NCLEX: What You Need to Know to Prepare for the Exam

The Certified Nursing Assistant Examination, referred to as the Exam, consists of both a written examination (the WE) and the clinical skills test (the CST). You must successfully pass both the WE and the CST to pass the certification examination. Specific details on both the WE and the CST, as well as tips on preparing for each portion, follow.

What You Need to Know to Prepare for the Exam: Taking the Written Examination

Focus topic: What You Need to Know to Prepare for the Exam

The written examination (WE) is a computerized exam with a time limit, usually two hours. Test sites are regional or local, depending on the state jurisdiction. We recommend you follow the instructions given by the testing center without exception and arrive at least 30 minutes early or, if you’re traveling a long distance, arrive a day early to locate the testing center and the most judicious travel route to avoid delays. Two forms of identification are often required, one of which is a picture ID. Because the testing environment is often kept cool, bring a sweater or light jacket for comfort. Remember to leave personal items (purses, cell phones, calculators, and so on) outside the testing areas. You will be furnished with testing materials as needed. Other helpful tips for a successful testing experience are as follows:

. Get a good night’s sleep.
. Don’t work the night before the examination.
. Avoid alcohol or excessive caffeine before the examination.
. Eat a light but well-balanced meal (protein, carbohydrates, and fats plus liquids) while studying and before the Exam. You (and your brain) need energy and maximum recall to be well prepared! Although heavy sugars give you an energy boost, avoid them because you might experience a sudden dip in blood sugar, causing fatigue and nausea. You might also become hungry later when you cannot eat, for example, when taking the Exam. To avoid sudden dips in blood sugar bring protein snacks, such as dry roasted nuts or cheese crackers.

. Take your time with the test questions, but pace yourself to finish the examination within the allotted time.
. Read each question thoroughly and completely before selecting the best answer.
. Don’t panic if you are not familiar with a question. Remember the Testing Now Tips (TNTs) on your Cram Sheet.
. Believe in yourself; we do! You can succeed!

Passing scores for the WE vary from state to state. Expect to earn at least a 70% for a passing score. You might have to wait two to three days for results. If needed, follow directions for scheduling a repeat examination.

To successfully pass the Critical Skills Test (CST), you must earn a score of at least 70% while following each critical step with 100% accuracy. You should be given the opportunity to correct any missed checkpoints or other aspects of the skill during your performance; however, when you have finished a particular skill and progress to the next one, you will not be able to correct a mistake made on the previous one. If you need to repeat any portion of the CST, you’ll receive directions from the evaluator regarding subsequent testing opportunities according to each state’s testing guidelines.

Some helpful tips for success on the CST are as follows:

. Practice, practice, practice!
. Follow each skill/procedure exactly as you learned them in your nurse aide program; this is not the time to improvise or take shortcuts!
. Follow safety standards and include them in your skill performance. This includes, but is not limited to, hand washing, handling of soiled items, and other safety precautions. These are examples of indirect care standards that will be evaluated with each skill. For example, prior to performing a skill, you must actually use water and wash your hands; the evaluator will tell you after you’ve washed your hands correctly for the first time that you can tell him or her when you would wash your hands rather than actually washing them for each subsequent skill.
. Work confidently and efficiently; you must complete each procedure in a timely manner.
. Remember, the skills test is designed to measure your competency; you will not be given assistance by the evaluator except to remind you of time limitations related to the skill performance.
. Imagine getting the good news: You passed! Imagery is a powerful tool to encourage success.

Find a quiet location each day where you can concentrate and review your notes, textbooks, CDs/DVDs, this review book, and any other helpful materials. A good plan is to review for a minimum of two hours each day. Studying in a group is helpful.

What You Need to Know to Prepare for the Exam: Testing Readiness

Focus topic: What You Need to Know to Prepare for the Exam

Answering practice questions at the end of each chapter in this text is one of the best strategies you can use to prepare for success on the WE. For the difficult questions, refer to the textbook and study that content. Pay particular attention to the Exam Alerts as well. Through review of missed practice test items, you might see a pattern of difficulty; for example, medical asepsis. If so, study that chapter in your textbook or other resource. Repeat those questions after further study to see how you progress. Keep repeating the process until you become more confident in your knowledge. Remember, answering every question correctly is not a realistic expectation. To successfully pass the WE, however, you must have sufficient knowledge about a variety of subjects. Use the test outline in the Introduction to help you prioritize the time you spend in reviewing the content. For example, if 35% of the examination covers nursing skills, spend more time reviewing that category than, say, legal/ethical aspects of care, which cover only 3% of the Exam.

Another activity to help measure your testing readiness is to use Appendix A, “Nursing Assistant Test Cross-Reference.” The appendix refers you to the questions in both Practice Examination I and Practice Examination II that match the Exam category. Review your score on the questions asked in each category to see which category requires the most study. Using the same example of medical asepsis, review your responses to questions in both Practice Examination I and II dealing with basic nursing skills. Pay particular attention to those questions that measure your knowledge of medical asepsis and the rationales for the correct response. Next, thoroughly review Chapter 4, “Promotion of Function and Health of Residents,” and Chapter 5, “Specialized Care.” Make flash cards of all terms in the chapters and use them to test your recall of the correct definitions (write the key term on one side of a note card and place the definition of the term on the back of the card). Repeat the drill until you can easily recall the terms. Continue to use Appendix A as a reference for further review of each category in the practice examinations to ensure that you do not omit any area in preparing for the Exam.

Finally, repeat both practice examinations until you score at least 80% of the questions correctly. Earning a score less than 80% means you need further study.

Use the sample 30-day review plan that follows to help organize your study time and increase your knowledge and confidence in being ready for the Exam.

What You Need to Know to Prepare for the Exam: Testing Strategies

Focus topic: What You Need to Know to Prepare for the Exam

Test-taking is a skill you can learn. Based on teaching experience, those students who use test-taking techniques are more likely to succeed on their examinations. The strategies suggested here are in no way a substitute for thorough knowledge of the subject matter. If you study the review materials thoroughly and practice using the suggested strategies wisely while applying your knowledge, you can successfully pass the Exam. Remember the mantra: Practice, Practice, and Practice!

What You Need to Know to Prepare for the Exam: Answering the Questions

Focus topic: What You Need to Know to Prepare for the Exam

The following terms help describe the key parts of a test question, commonly called test items:

  • Test item: The question and the answer options (all possible answer choices)
  • Options: All possible answers to a particular question
  • Stem: The part of the test item that asks a question or states a problem
  • Multiple-choice test item: A question offering four options. Test items are designed to measure your knowledge, attitude, or ability, not to trick you. With the multiple choice test item, it is possible that you might not like the question or any options in the item. However, you must choose the best option available and answer the question in the best way you can.

Follow these strategies (Testing Now Tips [TNTs]) for success in answering test questions.

  • Take your time: A common problem observed in test-takers is failing to read each question carefully. You might already be thinking of the right answer (option) before you finish reading the question in its entirety. Slow down and force yourself to finish reading the question before you select the option; you might be surprised that the end of the stem contains the most important information needed to select the correct option you would have otherwise missed by hurrying to record your answer. In other words, take your time!
  • In your own words: Rethinking the question and answers in your own mind helps you translate the intent of the question, or what the question is asking and how you would answer it in words that mean the most to you. Once you’ve done so, look for the option that is closest to the one you thought about; ask yourself whether that option is the best one available of the four provided. If so, go for it!
  • Stay under the umbrella: Two or more options might be similar and, in your opinion, part of the answer; however, you can choose only one option. If this occurs, look for an option that contains a broader choice, an umbrella term, that includes those similar options and best answers to the question. For example, if the question asks you to measure the resident’s physical status, you would not select option A (temperature) nor option B (pulse), nor option C (blood pressure), but option D (vital signs) that includes the other options.
  • Key into key terms: Very few absolutes occur in patient care, especially when selecting the best test option. These answers are seldom, if ever correct. For that reason, look for key words in the options such as always, never, all, only, most, none, every, and except. If part of the option, choose another one!
  • Opposites attract: Look for opposite options; usually, one of them is correct.
  • Feelings, feelings, feelings: When answering a communication-type question or one requiring a response, choose the option that acknowledges or deals with the resident’s feelings.
  • Safety first: If a test item asks you for an immediate response or for deciding what to do first, choose the option that protects the resident’s safety or well-being. Look for cues in the question that describe priority actions you would take, for example, “The first thing the nurse aide would do is”; “the most important step the nurse aide would take is to…”; “the best action the nurse aide should take is to…”, “which of the following is the nurse aide’s best response?”, and so on.
  • Remember the face value: Avoid reading too much into the test item. You might be tempted to remember a particular work-related or resident experience or situation that was very different from the test option you encounter. Read the item at face value, selecting the best option from the information presented.
  • When all else fails, choose option C: You will encounter questions for which you have no idea of the answer. If so, and all of the preceding listed strategies fail, give it your most educated guess. No evidence exists that choosing option C is the best strategy. The point is, you will not be penalized for guessing, only for not selecting any answer at all. With a multiple-choice question, you have four chances to answer it correctly.

What You Need to Know to Prepare for the Exam: Taking the Clinical Skills Test

Focus topic: What You Need to Know to Prepare for the Exam

The Clinical Skills Test (CST) is the competency validation portion that most certified nurse aide candidates dread; it is nerve racking to perform skills in front of a strange skills evaluator. A key to success on this test is, once again, to practice at least two hours each day. Review each skill you’ve learned so that, when the performance test day arrives, you can consider it just another practice day…only for real. Practice helps build confidence; confidence decreases test anxiety.

Speaking of real, you might be required to bring along someone who can serve as the clinical actor/resident on whom you will perform selected nursing skills. Your testing actor/resident will be briefed prior to the skills examination. Each procedure will be selected by the skills evaluator. Within a specified time limit, around 35–45 minutes, you will perform at least five procedures selected from a pool of 25–30 skills. Each selected procedure will be evaluated and scored according to a skills performance checklist. Although you are not expected to perform each skill perfectly, you must not omit a critical step or key checkpoint of the skill, often noted with an asterisk. A critical step is defined as a step within a procedure that ensures safety of the resident (or yourself), which includes infection control. You can perform steps in a procedure out of sequence as long as infection control or another physical safety principle is not compromised.

What You Need to Know to Prepare for the Exam: Self-Assessment

Focus topic: What You Need to Know to Prepare for the Exam

Before moving on to the remaining chapters of the book, complete the self-assessment Exam Prep Questions that follow to give you a baseline for focus in the upcoming chapters. See how well you recall information as you answer each question. The answer key and rationales are provided for immediate feedback. If you score 75% or better, congratulate yourself and begin reading the chapters with a smile. If you score less than 75%, congratulate yourself for completing the first step in your review journey with an honest appraisal of your knowledge, the “before” in your test readiness. Now, you can use the Exam Prep Questions as a beginning; subsequent questions at the end of each chapter and a mock written examination serve as the “after” story of your progress in preparing for the real Exam. Good luck! Let’s get started!

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