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NCLEX-RN For Dummies with Online Practice Tests (2020)

NCLEX-RN For Dummies with Online Practice Tests (2020) is your essential resource for acing certification exams with confidence.

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    NCLEX-RN For Dummies®, 2nd Edition with Online Practice Published by: John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030-5774, www.wiley.com Copyright © 2020 by John Wiley & Sons, Inc., Hoboken, New Jersey Media and software compilation copyright © 2020 by John Wiley & Sons, Inc. All rights reserved. Published simultaneously in Canada No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise, except as permitted under Sections 107 or 108 of the 1976 United States Copyright Act, without the prior written permission of the Publisher. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748-6011, fax (201) 748-6008, oronlineathttp://www.wiley.com/go/permissions. Trademarks: Wiley, For Dummies, the Dummies Man logo, Dummies.com, Making Everything Easier, and related trade dress are trademarks or registered trademarks of John Wiley & Sons, Inc., and may not be used without written permission. All other trademarks are the property of their respective owners. John Wiley & Sons, Inc., is not associated with any product or vendor mentioned in this book. LIMIT OF LIABILITY/DISCLAIMER OF WARRANTY: WHILE THE PUBLISHER AND AUTHOR HAVE USED THEIR BEST EFFORTS IN PREPARING THIS BOOK, THEY MAKE NO REPRESENTATIONS OR WARRANTIES WITH RESPECT TO THE ACCURACY OR COMPLETENESS OF THE CONTENTS OF THIS BOOK AND SPECIFICALLY DISCLAIM ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. NO WARRANTY MAY BE CREATED OR EXTENDED BY SALES REPRESENTATIVES OR WRITTEN SALES MATERIALS. THE ADVICE AND STRATEGIES CONTAINED HEREIN MAY NOT BE SUITABLE FOR YOUR SITUATION. YOU SHOULD CONSULT WITH A PROFESSIONAL WHERE APPROPRIATE. NEITHER THE PUBLISHER NOR THE AUTHOR SHALL BE LIABLE FOR DAMAGES ARISING HEREFROM. For general information on our other products and services, please contact our Customer Care Department within the U.S. at 877-762-2974, outside the U.S. at 317-572-3993, or fax 317-572-4002. For technical support, please visit https://hub.wiley.com/community/support/dummies. Wiley publishes in a variety of print and electronic formats and by print-on-demand. Some material included with standard print versions of this book may not be included in e-books or in print-on-demand. If this book refers to media such as a CD or DVD that is not included in the version you purchased, you may download this material at http://booksupport.wiley.com. For more information about Wiley products, visit www. wiley. com. Library of Congress Control Number: 2020941814 ISBN: 978-1-119-69282-9 (pbk) ISBN: 978-1-119-69280-5 (ebk); ISBN 978-1-119-69269-0 (ebk) Study.

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    NCLEX-RN For Dummies® with Online Practice To view this book's Cheat Sheet, simply go to www.dummies.com and search for “NCLEX-RN For Dummies Cheat Sheet” in the Search box. Table of Contents Cover Introduction About This Book Foolish Assumptions Icons Used in This Book Beyond the Book Where to Go from Here Part 1: Demystifying the Complexity of the NCLEX-RN Chapter 1: Meet the NCLEX-RN: Your Ticket to Getting a License The Big Deal behind the Big Exam You Must Remember This: Nursing Basics to Know by Heart The NCLEX-RN — Not Your Average CAT Scan! Thinking the NCLEX-RN Way When All Is Said and Done Chapter 2: Preparing for T-Day: Paperwork and Whatnot How Long Should | Wait after | Graduate? Deciding When to Test Applying to Take the NCLEX-RN Scheduling the Time and Place Planning Ahead for the Big Day Help, My Car Won't Start! Rescheduling the Test Chapter 3: The NCLEX-RN Blueprint Considering the Four Main Categories of Client Needs Queuing Up Question Types Chapter 4: Buffing Up: Study Tips and Test-Taking Strategies Setting Up an NCLEX-RN Study Schedule Identifying Your Weak Points and Hitting the Books Remembering Dear Maslow and His Needs Applying the Nursing Process in Test Questions

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    Dissecting the Questions and Finding Keywords Developing Critical-Thinking Strategies Avoiding Test Question Pitfalls Part 2: Testing Your Knowledge of Client Needs Chapter 5: Management of Care First Things First: Knowing Your Patient's Rights Rallying the Troops: Managing Care Recognizing Legal Rights and Nursing Responsibilities Knowing Where to Get the Support You Need Chapter 6: Safety and Infection Control Preventing Accidents and Injuries Disaster Planning and Emergency Response Keeping Infectious Bugs at Bay Keeping Clients Down in a Way That Lifts Them Up Accidents Happen: Knowing the Next Steps and Preparing an Incident Report Code Pink: Understanding the Protocol for Infant Abduction Chapter 7: Health Promotion and Maintenance Surveying the Stages of Growth and Development To Your Clients’ Health! Promoting Well-Being Creating and Implementing Care Plans Handling High-Risk Behavior and Alternate Lifestyle Choices Preparing Patients to Leave Your Care Chapter 8: Psychosocial Integrity Looking Beyond the Surface: Factors That Influence Behavior Coping, Counseling, and Crisis Intervention Helping Patients through Grief and Loss Caring for Patients with Abuse Issues Chapter 9: Basic Care and Comfort Giving Patients First What They Need Most Ensuring Adequate Nutrition and Hydration Resting Easy, Sleeping Soundly Keeping 'em Clean: Personal Hygiene Understanding the Process of Elimination Wading through Irrigations Providing Holistic Care with Alternative and Complementary Medicine Decreasing Pain without Pills Helping Patients Get Around (and What to Do if They Can't)

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    Chapter 10: Meditating on Meds: Pharmacological and Parenteral Therapies Remembering the Factors You Must Verify before Giving Meds Medicating Patients Safely Using Medicine to Manage Pain Giving Meds and More with a Stick and a Poke: Parenteral Therapy Chapter 11: Reduction of Risk Interpreting Lab Results without a Hitch Recognizing the Main Diagnostic Assessments Being Ready for the Bumps: Complications with Testing and Treating Taking a Load Off: Therapeutic Procedures and Diagnostic Tests Administering Conscious Sedation Safely Chapter 12: Physiological Adaptation Understanding What's Normal So You Know What Isn't Anticipating the Results of Imbalance Pathophysiology: Recognizing and Managing lliness and Disease Taking a Patient for Tests and Therapy Part 3: Just What You Were Looking For: A Full-Length Practice Test Chapter 13: A Story of Blood, Chills, and Pain: A Practice NCLEX-RN Chapter 14: The Answers to All Your Questions (and Explanations to Boot) Answers and Explanations Answer Key Part 4: The Part of Tens Chapter 15: Ten Myths about the NCLEX-RN Length Matters Every Question Counts Computer Savvy Is Essential You Can't Stop til You're Done The Test Plays Off Your Weakness You Have to Wait Eons to Retake a Failed Test Your First Instinct Is Probably Wrong The Same Question Popped Up Twice Your Test Schedule Chooses You Choice (3) Is the Magic Answer, and Other Multiple-Choice Fails Chapter 16: Ten Common Phrases Found in NCLEX-RN Questions Assessment and Priority

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    Diagnosis Planning and Assigning Care The Teaching Plan Outcomes and Goals Best Response Priority Action Interventions Further Teaching Chapter 17: Ten Rules to Remember When Prepping for the NCLEX-RN Read Each Question in Its Entirety Don’t Read into the Question Answer Questions with the Ideal Situation in Mind Avoid Changing Your Answers Don't Call the Doctor until You're Sure You Need To Avoid Answers That Make You Choose All or Nothing Don’t Memorize Facts, Questions, or Other Useless Trivia Don’t Think You Can Be Ready without Hard Work Know Your Strengths and Weaknesses Be Kind to Yourself Part 5: Appendixes Appendix A: Additional Info about Exam and Licensing Logistics Identifying Individual State and Territory Licensing Requirements Testing and Licensing Information Arranged by State and U.S. Territory Appendix B: Information for International Nurses Moving to the United States Following the Two-Step Process for Becoming Eligible to Take the NCLEX-RN Taking the NCLEX-RN Abroad Navigating Nursing Roles in the U.S. Getting Accustomed to U.S. Cultural Values Communicating Therapeutically Applying U.S. Nursing Know-How to the NCLEX-RN Appendix C: Glossary of Nursing Terms Index About the Authors Advertisement Page Connect with Dummies

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    End User License Agreement List of Tables Chapter 3 TABLE 3-1 Percentage Breakdown of NCLEX-RN Content Chapter 6 TABLE 6-1 Common Infectious Conditions and Precautions Chapter 10 TABLE 10-1 Endings Common to Drug Classifications TABLE 10-2 Solutions and Their Applications Chapter 11 TABLE 11-1 Normal Blood Values TABLE 11-2 White Blood Cell Values TABLE 11-3 Normal Urine Values TABLE 11-4 Normal Values for Adult Vital Signs TABLE 11-5 Normal Values for Newborn Vital Signs TABLE 11-6 Normal Values for Toddler Vital Signs List of Illustrations Chapter 3 FIGURE 3-1: Locate where to place the defibrillator paddles to help this man. FIGURE 3-2: Place the defibrillator paddles as indicated. FIGURE 3-3: Locate where the fingers should be placed to take a radial pulse. FIGURE 3-4: For a radial pulse, place the fingers as indicated. Chapter 4 FIGURE 4-1: Maslow’s hierarchy of needs. Chapter 12 FIGURE 12-1: An infectious illness chain of events.

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    . Introduction Welcome to NCLEX-RN For Dummies. Don’t worry, you're definitely not dumb for picking up this book. Like millions of other future nurses worldwide, you want straightforward advice and information without having to carry around 4,000-question test prep books. Trust me, you don’t want to tackle the NCLEX-RN without understanding how the test is put together and what it’s really all about. The NCLEX-RN is one important test. Clearly, you need a readable, concise, structured resource to help you tackle the exam. You’ve come to the right place. NCLEX-RN For Dummies puts everything you need to know to conquer the exam at your fingertips. I give you a complete review of concepts covered on the test and provide insight on how to avoid the pitfalls that the test developers have designed to test your knowledge. And I do all this in an enjoyable, easy-to-understand way. 1 take NCLEX-RN test prep one step farther by guiding you through some of the more difficult areas of the exam and sharing techniques for answering questions when you don’t know the answers. I even cover what you need to do throughout the exam process, from registration to test day, and how you become licensed in a state of your choice in the United States or its territories. I also share information about compact or multistate nursing licensing. If you're coming from an international school to practice nursing in the United States, I tell you what you need to do, too. You may have heard horror stories about the NCLEX-RN, perhaps about how you have to take it on a computer or how the questions get more difficult as you go along. Yes, the NCLEX-RN is no walk in the park, but it’s not the hardest test you’re ever going to take. The NCLEX-RN measures minimal competency and your clinical judgment, and the fact that you’ve graduated from nursing school is an indication that you’ve attained minimal knowledge competency already. From there, the NCLEX-RN expects you to be able to read carefully and quickly and then apply what you know from your nursing program classes to the situation presented in the question. You already have the nursing knowledge you need to succeed on the NCLEX-RN — you just have to apply your critical thinking skills to each situation to come up with the right answers. This book helps you refine those skills and apply them to the questions on the examination. Reading through this book and doing the practice questions (and I provide a lot of them both in the book and online) can give you a pretty good idea of what you’ll face on test day. . About This Book I suspect you aren’t eagerly anticipating sitting for the NCLEX-RN, and you probably aren’t looking forward to studying for it, either. The good news is that you already know everything you need to know for this exam, so studying is just identifying and sharpening your weak areas. What I do in this book is give you some points to concentrate on. I make the preparation process easier for you by breaking down the information you need to know into easy-to-process bites. Each chapter of NCLEX-RN For Dummies includes sample questions that illustrate just how the NCLEX-RN tests particular concepts. I want you to be comfortable with the way the NCLEX-RN phrases questions and expresses answer choices, so the sample questions read just like actual test questions. This book also gives you access to two practice exams: The exam that appears in the book is complete with answers and rationales, and the exam

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    online presents the questions in a manner similar to the actual exam. (I provide the answers and rationales for these questions, too.) Each of the practice exams contains 250 questions. There’s no silver bullet for passing this exam, but you can start out on the right foot by considering my advice for how to study and relax before you go in for the test. Time is of the essence when taking the NCLEX-RN, so I provide techniques for answering particular kinds of questions in the shortest amount of time. I also show you how to quickly eliminate incorrect answers and make educated guesses. The key to success on the test is harnessing your ability to draw upon the knowledge you picked up in school and think through the questions and answers. Knowing what the question is asking and then picking the right answer is the key to success, and this book helps you do just that. Sounds simple, doesn’t it? Actually, it is simple; it’s all in how you approach the exam. With so many review books on the market and so many questions to prepare for, you may be asking yourself, “What's the best way to review for this exam?” Well, the best way is to follow my advice and work through the chapters in this book. Focusing on the topics I cover and reviewing the sample questions and answers should leave you feeling completely prepared to tackle the exam. Doctor is a broad term encompassing a variety of disciplines and degrees. For simplicity, I use doctor throughout this book to refer to a client’s medical provider, who may be a physician, a nurse practitioner, and so on. . . Foolish Assumptions While writing this book, I made a few assumptions about you — namely, who you are and why you picked up this book. I assume that You've graduated from nursing school and are seriously considering taking the NCLEX-RN soon. (In fact, the sooner you take it after graduation, the better!) You aren’t a dummy; you graduated from nursing school, which is a huge accomplishment in itself. You just know little about the NCLEX-RN and want to increase your chances of being successful and passing on the first try. You've picked up this book primarily because you want to practice your chosen profession as soon as possible, and passing the NCLEX-RN is the only way to get there! o . Icons Used in This Book T use icons throughout this book to call your attention to important tidbits of information. Here’s the rundown of what each graphic icon highlights: Study!

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    You guessed it! This icon marks stuff you should remember. It’s also information that you should review if you find yourself with a few extra minutes of study time. This icon marks useful bits of information that may come in handy when you study for or take the NCLEX-RN. This icon identifies questions resembling those on the actual NCLEX-RN. The Warning icon alerts you to potentially dangerous situations. Beyond the Book In addition to what you’re reading right now, this book comes with a free access-anywhere Cheat Sheet that includes tips to help you prepare for the NCLEX-RN. To get this Cheat Sheet, simply go to www. dummies. com and type NCLEX-RN For Dummies Cheat Sheet in the Search box. You also get access to two full-length online practice tests (the one in this book and a unique one) and hundreds of flashcards. To gain access to the online practice, all you have to do is register. Just follow these simple steps: 1. Register your book or ebook at Dummies.com to get your PIN. Go to www.dummies.com/go/getaccess. 2. Select your product from the drop-down list on that page. 3. Follow the prompts to validate your product, and then check your email for a confirmation message that includes your PIN and instructions for logging in. If you do not receive this email within two hours, please check your spam folder before contacting us through our Technical Support website at http://support.wiley.com or by phone at 877-762-2974. Now you're ready to go! You can come back to the practice material as often as you want — simply log on with the username and password you created during your initial login. No need to enter the access code a second time. Your registration is good for one year from the day you activate your PIN. Study!

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    As this book goes to press, the worldwide COVID-19 pandemic has necessitated some temporary changes in how the NCLEX-RN is administered. Check out the Downloads tab on the NCLEX-RN page at dummies . com fora resource outlining those changes. Where to Go from Here If you bought this book or are thinking about it, you must be planning to take the NCLEX- RN. But just buying this book doesn’t help you much if it just sits on your bookshelf gathering dust. To get the full benefit, you have to open it up, read it, and work through the sample questions. Everyone has different strengths and weaknesses, so this book is designed to be read in a way that best suits you. For example, if you feel that you know everything about how to take the NCLEX-RN, from how it’s designed to how to tackle questions, then you can skip to Part 2 and the chapters that address client needs. If you're very comfortable with client needs and are an excellent caregiver but are unsure about the test, then you’re better off focusing on Part 1. To get the most out of the book as a study tool, I suggest that you take a more thorough approach to the subject and read the whole thing. But regardless of your overall approach, this book is designed in a way that allows you to skim through the sections that you know a lot about (perhaps hitting just the example questions) and focus on sections about which you're not as confident. If you're considering taking the test for a trial run before you crack this book and really start studying, I recommend against it. Taking the test without studying first is just a waste of your time and money. To get the most out of your NCLEX-RN experience, review all the client needs, know what the test is looking for, and then take the practice examinations. The practice exams show you which areas are your strengths and which areas you need to focus your attention on. I suggest you take the one in the book first, see which areas are your weakest, brush up on those areas, and then proceed online for the other practice exam. In the end, how you use this book is up to you. You're the one taking the test, and you're the one who has to decide what you study and how much time you set aside to do so.

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    Part 1 Demystifying the Complexity of the NCLEX-RN

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    IN THIS PART... Come to grips with the basics of taking the NCLEX-RN. Determine when to take the exam and get everything in order for your testing appointment. Brush up on client needs. Get a handle on the variety of question types on the NCLEX. Put together a strategy for taking the exam. Use important concepts such as Maslow’s hierarchy and question keywords to answer test questions. Study!

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    Chapter 1 . . Meet the NCLEX-RN: Your Ticket to Getting a License IN THIS CHAPTER Recalling nursing basics Understanding this type of test Approaching the NCLEX-RN with a plan Handling the aftermath — both good and bad Congratulations! You graduated from nursing school and you're almost ready to start practicing as a “real nurse.” Only one thing stands in your way: the NCLEX-RN, which is prepared and administered by the National Council of State Boards of Nursing (NCSBN) to every nursing school graduate in the 50 United States, the District of Columbia, and five U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands). A passing grade on this exam is your ticket to a new career; without it, you can’t practice nursing. From your current vantage point, passing the NCLEX-RN may look like a huge obstacle — one you may be afraid you can’t overcome. Take heart! I'm here to give you the confidence and knowledge you need to conquer the NCLEX-RN. In this chapter, I familiarize you with the test plan, talk about computer adaptive testing, and share what the NCLEX-RN really wants from you. I also tell you how to identify the correct answers to test questions by recognizing keywords and figuring out what the question is asking and give you an idea of what to expect after the exam. . o . The Big Deal behind the Big Exam The NCLEX-RN has only one objective: to determine whether you can safely operate as an entry-level nurse in the state in which you’ve chosen to practice. It isn’t a test of your IQ or how fast you can start an IV. It is looking at your clinical judgment: Do you know what to do in clinical situations? In other words, can you think critically? The NCLEX-RN doesn’t predict how successful your nursing career will be or whether you’ll become a nurse leader. All you have to do is demonstrate that you have the clinical knowledge and judgment necessary to provide safe and effective care necessary to meet the needs of the types of clients you'll encounter in the healthcare workplace. And in order to get your license, you must pass the test. Study!

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    NCLEX-RN: THE NEXT GENERATION You may have heard of the Next Generation NCLEX (NGN), a new version of the exam the NCSBN is developing in an attempt to better test the complexities of clinical judgment new nurses encounter. As part of this process, some candidates receive an extra, completely voluntary section on new question types at the end of their NCLEX exam. You can read more about the NGN at www.ncsbn.org/next-generation-nclex.htm. Sometimes students think that the NCLEX-RN is a certification examination; it’s not. A certification examination is one that certifies a certain body of knowledge by an organization that’s accredited to do so. In the case of the NCLEX-RN, you're tested on your ability to practice as a nurse. When you pass, you're issued a license by the state, and once you're licensed, you can go out and get the job of your dreams. Here's a little-known secret: If you graduated from a school of nursing, you can pass the NCLEX-RN. Nursing schools are evaluated on how well their graduates perform on the exam, so they re reluctant to graduate students who can’t demonstrate potential for success on the NCLEX-RN. So if you graduated, you have what it takes. Kudos! The NCLEX-RN is much less complicated than most exams you’ve taken in school, less difficult than most of your clinical rotations, and far less time-consuming than all the papers you've written, care plans you've devised, and other requirements you met in order to even be eligible to take this test. The NCSBN actually conducts a study every three years to determine what entry-level nurses do, what responsibilities they’re given, where they work, and what type of care is required to meet the needs of the client. In this way, the council can tailor the test questions to reflect what new nurses actually experience in their first jobs. The people who write the NCLEX-RN questions are looking for basic safety, competent decision-making, and logical prioritizing. Keep those topics foremost in your mind! . o You Must Remember This: Nursing . Basics to Know by Heart If nursing were just inputting data and outputting care plans, computers could replace live people. But nursing is much more than applying the nursing process to a disease process; it involves the care, feeding, and nurturing of people. The NCSBN, in its somewhat convoluted way, has broken these principles down into what it calls integrated processes. (Yes, it’s a fancy name for something basic, but after years of nursing school, you should Study!

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    be used to that.) What these four integrated processes — caring, communication, documentation, and teaching — boil down to is really very simple: Caring: Caring puts people above equipment or paperwork. Look at your patient before you look at machines, lab results, or even nursing processes. See the person first. Communication: Therapeutic communication skills help you immeasurably in dealing with everyone from your patients to lab technicians. Never underestimate the power of effective communication while working as a nurse; failure to communicate well may not only harm your patient but also make your life miserable. (Check out Chapter 8 for more on therapeutic communication.) Documentation: Documenting care given and the patient’s response to it is both a legal requirement and one of the major communication methods between healthcare workers. Teaching: As a nurse, you teach patients, their caretakers, and other team members every day. You can be a good technical nurse without integrating these concepts into your nursing care, but nursing is more than curing sick people; it’s caring for them, communicating with them, and teaching them. The four integrated processes appear on the NCLEX-RN in the form of practical applications. Keeping in mind all the theories and practices that you know from nursing school, you should recognize the following themes in exam questions: Patient safety is always a top priority. Remembering the client's ABCs (airway, breathing, circulation) is essential. Physiological needs should be met before other needs. Doing what it takes to meet patient needs comes before other tasks. A thorough assessment is necessary before undertaking other steps of the nursing process. Part of the first step in the nursing process is assessing the patient’s emotional status. Assess the patient’s readiness to learn before designing a teaching program. Denial and disbelieving are generally the first responses to news of a loss or anticipated loss. Nurses must deliver care in a nonjudgmental manner. The NCLEX-RN — Not Your Average CAT Scan! Study!

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    At some point in nursing school, you learned what a CAT scan is, right? Well, the NCLEX-RN is a CAT exam, but that doesn’t mean what you think. In this case, CAT stands for computerized adaptive testing. The NCLEX-RN is no longer a paper-and-pencil exam. Instead, the test is administered on computers, which allow for more reliable test results because the questions can be targeted to your ability (as judged by your answer to each question). Therefore, not everyone gets the same test. The test items that you see are specifically chosen based on the answer you give to the preceding question. Using your most recent response, the testing program searches the item bank for a question that has a degree of difficulty that’s equal to your ability. This process goes on until you answer enough questions to make it clear that your ability is either above or below the passing standard. This question process is why some people get 75 questions and pass and others get 75 questions and fail. So the length of your exam is not a predictor of a pass or fail result — don’t even waste your time trying to predict whether you've passed or failed! When you take the test, you get anywhere from 75 to 265 questions, all presented in random order. Of these questions, 15 are considered experimental items and are not scored because the NCLEX-RN people use them to determine whether they want to subject future test takers to those questions, depending on how you do on them. The NCLEX-RN scores only questions that have been tested for reliability, so some of the questions you get may not actually impact your score. Don’t panic if you get a question that you can’t seem to grasp; it may just be one of the experimental items. On the other hand, don’t assume that every difficult question is an experimental one and disregard it by taking an uneducated guess. Questions appear one at a time on your computer screen. You can view each question as long as you like, but you can’t go back to previous questions. You also can’t skip questions. After you choose your answer, you’re asked to confirm your choice by pressing the <NEXT> button. You can’t go on until you confirm your answer, but you can review the question and change your answer as many times as you like before you submit it. Another logistical issue to keep in mind come exam day is that the test is timed. You have up to six hours to complete the NCLEX-RN, with two prescheduled breaks that you may either take or opt out of. (One minute per question is more than enough time to complete the exam ahead of the six-hour limit, so don’t panic.) If you do run out of time for the test, the good news is that you still might pass! That’s because the test is evaluated by whether you were above the passing standard for the last 60 questions. So missing a question or two but staying above the passing standard down the stretch means you still pass! The computer tells you when your scheduled breaks begin, but you may break for as long as you like. From my own experience and that of all the nursing professionals I know, I urge you to take your breaks — don’t just sit at the computer. Leave the room and do deep breathing exercises, or just take a walk around the test center outside the testing area. During the breaks, don’t review your answers with other candidates or check your notes; you're not allowed to do either, and doing so anyway will definitely increase everyone’s anxiety because you'll all be convinced that another person was right! o o Thinking the NCLEX-RN Way

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    Students who take the NCLEX-RN often say that it’s the hardest test they’ve ever taken. Is this a logical statement? The NCLEX-RN is primarily made up of multiple-choice and select-all-that-apply questions based on nursing knowledge, and it tests your ability to make clinical decisions based on information provided. Sound familiar? The NCLEX-RN really isn’t that different from many other tests that you’ve already taken and passed. Primarily isn’t the same as entirely. The NCLEX features other nontraditional types of questions, such as hot spot and case study, which I cover in Chapter 3. The following sections give you an overview of some question-answering strategies and example questions to practice on. You can read more about these topics, including the keywords technique I use throughout, in Chapter 4. Getting to the root of the question The NCLEX-RN primarily consists of application questions that, when you get right down to it, simply ask, “What would you do in a certain situation?” Most of the situations presented on the NCLEX-RN could really happen, and you’re asked to solve problems using a technique called critical thinking. Critical thinking is just a buzzword for making a decision based on observing, identifying the problem, deciding what’s most important, recovering past knowledge (what you learned in school), and applying that knowledge to the situation presented. That doesn’t sound so hard, does it? The questions ask only about the particular situation presented. Most students’ biggest mistake is adding information that isn’t necessary or even appropriate to the questions. Remember, answer only the question that appears on the screen, using only the information you're given. Don’t add anything! The following is an example of a typical critical-thinking question. The answer explanation that follows it walks you through the answer process: A nurse is discussing long-term care with the parents of a child with a ventriculoperitoneal shunt. Which of the following should be included to prevent complications from the shunt? (1) Restrict all childhood activities. (2) Have the child wear a protective helmet. (3) Any signs of illness must receive immediate attention. (4) Avoid placing the child in a side-lying position. Use keywords to figure out what the question is truly asking. In this case, the keywords are long-term care, child with ventriculoperitoneal shunt, and should be included to prevent complications from the shunt. In this situation, the nurse is discussing long-term care, so the correct answer is something that needs to be done in order to maintain the Study.

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    child at an optimal level of function. Which of the choices is most likely to do that? Restricting all activities couldn’t possibly maintain optimal function in a child. A protective helmet doesn’t protect a ventriculoperitoneal shunt because it’s an internal device. Reporting any signs of illness for medical attention is a must because a ventriculoperitoneal shunt can become infected. Avoiding side-lying positioning is a short-term intervention in the recovery period, not in the discharge plan. So which of the choices answers the question? Of course, it’s Choice (3). Even if you don’t know what a ventriculoperitoneal shunt is, you can come to this answer by thinking the NCLEX-RN way. Read the question and ask yourself, “What's the main point of the question, and what knowledge do I need to use to choose the best answer?” By focusing on long-term care and what's best for a child, you can eliminate the wrong answers. Navigating the grand inquisition, or the integrated exam No matter what answers you have in your head, you may see something totally unexpected on the exam. The questions may be very different from the ones that you're used to getting in nursing school. You need to become “test wise” for the NCLEX-RN, which means that you need to know how to navigate through complex information. Tests in nursing involve complex information that has not only depth but also breadth. In addition to its own body of knowledge, nursing draws from a variety of disciplines. The content tested on the NCLEX-RN is what I call integrated, which means that it isn’t divided into separate categories, such as medical, surgical, psychiatric, pediatric, and obstetric nursing. It isn’t even limited to nursing classes — you may see questions about chemistry, biology, and all the other courses you took as a student. Questions on the exam may include a combination of these disciplines, as in this example: A pregnant woman presents in the emergency room with complaints of severe headache for two days, some episodes of double vision, and an observation that her rings have become tight lately. She has a history of hypertension and is on a sodium- restricted diet. Which of the following assessments would the nurse report to the physician immediately? (1) BP 130/88 (2) Proteinuria 2+ on dipstick (3) Fetal heart rate of 146 with good variability (4) 2+ nonpitting edema of the feet Look for keywords: pregnant woman, complaints of severe headache for two days, double vision, rings have become tight, history of hypertension, sodium-restricted diet, and which of the following assessments would the nurse report to the physician. This question is integrated because it tests your knowledge of different systems. Could the pregnancy be affecting the hypertension? Could the hypertension affect the pregnancy? The answer to those questions is “yes.” So which assessment finding is the most abnormal? Or, in other words, which finding needs immediate medical attention? Choice (1) isn’t an abnormal finding based on standard normal blood pressure values in adults of 100/70 to 140/90. Choice (2) is abnormal because urine should never contain Study!

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    protein; it’s an indication that the renal function is impaired. Choice (3) is normal; fetal heart rates range from 120 to 160 beats per minute. And as for Choice (4), nonpitting edema of the feet in pregnancy is a common discomfort related to increased pressure on the venous return by the growing uterus. With this information gathered from thoroughly examining each answer option, you can easily decide which finding should be reported to the physician. Choice (2) is correct because it indicates abnormal renal function needing immediate evaluation and treatment. Isn’t this easy? Or at least easier than you thought it was going to be? Regardless of the primary diagnosis of this patient, the abnormal finding impacts her well- being the same way. Don’t let the fact that questions contain integrated content distract you from what you already know! Avoiding test-taking missteps Sometimes, a question pops up that looks like one you’ve seen already. It may be because several questions address similar symptoms, diseases, or problems and yet address different aspects of nursing care. Also, an experimental (unscored) item may have content similar to an operational (scored) item. Don’t assume that a similar question indicates that you answered the first one incorrectly. Always answer each question as if it were the only question on the test; pay no mind to previous questions. Try not to go into the examination with any preconceived notions about what you’ll see on it. You need to use proper test-taking techniques (the ones you pick up in this book) throughout the entire examination. In my experience, most nursing students are able to easily reduce the number of possible answer options to two. But contrary to popular belief, you will only find one correct answer for each multiple-choice question on the examination. You need to use everything that you’ve taken away from your nursing program — including effective study and test-taking techniques and a positive mental attitude — to conquer the multiple-choice exam. Chapter 15 has information on other popular misconceptions about the NCLEX. Finding the real question behind the long scenario You get settled in your seat and log onto the test; everything’s looking good, you're feeling good, and you get the following question: A paraplegic client with a T10 injury from a skiing accident, as well as other trauma-related problems, is recovering from the injuries and getting ready to transfer from the acute care unit to a rehabilitation unit. When a nurse offers to assist in getting ready for the move, the client throws the suitcase on the floor and says, “You nurses around here don’t want to help me with anything.” Which of the following responses is the most appropriate for the nurse to give? (1) “You know I want to help you; I offered.” Study!

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    (2) “I'll pick these things up for you and come back later.” (3) “You seem pretty angry today. Going to rehabilitation may be scary for you.” (4) “When you get to rehabilitation, they won’t let you behave like a spoiled brat.” You read this question, and you’re ready to get out of your seat and leave the testing facility immediately. But you shouldn’t panic. Although this question has multiple sentences and this patient appears to have multiple issues, you can apply a methodology to finding the real question hidden under all this detail. (Throughout this book, I guide you through dissecting this type of question in order to find out what you're really being asked.) Yes, the client has many things going on, but the key is what the client is saying. As you take this question apart, you should always focus on the feelings that are underlying a particular action. The keywords for this question are paraplegic, ready for transfer, rehab unit, and “You nurses around here don’t want to help me with anything.” Choices (1) and (4) are confrontational and inappropriate coming from a nurse. Although offering to pick up the client’s belongings, Choice (2), is a nice thing to do, it doesn’t address the situation, and it reveals the nurse’s assumption that the patient can’t pick the things up. So the correct answer is Choice (3). The trauma and the T10 injury have nothing to do with the correct answer except to tell you the patient may have a serious back injury. Although I can’t guarantee that you won’t see a question like this one right off the bat, the questions should start out rather simple and get increasingly more difficult as you go through the exam. As you prove your ability to answer more- difficult questions, you get increasingly challenging ones until the computer decides that you have a minimal competency for nursing and doesn’t present any more questions. Keeping your cool when answering select-all-that-apply questions Select-all-that-apply questions tend to throw students into a panic. Really, they're basically the same as multiple-choice questions; the difference is any number of the facts you know about the subject may appear in the list. You already know the information; just mark what you know and ignore the rest. Make a list on your white board and use it to answer the question. Head to Chapter 4 to read about select-all-that-apply questions. Here's a simple example: Which of the following actions or conditions may be a secondary cause of lung cancer? Select all that apply. (1) Genetics (2) Occupational exposures (3) Smoking a pipe Study!

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    (4) Smoking cigarettes Keywords are actions or conditions and secondary cause of lung cancer. The correct answers are Choices (1), (2), and (3). As many as 90 percent of clients with lung cancer smoke cigarettes or have smoked them in the past, making cigarette smoking the number one cause of the disease. So Choice (4) isn’t a secondary cause. The other answers may in fact cause lung cancer. . When All Is Said and Done You're sitting at a computer taking an exam when all of the sudden, the computer goes blank. (And no, it’s not a power failure.) What do you do? Stay calm and don’t panic. The test shuts off automatically without warning when you’ve answered enough questions to determine your ability to provide safe basic care for patients. A screen appears stating that “Your test is concluded.” Youre then required to answer several exit questions, which are just multiple-choice questions about your examination experience. They don’t count toward your results. After you leave the not-so-horrific chamber of testing horrors, you get to sit on pins and needles for two to six weeks until the state board of nursing mails your results to you. Every computer exam is scored twice — once by the computer testing center and again after it’s transmitted to Pearson professional centers. I highly recommend that you put your books aside when you get home from the exam, go outside and play, and let your mind roam free (at least of the exam) for the next few weeks. There’s no sense worrying when you can’t light a fire under the nursing board anyway. You can’t become licensed until you get the official mailed results. But if you’re afraid you'll go crazy waiting to find out whether you passed, you may be able to get an early look at your results unofficially. Pearson offers a Quick Results service in some states that gives you your early results in two business days (for a minimal cost). If your state posts new licensees on its website, you also may be able to find out there. Otherwise, you just have to wait for the mailed results. Hey, nurse? Yeah, you! If you passed the exam, you’re officially a registered nurse — congratulations! Now comes the fun part ... you can go out and get a real job. Because this book is about taking the exam, I don’t get into how to go out and get the job. (You'll have to find another book to help you do that.) But I want to be the first to offer congratulations and wish you a long and happy career as an RN. So, you failed — it’s not the end of the world You may not want to read this particular section right now, but you probably should so that you know what happens if you fail the NCELX-RN exam. When you have to tell your family, friends, supervisor, and co-workers that you didn’t pass the licensing examination, you may feel like you're the only person who ever failed this test in the entire world. I assure you, you're not alone. If you were, I wouldn’t have an NCLEX tutoring business. If you fail the exam, you receive a diagnostic profile from the NCSBN that tells you how many questions you answered on the examination. (The more questions you answered, the closer you came to meeting the passing standard; see the section “The NCLEX-RN — Not Your Average CAT Scan!” earlier in this chapter for details on how the computer adaptive test measures your competency.) The diagnostic profile helps you identify your strengths

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    and weakness so that you know where to concentrate your study habits when you prepare to take the examination again. However, it doesn’t give you the questions you missed or by how much you missed the passing mark. Many people who fail the first time are disheartened enough to ask, “Should I take the test again?” Absolutely! You've completed your education to become a registered nurse, so don’t throw away all that work and planning. Think back to the stages of grieving — that’s exactly what you're going through. After you get through the stages of grieving, you're ready to go back and take the exam again. After all, you really want to be a nurse! You can’t retake the examination for 45 days. So schedule your next attempt, and allow yourself enough time to prepare for it. Then figure out why you failed this round. Although it may involve painful self-examination, you need to know why you failed so that you can establish a plan for success the next time. You should prepare differently this time because, well, obviously your old plan didn’t work. You need to start fresh with a new plan of action. You get only so many tries to pass the exam — for example, Indiana allows three failed attempts before you're required to pursue remediation. A remedy could include taking an accredited NCLEX-RN prep program or refresher course. With a written letter of completion from that program and a 95% pass rate guarantee sent to the board of nursing, you should then be able to take the NCLEX-RN again. The good thing about retaking the test is that you’ve already seen it — and that’s a major advantage! You know exactly what to prepare for. The computer (clever machine that it is) remembers what questions you were given before, so you won’t receive any of the same questions, but the content and style of the questions and the types of answer choices don’t change. So you shouldn’t have any surprises the second time. (Note: The machine just knows which questions you had the last time. It does not specifically give you the content you missed previously to make you fail again.) Second-time test takers sometimes have test anxiety when going back the second time. Remember, having a good study plan and knowing the content is a way to work around anxiety, but you may also want to come up with an anxiety test plan. What will you do if you become anxious and need to relax — make sure you’re wearing a calming scent? Practice deep-breathing exercises? Something else? There’s no substitute for mastering nursing content. Go through your review books again, and become expert in reading the questions and being able to effectively answer what’s being asked. Practice your test-taking strategies, too. (Throughout this book, I give you strategies to help you succeed whether it’s your first test or not. Chapter 4 is a good place to start.) As you gear up for your next attempt at the NCLEX-RN, follow this simple advice. It may seem obvious, but it will help you be more relaxed when you take the exam again: Choose to take the test at the time of the day when you’re most alert. Choose a familiar testing site. Study!

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    Accept the earplugs that are offered at the testing site. Take your breaks. If you become distracted or fatigued during the test, take a break. Plan on spending six hours for testing; if you get out early, it’s a pleasant surprise. Always keep a positive attitude; say to yourself, “I will pass the NCLEX-RN.”

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    Chapter 2 - . Preparing for T-Day: Paperwork IN THIS CHAPTER Evaluating when to take the test Completing and submitting applications Making your testing appointment Covering all your bases on test day Rescheduling your NCLEX-RN EE LLL EE ET ET PP PP PP PP PP PP PPP As if taking the NCLEX-RN doesn’t give you enough things to worry over, you also have to think about the logistics of the exam — the paperwork required just to be allowed to take the test, the fees you have to fork over (even though it may seem fairer to have someone pay you to take the test), and the potential for sudden changes to your test-taking plans (like what happens if you break out in chickenpox the morning of the exam). One important point to note before you apply for the exam is that you must have graduated with a nursing degree in order to take it (such as an ASN or BSN). If you still have one more course to take, you must complete it before you can file for your application; otherwise, your application will be rejected. The board of nursing doesn’t care that you're only two basket weaving credits short of graduation; no diploma, no boards. If you have transfer credits from another school, make sure that they’ve all been accepted and applied to your academic record. In fact, it’s a good idea to sit down with your advisor one last time before your last semester to make sure that everything really is in order for graduation. In this chapter, I walk you through the application process, tell you how to find a scheduling center, and explain what you need to know to get to that scheduled exam. o How Long Should I Wait after 1 . ge Graduate? Deciding When to Test How soon after graduation you take the exam is up to you, with some caveats. Some eager-beaver types want to take the test 14 minutes after graduation, while others are still dragging their feet 14 months from graduation. Each state has its own rules — of course! — about how long after graduation you need to wait before taking the test, but most states require you to wait 45 days. Refer to Appendix A for specific testing information about your state. Study!

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    1 suggest that you take the exam as soon as you graduate if possible because all that information you crammed into your brain is still fresh. Many students wait months before taking the exam because they feel that they aren’t prepared. But the longer you procrastinate, the more you have to study, and the less chance you have of passing on your first try. Most nursing schools provide review courses, so if you're a recent graduate, you've probably honed your test-taking skills in the last few years, and your test-taking ability is at its peak. And the sooner you pass the NCLEX-RN, the sooner you can start work, start helping people, and buy yourself that new fancy car — or pay off your student loans! That being said, if you aren’t getting the scores the NCLEX prep course you're taking suggests, plan to take more time. No school, family member, or faculty member can tell when you're ready just because everyone else is taking it. Everyone else isn’t you. Don’t even let a potential new job tell you when to take the test. Of course, if you've delayed getting transcripts, sending in your fees, and paying your campus parking tickets, you may find yourself taking your test later rather than sooner. You must take the exam while your Authorization to Test (ATT) is valid, so the clock starts ticking after you get your ATT. (For more on the ATT, see “Scheduling the Time and Place” later in this chapter.) Check your calendar for weddings, births (presumably you'll know whether you or your partner will be giving birth any time soon; you’re almost a nurse, for heaven’s sake!), vacations, moving plans, and other personal events and factors that may delay your taking the exam after you have your ATT in hand. Plan to take the exam before you get too involved in a new job as a graduate nurse. Job requirements usually take up a significant amount of your time, especially when you're a new employee. Accepting a position but not starting the job until you actually take the exam may be in your best interest. In this period of acute nursing shortages, healthcare agencies want people to start working right away, but your best bet may be to take the time to study for the exam first. Get it over with, and then start the job with a clear focus on beginning your new career. Each state determines the requirements for graduate nurses pending licensure. If you’re working as a new graduate nurse, you must be aware of the state rules governing your practice. Check with your local state board for requirements for new graduates and to find out whether you can get a temporary permit in the state in which you choose to work.

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    o Applying to Take the NCLEX-RN Applying to take the NCLEX-RN may be easy or hard, depending on the size of your nursing school and how much help it can offer you in filling out your paperwork. At some schools, you may just be handed the paperwork in your last semester and told to take care of it; in others, the whole class may go over the paperwork together. (Send your nursing instructors flowers if that’s the kind of program you’re in.) In order to take the NCLEX- RN, you need to apply to two places: your state board of nursing for licensure and Pearson VUE, the company that contracts with nursing boards to administer the test. Completing the application process Every state has its own application and way to apply. Depending on the state, you may be able to apply online only, on paper only, or through either method. Know your state (see Appendix A for information on each state). Here’s how the application process works. 1. Apply to your nursing board either online or on paper. Every state charges a fee with this application. 2. Meet the requirements of your board of nursing (BON) or Nursing Regulatory Board (NRB), as it appears on some state websites. Some states require a school transcript as proof you've completed the program; flip to the later section “Tying up academic loose ends” for more on that process. You also need to get your criminal history done and your fingerprints taken to be eligible to take the test. States differ in how they take care of this process. 3. Register with Pearson VUE. Pearson VUE sends you your ATT. Then you can schedule your test either online or by phone (check out “Scheduling the Time and Place” later in this chapter for more on the scheduling process). You can complete your application to Pearson VUE over the phone by dialing 1-866-49- NCLEX. Have a credit card handy (Visa, MasterCard, or American Express) to pay your fees immediately. If you’d rather not talk to a live person, you can register online. Get your credit card out and go to the NCLEX-RN candidate website at www.vue.com/nclex. If you need to contact Pearson by mail, the general address and email address are NCLEX-RN Examination Program Pearson Professional Testing 5601 Green Valley Drive Bloomington, MN 55437-1099 Study!

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    Email: vuepearsonprofessionaltesting@vue.com Paying your dues There’s no such thing as a free lunch ... or a free nursing license! The cost of a license varies from state to state, but the examination fee for the NCLEX-RN is $200. (Yep, you read that correctly — you have to pay a license fee and a test fee.) Appendix A lists the fees for each state. You know that your money has been received and your credit cards accepted when you receive a card from your state board of nursing stating that all your information has been received and you're ready to go. If you don’t hear from the state board in a reasonable amount of time (and three hours isn’t a reasonable amount of time), call to make sure that your application was received. Hitting a bump: Potential problems with the licensure application Problems are inevitable. Life is full of them. So don’t be surprised to experience a glitch or two when you're trying to get your paperwork all filled in, sent, and processed. Many problems arise when people (this may mean you) don’t read the instructions — all the instructions. In your rush to complete application paperwork and get it out of your house and out of your sight, don’t overlook some major requirement; correcting the error can hold you up even more. Tying up academic loose ends Some states require that your permanent transcript be mailed with your application. You can get an official sealed student copy of your transcript from your school’s registrar, but you can’t always get it the same day you request it, so put in the request before you actually need the transcript. (I emphasize the point of an official sealed student copy because a licensing agency may not accept an opened unofficial transcript. You can’t just copy your grades for the last three years of classes and send them in.) If your school has closed since you've left and you still need a transcript, find out who the school transferred the responsibility of dealing with its transcripts for past graduates to and contact that organization. All states have a State Board of Education; if needed, you can contact it if you need assistance in getting your transcript. You can also avoid problems with your application by making sure that you've met all the requirements for graduation. Some students truly do get all the way to the end of their senior years and start planning graduation parties and inviting friends and family to the big event just to find out that they’ve been ill-advised and still need to take those infamous electives or that one math course that they put off for two or three years. If you think this misstep doesn’t happen to otherwise intelligent people, think again! Have you been delinquent during your college years? If so, pay up! If you owe any library fines or have any unpaid parking tickets, your school can delay the release of your

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