in any stage of life,

from neonatal to geriatric. These clients —

clients, in NCLEX lingo — may be of any

background, may be completely well or

extremely ill, and may have any disorder.

Client needs, front and center

The NCLEX draws questions from four categories

of client needs that were developed

by the National Council of State Boards of

Nursing (NCSBN), the organization that sponsors

and manages the NCLEX. Client needs

categories ensure that a wide variety of topics

appear on every NCLEX examination.

The NCSBN developed client needs categories

after conducting a practice analysis

of new nurses. All aspects of nursing care

observed in the study were broken down into

four main categories, some of which were

broken down further into subcategories. (See

Client needs categories, page 5.)

The whole kit and caboodle

The categories and subcategories are used

to develop the NCLEX test plan, the content

guidelines for the distribution of test questions.

Question-writers and the people who

put the NCLEX together use the test plan and

client needs categories to make sure that a

full spectrum of nursing activities is covered

in the examination. Client needs categories

appear in most NCLEX review and questionand-

answer books, including this one. As a

test-taker, you don’t have to concern yourself

with client needs categories. You’ll see those

categories for each question and answer in

this book, but they’ll be invisible on the actual


Preparing for

the NCLEX® 1

4 Preparing for the NCLEX

Guidelines for international nurses

To become eligible to work as a registered nurse in the United States, you’ll need to complete several

steps. In addition to passing the NCLEX® examination, you may need to obtain a certificate and

credentials evaluation from the Commission on Graduates of Foreign Nursing Schools (CGFNS!)

and acquire a visa. Requirements vary from state to state, so it’s important that you first contact the

Board of Nursing in the state where you want to practice nursing.


Most states require that you obtain CGFNS

certification. This certification requires:

• review and authentication of your credentials,

including your nursing education, registration,

and licensure

• passing score on the CGFNS Qualifying Examination

of nursing knowledge

• passing score on an English language proficiency


To be eligible to take the CGFNS Qualifying

Examination, you must complete a minimum

number of classroom and clinical practice hours

in medical-surgical nursing, maternal-infant

nursing, pediatric nursing, and psychiatric

and mental health nursing from a governmentapproved

nursing school. You must also be

registered as a first-level nurse in your country

of education and currently hold a license as a

registered nurse in some jurisdiction.

The CGFNS Qualifying Examination is

a paper and pencil test that includes 260

multiple-choice questions and is administered

under controlled testing conditions.

Because the test is designed to predict

your likelihood of successfully passing the

NCLEX-RN examination, it’s based on the

NCLEX-RN test plan.

You may select from three English proficiency

examinations—Test of English as a

Foreign Language (TOEFL®), Test of English

for International Communication (TOEIC®), or

International English Language Testing System

(IELTS). Each test has different passing

scores, and the scores are valid for up to

2 years.


This evaluation is a comprehensive report that

analyzes and compares your education and

licensure with U.S. standards. It’s prepared by

CGFNS for a state board of nursing, an immigration

office, employer, or university. To use this

service you must complete an application, submit

appropriate documentation, and pay a fee.

More information about the CGFNS

certification program and credentials evaluation

service is available at


You can’t legally immigrate to work in the

United States without an occupational visa

(temporary or permanent) from the United

States Citizenship and Immigration Services

(USCIS). The visa process is separate from

the CGFNS certification process, although

some of the same steps are involved. Some

visas require prior CGFNS certification and a

VisaScreen™ Certificate from the International

Commission on Healthc are Professions (ICHP).

The VisaScreen program involves:

• credentials review of your nursing education

and current registration or licensure

• successful completion of either the CGFNS

certification program or the NCLEX-RN to provide

proof of nursing knowledge

• passing score on an approved English language

proficiency examination.

After you successfully complete all parts of

the VisaScreen program, you’ll receive a certificate

to present to the USCIS. The visa granting

process can take up to one year.

You can obtain more detailed information

about visa applications at

Testing by computer

Like many standardized tests today, the

NCLEX is administered by computer. That

means you won’t be filling in empty circles,

sharpening pencils, or erasing frantically. It

also means that you must become familiar

with computer tests, if you aren’t already.

Fortunately, the skills required to take the

NCLEX on a computer are simple enough to

NCLEX basics 5

allow you to focus on the questions, not the



When you take the test, depending on the

question format, you’ll be presented with a

question and four or more possible answers,

a blank space in which to enter your answer, a

figure on which you’ll identify the correct

area by clicking the mouse on it, a series

of charts or exhibits you’ll use to select the

correct response, items you must rearrange

in priority order by dragging and dropping

them in place, an audio recording to listen to

in order to select the correct response, or a

question and four graphic options.

Feeling smart? Think hard!

The NCLEX is a computer-adaptive test,

meaning that the computer reacts to the

answers you give, supplying more difficult

questions if you answer correctly, and slightly

easier questions if you answer incorrectly.

Each test is thus uniquely adapted to the

individual test-taker.

A matter of time

You have a great deal of flexibility with the

amount of time you can spend on individual

questions. The examination lasts a maximum

of 6 hours, however, so don’t waste time. If

you fail to answer a set number of questions

within 6 hours, the computer will determine

that you lack minimum competency.

Most students have plenty of time to

complete the test, so take as long as you need

to get the question right without wasting time.

But remember to keep moving at a decent

pace to help you maintain concentration.

Difficult items = Good news

If you find as you progress through the test

that the questions seem to be increasingly

difficult, it’s a good sign. The more questions

you answer correctly, the more difficult the

questions become.

Some students, though, knowing that

questions get progressively harder, focus on

the degree of difficulty of subsequent questions

to try to figure out if they’re answering

questions correctly. Avoid the temptation to

do this, as this may get you off track.

Free at last!

The computer test finishes when one of the

following events occurs:

• You demonstrate minimum competency,

according to the computer program, which

Client needs categories

Each question on the NCLEX is assigned a category based on client needs. This chart lists client

needs categories and subcategories and the percentages of each type of question that appears on

an NCLEX examination.

Category Subcategories Percentage of

NCLEX questions

Safe and effective care environment • Management of care

• Safety and infection control

16% to 22%

8% to 14%

Health promotion and maintenance 6% to 12%

Psychosocial integrity 6% to 12%

Physiological integrity • Basic care and comfort

• Pharmacological and parenteral


• Reduction of risk potential

• Physiological adaptation

6% to 12%

13% to 19%

10% to 16%

11% to 17%

I react to


6 Preparing for the NCLEX

does so with 95% certainty that your ability

exceeds the passing standard.

• You demonstrate a lack of minimum competency,

according to the computer program.

• You’ve answered the maximum number of

questions (265 total questions).

• You’ve used the maximum time allowed

(6 hours).

Unlocking the NCLEX


In April 2004, the NCSBN added alternateformat

items to the examination. However,

most of the questions on the NCLEX are

four-option, multiple-choice items with only

one correct answer. Certain strategies can

help you understand and answer any type of

NCLEX question.

Alternate formats

The first type of alternate-format item is

the multiple-response question. Unlike a

tradition al multiple-choice question, each

multiple- response question has one or

more correct answers for every question,

and it may contain more than four possible

answer options. You’ll recognize this type

of question because it will ask you to select

all answers that ap ply — not just the best

answer (as may be requested in the more

traditional multiple-choice questions).

All or nothing

Keep in mind that, for each multiple-response

question, you must select at least one answer

and you must select all correct answers for

the item to be counted as correct. On the

NCLEX, there is no partial credit in the scoring

of these items.

Don’t go blank!

The second type of alternate-format item is

the fill-in-the-blank question. These questions

require you to provide the answer yourself,

rather than select it from a list of options. You

will perform a calculation and then type your

answer (a number, without any words, units

of measurements, commas, or spaces) in the

blank space provided after the question. Rules

for rounding are included in the question

stem if appropriate. A calculator button is

provided so you can do your calculations


Mouse marks the spot!

The third type of alternate-format item is a

question that asks you to identify an area

on an illustration or graphic. For these “hot

spot” questions, the computerized exam will

ask you to place your cursor and click over

the correct area on an illustration. Try to

be as precise as possible when marking the

location. As with the fill-in-the-blanks, the

identification questions on the computerized

exam may require extremely precise

answers in order for them to be considered


Click, choose, and prioritize

The fourth alternate-format item type is the

chart/exhibit format. For this question type,

you’ll be given a problem and then a series

of small screens with additional information

you’ll need to answer the question. By clicking

on the tabs on screen, you can access

each chart or exhibit item. After viewing the

chart or exhibit, you select your answer from

four multiple-choice options.

Drag n’ drop

The fifth alternate-format item type involves

prioritizing actions or placing a series of

statements in correct order using a drag-anddrop

(ordered response) technique. To move

an answer option from the list of unordered

options into the correct sequence, click on

it using the mouse. While still holding down

the mouse button, drag the option to the

ordered response part of the screen. Release

the mouse button to “drop” the option into

place. Repeat this process until you’ve moved

all of the available options into the correct


Now hear this!

The sixth alternate-format item type is the

audio item format. You’ll be given a set of

headphones and you’ll be asked to listen to an

The harder

it gets, the

better I’m


Unlocking the NCLEX mystery 7

audio clip and select the correct answer from

four options. You’ll need to select the correct

answer on the computer screen as you would

with the traditional multiple-choice questions.

Picture perfect

The final alternate-format item type is the

graphic option question. This varies from the

exhibit format type because in the graphic

option, your answer choices will be graphics

such as ECG strips. You’ll have to select the

appropriate graphic to answer the question


The standard’s still the standard

The NCSBN hasn’t yet established a

percentage of alternate-format items to be

administered to each candidate. In fact, your

exam may contain only one alternate-format

item. So relax; the standard, four-option,

multiple-choice format questions constitute

the bulk of the test. (See Sample NCLEX questions,

pages 8 to 10.)

Understanding the question

NCLEX questions are commonly long. As a

result, it’s easy to become overloaded with

information. To focus on the question and

avoid becoming overwhelmed, apply proven

strategies for answering NCLEX questions,


• determining what the question is asking

• determining relevant facts about the client

• rephrasing the question in your mind

• choosing the best option or options before

entering your answer.



Read the question twice. If the answer isn’t

apparent, rephrase the question in simpler,

more personal terms. Breaking down the

question into easier, less intimidating terms

may help you to focus more accurately on the

correct answer.

Give it a try

For example, a question might be, “A 74-yearold

client with a history of heart failure is

admitted to the coronary care unit with

pulmonary edema. He’s intubated and placed

on a mechanical ventilator. Which parameters

should the nurse monitor closely to assess

the client’s response to a bolus dose of furosemide

(Lasix) I.V.?”

The options for this question — numbered

from 1 to 4 — might include:

1. Daily weight

2. 24-hour intake and output

3. Serum sodium levels

4. Hourly urine output

Hocus, focus on the question

Read the question again, ignoring all details

except what’s being asked. Focus on the last

line of the question. It asks you to select the

appropriate assessment for monitoring a

client who received a bolus of furosemide I.V.



Next, sort out the relevant client information.

Start by asking whether any of the

information provided about the client isn’t relevant.

For instance, do you need to know that

the client has been admitted to the coronary

care unit? Probably not; his reaction to I.V.

furosemide won’t be affected by his location

in the hospital.

Determine what you do know about the

client. In the example, you know that:

• he just received an I.V. bolus of furosemide,

a crucial fact

• he has pulmonary edema, the most

fundamental aspect of the client’s underlying


• he’s intubated and placed on a mechanical

ventilator, suggesting that his pulmonary

edema is serious

• he’s 74 years old and has a history of heart

failure, a fact that may or may not be relevant.


After you’ve determined relevant information

about the client and the question being

asked, consider rephrasing the question to

make it more clear. Eliminate jargon and

put the question in simpler, more personal

terms. Here’s how you might rephrase the

question in the example: “My client has

pulmonary edema. He requires intubation and

Focusing on

what the question

is really asking can

help you choose the

correct answer.

(Text continues on page 10.)

8 Preparing for the NCLEX

Sample NCLEX questions

Sometimes, getting used to the format is as important as knowing the material. Try your hand at

these sample questions and you’ll have a leg up when you take the real test!

Sample four-option, multiple-choice question

A client’s arterial blood gas (ABG) results are as follows: pH, 7.16; Paco2, 80 mm Hg;

Pao2, 46 mm Hg; HCO3

–, 24 mEq/L; Sao2, 81%. These ABG results represent which


1. Metabolic acidosis

2. Metabolic alkalosis

3. Respiratory acidosis

4. Respiratory alkalosis

Correct answer: 3

Sample multiple-response question

A nurse is caring for a 45-year-old married woman who has undergone hemicolectomy

for colon cancer. The woman has two children. Which concepts about families should

the nurse keep in mind when providing care for this client?

Select all that apply:

1. Illness in one family member can affect all members.

2. Family roles don’t change because of illness.

3. A family member may have more than one role at a time in the family.

4. Children typically aren’t affected by adult illness.

5. The effects of an illness on a family depend on the stage of the family’s life cycle.

6. Changes in sleeping and eating patterns may be signs of stress in a family.

Correct answer: 1, 3, 5, 6

Sample fill-in-the-blank calculation question

An infant who weighs 8 kg is to receive ampicillin 25 mg/kg I.V. every 6 hours. How

many milligrams should the nurse administer per dose? Record your answer using a

whole number.

_______________________________________ milligrams

Correct answer: 200

Sample hot spot question

A client has a history of aortic stenosis. Identify the area where the nurse should place

the stethoscope to best hear the murmur.


Correct answer:

I can be

ambivalent. More

than one answer

may be correct.

Unlocking the NCLEX mystery 9

Sample NCLEX questions (continued)

Sample exhibit question

A 3-year old child is being treated for severe status asthmaticus. After reviewing the

progress notes (shown below), the nurse should determine that this client is being

treated for which condition?

1. Metabolic acidosis

2. Respiratory alkalosis

3. Respiratory acidosis

4. Metabolic alkalosis


Correct answer: 3

Sample drag-and-drop (ordered response) question

When teaching an antepartal client about the passage of the fetus through the birth

canal during labor, the nurse describes the cardinal mechanisms of labor. Place these

events in the sequence in which they occur. Use all options:


Correct answer:



Progress notes

Pt. was acutely restless, diaphoretic, and with dyspnea at 0530. Dr. T.

Smith notified of findings at 0545 and ordered ABG

analysis. ABG drawn from R radial artery. Stat results as follows: pH

7.28, Paco2 SS mm Hg, HCO3- 26 mEg/L. Dr. Smith

with pt. now. J. Collins, RN.

1. Flexion

2. External rotation

3. Descent

4. Expulsion

5. Internal rotation

6. Extension

3. Descent

1. Flexion

5. Internal rotation

6. Extension

2. External rotation

4. Expulsion


10 Preparing for the NCLEX

mechanical ventilation. He’s 74 years old and

has a history of heart failure. He received an

I.V. bolus of furosemide. What assessment

parameter should I monitor?”


Armed with all the information you now have,

it’s time to select an option. You know that the

client received an I.V. bolus of furosemide,

a diuretic. You know that monitoring fluid

intake and output is a key nursing intervention

for a client taking a diuretic, a fact that eliminates

options 1 and 3 (daily weight and serum

sodium levels), narrowing the answer down

to option 2 or 4 (24-hour intake and output or

hourly urine output).

Can I use a lifeline?

You also know that the drug was administered

by I.V. bolus, suggesting a rapid

effect. (In fact, furosemide administered by

I.V. bolus takes effect almost immediately.)

Sample NCLEX questions (continued)

Sample audio item question

Listen to the audio clip. What sound do you hear in the bases of this client with heart


1. Crackles

2. Rhonchi

3. Wheezes

4. Pleural friction rub

Correct answer: 1

Sample graphic option question

Which electrocardiogram strip should the nurse document as sinus tachycardia?





Correct answer: 1

Key strategies 11

Monitoring the client’s 24-hour intake and

output would be appropriate for assessing

the effects of repeated doses of furosemide.

Hourly urine output, however, is most appropriate

in this situation because it monitors the

immediate effect of this rapid-acting drug.

Key strategies

Regardless of the type of question, four key

strategies will help you determine the correct

answer for each question. These strategies are:

• considering the nursing process

• referring to Maslow’s hierarchy of needs

• reviewing client safety

• reflecting on principles of therapeutic communication.

Nursing process

One of the ways to answer a question is

to apply the nursing process. Steps in the

nursing process include:

• assessment

• diagnosis

• planning

• implementation

• evaluation.

First things first

The nursing process may provide insights

that help you analyze a question. According

to the nursing process, assessment comes

before analysis, which comes before planning,

which comes before implementation, which

comes before evaluation.

You’re halfway to the correct answer

when you encounter a four-option,

multiple-choice question that asks you to

assess the situation and then provides two

assessment options and two implementation

options. You can immediately eliminate

the implementation options, which

then gives you, at worst, a 50-50 chance of

selecting the correct answer. Use the following

sample question to apply the nursing


A client returns from an endoscopic

procedure during which he was sedated.

Before offering the client food, which action

should the nurse take?

1. Assess the client’s respiratory status.

2. Check the client’s gag reflex.

3. Place the client in a side-lying position.

4. Have the client drink a few sips of


Assess before intervening

According to the nursing process, the nurse

must assess a client before performing an

intervention. Does the question indicate

that the client has been properly assessed?

No, it doesn’t. Therefore, you can eliminate

options 3 and 4 because they’re both


That leaves options 1 and 2, both of which

are assessments. Your nursing knowledge

should tell you the correct answer — in this

case, option 2. The sedation required for

an endoscopic procedure may impair the

client’s gag reflex, so you would assess the

gag reflex before giving food to the client

to reduce the risk of aspiration and airway


Final elimination

Why not select option 1, assessing the

client’s respiratory status? You might select

this option but the question is specifically

asking about offering the client food, an

action that wouldn’t be taken if the client’s

respiratory status was at all compromised. In

this case, you’re making a judgment based

on the phrase, “Before offering the client

food.” If the question was trying to test your

knowledge of respiratory depression following

an endoscopic procedure, it probably

wouldn’t mention a function — such as giving

food to a client — that clearly occurs only

after the client’s respiratory status has been


Maslow’s hierarchy

Knowledge of Maslow’s hierarchy of needs can

be a vital tool for establishing priorities on the

NCLEX. Maslow’s theory states that physiologic

needs are the most basic human needs of

all. Only after physiologic needs have been met

can safety concerns be addressed. Only after

12 Preparing for the NCLEX

safety concerns are met can concerns involving

love and belonging be addressed, and so forth.

Apply the principles of Maslow’s hierarchy of

needs to the following sample question:

A client complains of severe pain 2 days

after surgery. Which action should the nurse

perform first?

1. Offer reassurance to the client that he

will feel less pain tomorrow.

2. Allow the client time to verbalize his


3. Check the client’s vital signs.

4. Administer an analgesic.

Phys before psych

In this example, two of the options — 3 and

4 — address physiologic needs. Options 1 and

2 address psychosocial concerns. According

to Maslow, physiologic needs must be met

before psychosocial needs, so you can eliminate

options 1 and 2.

Final elimination

Now, use your nursing knowledge to choose

the best answer from the two remaining

options. In this case, option 3 is correct

because the client’s vital signs should be

checked before administering an analgesic

(assessment before intervention). When

prioritizing according to Maslow’s hierarchy,

remember your ABCs — airway, breathing,

circulation — to help you further prioritize.

Check for a patent airway before addressing

breathing. Check breathing before checking

the health of the cardiovascular system.

One caveat…

Just because an option appears on the NCLEX

doesn’t mean it’s a viable choice for the client

referred to in the question. Always examine

your choice in light of your knowledge and

experience. Ask yourself, “Does this choice

make sense for this client?” Allow yourself

to eliminate choices — even ones that might

normally take priority — if they don’t make

sense for a particular client’s situation.

Client safety

As you might expect, client safety takes high

priority on the NCLEX. You’ll encounter

many questions that can be answered by

asking yourself, “Which answer will best

ensure the safety of this client?” Use client

safety criteria for situations involving laboratory

values, drug administration, activities of

daily living, or nursing care procedures.

Client first, equipment second

You may encounter a question in which

some options address the client and others

address the equipment. When in doubt, select

an option relating to the client; never place

equipment before a client.

For example, suppose a question asks

what the nurse should do first when entering

a client’s room where an infusion pump alarm

is sounding. If two options deal with the infusion

pump, one with the infusion tubing, and

another with the client’s catheter insertion

site, select the one relating to the client’s catheter

insertion site. Always check the client

first; the equipment can wait.

Therapeutic communication

Some NCLEX questions focus on the nurse’s

ability to communicate effectively with the

client. Therapeutic communication incorporates

verbal or nonverbal responses and


• listening to the client

• understanding the client’s needs

• promoting clarification and insight about

the client’s condition.

Room for improvement

Like other NCLEX questions, those dealing

with therapeutic communication commonly

require choosing the best response. First,

eliminate options that indicate the use of poor

therapeutic communication techniques, such

as those in which the nurse:

• tells the client what to do without regard to

the client’s feelings or desires (the “do this”


• asks a question that can be answered

“yes” or “no,” or with another one-syllable


• seeks reasons for the client’s behavior

• implies disapproval of the client’s behavior

• offers false reassurances

Client safety

takes a high

priority on the


Say it 1,000

times: Studying for

the exam is fun…

studying for the

exam is fun…

Avoiding pitfalls 13

• attempts to interpret the client’s behavior

rather than allow the client to verbalize his

own feelings

• offers a response that focuses on the

nurse, not the client.

Ah, that’s better!

When answering NCLEX questions, look for

responses that:

• allow the client time to think and reflect

• encourage the client to talk

• encourage the client to describe a

particular experience

• reflect that the nurse has listened to the

client, such as through paraphrasing the

client’s response.

Avoiding pitfalls

Even the most knowledgeable students can

get tripped up on certain NCLEX questions.

(See A tricky question, page 14.) Students

commonly cite three areas that can be difficult

for unwary test-takers:

knowing the difference between the

NCLEX and the “real world”

delegating care

knowing laboratory values.

NCLEX versus the real world

Some students who take the NCLEX have

extensive practical experience in health care.

For example, many test-takers have worked

as licensed practical nurses or nursing

assistants. In one of those capacities, testtakers

might have been exposed to less than

optimum clinical practice and may carry those

experiences over to the NCLEX.

However, the NCLEX is a textbook examination

— not a test of clinical skills. Take

the NCLEX with the understanding that what

happens in the real world may differ from

what the NCLEX and your nursing school say

should happen.

Don’t take shortcuts

If you’ve had practical experience in health

care, you may know a quicker way to perform

a procedure or tricks to get by when you don’t

have the right equipment. Situations such as

staff shortages may force you to improvise.

On the NCLEX, such scenarios can lead to

trouble. Always check your practical experiences

against textbook nursing care, taking

care to select the response that follows the


Delegating care

On the NCLEX, you may encounter questions

that assess your ability to delegate care. Delegating

care involves coordinating the efforts

of other health care workers to provide effective

care for your client. On the NCLEX, you

may be asked to assign duties to:

• licensed practical nurses or licensed vocational


• direct-care workers, such as certified

nursing assistants and personal care aides

• other support staff, such as nutrition assistants

and housekeepers.

In addition, you’ll be asked to decide

when to notify a physician, a social worker, or

another hospital staff member. In each case,

you’ll have to decide when, where, and how to


Shoulds and shouldn’ts

As a general rule, it’s okay to delegate

actions that involve stable clients or standard,

unchanging procedures. Bathing, feeding,

dressing, and transferring clients are examples

of procedures that can be delegated.

Be careful not to delegate complicated or

complex activities. In addition, don’t delegate

activities that involve assessment, evaluation,

or your own nursing judgment. On the

NCLEX and in the real world, these duties fall

squarely on your shoulders. Make sure that

you take primary responsibility for assessing

and evaluating the client and for making

decisions about the client’s care. Never hand

off those responsibilities to someone with less



this is an

exam, not the

real world.

14 Preparing for the NCLEX

Calling in reinforcements

Deciding when to notify a physician, a social

worker, or another hospital staff member is

an important element of nursing care. On

the NCLEX, however, choices that involve

notifying the physician are usually incorrect.

Remember that the NCLEX wants to see you,

the nurse, at work.

If you’re sure the correct answer is to

notify the physician, though, make sure the

client’s safety has been addressed before notifying

a physician or another staff member. On

the NCLEX, the client’s safety has a higher

priority than notifying other health care





• Blood urea

nitrogen: 8 to

25 mg/dl

• Creatinine: 0.6

to 1.5 mg/dl

• Sodium: 135 to

145 mmol/L

• Potassium: 3.5

to 5.5 mEq/L

• Chloride: 97 to

110 mmol/L

• Glucose (fasting

plasma): 70 to

110 mg/dl

• Hemoglobin

Male: 13.8 to

17.2 g/dl

Female: 12.1 to

15.1 g/dl

• Hematocrit

Male: 40.7% to


Female: 36.1% to


The NCLEX occasionally asks a particular kind of question called the “further teaching” question,

which involves client-teaching situations. These questions can be tricky. You’ll have to choose the

response that suggests the client has not learned the correct information. Here’s an example:

37. A client undergoes a total hip replacement. Which statement by the client indicates

he requires further teaching?

1. “I’ll need to keep several pillows between my legs at night.”

2. “I’ll need to remember not to cross my legs. It’s such a bad habit.”

3. “The occupational therapist is showing me how to use a ‘sock puller’ to help me get


4. “I don’t know if I’ll be able to get off that low toilet seat at home by myself.”

The option you should choose here is 4 because it indicates that the client has a poor understanding

of the precautions required after a total hip replacement and that he needs further teaching.

Remember: If you see the phrase further teaching or further instruction, you’re looking for a wrong

answer by the client.

Advice from the experts

A tricky question

Knowing laboratory values

Some NCLEX questions supply laboratory

results without indicating normal levels. As a

result, answering questions involving laboratory

values requires you to have the normal

range of the most common laboratory values

memorized to make an informed decision

(See Normal laboratory values.)

NCLEX-RN Review Made Incredibly Easy! 5th edition Lippincott eBook