Essential NCLEX Preparation Strategies: Tips and Resources for Nursing Students

welcome everyone we're so pleased that you're able to join us this evening and so our plan

for this evening we're going to be sharing and practicing lots of questions tonight the

conventional traditional types of questions such as multiple choice and we're also going to be practicing a

lot of alternate item test questions we're going to look at some smart

study tips for nclex preparation and also angela is going to demonstrate how to locate

those practice questions that you need to pass your nursing exams and the nclex we're also going to take a look at the

nclex exam and the new covet modifications that are starting on october 1st

we're going to talk about the nclex and your nclex goals for that very important exam

we're going to show you the components of the test plan and angela is going to pull up an actual

test plan for you and as i mentioned before we're going to do lots of practice questions

we also want to remind you at this time of an upcoming session that's going to be held in

october 6th so just a few weeks away and that one is on mastering pharmacology and we know you're going to

love that session okay so on this next slide we have some smart

study tips so first while you're in nursing school use your textbooks and nclex review

books and practice questions to get ready for your nursing exams

select those practice questions using the evolve resources in your books and you can

select questions based on body system or health problems

and shortly angela's going to share her screen and show you just how to do this now for your nursing exams and in klex

prep practice as many test questions as possible

and always read the rationales and strategies practicing test questions is critical

and we can't emphasize this enough as to how important

it is um to do this in order to get ready for your exams and the nclex so on this next slide let's just take a

look at some of the top nursing resources and how you can locate what you need to

do to be successful so on the top left we have the strategies book

which is for both rnp and students and this is really helpful in developing your test taking skills

and each chapter in that book goes into great detail

about how to apply strategies as you answer test questions and there are actually over

1200 practice questions in that book and next on the top row we have additional

rn products and all of the pn products are noted below the comprehensive review books are

perfect resources while you're in nursing school to use during your courses and

while you're studying for exams they include content and well over five thousand practice

questions and we'll quickly show you that table of contents in a moment and then to the right is the q a book

and this book is all practice questions based on the nclex test plan blueprint

there's over 6 000 practice questions in these books and these are different than the ones in

the comprehensive review so you get different questions in the q a book

and finally to the right are the online review programs which provide lots of content lots of

practice questions audios videos and this these programs will help you to put

those finishing touches on the nclex prep so now i'm going to

turn it over to angela and she's going to take a look with you at the table of contents great thank you

so much linda hi everyone so let's take a quick look at the table of contents this is for the

comprehensive review that linda was mentioning while you're in nursing school you can

read the sections that you're learning about for example if you're learning about

maternity you can review the outlined maternity chapters and then practice the

questions that go along with those sections on evolve which is the electronic

resource that accompanies the book we do also want to point out that there are 13

pharmacology review chapters in the book that coincide with the content area or the body system

so for example you have a cardiovascular chapter then followed by a cardiovascular

medications chapter so if you look at the table of contents here you'll see

once you do get to those adult health units you'll see how the medication chapters come

after the body system chapters which has been very helpful to students and then on the next slide

we will show you the table of contents for the q a or the question and answer book

and as you can see linda mentioned these chapters are designed so that they address and

provide questions for each client needs component of the test plan which is the way

that nclex organizes the information on the test plan so it's a really helpful resource as

you're getting ready to take the nclex the comp is really helpful during nursing school

and for nclex but then the q a based on and organized by these specific client needs categories is very helpful

during that time period where you're really sitting down and focusing on studying for the nclex

this happens to be the evolve resources for the q and a the rn q a

so if you click here on the study mode and then a couple ways that we recommend studying especially during nursing

school when you're studying for exams during nursing school you then click

health problem and then you can see here that it's organized here's adult health maternity mental health newborn and then

pediatric specific so let's just look at adult health here and let's say you have an exam on

cardiovascular for example and let's say specifically your exam is going to be on heart failure

and on myocardial infarction so there will be 83 practice questions specific to those

areas that you can study for for that exam students really like the ability to filter it down to that

level and i do want to show you one more way to filter questions again if you go to

the study mode which gives you practice questions with instant feedback and then to

content area and if you go to pharmacology then you can go by body system

and then also you can go by drug classification so let's say you're going to be tested on

anticoagulants there's 44 questions for you specific to anticoagulants this was something that

students really we're looking for and asking for and so we were really happy to be able

to to do this because it seems to be quite helpful

for students as they're studying for exams during their program and then when you get when you're

getting ready for nclex you can use this product and maybe not filter it down to that level

and it would still be helpful for you um but it is an option with this particular

product and so we did want to just demonstrate that to you

thanks angela and that was a great presentation of how to use that evolved site so thank you for that

so now on this slide let's look at the modifications to the nclex

starting october 1st due to the clovid 19 crisis now the mcsbn tells us just this past

week that these will be in effect for a while and will remain in effect until further notice so

in your two far right hand columns you can see what the original rn and pm test plan included and

what's significant to note on this chart is that for now both the rnn the pn will be a

five hour exam and will be comprised of a minimum of 75 questions and a maximum of 145

questions also it's important to note that 15 of these questions are experimental

or pre-test unscored questions in the exam the other point is that

nclex has also reintroduced their ngn next generation nclex research section which is completely

voluntary and you will see this research section at the end of your nclex exam

they'll ask you if you would like to participate and again it's voluntary however we

highly encourage you to participate in this very important research

study because the ncsbn is collecting data for these new item types and they really need your

participation and input and the test remains as a computer adaptive test so that's an important

point to remember also now all of these changes that they've made from the original

exams do not make the test more difficult the psychometricians have found that

they can validly and reliably determine competency with these number of test

questions and also we want to point out too that the cdc disease control guidelines

are being followed in all of the test centers including enhanced cleaning especially between

each test taker so now on this next slide we've listed some references for you to the ncsbn

and this is where you can find lots of additional information about the nclex there's a

wealth of information about the exam testing centers candidate bulletins the test plans and

we highly encourage you to access the website on a regular basis basis

to keep keep up with what's happening okay so on this next slide we're going to talk a little bit about about

goals and i'm going to turn this over to angela wonderful thank you so for those of you

who are beginning or perhaps intermediate students or level 1 students whatever terminology is

used you're at a strategic advantage because you have some time before you take the

nclex and you can use that time to prepare for the exam at the same time that

you're studying and preparing for your nursing exams and other requirements in the program

and so your goal really does need to be preparing for nclex while in nursing school that's going to be very very

helpful to you for those of you who might be level 2 students or

higher level students upper level students or seniors everything that you've learned so far in

class in clinical during your program whatever efforts you've put towards preparation

have been preparing you for the nclex and so now your goal should be to put on the

finishing touches and we're going to talk about these specific strategies in a bit

but the first thing that we want to talk to you about is the nclex test plan

and so if we look at this slide here the test plan is very important to be familiar with

why is that because it actually lists the content and activities that you as a newly licensed entry-level nurse must be

able to perform to provide clients with safe effective nursing care

and so the test plan tells you what you're going to be tested on how great is that and

on this slide here we have two examples of what are listed in the test plan the first one is in the safe and

effective care environment component of the test plan we'll talk more about that component in

a bit but it tells you that you need to know guidelines for using ergonomic

principles so use ergonomic principles when providing care such as safe patient handling and prop

proper lifting so that's a pretty detailed statement the second one is from the physiological

integrity component of the test plan and actually tells you the exact lab values that you need to

know for the nclex so lab values for abg's bun cholesterol creatinine glucose

hemoglobin a1c hematocrit hemoglobin inr platelets potassium and so forth so again

very very detailed information so that's really helpful for you as you study you should know the

normal lab values for these tests so that you can recognize if a lab result is high or low if it's

presented in a question and what that value means with regard to the client and the question

as of now you you may not see reference ranges provided for you but they have nclex or ncsb and has

recently started to have that discussion about including normal reference ranges in the exam so

you may or you may not see them but either way you'd rather err on the side of caution

and be prepared for that and be able to interpret the significance of a lab value

presented and so with that we highly recommend that you access the ncsbn website you

download the test plan save it on your computer or print it out use it as your study guide for the nclex

as you master each content area or activity listed in the plan you should highlight it and then once your test

plan is all highlighted then you should feel ready and so the link to access the test plan is here on

this slide and just be sure that you download the correct plan the rn or

pn plan whichever one is appropriate for you and i'm actually going to show you now

page that you'll come to and you'll want to click download publication and this happens to be on page 14 of 65.

this is the safe and effective care environment component of the test plan and you can see these are the activity

statements here these are the things that you want to be able to go through and highlight

by the time that you are done studying and getting ready to take the exam and they're pretty detailed and in some

areas they're more detailed than others but it really helps you so they they tend to

be in boxes these activity statements we're going to look at the levels of cognitive ability

so the levels of cognitive ability are remembering understanding applying analyzing evaluating

synthesizing or creating it's not at all likely that you'll encounter questions that address

the level of remembering or understanding questions are written typically at the

applying level or higher because the practice of nursing requires clinical reasoning

and clinical judgment this means that you'll be required to apply analyze and evaluate

with regard to the information provided to you in the test question you'll also be required to use the

levels of cognitive ability of synthesizing and creating an example of this might be creating plans

of care or creating teaching plans for your clients

so let's take a look on the next slide at a sample question that addresses the level of cognitive ability of

applying a pregnant client tells the nurse that she felt wetness on her peripad and

found some clear fluid the nurse inspects the perineum

and notes the presence of the umbilical cord what is the immediate nursing action

one monitor the fetal heart rate two notify the primary health care provider three transfer the client to the

delivery room or four place the client in the trendelenburg position

so you can go ahead and use the polling feature to answer this question all right so it looks like about half of

you 50 percent of you chose um option 4 and option four is actually the correct

answer to this question so let's take a little bit of a deeper dive into this

this question asks what are you going to do it's an applying question it asks for an immediate action on the

nurse's part to prevent or relieve the cord compression

so make sure you're reading every option consider reading each option more than once the

only action that is really going to achieve this is going to be option number four as far as relieving the

pressure on the cord remember if the umbilical cord is noted upon assessment

the nurse should immediately place the client in the trendelenburg position while gently holding the presenting part

upward to relieve the cord compression this position is maintained the the healthcare provider

is notified and the fetal heart rate should also be monitored for any fetal distress

but positioning is going to be the immediate action in this case the client would be transferred to the

delivery room if if and when that's indicated by the provider

all right so moving on we have listed the integrated processes um so the ncsbn has identified

five processes as components of the test plan that are considered fundamental to the practice of nursing

these include caring communication and documentation culture and spirituality the nursing

process in teaching and learning what this means is that each test question will address

one or more of these components and so we can go ahead and look at a practice question that addresses the integrated

process teaching and learning the nurse is caring for a hospitalized child

with a diagnosis of viral pneumonia describes the treatment plan to the parents the nurse determines the need

for further teaching when the parents make which statement regarding the treatment

one we need to be careful since oxygen is flammable

two it's difficult to watch you insert the needle to give those iv fluids three it's important that my

child isn't allergic to the antibiotic that's prescribed

and four the chest treatments will loosen the lung congestion and so coughing can more easily clear

the lungs all right so it looks like in this case 35 percent of you

chose the correct answer which is going to be option number three what you want to really be careful to

note here are these strategic words that we have kind of highlighted here for you

need for further teaching so these words ask you to select an option that is an incorrect statement and you also do want

to note the word viral in the question and remember that therapeutic management for viral pneumonia is going to be

supportive and antibiotics typically are not given unless the pneumonia is

considered to be a bacterial pneumonia oxygen intravenous fluids and chest

physiotherapy are all appropriate interventions for a hospitalized child all right so with

that i'll go ahead and turn it over to linda to talk about the client needs categories of the rn and pn test plans

thank you angela now this um next slide shows you the client needs categories for both the rn

and the pm test plan now i know this slide looks a little bit busy but all of this information is actually

in your test plan so don't feel like you have to write all this information down

because if you do download the test plan as angela suggested and as we highly recommend all this

information and the pres uh percentages are going to be presented there for you now the ncsbn

identifies four major categories under the heading of client needs and these are safe and

effective care environment your health promotion and maintenance your psychosocial

integrity and your physiological integrity and as you can see some of these categories are further

divided into subcategories and then you'll see the percentage of questions for each

and it does vary by the category but there are a few things that we want to point out

and then we'll provide you with some specifics about content you will be asked on the exam and again

we're going to show you some sample questions so first you can see that the safe and

effective care environment and the physiological integrity categories comprise

the highest percent for this exam so you want to be sure that you're really strong

in the management of care and the safety and infection control area and with the kovid 19 pandemic

you're certainly likely to see a lot of questions on trans transmission precautions so be

sure that you feel really proficient in the theory and the application of these principles

also because physiological integrity is a high percent your most likely to see lots of adult

health questions note that the health promotion and maintenance and the psychosocial

integrity are your lowest percentages so you may or you may not have maternity questions you

may or you may not have mental health questions but then again you can so be prepared

for these areas because they are content areas in the test plan

and remember that everyone's exam is different because your questions are being pulled from an

extremely large pool of questions that the mcsbn houses okay on this next slide we

provided the percentage for the rn and the pn test for the safe and effective care

environment and listed some but not all of the content areas that you will be asked

about so again follow your test plan and as you know

management of care coordinated care addresses content such as advanced directives client

rights confidentiality and privacy issues consents assignments and supervision

and prioritizing and again we want to emphasize here that the safety and infection

control section focuses on all the safety issues as a priority so this is really

important to remember and remember to be sure that you understand the concepts related to

transmission precautions and how as a nurse you would apply these precautions on this next slide we have an example

of the management of care coordinated care question the nurse working on a medical nursing

unit during an external disaster is called to assist with care

for clients coming into the emergency department using principles of triage the nurse

would implement immediate care for a client with which injury

one fractured tibia two penetrating abdominal injury three right red bleeding from a neck

wound and four open massive head injury resulting in deep coma i'll give you

some time to answer that okay so it looks like 53 percent of you selected a bright red bling

bleeding from a neck wound and that is the correct answer so great work now with these types of

questions whether it's in the emergency department or it's out in the field think about

the clients or the victims that you can save the victim with the price the bright red

bleeding which means arterial bleeding from the neck wound is in immediate need of treatment in

order to save that client's life you need to do something the victim with a fractured tibia

requires intervention but there's no data in this question or in the option warranting immediate

intervention so this victim can wait a bit and can probably provide even some of their own

self-care now the client with the penetrating abdominal injury would be classified as

an urgent victim requiring intervention within

120 minutes but not immediately based on the information provided here and the client with an

open massive head injury resulting in deep coma has a minimal chance of survival

so this client will be given supportive care and pain management but is given definitive treatment last

after these other victims are treated okay on this next slide we have an example of

a safety and infection control question the clinic nurse provides home care instructions to the mother of a child

with a diagnosis of chickenpox about preventing the transmission of the virus

which instruction would the nurse provide one isolate the child until the skin

vesicles have dried and crusted two ensure that the child uses a separate bathroom for elimination

three bring all household members to the clinic for a varicella vaccine and four request a prescription

for antibiotics for all household members so let's see what you do with that

okay so looks like 81 percent of you great job have selected the correct answer the correct answer is

option one and you want to remember chickenpox is caused by the varicella zoster virus and transmission

occurs by direct contact with secretions from the vesicles or contaminated objects and also via respiratory tract

secretions but it's not transmitted via urine or feces and that's why option two is incorrect

and the recommended preventative schedule for receiving the varicella vaccine is

12 to 15 months of age for the first dose and four to six years of age for the second dose it is

not administered at the time of exposure to the virus and since it's a viral infection

antibiotics are not used to treat um chickenpox okay so now i'll turn it over to angela to talk about the health

promotion and maintenance category all right thank you very much so you can see here that

we've provided the percentage for the health promotion and maintenance category which is

6 to 12 for both rn and pn and some of the content areas not all of them though

that you'll be asked about are noted here as well which includes developmental stages and transitions

so the growth and development concepts would be important the aging process all normal maternity

and newborn care health screening and risk factors for disease and

the techniques of physical assessment so be sure that you review all of those areas

and then review of course the test plan for any additional content that may be in this

area and moving forward we have a practice question focused on health

promotion and maintenance the nurse is percussing the anterior thorax

and the abdomen for tones and expects to note dullness in which anatomic location so using the

figure here decide if it's a b c or d all right excellent well it looks like

66 percent of you chose the correct answer which is going to be option number three or letter c

percussion involves tapping the body with the fingertips to set the underlying structures in

motion and thus producing a sound dullness would be noted over the liver

which is located in the upper right quadrant of the abdomen resonance is the percussion tone that

you would hear between the ribs and remember that dullness on percussion indicates the presence of an

organ and that will also help you to answer this question all right and now we have

provided here the percentage for you for the psychosocial integrity category for the rn that's going to be

six to 12 percent and for the pn a little bit higher at 9 to 15 percent

some of the content areas might include content such as abuse and neglect or violence

crisis grief and loss in the end of life depression and suicide to name a few and we've listed more here on this slide as

well so now let's take a look at a practice question

focused on psychosocial integrity a client who is demonstrating delusional thoughts

says to the nurse terrorists are sent here to kill me which response would the nurse make to

the client one no one's going to kill you two the medication is making you feel

like this three do you feel afraid that people are trying to hurt you

or four what makes you think that terrorists were sent to hurt you so 57 of you chose the correct answer

which is option number three it's most therapeutic for the nurse to emphasize empathize

with the client's experience and to encourage them to express their feelings disagreeing with them or disagreeing

with the delusions such as in option one may make them feel more defensive

and the client may cling to the delusions even more and so it's not therapeutic medication may be prescribed

to prevent the occurrence of delusions but it doesn't cause the delusions and then

encouraging discussion regarding the delusion as noted in option four would be

inappropriate and non-therapeutic okay so on the next slide linda is going to talk about the physiologic

excuse me physiological integrity categories okay thank you angela now on this slide

we've provided the percentages for the physiological integrity categories and we listed some but not all of the

content areas that you're going to be asked about we're not going to read this slide to

you and we refer you again to the test plan for the specifics but what we want to

again emphasize is that physiological integrity is the largest component of

the test plan and adult health is a primary focus but we do want to point out that you may

also be asked about pediatrics risk conditions associated with

pregnancy such as diabetes preeclampsia prolapsed the prolapsed cord placenta previa

and abruptio placenta so be sure that you read all of the activities listed in the test plan

so on this next slide is an example of a basic care and comfort question the nurse is

inserting an indwelling urinary catheter as the nurse inflates the balloon of the catheter the

client reports discomfort which action would the nurse take

one administer pain medication two remove the syringe from the balloon three deflate the balloon and advance

the catheter and four remove the catheter and reinsert a new catheter

so let's see what you do with that okay so great job eighty percent of you selected option three which is deflate

the balloon and advance the catheter and that is correct so when pain occurs during urinary

catheter insertion it's usually caused by the balloon being inflated within the urethra so in other

words the balloon's not entirely in the bladder yet so if pain occurs the nurse needs to aspirate the fluid from

the balloon and then insert the catheter a little bit further so the balloon can inflate

in the bladder rather than the urethra now administering pain med is really not appropriate in this

situation removing and reinserting the catheter is unnecessary

it's weights wasteful and also it increases the risk of infection for that client

okay on this next slide is an example of a pharmacology question in physiological integrity and we want

to point out that this is an alternate item format question known as a multiple response and these are the

questions that require one or more than one answer thank you answer and possibly

all options could be correct currently partial credit is not given when you supply some but not all of the

correct selections so you need to do exactly as the question

asks and select all that apply now nclex candidates tell us that they receive

15 to 17 even more multiple response questions on their exam and these type are very difficult to answer

but the nclex resources that we showed you and angela presented on the evolv site

provide you with several hundreds of these types of questions and in fact all types of alternate item

questions so let's look at this one which medication instructions would the nurse

provide to a client who has been prescribed level thyroxine select all that apply one monitor your

own pulse rate two take the medication in the morning three

notify the primary health care provider if chest pain occurs four expect the pulse rate to be greater

than 100 beats per minute and five it may take one to three weeks for a full therapeutic effect to occur

okay so now your answer here is options one two option three and option five

so let's take a look at this you did really well um level thyroxine is a thyroid hormone and

it's used to treat hypothyroidism so that's an important point to remember

and the client is instructed to monitor his or her own pulse rate the client's also

instructed to take the medication in the morning before breakfast to prevent insomnia and to take the

medication at the same time each day to maintain those hormone levels

additional instructions include calling the primary health care provider if the heart rate is

greater than 100 beats per minute and notifying the health care provider also if chest

pain occurs because this could mean um overdose the client is also told that full therapeutic effect

may take one to three to three weeks and that he or she

needs to have follow-up thyroid blood studies to monitor therapy and to make sure that the client

is receiving the correct dose okay on this next slide we have an example of a reduction of risk

potential question and physiological integrity a client is scheduled for a renal biopsy

to minimize the risk of post procedure complications the nurse reports which laboratory

result to the primary health care provider before the procedure okay so we have prothrombin time 15

seconds potassium 3.8 meq slash l serum creatinine 1.2 milligrams

per dl and bun 18 milligrams per dl okay you guys did great with that 58

percent of you selected the correct answer which is the pro thrombin time i just want to make a point

here for the nclex rn you're going to see a lab value and then you're going to see

a second value in parentheses with most of your labs this

is called the s i unit or value and the reason it's there is because in canada lab values are reported in

s i units and canadian graduates do take the nclex exam you don't need to worry about bsi units

or worry about learning them again they're there for the canadian nurses

okay so back to this question um post-procedure hemorrhage is a complication after renal biopsy and if

the if the client bleeds you would provide pressure to the site right away

so because of the risk of bleeding the prothrombin time is checked before the procedure the

normal prothrombin time is 11 to 12.5 seconds so the value here is prolonged the values noted in option

2 3 and 4 are all normal values okay and then moving along to the next slide

is an example of a physiological adaptation question in the physiological integrity

component of the exam a client admitted to the emergency department reporting

severe radiated chest pain is restless extremely restless frightened and dyspnia

immediate admission prescriptions include oxygen by nasal cannula at four liters

per minute troponin creatinine phosphokinase and isoenzymes blood levels

a chest x-ray and a 12-lead ecg which action would the nurse take first one obtain the 12-lead ecg

2 draw the blood specimens 3 apply the oxygen to the client and 4 schedule the chest x-ray study

oh excellent work 91 percent of you selected option three and that is the correct

answer you need to remember that the immediate goal of therapy is to prevent myocardial

ischemia therefore your first action would be to apply the oxygen

because the client can be experiencing ischemia the ecg can provide evidence of cardiac

damage and the location of the ischemia however oxygen

is the priority to prevent that further cardiac damage and drawing the blood specimens would be

done after oxygen administration and maybe just before

or just after the ecg depending on the situation and although the chest x-ray can show

some cardiac enlargement having the chest x-ray would not really influence

the immediate treatment that you would give to this client okay so i'm going to turn this over to

angela so she can look at some alternate item questions with you awesome okay so the current rn and

pn test plan both include multiple choice and alternate item format questions you're

likely very familiar with the multiple choice question in which there's four options and there's only one

correct option linda pointed out earlier a multiple response question

as well and so now why don't we take a look at some of the other types on this slide here you'll see a figure

question or an image question so let's try to do this question now the nurse notes this heart rate pattern

refer to figure on the cardiac monitor of a client recently admitted with chest pain

the nurse would take which initial action one notify the primary health care provider

two initiate cardiopulmonary resuscitation three continue to monitor the client and

the heart rate patterns or four administer oxygen with the face mask at eight to ten liters per minute

okay so it looks like 48 of the group chose the correct answer which is option number two and

again this is considered an alternate item because it includes the figure so first look at the strategic word

initial the monitor here is showing ventricular fibrillation

which is a life-threatening dysrhythmia that requires cpr and defibrillation in order to

maintain life although the primary healthcare providers must be notified

cpr would be the initial action here oxygen is necessary but again initiating cpr is of higher priority because

it provides more than just oxygen to the client monitoring the clients necessary but not as the initial action

emergency resuscitative treatment must be provided to the client immediately with

v-fib all right so moving on we have another alternate item called a hot spot so

let's take a look at this one the nurse is assessing the apical heart rate of a client

the nurse places the stethoscope in which anatomical area the directions will tell you to refer to

the figure and then using the mouse point and click on the correct area

so um so the answer is going to be option d the apical heart rate is best assessed by placing the stethoscope in

the mitral area which is located and you can see this on the figure in the fifth intercostal space on the left

side of the chest at the apex of the heart the aortic area is located in the second

intercostal space just right of the sternum the pulmonic area is located in the

second intercostal space but at the left of the sternum and then herb's point is located in the third intercostal space

just left of the sternum so remember the apical heart rate should be assessed for

one full minute that's another important point to remember and the nurse should count the rate as

well as noting its rhythm and then moving forward on the next slide we have a fill in the blank

question and these are questions that ask you to solve a calculation such as a medication

calculation or an intravenous flow rate or even possibly a calculation of intake and output

these questions require you to fill in the blank with a number and it's really important that you

follow the directions provided with the question if the question asks you to round to a

certain point then that's exactly what you're going to want to do

if it does not ask you to do that then type in the answer without rounding if you do have to round always round at

the end at the very end when you've done your calculation

there will be a little box for you to type the answer in and you need to only type in a number as

your answer in the answer box you don't have to worry about typing in the unit of measures such as milliliters

this will be there for you outside of the box and so that also indicates the end unit of measurement

that the calculation is looking for the rules for rounding an answer are provided in the tutorial provided by the

ncsbn and they're also provided in the specific question itself you also want to type in a decimal point if one's

necessary but if it's not necessary what's not necessary is to type a zero

before that decimal point also you want to note that you will have an on-screen calculator

to perform calculations and we definitely highly recommend that you verify your calculations with that

calculator so let's take a quick look at this a physician prescribes a dose of 200

000 units of penicillin g the label on the 10 ml ampule sent from the pharmacy reads

penicillin g 300 000 units per ml how much medication in ml does the nurse prepare to

administer the correct dose round your answer to the nearest tenth so we recommend that you set up this

medication calculation using the formula on the slide desired over available

times the vector which in this case is ml there are other ways that it can be done

as well such as with dimensional analysis for example but you can see here how it's set up

with the two hundred thousand units on the top 300 000 units on the bottom times 1 ml

which comes out to 0.66 which you would then round to the nearest tenth of 0.7 or 0.7

so you could list it as either 0.7 or 0.7 and those both would be correct all right so moving on we have an

ordered response or a prioritizing question these are prioritization questions that

require you to rank the answers in order of priority in this type of question you're asked to

number a list of nursing actions in their order of priority after reading the information presented in the

question you must then determine what you would do first second third and so forth the unordered

options are located in boxes on the left side of the screen and what you would do is you would click

and drag all the options to the ordered response boxes on the right side of the screen

specific directions for moving the options are provided within the question itself and one tip

to answer these types of questions is to visualize the scenario and so to go over the answer to this

question so let's i'll read the question first and um and then i'll just go over the

ordered responses the nurse witnesses a child getting hit in the nose with a baseball

the nurse rushes to the child who's bleeding from the nose in order of priority what actions would

the nurse take arrange the actions in the order that they should be performed and all options must be used

so if a nosebleed occurs in a child it's important for first the nurse to remain calm and keep

the child calm as well otherwise the child can become agitated and it's difficult to get the child to

cooperate with the necessary interventions next the child should be assisted to a

sitting up and leaning forward position to prevent aspiration of blood the child should not be placed in a

lying down position because of the risk of aspiration next nosebleeds usually originate in the

anterior part of the nasal septum and can be controlled by applying pressure to the soft

lower portion of the nose with the thumb and forefinger for at least 10 minutes and then if bleeding persists

cotton or wadded tissue should be placed into each nostril and ice or a cold cloth should be

applied to the bridge of the nose and in addition if bleeding does persist the healthcare provider needs to be

notified and the nose may require packing by the healthcare provider after the nosebleed has stopped

petroleum or a water-soluble jelly may be inserted into each nostril to prevent crusting of the old blood

and to lessen the likelihood of the child picking up the crusted lesions and restarting the bleeding

repeated bleeding episodes that last longer than 30 minutes may be an indication for the need of evaluating

for a bleeding disorder and then finally documentation of the event the actions taken and the child's

response would be next so moving forward we show you a chart exhibit question

these questions these are questions that come with an accompanying chart or an exhibit

that you must refer to and read before you answer the question in this type of question

you're presented with a problem and a chart or exhibit plus tabs or buttons that you must click to

obtain the information needed to answer the question a message will appear to prompt you to

click on a tab or a button so let's look at this one we have a client's chart which you need to read

and then the question that asks about something in the chart so looking at the question the nurse is

reviewing the assessment data on a client who's pregnant which assessment finding does the nurse

recognize as abnormal one the appearance of striae two pale oral mucous membranes three secretion of

colostrum from the breasts or four spontaneous accelerations of the heart rate

so looking at their chart with their physical exam findings you can try to answer this question

all right so it looks like 78 percent of you guys chose the correct answer which is option number two

so you want to note that the question asks you to identify the abnormal data you need knowledge of normal findings in

pregnancy in order to answer this correctly think about what the normal and abnormal

findings are that are listed here the word pale in option 2

also will help to direct you to this option paleness could indicate anemia striae and the secretion of colostrum

are normal findings during pregnancy and accelerations of the fetal heart rate are normal and healthy and indicate

that the fetus has an adequate oxygen supply okay so now moving on we show you an

audio question these are questions accompanied by an audio clip such as breath sounds or

bowel sounds you will have headphones for these questions you can adjust the volume

and you can listen to the sound as many times as you want so let's look at this a nurse is

assessing a client's breath sounds what sound is the nurse hearing okay so it looks like 63 percent of the

group chose strider as the correct answer and so again audio questions require you

to listen to the sound before you're able to answer the question you'll be prompted to use the headset

provided and to select the sound icon and you'll be able to select the volume button adjust the volume for your

comfort you can listen as many times as necessary

um examples of some content that you may be tested on would be lung sounds heart sounds

and vowel sounds all right so next we have a graphic option question these are questions that present graphic

answer options instead of text answer options so you would have pictures as the options

as with all questions on nclex options will be preceded by a circle and you'll use the mouse to

click on the circle that represents your answer choice so let's look at this question a nurse

is planning to insert a nasogastric tube in which position would the nurse place the client for the procedure

it would be one two three or four and it looks like you can do the poll for this question

all right excellent so it looks like 86 percent of you chose the correct answer which is option

number one for this question you would need to know the procedure

for inserting an ng tube and thinking about this type of tube and its purpose where its placement would be

and then looking at the options to best determine that the position would be high

fowlers all right and finally we want to thank you for taking the time to spend with us this evening

and we wish you the very best of luck in your program

and on the nclex we always love to remind our students to stay positive to believe in yourself

remember that you can do this and with that we hope that you stay safe and have a

great night [Music]