NCLEX: How to Prepare for and Other Nursing Exams

Studying for the NCLEX-RN or other similar exams requires careful planning and preparation. You can make the best use of your time by developing a systematic approach to study that includes these five steps to test for success:

■ Assessing your study needs.
■ Developing a study plan.
■ Refining your test-taking strategies.
■ Rehearsing test anxiety management skills.
■ Evaluating progress on a regular basis.

Use these five steps as you take your first test in nursing school. Refine your test-taking strategies as you evaluate your progress at each step of the way, so that when you are ready to take the licensing exam you will be an experienced and successful test-taker.

How to Prepare for and Other Nursing Exams: Assessing Study Needs

Focus topic: How to Prepare for and Other Nursing Exams

The first step toward test success is to determine your strengths and limitations. Even students who have been successful throughout their academic life, and nurses who are excellent caregivers, have areas in which they need improvement. Be honest with yourself as you assess your own study needs. These steps can help you in your assessment:

■ Review your success in nursing school. Review your record of achievement in courses in the nursing curriculum. Success on the NCLEX-RN tends to correlate with grades (grade point average) achieved in nursing school. Subjects in which you received high grades, that you found easy to learn, or in which you have had additional clinical practice or work experience are likely to be areas of strength. On the other hand, subjects you found difficult to learn (or in which you did not achieve high grades) should be areas for concentrated review. Also consider content areas that you have not studied for a while. Recent course work will be the most familiar and, therefore, may require the least amount of study. All students, even students who have achieved success in nursing courses, benefit from identifying areas requiring study and spending time practicing test-taking skills. You also can use the practice exams in this book to identify areas needing further study. Begin with the subjects you find most difficult or in which you have the least confidence.

■ Assess your test-taking skills. Using effective test-taking skills contributes to exam success. What have you done in the past to make you confident about taking a test? How do you feel when you are in the exam situation? What has worked in the past to help you be successful? Review these strategies to build on past successes and work on problem areas. Consider additional strategies suggested in the section “Refining Your Test-Taking Strategies,”. You can practice these skills by simulating the testing situation using the practice tests and comprehensive exams in this review book.

■ Assess your ability to take tests that require application, analysis, and evaluation. Test questions used on the licensing exam are written at higher levels of the cognitive domain. Many candidates’ experience with taking tests has come from taking “teacher-made” tests—tests developed by the faculty at your school of nursing. These tests are commonly written to test students’ knowledge and understanding of course content and may not include questions that require application, analysis, or evaluation of course material. Additionally, several of the types of alternate-format questions have recently been added to the exam, and nursing faculty may not yet be designing their own test questions using these formats. Finally, some students are able to “second guess” the teacher and use this ability to their advantage when taking teacher-made classroom tests. However, it is not as easy to anticipate test questions on standardized and licensing exams, and you will need to develop skills that will help you think critically when presented with an unfamiliar situation. As you prepare to take the licensing exam, spend time on questions where you need to “figure out” the best approach to answering the question. You can use the questions in this book and CD-ROM to be sure you understand the difference between questions that require only recall and understanding and those that require you to apply information to provide client care, make clinical judgments, and initiate nursing actions.

How to Prepare for and Other Nursing Exams

■ Assess your English language skills. Persons for whom English is an additional language or who do not have well-developed reading and comprehension skills may require additional practice in reading and answering NCLEX-RN-style test questions. If you are one of these persons, plan additional time to practice reading and answering questions, to time yourself when answering questions, and to validate that you understand the question correctly. If necessary, seek assistance.

■ Assess your ability to take timed tests. Are you always the last one to finish a test? Do you request additional time to complete a test? If so, you will want to practice taking timed tests and doing your best, while completing as many questions as possible. The licensing exam is designed to be completed in 6 hours; only questions completed within that time frame will be scored. As you use the practice questions and tests in this book and CD-ROM, time yourself and, if needed, determine ways that you can increase your speed without sacrificing accuracy.

■ Assess your skills for taking computer administered exams. Although previous computer experience is not necessary to take the NCLEX-RN, you should familiarize yourself with the differences between taking a paper-and-pencil exam and taking exams administered by the computer. If you have not used a computer before, find a learning resource center at your college, university, library, or hospital where you can become familiar with basic computer keyboard skills. The CD-ROM accompanying this book, which simulates the computerized NCLEX, offers you the opportunity to practice taking computer-administered test questions. Use it to practice reading questions from the computer screen and become acquainted with answering questions in a computerized format. If you are accustomed to underlining key words or making notes in the margins of paper-and-pencil tests, adapt these strategies to reading and answering the questions on the computer screen. Also be sure that you can use a drop down calculator to answer questions requiring the use of math skills.

How to Prepare for and Other Nursing Exams: Developing a Study Plan

Focus topic: How to Prepare for and Other Nursing Exams

Once you have identified areas of strength and areas needing further study, develop a specific plan and begin to study regularly. Students who study a small amount of content over a longer period of time tend to have higher success rates than students who wait until the last few weeks before the exam and then “cram.” Consider these suggestions:

■ Identify a place for study. The area should be quiet and have room for your books and papers. This area might be in your home, at your nursing school, at your workplace, or in a library. Be sure your friends and family understand the importance of not interrupting you when you are studying.

■ Establish regular study times. Make appointments with yourself to ensure a commitment to study. Frequent, short study periods (1 or 2 hours) are preferable to sporadic, extended study periods. Plan to finish your studying 1 week before the NCLEX-RN; last-minute cramming tends to increase anxiety.

■ Obtain all necessary resources. As you begin to study, it is helpful to have easy access to textbooks, notes, and study guides.

■ Make the best use of your time. Make review cards that you can carry with you to study during free moments throughout the day. Some students record review notes and listen to the tapes or Podcasts while driving or exercising.

■ Reduce or eliminate stressful situations. Students who are juggling multiple responsibilities (such as working, managing a family, taking courses, planning a wedding, or caring for elderly parents) may find it difficult to find time to study or to concentrate when studying. Managing a variety of stressful situations puts students at risk for failing exams. If possible, reduce the number of stressful situations you are involved in during the time you are preparing to take the NCLEX-RN exam.

■ Develop effective study skills. Study skills enable you to acquire, organize, remember, and use the information you need to take the NCLEX-RN. These skills include outlining, summarizing, applying, synthesizing, reviewing, and practicing test taking strategies. Use these study skills each time you prepare for an exam.

■ Use study skills with which you are familiar and that have worked well for you in the past. Recall effective study behaviors that you used in nursing school, such as reviewing highlighted text, outlines, or content maps.

■ Study to learn, not to memorize. The NCLEX-RN tests application and analysis of knowledge. When reviewing content, continually ask yourself, “How is this information used in client care?” “What clinical decision-making will be required of this information?” and “What is the role of the nurse in using this information?” Being able to apply information, rather than just being able to list or recognize information, is one of the most important study skills to master.

■ Identify your learning and study style preferences. Each student has a preferred way of learning. For example, some students prefer learning material by listening; they are considered auditory learners. If this describes your preference, you will benefit from reviewing taped notes or class lectures. Some students learn best in a visual mode. They learn by reading, reviewing slide presentations, or looking at illustrations. For these visual learners, reading and looking at images is helpful. Kinesthetic learners, those who like to touch and manipulate to learn, benefit from working with models and manikins to reinforce their learning. While you likely have one learning style and study preference, using a variety of styles will enhance the study experience.

■ Some students prefer to study alone, whereas others benefit from study groups; know which approach works best for you and develop your study plan accordingly. If you participate in a study group, limit the group. The group should develop norms for working together that focus on understanding and applying nursing content, rather than memorizing facts. Every member must come prepared to contribute.

■ Anticipate questions. As you study, formulate questions around the content. Practice giving a rationale for your answer to these questions. If you work in a study group, have each member contribute questions that the entire group answers.

■ Study common, not unique, nursing care situations. The NCLEX-RN tests minimum competence for nursing practice; therefore, focus on common health problems and client needs. Review the RN Practice Analysis, published by the National Council of State Boards of Nursing, and the current licensing exam test plan to determine common nursing care activities.1

■ Simulate test-taking. The comprehensive tests in Part Three of this book and the CD-ROM are designed to simulate the random order in which questions appear in the NCLEX-RN. Use these resources to focus on areas of common concern in nursing care rather than on the traditional content delineation of adult, pediatric, psychiatric, and childbearing clients. Make additional copies of answer sheets, and retake the exams on which you had low scores.

How to Prepare for and Other Nursing Exams: Refining Your Test-Taking Strategies

Focus topic: How to Prepare for and Other Nursing Exams

Knowing how to take a test is as important as knowing the content being tested. Strategies for taking tests can be learned and used to improve test scores. Here are some suggestions for building a repertoire of effective test-taking strategies:

■ Understand the type of test item and the cognitive level and related thinking processes.

■ Understand which integrated process (step of the nursing process, caring, communication, documentation, teaching/learning) is being tested. For example, as you read the question, determine whether the question is asking you to set priorities (planning) or judge outcomes (evaluation).

■ Understand client needs. As you read the question, consider the question in the context of client needs. Be sure to understand if the question is asking you to determine what to do “first” or to select the nursing action that is “best.”

■ Understand the age of the client noted in the test question. If relevant to answering the question, the age of the client will be specified; consider what information about that age-group will be important to answering the question. If the age of the client is not specified, assume that the client is an adult and base your answers on principles of adult growth and development.

■ Read the question carefully. This is one of the most important aspects of effective test taking. Do not rush. Ask yourself, “What is this question asking?” and “What is the expected response?” If necessary, rephrase the question in your own words.

■ Do not read meaning into a question that is not intended, and do not make a question more difficult than it is. If you do not understand the question, try to figure it out. If, for example, the question is asking about the fluid balance needs of a client with pheochromocytoma and you do not remember what pheochromocytoma is, then try to answer the question based on your knowledge of principles of fluid balance.

■ The exam questions reflect national nursing practice standards and are not written to test knowledge of procedures or practices at specific health care agencies. Thus, it is important to answer the question from the framework of best nursing practice, not unique practices or procedures that are specific to one clinical agency.

■ Determine if the question is asking you to set priorities or place steps of a procedure in a particular order. Read the stem of the question carefully and be clear about the priority (first, last) or order (first, last) in which you are to answer the question. Base your answer on commonly used nursing frameworks for setting priorities, such as the nursing process: assess, plan, implement, evaluate; Maslow’s hierarchy of needs; physiological, safety and security; love and belonging, self-esteem; self-actualization; principles of emergency care: breathing, bleeding, circulation; principles of triage: resuscitation, emergent, urgent, less urgent, non-urgent; fire response priorities: rescue, alarm, confine, extinguish; role of the nurse vs. role of the physician, vs. role of the licensed practical nurse (LPN) and unlicensed assistive personnel (UAP); or procedures for delegation: scope of practice, workload, ability, follow up.

■ Look for key words that provide clues to the correct answer. For instance, words such as “except,”“not,” and “but” can change the meaning of a question; words such as “first,” “next,” and “most” ask you to establish a priority or use an order or sequence of steps; key words such as “most likely” or “least likely” are asking you to determine a probability of a successful outcome. When the question asks you to “select all that apply”, be sure you are considering each option as having the possibility of being correct, and have ruled out the ones you have not selected as being incorrect.

■ Be certain you understand the meaning of all words in the question. If you see a word you do not know, try to figure out its meaning from a familiar base of the word or from the context of the question.

■ Attempt to answer the question before you see the answers, and then look for the answer(s) (hot spot and graphics) that is/are similar to the one(s) you generated.

■ Eliminate answers that you know are not correct.

■ Base answers on nursing knowledge. Remember that the NCLEX-RN is used to test for safe practice and that you have learned the information needed to answer the question.

■ If you do not know an answer, make a reasonable guess. Hunches and intuition are often correct. Do not waste time and energy; give yourself permission to not know every question, and move on to the next one. In CAT, you must answer each question before the next item is administered, and because the level of difficulty will be adjusted as you answer each question, it is likely that you will know the answer to one of the next questions.

How to Prepare for and Other Nursing Exams: Strategies for Managing Test Anxiety

Focus topic: How to Prepare for and Other Nursing Exams

All test takers experience some anxiety. A certain amount of anxiety is motivating, but be prepared to control unwanted anxiety. Anxiety can be managed by both physical and mental activities. Practice anxiety management strategies while you are taking the comprehensive examinations in this book, and use them with each exam you take in school or elsewhere. Practicing managing test anxiety when taking “low stakes” tests, such as classroom tests, will make managing test anxiety much easier when you are taking the “high stakes” tests, such as course or program final exams and, of course, the licensing exam. Commonly used anxiety management strategies include:

Mental rehearsal—Mental rehearsal involves reviewing the events and environment during the examination. Anticipate how you will feel, what the setting will be like, how you will take the exam, what the computer screen will look like, and how you will talk to yourself during the exam. Visualize your success. Rehearse what you will do if you have test anxiety.

Relaxation exercises—Relaxation exercises involve tensing and relaxing various muscle groups to relieve the physical effects of anxiety. Practice systematically contracting and relaxing muscle groups from your toes to your neck to release energy for concentration. You can do these exercises during the exam to promote relaxation. Smile! Smiling relaxes tense facial muscles and reminds you to maintain a positive attitude.

Deep breathing—Taking deep breaths by inhaling slowly while counting to 5 and then exhaling slowly while counting to 10 increases oxygen flow to the lungs and brain. Deep breathing also decreases tension and helps manage anxiety by focusing your thoughts on the breathing and away from worries.

Positive self-talk—Talking to yourself in a positive way serves to correct negative thoughts (e.g., “I can’t pass this test” and “I don’t know the answers to any of these questions”) and reinforces a positive self-concept. Replace negative thoughts with positive ones, for example, tell yourself, “I can do this,” “I studied well and am prepared,” or “I can figure this out.” Visualize yourself as a nurse—you have passed the test!

Distraction—Thinking about something else can clear your mind of negative or unwanted thoughts. Think of something fun, something you enjoy. Plan now what you will think about to distract yourself during the exam.

Concentration—During the exam, be prepared to concentrate. Have tunnel vision. Do not worry if others finish the test before you. Remember that everyone has his or her own speed for taking tests and that each test is individualized. Do not rush; you will have plenty of time. Focus; do not let noises from the keyboard next to you divert your attention. Do not become overwhelmed by the testing environment. Use positive self-talk as you begin the exam. Some students become bored during the exam and then become careless as they answer questions toward the end of the exam. Practice taking tests of at least 265 questions and discover how long you can focus your attention on the test questions. Practice taking breaks if you begin to lose your concentration.


How to Prepare for and Other Nursing Exams: Evaluating Your Progress

Focus topic: How to Prepare for and Other Nursing Exams

The last step of your study plan is to check your progress. Note if your scores on the practice and comprehensive tests improve. Do not spend time on content you have mastered, on areas in which you obtained high scores on the practice exam, or on areas with which you feel confident. Use the results of your evaluation to set priorities for study on areas needing additional review. As noted above, evaluate your study skills, your test taking abilities, and the use of test-anxiety management strategies as you take each test throughout your academic program. Doing so now will prepare you to test for success.

How to Prepare for and Other Nursing Exams: Tips from Students Who Have Passed the NCLEX-RN®

Focus topic: How to Prepare for and Other Nursing Exams

Students who have successfully passed the NCLEX-RN offer these tips for preparing for, and taking, this exam:

■ Study regularly several months before taking the exam. Be sure you are well prepared. Accept responsibility for your study plan—being prepared is up to you!

■ Practice taking randomly generated test questions. Most students are accustomed to taking teacher-made exams that cover several topics in the same content area. When taking the NCLEX-RN examination, however, each question will come from a different topic or content area, and you will need to be prepared to shift your focus to a different practice area for each question.

■ Use practice questions until you can score at least 75% on the exam. Use practice exams with at least 2,000 questions so you test yourself with a wide range of content and types of questions.

■ Use a timer to determine how many questions you can answer in a specified amount of time. Use the timer to be sure you are keeping a steady pace, but not rushing through the test.

■ Schedule to take the exam when YOU are ready, but as soon after graduation as is feasible.2 Candidates who take the exam before they are prepared are not as successful. You are in control of when you take the exam!

■ Make sure you know the date, time, and place the exam will be given; how to get to the exam site; how long it takes to drive there; and where you can park. It may be helpful to visit the exam site and see the room where the exam will be given.

■ Visualize yourself in the room taking the test. Use mental rehearsal to practice anxiety-managing strategies.

■ Organize the information you will need to bring to the testing center the night before the exam. You will need to present your Authorization to Test. You will also need to provide required identification.

■ Make sure you are physically prepared. Get enough rest before the examination; fatigue can impair concentration. If you work, it may be advisable not to work the day before the exam; if you work on a shift that is different from the time of the exam, adjust your work schedule several days ahead of time.

■ Avoid planning time-consuming activities (e.g., weddings, vacation trips) immediately before the exam.

■ Do not use any drugs you usually do not use (including caffeine and nicotine), and do not use alcohol for 2 days before the exam.

■ Eat regular meals before the exam. Remember that high-carbohydrate foods provide energy, but excessive sugar and caffeine can cause hyperactivity.

■ Dress comfortably, in layers that can be added or removed according to your comfort level. The authors of this review book and CD-ROM offer you our best wishes for success on all of the exams you will be taking throughout your academic career. We are confident that your review and preparation have given you a good foundation for a positive testing experience!













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