© ARLOU_ANDREI/Shutterstock.comDissecting NCLEX-RN questions
The key to answering an NCLEX-RN question is dissecting what it’s asking about meaning and pathophysiology. Look for the following to identify the keywords that help you figure out what the question is asking and choose the correct answer.
- Client: Who is the client? You can then limit your answer to this group.
- Condition/procedure: How does it affect the client? Is there a complication?
- Signs and symptoms: Do they match the condition, procedure, or a complication?
- Medications: Are they the medications given for the condition, procedure, or complication? Do they have side effects that are in the question? Do they affect labs?
- Labs: Are they related to the condition, procedure, or complication? Are they related to any medications listed in the question?
Steps of the nursing process
As you take the NCLEX-RN exam, remember the five-step nursing process that was in everything you learned at nursing school. Here’s a nursing process refresher:
- Assessment Collect data, verify data, and communicate information.
- Organization/Analysis Cluster data, interpret data, collect additional data, and communicate information.
- Planning Identify goals, project expected outcomes, set priorities, and identify interventions.
- Implementation Implement nursing care.
- Evaluation Identify patient response to nursing care, compare actual outcome with expected outcomes, analyze factors that affected the actual outcomes of care, and modify the plan as necessary.
3-Step method for med calculations on the NCLEX-RN
You won’t find a lot of math on the NCLEX-RN, but you do want to know how to calculate medication dosage. Here’s a three-step process for making med calculations:
- Ask yourself, “Is a conversion necessary?” If the measurements are in different systems or units, do the conversion before moving on to the next step.
- Calculate the converted dosage using the following formula:
(Dose ordered ÷ Dose on hand) × Amount on hand = Amount to administer - Ask yourself, “Does the answer make sense?” If it does, well done! If it doesn’t, start from the beginning, check your numbers, and try again.
Common measurement equivalents
The following table shows you common conversions used for the math for pharmacology on the NCLEX-RN exam. You want to be familiar with these conversions and know how to use them in medication calculations on the test.
| 1 cubic centimeter (cc) | = | 1 milliliter (ml) |
| 1,000 milliliters (ml) | = | l liter (L) |
| 1 L | = | 1 quart (qt) |
| 30 ml | = | 1 ounce (oz) |
| 240 ml | = | 8 oz |
| 5 ml | = | 1 teaspoon (tsp) |
| 1,000 micrograms (mcg) | = | 1 milligram (mg) |
| 60 mg | = | 1 grain (gr) |
| 1,000 mg | = | 1 gram (g) |
| 1,000 g | = | 1 kilogram (kg) |
| 1 kg | = | 2.2 lbs |
Normal arterial blood gas values
Knowing the arterial blood gas values is invaluable for nursing students while taking the NCLEX-RN. The ability to figure out what acid-base imbalance the client is in helps you answer questions and know what nursing interventions need to be done.
| Arterial Blood Gas | Normal Range |
| PH | 7.35–7.45 |
| PCO2 | 35–45% |
| PO2 | 75–100% |
| HCO3 | 22–26 mEq/L |
| O2 Sat. | 95–100% |
Normal results for a common blood test
Lab ranges for varying tests are important to know for the NCLEX-RN. The following table gives you a starting point, but remember that the ranges used on the NCLEX exam may differ depending on the age, sex, and ethnicity of the client.
| Blood Counts | Normal Range |
| Hemoglobin (HgB) | Male: 13–17 g/dl Female: 12–15 g/dl |
| Hematocrit (HCT) | Male: 40–50% Female: 38–44% |
| Red blood cells (RBCs) | 3.6–5 million cells/mcL |
| Platelets | 150,000–400,000 mcL |
| White blood cells (WBCs) | 5,000–10,000 cells/mcL |
Quick do’s and don’ts for evaluating NCLEX-RN answer choices
As with any multiple-choice test, you may find yourself looking at NCLEX-RN answer choices and feeling stumped. Here are some tips for assessing the answer choices so you can narrow down the options:
- Do think before answering; the obvious answer isn’t always the correct one.
- Do key in on what the question is asking.
- Do use your real-world experience to visualize the patient described in a question, but choose the answer that you’d be most likely to find in a textbook.
- Do focus on the patient, not on the nurse.
- Do prioritize patients over equipment.
- Do choose an answer that acknowledges the client, shows open-ended communication, and encourages discussion and expression of feelings.
- Do choose the answer with the broadest focus, called an umbrella option. One answer usually encompasses more correctness than the others.
- Do pay attention to qualifying words in the question stem, such as first, most, initial, highest priority, “better, and These words are part of the keywords you’re looking for! They signal that the question is a priority question.
- Do pay attention to negative words in the question stem. For example, “needs more teaching” or “intervene when” signals that the question is asking for incorrect information.
- Do look for keywords regarding who the client is; what condition, procedure, or complication is present; and what symptoms, medications, and/or labs may be pertinent to the client.
- Do read the answers only twice: once to see what’s there and once to mark the answer.
- Do look for the proper sequence of actions and follow the nursing process.
- Don’t be quick to call the physician. (The people who write this exam want to know what the nurse should do, not what the doctor would do.)
- Don’t look for the correct response; rather, eliminate all the wrong answers.
- Don’t choose answers that make a patient seem unworthy or ignorant.
- Don’t choose answers that have absolutes, such as always, all, every, never, only, and
- Don’t choose an option that’s presented differently than the others.
- Don’t look at other answers after you’ve marked yours; they’ll distract you.
5 “rights” of delegation for nurses
As a nurse these days, you don’t have to provide all the care a patient needs simply because he or she is your assigned patient — you can get some help. When delegating tasks to RNs, LPNs, and unlicensed assistive personnel, you need to consider the following:
Right task
Right person
Right direction or communication
Right supervision and feedback
Right circumstances
6 “rights” of medication administration. . . and then some
The six “rights” of medication administration are one of nursing’s most basic principles. Not all textbooks include documentation on the list, but it’s good to know.
Right patient
Right drug
Right dose
Right route
Right time
Right documentation
You might’ve heard about a few more medication administration “rights,” added to help ensure the safety of all clients in medical care.
Right history and assessment
Right to refuse medication
Right drug-to-drug interaction
Right education
The functions of electrolytes
When you’re taking the NCLEX-RN, understanding electrolytes is key. Use the following table as a quick reference on what these electrolytes do. Pay special attention to calcium, potassium, and magnesium, three main electrolytes that affect the ECG.
| Electrolyte | Function |
| Calcium | Helps stabilize blood pressure and control skeletal muscle contraction. Used for building strong bones and teeth. |
| Chloride | Maintains acid-base balance and fluid balance with potassium |
| Magnesium | Influences metabolism of the nucleic acids and proteins. Also helps with regulating muscle contraction, heart rhythm, and nerve function. |
| Potassium | Controls cellular osmotic pressure. Affects regulation of heartbeat, muscle function, and the nervous system. |
| Sodium | Influences the kidneys, regulation of the body’s water, and electrolyte status |
