Some of you are CNAs or other unlicensed assistive personnel (UAPs) completing your practical/vocational nursing studies, while others are EMTs. Some of you worked during school as student techs. All of you, however, spent time in clinical during your practical/vocational nursing education. All of this adds up to a lot of experience. Experience will help you get a job, but answering questions based on your experience can be dangerous on the NCLEX-PN® exam.
Look at the following question.
Let’s see how someone using his or her real-world experience would approach this question:
“The roommate is never involved in identification of a client.”
“A confused client cannot be relied on for an accurate identification.”
“Sounds reasonable. I have seen this done in some circumstances.”
“A photograph? What photograph? I’ve never seen a photograph of a client in a medical record!”
Possible conclusions drawn by this person would include: “OK, I’ve seen one LPN/LVN ask another for information so (3) must be the answer,” or “Well, maybe the client isn’t all that confused, so I’ll select (2).”
According to nursing textbooks, asking another health care professional is not the correct way to identify a client. Many acute-care settings now include a photograph of the client in the medical record for just this type of situation. The correct answer to this question is (4). Many students reject this answer because there are rarely photographs of clients in the medical records. Real-world experience doesn’t count, though; in this case, the client does have a photograph in the medical record.
The NCLEX-PN® exam is a standardized exam administered by the NCSBN. Because the NCLEX-PN® exam is a national exam, students should be aware that in some parts of the country, practical/vocational nursing is practiced slightly differently. However, to ensure that the test is reflective of national trends, questions and answers are all carefully documented. The test makers ensure that the correct answers are documented in at least two standard nursing textbooks or one textbook and one nursing journal.
When you are unsure of an answer choice, don’t ask yourself, “What do they do on my floor?” but “What does the medical/surgical textbook writer Brunner say?” or “What do Potter and Perry say to do?” This test does not necessarily reflect what happens in the “real world,” but is based on textbook nursing.
Remember the following when taking the NCLEX-PN® exam:
You have all of the time and resources you need to provide appropriate care to your client. (Checking for bowel sounds for 5 minutes in all four quadrants, no problem!)
You have all of the equipment you need. (Remember the bath thermometer you learned to use in the nursing lab? For the NCLEX-PN® exam, you will have one available to test the temperature of bath water.)
There are no staffing problems on the NCLEX-PN® exam. You are caring only for the client described in the question, and that person is your only concern.
All care given to clients is “by the book.” No shortcuts are used.
Answer the following question.
Let’s look at this using real-world logic.
Ask the security guard to stay with the client. Yes, in the real world, security is called when clients are agitated.
Have UAP remain with the client. Sounds good, but what if you don’t have enough staff to assign a UAP to remain with the client?
Leave the client alone until the medications take effect. Yes, that is done in the real world for most medicated preoperative clients, but this client is agitated and confused. This is not the best answer.
Restrain the client with the help of a coworker. Yes, this is done in the real world.
According to real-world logic, the correct answer must be (1) or (4). However, textbook theoretical nursing practice states that this client should not be left alone while in an agitated state. A member of the health care staff should remain with the client. Therefore, the correct answer is (2).
Use your real-world experience to help you visualize the client described in the test question, but select your answers based on what is found in nursing textbooks.
Your nursing faculty has been very conscientious about instructing you in the most up-to-date nursing practice. According to the National Council of State Boards of Nursing, the primary source for documenting correct answers is in nursing textbooks, and the most up-to-date practice might not always agree with the textbooks. When in doubt, always select the textbook answer!
The next question illustrates this point.
Let’s look at these answers more closely.
Pumping the breasts will stimulate milk production. This is clearly wrong.
Wearing a tight bra and using ice packs are appropriate interventions for a nonbreastfeeding mother.
Taking a medication (mild analgesic) is an appropriate intervention for a nonbreastfeeding mother.
Medication to prevent lactation is not frequently prescribed because of potentially dangerous side effects. However, a medication may be prescribed to prevent lactation. This would be considered an appropriate intervention.
