ANSWERING NCLEX STYLE QUESTIONS

1. ABCs (Airway, Breathing, Circulation)

2. When in distress DO NOT ASSESS! Unless 2nd hand information is received. 3. Scenario
• Expected outcome with Disease Process o Continue to monitor
o Document finding
• Unexpected finding with Disease Process
o Nursing intervention that must make a difference
o Call HCP 4. Mini Maslow’s
1. ABCs (& Pain unrelieved by meds)
2. Safety
3. Comfort (Pain)
4. Psychological
5. Social
6. Spiritual
5. STAT words → Pick the answer that failing to do so will kill or cause great harm
o Highest Priority
o Most Important o Immediate Action
6. *Least Invasive First*
7. Secondhand Info → Any time you have 2nd hand info, the right answer is assess
        · UAP · Labs · EKG
· Family
· EMR
· BP machine
8. Never ever take away the coping mechanism a patient uses during a crisis, except if the
mechanism puts the patient or others @ risk
9. Eliminate answer choices & DNR
10. Never withhold Tx! If you’re left with two answer choices and the options are to Tx, or
watch the patient, Pick Tx!
11. Anytime there’s a reversal from the norm, you must worry!
o Ex: rebound tenderness (pain after you relieve pressure)
12. Stable Patients o UAP
o LPN
o New nurse
o Graduate Nurse o Float Nurse
o Travel nurse
13. Anytime you see excessive findings, That’s not normal!
14. Always empower your patient
15. If a question has “ ”, pick an answer that has what they’re feeling & not what they’re saying
16. 3 R’s of Psych
1. Reality – Functional psych patient

2. Reassure – Delirium
3. Redirect – Dementia
Who Do You See First?
Consider:
o Unstable vs. Stable
o Unexpected vs. Expected o ABCs
o Acute vs. Chronic
o Actual vs. Potential
Common NCLEX Traps
o Do not ask “Why?”
o Do not leave the client.
o Do not persuade the client.
o Do not say, “Don’t worry!”
o Do not ‘do nothing.’
o Do not read into the question. o Do not pass the buck.
Strategies
o Only use textbook nursing – textbook knowledge
o Pain is psychosocial, unless it’s severe, acute, & unrelenting
o If it’s a position question, is it going to prevent or promote something – position, prevent,
promote o Teaching/learning – use T/F on each answer
o Risk Questions – use Risk Factors
o If the answers have an absolute in them, do not pick them
o Questions that have the phrase ‘And Then’ – did they miss something?
Default Answers
1. Give meds either 1 hour before meal or 2 hours after meal 2. Give antacids 1 hour before med
or 4 hours after med
3. When in doubt pick K (potassium)
4. 2 – 3 L of fluids
5. When in doubt pick answer that has you stay with patient
6. Anytime you see restless & ↓ level of consciousness = early sign always pick 7. Head of Bead
→ 30-45 degrees for any neuro patient
8. Elderly with acute onset confusion → UTI
9. Secretions will turn Orange/Red for meds
10. Anytime you have GI problem/exacerbation = NPO
11. All surgeries
o 1st 24 hrs – bleeding o 48 hrs – infection

12. Check daily weights if it’s a fluid problem 13. Lateral position for maternity
14. Remove answer choices that are ‘absolutes’
Kaplan NCLEX Strategies
Kaplan RN Decision Tree
Step 1 – Can you identify the topic of the question
Step 2 – Are the answers assessment (get data) or implementation (to effect change)?
Step 3 – Apply Maslow: Are the answers physical or psychosocial? (Physical trumps
psychosocial) Step 4 – Are the answer choices related to ABCs?
Step 5 – What is the outcome of each of the remaining answers?
Rules for Delegation
• RN ASSIGNMENT
o Cannot delegate assessment, teaching, or nursing judgement
• LPN/LVN ASSIGNMENT
o Assign stable with expected outcomes
• UAP ASSIGNMENT
o Delegate standard, unchanging procedures
Five Rights of Delegation
o RIGHT TASK – scope of practice, stable client
o RIGHT CIRCUMSTANCES – workload
o RIGHT PERSON – scope of practice
o RIGHT COMMUNICATION – specific task to be performed, expected results, follow-up
communication o RIGHT SUPERVISION – clear directions, intervene if necessary
Therapeutic Communication Tips:
DO: DO NOT:
     ● Do respond to feeling tone
● Do provide information
● Do focus on the client
● Do use silence
● Do use presence
   ● Do not ask ‘why’ questions
● Do not ask ‘yes/no’ questions, except in the case of possible self-
harm
● Do not focus on the nurse
● Do not explore
● Do not say, “Don’t worry!”
 NCLEX TIPS
 1. When getting down to two answers, choose the assessment answer (assess, collect, auscultate,
monitor, palpate) over the intervention except in an emergency or distress situation. If one
answer has an absolute, discard it. Give priority to answers that deal directly to the patient’s
body, not the machines/equipment.
2. Key words are very important. Avoid answers with absolutes for example: always, never,
must, etc.
3. With lower amputations patient is placed in prone position.

4. Small frequent feedings are better than larger ones.

5. Assessment, teaching, meds, evaluation, unstable patient cannot be delegated to an Unlicensed
Assistive Personnel.
6. LVN/LPN cannot handle blood.
7. Aminoglycosides (like vancomycin) cause nephrotoxicity and ototoxicity.
8. IV push should go over at least 2 minutes except for adenosine which goes superfast, 2-4
seconds..
9. If the patient is not a child an answer with family option can be ruled out easily.
10. In an emergency, patients with greater chance to live are treated first
11. ARDS (fluids in alveoli), DIC (disseminated intravascular coagulation) are always secondary
to something else (another disease process).
12. Cardinal sign of ARDS is hypoxemia (low oxygen level in tissues).
13. in pH regulation the 2 organs of concern are lungs/kidneys.
14. edema is in the interstitial space not in the cardiovascular space.
15. weight is the best indicator of dehydration
16. wherever there is sugar (glucose) water follows.
17. aspirin can cause Reye’s syndrome (encephalopathy) when given to children
18. when aspirin is given once a day it acts as an antiplatelet.
19. Use Cold for acute pain (e.g. Sprain ankle) and Heat for chronic (rheumatoid arthritis)
20. guided imagery is great for chronic pain.
21. when patient is in distress, medication administration is rarely a good choice.
22. with pneumonia, fever and chills are usually present. For the elderly confusion is often
present.
23. Always check for allergies before administering antibiotics (especially PCN). Make sure
culture and sensitivity has been done before administering first dose of antibiotic.
24. Cor pulmonale (s/s fluid overload) is Right sided heart failure causedby pulmonary disease,
occurs with bronchitis or emphysema.
25. COPD is chronic, Pneumonia is acute. Emphysema and Bronchitis are both COPD.
26. In COPD patients the baroreceptors that detect the CO2 level are destroyed. Therefore, O2
level must be low because high O2 concentration blows the patient’s stimulus for breathing.
27. Exacerbation: acute, distress.
28. Epi always given in TB syringe.
29. Prednisone toxicity: Cushing’s syndrome= buffalo hump, moon face, high glucose,
hypertension.
30. 4 options for cancer management: chemo, radiation, surgery, allow to die with dignity.
31. No live vaccines, no fresh fruits, no flowers should be used for neutropenic patients.
32. Chest tubes are placed in the pleural space.
33. Angina (low oxygen to heart tissues) = no dead heart tissues. MI = dead heart tissue present.
34. Mevacor (anti-cholesterol med) must be given with evening meal if it is QD (per day).
35. Nitroglycerine is administered up to 3 times (every 5 minutes). Ifchest pain does not stop go
to hospital. Do not give when BP is < 90/60.
36. Preload affects amount of blood that goes to the right ventricle.Afterload is the resistance the
blood has to overcome when leaving the heart.
37. Calcium channel blocker affects the afterload.
38. For a CABG operation when the great saphenous vein is taken it isturned inside out due to
the valves that are inside.
39. Unstable angina is not relieved by nitroglycerin.
40. Dead tissues cannot have PVC’s (premature ventricular contraction). If left untreated PVC’s
can lead to VF (ventricular fibrillation).

41. 1 t (teaspoon)= 5 ml
1 T(tablespoon)= 3 t = 15 ml
1 oz= 30 ml
1 cup= 8 oz
1 quart= 2 pints
1 pint= 2 cups
1 gr (grain)= 60 mg
1 g (gram)= 1000 mg
1 kg= 2.2 lbs.
1 lb.= 16 oz
* To convert Centigrade to F. F= C+40, multiply 9/5 and subtract 40 * To convert Fahrenheit to
C. C= F+40, multiply 5/9 and subtract 40.
42. Angiotensin II in the lungs = potent vasodilator. Aldosterone attracts sodium. 43. REVERSE
AGENTS FOR TOXICITY
o Heparin= protamine sulfate
o Coumadin= vitamin k
o Ammonia= lactulose
o Acetaminophen=-Acetylcysteine o Iron= deferoxamine
o Digitoxin, digoxin= Digi bind
o Alcohol withdrawal= Librium
o Methadone is an opioid analgesic used to detoxify/treat pain in narcotic addicts. o Potassium
potentiates dig toxicity.
44. Heparin prevents platelet aggregation.
45. PT/PTT are elevated when patient is on Coumadin
46. Cardiac output decreases with dysrhythmias. Dopamine increases BP.
47. Med of choice for Ventricular tachycardia is lidocaine
48. Med of choice for SVT is adenosine or adenocard
49. Med of choice for Asystole (no heartbeat) is Atropine
50. Med of choice for CHF is Ace inhibitor.
51. Med of choice for anaphylactic shock is Epinephrine
52. Med of choice for Status Epilepticus is Valium.
53. Med of choice for bipolar is lithium.
54. Amiodarone is effective in both ventricular and atrial complications.
55. S3 sound is normal in CHF, not normal in MI.
56. Give Carafate (GI med) before meals to coat stomach
57. Protonix is given prophylactically to prevent stress ulcers.
58. After endoscopy check gag reflex.
59. TPN (total parenteral nutrition) given in subclavian line.
60. Low residue diet means low fiber
61. Diverticulitis (inflammation of the diverticulum in the colon) pain is around LL quadrant.
62. Appendicitis (inflammation of the appendix) pain is in RL quadrant with rebound tenderness.
63. Portal hypotension + albuminemia= Ascites.
64. Beta cells of pancreas produce insulin
65. Morphine is contraindicated in Pancreatitis. It causes spasm of the Sphincter of Oddi.
Therefore, Demerol

should be given.
66. Trousseau and Chvostek signs observed in hypocalcemia
67. With chronic pancreatitis, pancreatic enzymes are given with meals, not before or after, given
with meal. 68. Never give K+ in IV push.
69. Mineralocorticoids are given in Addison’s disease.
70. Diabetic ketoacidosis (DKA)= when body is breaking down fat instead of sugar for energy.
Fats leave ketones (acids) that cause pH to decrease.
71. DKA is rare in diabetes mellitus type II because there is enough insulin to prevent
breakdown of fats.
72. Sign of fat embolism is petechiae. Treated with heparin.
73. For knee replacement use continuous passive motion machine.
74. Give prophylactic antibiotic therapy before any invasive procedure.
75. Glaucoma patients lose peripheral vision. Treated with meds
76. Cataract= cloudy, blurry vision. Treated by lens removal-surgery
77. Co2 causes vasoconstriction.
78. Most spinal cord injuries are at the cervical or lumbar regions
79. Autonomic dysreflexia (life threatening inhibited sympathetic responseof nervous system to a
noxious stimulus- patients with spinal cord injuriesat T-7 or above) is usually caused by a full
bladder.
80. Spinal shock occurs immediately after spinal injury
81. Multiple sclerosis= myelin sheath destruction, disruption in nerveimpulse conduction.
82. Myasthenia gravis= decrease in receptor sites for acetylcholine. Since smallest concentration
of ACTH receptors are in cranial nerves, expect fatigue and weakness in eye, mastication,
pharyngeal muscles. 83. Tensilon test given if muscle is tense in myasthenia gravis.
84. Guillain-Barre syndrome= ascending paralysis. Keep eye on respiratory system.
85. Parkinsons = RAT: rigidity, akinesia (loss of muscle movt), tremors.Treat with levodopa.
86. TIA (transient ischemic attack) mini stroke with no dead brain tissue
87. CVA (cerebrovascular accident) is with dead brain tissue.
88. Hodgkin’s disease= cancer of lymph is very curable in early stage.
89. Rule of NINES for burns
o Head and Neck= 9% o Each upper ext= 9% o Each lower ext= 18% o Front trunk= 18%
o Back trunk= 18%
o Genitalia= 1%
90. Birth weight doubles by 6 month and triple by 1 year of age.
91. If HR is <100 do not give dig to children.
92. First sign of cystic fibrosis may be meconium ileus at birth. Baby is inconsolable, do not eat,
not passing meconium.
93. Heart defects. Remember for cyanotic -3T’s( ToF, Truncus arteriosus, Transposition of the
great vessels). Prevent blood from going to heart. If problem does not fix or cannot be corrected
surgically, CHF will occur following by death.
94. With right side cardiac cath=look for valve problems (tricuspid valve problems)
95. With left side in adults look for coronary complications.
96. Rheumatic fever can lead to cardiac valves malfunctions.

97. Cerebral palsy = poor muscle control due to birth injuries and/or decrease oxygen to brain
tissues. 98. ICP (intracranial pressure) should be <2. measure head circumference.
99. Dilantin level (10-20). Can cause gingival hyperplasia
100. for Meningitis check for Kernig’s/ Brudzinski’s signs.
101. Wilm’s tumor is usually encapsulated above the kidneys causing flank pain (don’t palpate
abdomen) 102. Hemophilia is x-linked. Mother passes disease to son.
103. When phenylalanine increases, brain problems occur.
104. Buck’s traction= knee immobility
105. Russell traction= femur or lower leg
106. Dunlap traction= skeletal or skin
107. Bryant’s traction= children <3y, <35 lbs. with femur fx.
108. Place apparatus first then place the weight when putting traction
109. Placenta should be in upper part of uterus
110. Eclampsia is seizure. (hypocalcemia) - give calcium
111. A patient with a vertical c-section surgery will more likely have another c-section.
112. Perform amniocentesis before 20 weeks’ gestation to check for cardiac and pulmonary
abnormalities. 113. Rh - mothers receive RhoGAM to protect next baby.
114. anterior fontanelle closes by 18 months. Posterior 6 to 8 weeks.
115. Caput succedaneum= diffuse edema of the fetal scalp that crosses the suture lines. Swelling
reabsorbs within 1 to 3 days.
116. Pathological jaundice= occurs before 24hrs and lasts 7 days. Physiological jaundice occurs
after 24 hours. 117. Placenta previa = there is no pain, there is bleeding. Placenta abruption =
pain, bleeding.
118. Betamethasone (celestone)=surfactant. Med for lung expansion.
119. Dystocia= baby cannot make it down to canal
120. Pitocin med used for uterine stimulation
121. Magnesium sulfate (used to halt preterm labor) is contraindicated if deep tendon reflexes
are ineffective. If patient experiences seizure during magnesium adm. Get the baby out stat
(emergency).
122. Do not use why or I understand statement when dealing with patients
123. Milieu therapy= taking care of patient/environment
124. cognitive therapy= counseling
125. Crisis intervention=short term.
126. FIVE INTERVENTIONS FOR PSYCH PATIENTS
o Safety
o Setting limits
o Establish trusting relationship
o Meds
o Least restrictive methods/environment.
127. SSRI’s (antidepressants) take about 3 weeks to work.
128. Obsession is to think. Compulsion is to action
129. If patients have hallucinations redirect them. In delusions distract them.
130. Thorazine, Haldol (antipsychotic) can lead to EPS (extrapyramidal side effects)
131. Alzheimer’s disease is a chronic, progressive, degenerative cognitive disorder that accounts
for more than 60% of all dementia
132. Change in color is always a LATE sign!
133. Let’s say every answer in front of you is an abnormal value. If potassium is there, you can
bet it is a problem they want you to identify, because values outside of normal can be life
threatening. Normal potassium is 3.5-5.0.

Even a bun of 50 doesn’t override a potassium of 3.0 in a renal patient’s priority.

134. Look carefully when you have no idea. In a word like rhabdomyosarcoma you can easily
ascertain it has something to do with muscle (myo) cancer (sarcoma). The same thing goes for
drug names. For example, if it ends in –ide it’s probably a diuretic, as in Furosemide, and
Amiloride.
135. When choosing an answer, think in this manner...if you can only do ONLY one thing to
help this patient what would it be? Pick the most important intervention.
136. An answer that delays care or treatment is ALWAYS wrong.
137. If two of the answers are the exact opposite, like bradycardia or tachycardia → one is
probably the answer. 138. If two or three answers are similar or are alike, none is correct.
139. When asking patients questions NEVER use “why” questions. Eliminate all “why?” answer
options.
140. If you have never heard of it → please don’t pick it!
141. Always deal with actual problems or harm, before potential problems.
142. Always select a “patient focused” answer.
143. An answer option that states "reassess in 15 minutes"is probably wrong.
144. Think positive and you can achieve great things.
145. Think of present and future, the past is gone. Forget your past mistakes and focus on your
successes encouraging yourself to greater achievements in the future.
146. Always do your best so you can be proud that you gave it your best shot.
147. Focus on your achievements rather than your failures. If you do find yourself thinking about
how you failed, then look at what you managed to do right, and how you could correct what you
did for next time.