The NCLEX is all about testing your competency to practice as a nurse, but students often feel that questions are set out to deliberately mislead them. While it’s true that some questions can appear to be worded slightly ambiguously, the exam is ultimately testing not only your knowledge – after all you’ve graduated school, you already have the knowledge to practice – but also your ability to apply that knowledge.
When you’re preparing for the NCLEX, as well as reviewing and refreshing what you’ve learned in school, there are also some pointers to look out for in the actual wording of the questions themselves. Prepare for these to minimize making careless mistakes on questions that you already know the answer to.
Apply these NCLEX strategies while you’re doing practice questions and quizzes, and you’ll recognize them more easily when you come across them on the exam.
Most Correct
Almost from the day you enter nursing school you’ll become painfully familiar with the term “They might all be correct but which one is most correct?” It’s quite possibly one of the most frustrating phrases in any school curriculum, but it doesn’t need to be.
Many questions will appear to have more than one correct answer, even though in straight forward multiple choice questions you can only choose one. In these instances, look for phrases like ‘most common’ or ‘least often’.
Example: What is the most common cause of appendicitis?
Parasites, Infection, Obstruction, Growth
While all answers are known causes for appendicitis, the most common cause is Obstruction
Age
Typically a patient’s age will not be mentioned in an NCLEX question unless it’s relevant to the answer so if you see an age, or a reference to age like ‘elderly’, ‘toddler’ or ‘child’ then be aware that it’s required for the correct answer choice.
Example: Arthritis affects all ages but juvenile arthritis, affecting children and teens, is different to osteoarthritis, typically affecting the older generation.
Absolutes
There are few, if any, absolutes in medicine so look for words such as ‘always’, ‘never’, ‘none’, ‘all’ or ‘everyone’. If you see these in an answer, be cautious about choosing them as they will rarely be correct.
Example: A client with Type I diabetes wants to start a family, and asks the nurse about pre-conceptual care. What information should the nurse include?
People with Type I diabetes always have problems conceiving.
While some diabetics, and especially those with poorly controlled blood glucose, may have difficulty conceiving, this isn’t always the case.
Odd one out
Sometimes an answer may be different to all the others. This difference may make that answer the correct one, or it may make it absolutely incorrect.
Example: While documenting a client’s fluid input for the shift, the nurse records 0.9% NaCl 1000ml; 1 unit packed red blood cells (350ml); Urine 525ml; Hemovac drain 35ml; emesis 200ml. How many liters will the nurse record as the client’s output?
760ml, 2110ml, 0.76L, 1760ml
Although the question uses milliliters, it asks for the correct answer in liters, and only one answer choice is in liters.
Negatives
Many questions are worded so that you need to find the answer that reflects what you wouldn’t do. These often ask questions like “Which response by the client indicates a need for further teaching?” or “When supervising the student nurse, which action would cause the RN to intervene?”
Prioritizing
Many NCLEX questions focus on priority of care, from which patient to see first, to what to do when faced with a client emergency, such as an allergic reaction. Questions that indicate priority use words such as ‘best’, ‘first’, ‘most’ or ‘main’. Often all answer choices are correct but you need to determine the priority. Use the Nursing Process (assess before implement) or Maslow’s (physiological before psychosocial) to help determine an answer.
If it looks like a duck, moves like a duck, and quacks like a duck, it’s a duck
Students are often confused by blatantly simple questions. Don’t be, especially early on in your exam. Easy questions are just that; EASY. Don’t second-guess yourself, don’t look for the ‘trick’. If a diabetic patient is having a hypoglycemic attack, treat it.
Delegation
Delegation questions appear in many sections of the NCLEX, from Management of Care to Safety. A rule of thumb, delegate stable clients with predictable outcomes, delegate standard unchanging procedures and actions. Don’t delegate actions that involve assessment, evaluation or teaching.
Least harm
If you come across a question that you really don’t know the answer to, choose the one that will cause the least harm
