How to Master NCLEX-Style Test Questions
| Maura Deering
Nurses must pass the National Council Licensure Examination (NCLEX) to become licensed. Registered nurses take the NCLEX-RN, while licensed practical nurses (called licensed vocational nurses in some states) sit for the NCLEX-PN. Both exams test a candidate's nursing knowledge and practice readiness in four focus areas: providing a safe and effective care environment, health promotion and maintenance, psychosocial integrity, and physiological integrity.
While multiple-choice questions comprise most of the exam, other formats may be included. The exam follows a variable question format in which the computer adapts to the test-taker's performance with increasingly difficult questions, continuing until the computer reaches 95% certainty of a passing score.
This guide focuses on NCLEX test-taking strategies, with advice from nurses who have passed the NCLEX-RN exam. While the NCLEX-RN has 74-145 questions, Alaina Ross, an RN and expert contributor for Test Prep Insight, advises test-takers not to worry.
"Do not automatically assume you failed if the exam goes past 75 questions," she says. "Stay focused, stay positive, and keep trucking."
The exam will shut off when it reaches a 95% certainty of a passing score or if the test-taker misses too many questions to achieve a passing score.
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How Learning Styles Help in Test Taking
Anne Dabrow Woods, chief nurse at Wolters Kluwer, Health Learning, Research and Practice, suggests that nurses preparing for the NCLEX acknowledge their learning style and stick with methods that have worked in the past. Styles include auditory, kinesthetic, visual, or a combination of styles and study habits.
"Some tried and true methods are using mnemonics, drawing out concepts or relationships, using the teach-back method where you teach someone else about concepts and applications, or using flashcards," Dabrow Woods says.
"As adult learners," Dabrow Woods adds, "we retain more information if we use a variety of study methods to learn information."
NCLEX Test-Taking Strategies
When trying to improve your test-taking skills, it may help to identify the components of a multiple-choice question:
The stem is the part that asks the question
In addition to the correct answer, there will also be:
The case (patient's situation or scenario)
Distractors (choices that are actually wrong or not the best answer)
It is easier to analyze a question once you have identified each part. Read the stem at least twice to thoroughly understand the question.
Below are key strategies to use while taking the NCLEX.
One of the most effective NCLEX strategies involves focusing on keywords. "For instance, if the question asks for an intervention, look for the answer that is an intervention," Dabrow Woods advises. Answers that emphasize signs and symptoms, or anything other than an intervention, can be eliminated right away, she says.
Identify Repeated Words
Examinees should pay close attention to repeated words and synonyms that appear in both questions and answers. For example, for a question that contains "signs," the right answer may include "symptoms."
"Test-takers have a tendency to read too much into answer choices and overanalyze," says Ross. "Do not fall into this trap!"
Do Not Second Guess Yourself
Do not second guess what is being asked, cautions Dabrow Woods, and do not change your answers. "The first answer is usually the correct one if you have taken the time to reason through the question," says Dabrow Woods.
Ross advises, "Read each answer choice and pick the best choice based on instinct."
Look for Opposite Answers
If two of the answer choices have opposites, like increased heart rate or decreased heart rate, one of the two choices is usually the correct answer. Correctly answering NCLEX-style questions requires familiarity with all the types of questions you may see on the exam, says Ross.
Read the Entire Question Before Answering
"Read the entire question before focusing on the answer," says Dabrow Woods. Examinees who do not thoroughly read the questions may miss a keyword or phrase or misinterpret the question's focus.
"Whether you are taking a practice test or the real NCLEX exam, make sure you understand what the question is really asking," advises Dabrow Woods.
Eliminate distractors first in the answer choices and then focus on any options that might be correct. Dabrow Woods advises examinees to read the question and answers, "then start eliminating the distractors that are not correct."
For instance, Dabrow Woods suggests, "If the question asks for an intervention but some of the distractors are signs and symptoms, eliminate those distractors and focus on the one distractor that most closely resembles the right answer."
Use Prioritization Techniques
Questions using words such as initial, first, and best are asking for your prioritizing skills. The choices are usually all correct but only one should be done first. When prioritizing, you should consider the following:
- ABC's (Airway, Breathing, and Circulation)
- Patients with airway problems or interventions to provide airway management receive top priority.
- Maslow's Hierarchy of Needs
- Physiologic needs (pain, food, sleep) come first before safety and security and psychosocial problems. This is typically used in complex patients with multiple problems.
- Nursing Process
- Assessment should always be done before planning anything or instituting interventions. Ask yourself if you would need to collect more assessment data on this patient before jumping into an intervention or calling the doctor.
In the NCLEX world, you are one nurse with only one patient, and all the orders you need are written. The only time the nurse would need to call the doctor is after intervention has failed and there is nothing else the nurse can do. Never call a physician about something that is expected with the disease process. It is essential for nursing students to know the expected signs and symptoms of a disease versus signs and symptoms of potential complications.
Tips From Nurses Who Mastered the NCLEX
- Manage Your Stress
- Take the day before the exam off; stop studying and relax.
- Dabrow Woods says, "Practice relaxation breathing so when you start to become stressed, you can easily manage it down to an acceptable level." She also advises eating "something with protein and carbs prior to going into the exam so you don't experience hypoglycemia."
- Control the Things You Can Control
- Dabrow Woods and other nurses recommend taking a formal NCLEX prep course. "Choose one that follows the NCLEX blueprint, has many practice questions and tests, and has a proven track record," says Dabrow Woods.
- She also suggests filling up your gas tank the night before and taking a practice drive to the location.
- Practice, Practice, Practice!
- "Practice tests will identify the areas where you should take time to prep," says Dabrow Woods. "Schedule at least two hours per day to devote to studying."
- Ross agrees and says that practice helps you gauge your strengths and weaknesses. "This will then guide which areas you need to focus on to see improvement," she says.
- Do Not Overthink Questions
- According to Ross, "Overanalysis and reading too much into answer choices kills NCLEX test-takers."
- "Many times, test-takers overthink questions by questioning what is being asked or thinking about a real-life experience they have encountered in practice," Dabrow Woods states. "Don't second guess what is being asked and don't bring your personal experience into the question scenario."
- Test Early
- Schedule your exam as soon as possible after your nursing program ends. This is the time when the material will be freshest in your mind, and early testing means less study time relearning information.
- "The NCLEX is most easily mastered through practice by doing rather than by content review," says Ross.
- Understand COVID-19 Changes
- "The exam is several hours in length," Dabrow Woods reminds candidates.
- But test-takers must wear masks when inside the testing center and may wear gloves. Testing centers will implement social distancing and sanitizing and also limit the number of test-takers permitted in the centers. The test content and format should not change.
Meet Our Contributors
Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN
A nurse for over 35 years and a board-certified nurse practitioner since 1998, Dr. Dabrow Woods practices as an acute care/critical care nurse practitioner for Penn Medicine, Chester County Hospital. She also serves as adjunct faculty in the graduate nursing program at Drexel University and precepts nurse practitioner and DNP students. Dr. Dabrow Woods is the chief nurse of Wolters Kluwer, Health, Learning, Research and Practice, a global company that produces and publishes information for healthcare professionals in education, practice, and research.
Alaina Ross, RN, BSN
Alaina Ross, RN, BSN, has 10 years of experience as a post-anesthesia care unit nurse. Ross is also an expert contributor for Test Prep Insight, a test prep company that helps students pass exams like the Test of Essential Academic Skills and NCLEX.
Elizabeth Clarke, FNP, MSN, RN, MSSW
Elizabeth Clarke, FNP, MSN, RN, MSSW, is a board-certified family nurse practitioner. A native of Boston, Massachusetts, Clarke tired of the cold and snowy winters and moved to Coral Gables, Florida to complete her undergraduate degree in nursing at the University of Miami. After working for several years in the UHealth and Jackson Memorial Medical systems in the cardiac and emergency room units, Clarke returned to the University of Miami to complete her master of science in nursing (MSN). Since completing her MSN degree, Clarke has worked providing primary and urgent care to pediatric populations.
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