When most nursing students hear the word NCLEX, they cringe. This exam is the “grand finale” of a nursing student’s academic career. Everything the student has previously accomplished hinges on this one exam, and it determines whether he or she will be able to work as a nurse.
The NCLEX exam is a comprehensive, critically thinking exam that tests the nurse graduate’s knowledge on everything he or she has learned in nursing school. The questions on NCLEX are difficult and tricky. They require a complete understanding of nursing theory and concepts.
In addition, the nurse graduate must be able to properly analyze each question and determine which answer is the best. On the NCLEX, some questions will have more than one answer that is correct, and the graduate must pick the “best” response. This is what makes the exam difficult. However, there are some clever tricks graduates can use to help eliminate options.
In this article, I am going to give you three tricks on how to answer NCLEX style questions. To do this, I will show you a typical NCLEX exam question that deals with how to select the best response, and then I will elaborate on how to apply these three tricks in answering the question.
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NCLEX Practice Question
A patient is hospitalized with congestive heart failure exacerbation. On assessment, you note the patient has 2+ pitting edema in the lower extremities and crackles throughout the lung fields. The vital signs are as follows: blood pressure 180/96, heart rate 95 bpm, respirations 16, temperature 98.6’F, and oxygen saturation on room air is 90%. The patient is taking the following medications: Lasix IV, Digoxin, Miralax, and multivitamins. Which of the following findings cause the MOST concern?
1. Patient’s potassium level is 5.8.
2. Patient states, “I’ve been up all night urinating.”
3. Patient states, “The lights look like they have halos around them.”
4. Patient has a blood glucose level of 190.
Trick 1: Look for clues in the question!
Always pay attention to key words in a question because this will give you a hint into what the question is asking. The above question wants to know the MOST concerning finding. Therefore, be ready to pick the option that is most concerning. For example, before analyzing the options, always make note of the following information (if given) in a NCLEX question:
Patient’s diagnosis: “How does this disease process present?” and “What are the nursing interventions for this disease?”
Assessment findings: “Is this a normal or abnormal finding?” and “What are the nursing interventions (if any) for this assessment finding?”
Vital signs: “Are they normal?”
Medications: “What are the side effects of these medications (especially toxicity signs)?” and “Why is this patient on these particular medications?”
Analysis for this question using Trick 1: The patient is in fluid overload which is a typical finding with congestive heart failure exacerbation. Therefore, crackles in the lungs, edema in the lower extremities, and elevated blood pressure/heart rate are expected assessment findings.
The physician has ordered IV Lasix (a loop diuretic) to remove extra fluid from the body. Lasix increases urine production quickly, which will waste potassium through the urine. Therefore, the patient is at risk for hypokalemia (low potassium levels in the blood).
Looking further at the patient’s medications, it is also important to note that the patient is on Digoxin. Digoxin is sensitive to low potassium levels, which can lead to Digoxin toxicity. So, you want to keep this information in the back of your mind before analyzing the options.
Trick 2: Don’t get distracted with false or unrelated statements.
When you are trying to eliminate options, ask yourself if this is a correct statement and if the provided options really correspond with what is going on with the patient. Let’s apply this trick to the options:
1. The patient’s potassium level is 5.8. (False statement: Yes, this potassium level is slightly high, but it is not common for patients who are using Lasix to have issues with high potassium levels. Rather, they often have issues with low potassium levels. However, drugs that conserve potassium, such as Spironolactone, can cause high potassium levels, and it would be concerning to see this potassium level if the patient was on this type of diuretic (but not in this case). Therefore, we will eliminate this option because it is a distraction and not true for this scenario.)
2. Patient states, “I have been up all night urinating.” (True statement: We will keep this option because Lasix will cause the patient to urinate often, but is it a real concern?)
3. Patient states, “The lights look like they have halos around them.” (True statement: This statement is concerning because anytime a patient reports a sensory change, it could be due to drug toxicity, but could it be an expected finding? Since the patient is on Digoxin, we need to look into this further because “vision changes” are a sign of Digoxin toxicity. So, we will keep this option in mind and see if it applies to our scenario.)
4. Patient’s blood glucose level is 190. (Distracting option: The blood glucose level is high but not so high to cause concern, especially with options B and C presenting. So, we will eliminate this option.)
Eliminated: A & D
Trick 3: Use Maslow’s hierarchy or the ABC’s.
When you are trying to answer priority questions and have multiple options left, use Maslow hierarchy or the ABCs (airway, breathing, and circulation) to find the correct answer.
We’re left with options B & C:
1. Patient states, “I have been up all night urinating.”
2. Patient states, “The lights look like they have halos around them.”
According to Maslow’s hierarchy, physiological needs take over psychological needs, and airway, breathing, and circulation issues are important findings as well. In option B, it is normal to urinate frequently with diuretic therapy, and it is more of a nuisance for the patient (psychological need) than a concern. So, it is safe to eliminate this option.
However, “vision changes” take priority because the patient may be experiencing Digoxin toxicity, which affects physiological needs. The key word in this option is “halos”. This is a classic sign of Digoxin toxicity. In addition, the circulatory system is at risk if there is too much Digoxin in the body system.