Because the NCLEX-PN® exam tests your critical thinking, the topic of the questions may be unstated. You may see a question that concerns a disease process or procedure with which you are unfamiliar. Most test takers who are “clueless” about a question will read the question and answer choices over and over again. They do this because they hope that:
They will remember seeing the topic in their notes or on a textbook page.
The light will dawn and they will remember something about the topic.
They believe there is some clue in the question that will point them toward the correct answer.
What usually happens? Absolutely nothing! The student then randomly selects an answer choice. When you randomly select an answer, you have one chance in four of getting it right. You can better those odds, and here’s how: when you encounter a question that deals with unfamiliar nursing content, look for clues in the answer choices instead of in the question stem.
If you find yourself “clueless” after you carefully read a question, follow these steps:
Step 1. Resist the impulse to read and reread the question. Read the question only once. Identify the topic of the question. It is often unstated.
Step 2. Read the answer choices, not to select the correct answer, but to figure out, “What is the topic of the question?” or “What should I be thinking?” You are looking for clues from the answer choices.
Step 3.After reading the answer choices, reword the question using the clues that you have obtained.
Step 4. Then use the strategies previously discussed to answer the question you have formulated.
Let’s try this strategy with a question.
Step 1.Read the stem of the question. Can you identify the topic of the question? No, you can’t. The LPN/LVN is telling the client to do something, but about what topic? The topic is unstated in the question.
Step 2. Read the answer choices to obtain clues about the topic of the question. Each answer choice deals with ways to maintain a normal blood glucose.
Step 3.Reword the question. “What does the LPN/LVN tell the client about ‘sick day rules’?”
ANSWERS:
“Hold your regular dose of insulin.” This is an implementation that would increase the blood glucose level. The LPN/LVN should collect data first. Eliminate.
“Check your blood glucose level every 3 to 4 hours.” This is data collection. Before you can advise the client, you must identify whether the client is hypoglycemic or hyperglycemic. Keep this answer for consideration.
“Increase your consumption of foods containing simple sugars.” This is an implementation and would increase the client’s blood glucose level. The LPN/LVN should collect data first. Eliminate.
“Increase your activity level.” This is an implementation that would decrease the client’s blood glucose level. The LPN/LVN should collect data first. Eliminate.
The nurse should always collect data before implementing nursing care. The correct answer is (2).
No matter how much you prepare for the NCLEX-PN® exam, there may be topics you see on your test with which you are unfamiliar. Reading the answer choices for clues will increase your chances of selecting a correct answer. Remember, you do have a body of knowledge. You just have to be calm and access this knowledge.
Read this question.
Not sure what Addison’s disease is? Not sure how to adjust the dose of cortisone?
Step 1. Read the question once. Resist the impulse to reread the question.
Step 2.Read the answer choices. What should you be thinking? The question concerns cortisone. If the client is receiving cortisone, Addison’s disease must be something that requires cortisone, a hormone from the adrenal glands. You notice that dosages are both increased and decreased.
Step 3. Use these clues to find the answer to THE REWORDED QUESTION, “What is true about adjusting cortisone dosage?”
Dosage is increased when the blood glucose level increases. Is this true about cortisone? No. This sounds like insulin. Eliminate.
Dosage is decreased when dietary intake is increased. Is this true about cortisone? No. Cortisone requirements are not related to diet. Eliminate.
Dosage is decreased when infection stimulates endogenous steroid secretion. Endogenous means “within the client.” If the client is receiving cortisone for Addison’s disease, the client must have adrenal insufficiency. Therefore, infection can’t stimulate steroid secretion. Eliminate.
Step 4. The correct answer is (4) because it is the only choice remaining. Even if you are not confident that cortisone is increased during periods of stress, you can conclude that this is the correct answer because the other choices have been eliminated.
If you’re not sure about the topic of the question, read the answer choices for clues.
Let’s look at another path.
In some questions, the NCLEX-PN® exam asks you to figure out the topic of the question. In other questions, you are required to use critical thinking skills to figure out what the answer choices really mean. The NCLEX-PN® exam can take a concept with which you are very familiar and make it difficult to recognize. The following question illustrates this point.
It is not difficult to identify the topic of this question, “What is a priority for a client with heart failure?” Many students get tripped up on this question by not thinking through the answers as carefully as they should. In some questions, you have to figure out the topic of the question. In this question, you have to figure out what the answer choices mean.
Step 1.Read the stem of the question.
Step 2. Reword the question in your own words.
Step 3.Read the answer choices.
Step 4. Think: “What nursing concept should I identify in the answer choices?”
THE REWORDED QUESTION: What is a priority for a client with heart failure?
ANSWERS:
“Do your ankles swell at the end of the day?” Why would you ask a client this question? Because edema is a symptom of right-sided heart failure. Is right-sided failure your priority? No, left-sided failure takes priority because it affects the lungs. Eliminate this answer.
“How do you position yourself for sleep?” Why would you ask a client this question? If the client sleeps flat in bed, breathing is not compromised. If the client sleeps in a recliner, the client experiences orthopnea, a symptom of left-sided failure. This would be a priority. Keep this answer for consideration.
“How do you feel after you eat dinner?” Why would you ask a client this question? Bloating after meals is a symptom of right-sided failure. This is not as important as breathing problems. Eliminate this answer.
“Do you have chest pain when you inhale?” Why would you ask a client this question? It does indicate a breathing problem. The student who reacts rather than thinks may select this answer. Pain on inspiration may indicate irritation of the parietal pleura of the lung, which is not associated with heart failure. Eliminate this answer.
The correct answer is (2). In order to select this answer, you must recognize that “Where do you sleep at night?” represents orthopnea. The NCLEX-PN® exam can take important concepts such as this and “hide” the concept in some fairly simple behaviors.
Let’s try another question where you have to figure out what the answer choices really mean.
Step 1. Read the stem of the question.
Step 2.Reword the question in your own words.
Step 3. Read the answer choices.
Step 4.Think: “What nursing concept should I identify in the answer choices?”
THE REWORDED QUESTION: What is the highest priority for a client after a paracentesis?
ANSWERS:
“Do your clothes feel tight?” Why would you ask a client this question? Clothes should fit looser because the abdominal girth has decreased after fluid has been removed with a paracentesis. This is an expected outcome. Eliminate.
“Do you need to void?” Why would you ask a client this question? It is imperative to empty the bladder prior to the procedure, not after the procedure. There is no compelling reason to ask the client this question. Eliminate.
“Are you feeling dizzy?” What makes a client dizzy? One of the causes is a decrease in cerebral perfusion due to a fall in blood pressure. Could this client have a decreased blood pressure? Yes. Hypotension and hypovolemic shock are complications of a paracentesis due to removal of a large volume of fluid. Keep this answer for consideration.
“Do you have any pain?” You ask this question to assess pain level. This client may have discomfort where the paracentesis was performed, but this is an expected outcome. Eliminate.
The correct answer is (3).
These questions illustrate why knowing nursing content is not enough to answer application/analysis-level questions. You must be able to effectively use the information you learned in practical/vocational nursing school to answer NCLEX-PN® exam-style test questions. Review the lessons that you learned in this chapter:
Reword the question.
Eliminate answer choices you know to be incorrect.
