Lippincott’s Q&A Review for NCLEX-RN

Application-Level Item Application-level items test your ability to apply knowledge to a specific scenario. These questions draw on your ability to know and understand nursing content, and to then apply this information to a specific scenario or situation (see Fig. 2.10). Figure 2.10 Sample Application-Level Item Strategies for Answering Application- Level Questions Read the question and consider what information you already know and how that information should be used to answer this particular question. Consider how information you can recall should be applied to nursing care for the client that is described in the scenario for the question. Apply known formulas (divided dose/drip rate calculation), frameworks (eg, Maslow's hierarchy, developmental stages, stages of moral development), and procedural steps (how to administer a particular medication) to answer the question posed in the new clinical situation (scenario). Double-check your answer by recognizing what information you are applying to answer the question. Analysis-Level Items Questions at this level ask you to analyze data, clusters of symptoms, and implementation plans, and then make nursing diagnoses and clinical decisions. These questions can also ask about what additional information should be obtained to make a clinical decision, plan care, or make a nursing diagnosis (see Fig. 2.11). Figure 2.11 Sample Analysis-Level Item Strategies for Answering Analysis- Level Questions Identify the data presented in the scenario that lead you to draw a conclusion. Identify how the parts are related and how the nurse should assemble them to make a complete care plan. Determine if you have sufficient information to make a decision. Review data from all sources possible (client's vital signs, client's responses to medication and treatments, chart information, client assignment list, etc.) Double-check your answer by determining that you have understood all of the components of care and have made the correct nursing decision based on those components. Synthesis-Level Items Synthesis-level test items ask you to use several pieces of information to make a clinical decision. The focus here is on obtaining sufficient information to make a clinical decision, rather than analyzing data already available. The information may come from the client/family or members of the health care team. In synthesis-level items, you must determine accuracy and usefulness of information for the particular situation, sort relevant data from irrelevant data, and use it to plan or give nursing care (see Fig. 2.12). Figure 2.12 Sample Synthesis-Level Item Strategies for Answering Synthesis- Level Questions Read the question to determine what information is necessary to provide safe client care. Determine if you have sufficient and accurate information. Interpret all data obtained in context of the question and the client's needs. Make a clinical decision about the relevant nursing action. Double-check your answer by being sure that the information you have directs you to the correct answer. Evaluation-Level Items Evaluation-level items ask you to make judgments about care, determine the effectiveness of nursing care, or evaluate the extent to which an intended outcome has been achieved. Evaluation-level test items can also ask you to determine if the care given by others (client/family, health care team, health care provider) is appropriate (see Fig. 2.13). Figure 2.13 Sample Evaluation-Level Item Strategies for Answering Evaluation- Level Questions Review the question to determine what is to be evaluated. Consider if the question is asking you to verify a client's understanding or if the question is asking if a particular outcome has been attained. Before looking at possible answers, consider what is the accepted standard of care, ideal level of care, or intended outcome. Match the answers with your understanding of the standard of care. Double-check your answer with the scenario and expected standard of care in that scenario. Creation-Level Items Creation-level test items require you to use information obtained from a client, family, or clinical situation and develop a new or unique approach to solving the clinical problem. For example, the test items may ask you to develop a plan of care, a discharge plan, or an action plan to manage quality improvement (see Fig. 2.14). Figure 2.14 Sample Creation-Level Item Strategies for Answering Creation- Level Test Questions Read the question to determine what is to be developed or created. Consider all of the elements necessary to have a complete plan of care, discharge plan, etc. Understand what is and is not appropriate to include in the plan being created, and rule out inappropriate aspects of care for the client or situation presented in the scenario. Double-check your answer by reviewing the appropriateness of each of the elements in the plan you have developed. References Anderson, L. W., & Krathwohl, D. (Eds.) (2001). A Taxonomy for Learning, Teaching, and Assessing: A Revision of Bloom's Taxonomy of Educational Objectives. New York, NY: Longman. National Council of State Boards of Nursing, Inc. Retrieved September 28, 2012, from Su, W. M., Osiek, P. J., & Starnes, B. (2005). Using the revised Bloom's Taxonomy in the clinical laboratory. Nurse Educator, 30(3), 117–122. Wendt, A., & Harmes, C. (2009). Evaluating Innovative Items for the NCLEX-RN®, Part I Usability and Pilot Testing. Nurse Educator, 34(2), 56–59. Wendt, A., & Kenny, L. (2009). Alternate item types: Continuing the quest for authentic testing. Journal of Nursing Education, 48(3), 150–156. 3 How to Prepare for and Take the NCLEX-RN® and Other Nursing Exams Studying for the NCLEX-RN or other similar exams requires careful planning and preparation. You can make the best use of your time by developing a systematic approach to study that includes these five steps to test for success: Assessing your study needs. Developing a study plan. Refining your test-taking strategies. Rehearsing test anxiety management skills. Evaluating progress on a regular basis. Use these five steps as you take your first test in nursing school. Refine your test-taking strategies as you evaluate your progress at each step of the way, so that when you are ready to take the licensing exam you will be an experienced and successful test taker. Use the Personal Study Plan in Table 3.1 to help develop your own study plan. Assessing Study Needs The first step toward test success is to determine your strengths and limitations. Even students who have been successful throughout their academic life, and nurses who are excellent caregivers, have areas in which they need improvement. Be honest with yourself as you assess your own study needs. These steps can help you in your assessment: Review your success in nursing school. Review your record of achievement in courses in the nursing curriculum. Success on the NCLEX-RN tends to correlate with grades (grade point average) achieved in nursing school. Subjects in which you received high grades, that you found easy to learn, or in which you have had additional clinical practice or work experience are likely to be areas of strength. On the other hand, subjects you found difficult to learn (or in which you did not achieve high grades) should be areas for concentrated review. Also consider content areas that you have not studied for a while. Recent course work will be the most familiar and, therefore, may require the least amount of study. All students, even students who have achieved success in nursing courses, benefit from identifying areas requiring study and spending time practicing test-taking skills. You also can use the practice exams in this book to identify areas needing further study. Begin with the subjects you find most difficult or in which you have the least confidence. Assess your test-taking skills. Using effective test-taking skills contributes to exam success. What have you done in the past to make you confident about taking a test? How do you feel when you are in the exam situation? What has worked in the past to help you be successful? Review these strategies to build on past successes and work on problem areas. Consider additional strategies suggested in the section “Refining Your Test-Taking Strategies,” page 31. You can practice these skills by simulating the testing situation using the practice tests and comprehensive exams in this review book. Assess your ability to take tests that require application, analysis, and evaluation. Test questions used on the licensing exam are written at higher levels of the cognitive domain. Many candidates' experience with taking tests has come from taking “teacher-made” tests—tests developed by the faculty at your school of nursing. These tests are commonly written to test students' knowledge and understanding of course content and may not include questions that require application, analysis, or evaluation of course material. Additionally, several of the types of alternate-format questions have recently been added to the exam, and nursing faculty may not yet be designing their own test questions using these formats. Finally, some students are able to “second-guess” the teacher and use this ability to their advantage when taking teacher-made classroom tests. However, it is not as easy to anticipate test questions on standardized and licensing exams, and you will need to develop skills that will help you think critically when presented with an unfamiliar situation. As you prepare to take the licensing exam, spend time on questions where you need to “figure out” the best approach to answering the question. You can use the questions in this book and CD-ROM to be sure you understand the difference between questions that require only recall and understanding and those that require you to apply information to provide client care, make clinical judgments, and initiate nursing actions. Table 3.1 Personal Study Plan Assess your English language skills. Persons for whom English is an additional language or who do not have well-developed reading and comprehension skills may require additional practice in reading and answering NCLEX-RN-style test questions. If you are one of these persons, plan additional time to practice reading and answering questions, to time yourself when answering questions, and to validate that you understand the question correctly. If necessary, seek assistance. Assess your ability to take timed tests. Are you always the last one to finish a test? Do you request additional time to complete a test? If so, you will want to practice taking timed tests and doing your best, while completing as many questions as possible. The licensing exam is designed to be completed in 6 hours; only questions completed within that time frame will be scored. As you use the practice questions and tests in this book and CD-ROM, time yourself and, if needed, determine ways that you can increase your speed without sacrificing accuracy. Assess your skills for taking computer-administered exams. Although previous computer experience is not necessary to take the NCLEX-RN, you should familiarize yourself with the differences between taking a paper-and- pencil exam and taking exams administered by the computer. If you have not used a computer before, find a learning resource center at your college, university, library, or hospital where you can become familiar with basic computer keyboard skills. The CD-ROM accompanying this book, which simulates the computerized NCLEX, offers you the opportunity to practice taking computer-administered test questions. Use it to practice reading questions from the computer screen and become acquainted with answering questions in a computerized format. If you are accustomed to underlining key words or making notes in the margins of paper-and-pencil tests, adapt these strategies to reading and answering the questions on the computer screen. Also be sure that you can use a drop-down calculator to answer questions requiring the use of math skills. Assess your reason(s) for not answering the test question accurately. There are many reasons why students select an incorrect answer. These could include not reading the question carefully (not reading all of the words in the sentence; missing key words), not reading the options carefully, not knowing the answer (knowledge deficit), not recognizing the rationale for the correct answer, guessing, or not being rested or dealing with health problems when taking the exam. The most important thing you can do to assess the reason why you are not answering questions correctly is to use the Content Mastery and Test-Taking Skill Self-Analysis table (Table 3.2) to identify your specific reason(s) for not answering the questions in this book correctly. Total the check marks in the columns to identify patterns of reasons for not answering the questions correctly. There is a tear-out copy of the Content Mastery and Test-Taking Skill Self- Analysis table (at the back of the book) which you can copy and use for each test in this book. Assess your risk for not passing the licensing exam. Recent evidence indicates that factors associated with not passing the licensing exam can be identified (Breckenridge, Wolf & Roszkowski, 2012). Table 3.3 lists these factors; having more factors is associated with higher risk. It is important that you identify your risk for not passing the licensing exam and take advantage of all resources available to assist you to lower your risk. Interventions include forming study groups, attending review sessions, establishing effective study habits, practicing test taking on a regular basis, determining reasons for not answering questions correctly (use the Content Mastery and Test-Taking Skill Self-Analysis table in this book), and taking action steps to improve knowledge of nursing content and test-taking strategies. The earlier in the academic program that you can identify your risk, use interventions, and monitor your progress, the more likely you are to reverse your risk and improve your chance of passing! Developing a Study Plan Once you have identified areas of strength and areas needing further study, develop a specific plan and begin to study regularly. Students who study a small amount of content over a longer period of time tend to have higher success rates than students who wait until the last few weeks before the exam and then “cram.” Consider these suggestions: Identify a place for study. The area should be quiet and have room for your books and papers or electronic study materials. Do not study while playing music, responding to text messages, or listening to the television; background noise is distracting and will not be allowed at the actual NCLEX-RN testing site. Your area for study might be in your home, at your nursing school, at your workplace, or in a library. Be sure your friends and family understand the importance of not interrupting you when you are studying. Establish regular study times. Make appointments with yourself to ensure a commitment to study. Frequent, short study periods (1 or 2 hours) are preferable to sporadic, extended study periods. Test yourself often by taking test questions or generating test questions yourself; using practice test questions is more effective than rereading your textbooks or notes (Shellenbarger, 2011). Plan to finish your studying 1 week before the NCLEX-RN; last-minute cramming tends to increase anxiety. Obtain all necessary resources. As you begin to study, it is helpful to have easy access to textbooks, electronic resources, notes, and study guides. Make the best use of your time. Make review cards that you can carry with you to study during free moments throughout the day. Some students record review notes and listen to the tapes or podcasts while driving or exercising. Use electronic devices and smartphones to add test review “apps” to practice test questions on a regular basis. (Find NCLEX-RN Q and A apps at the iTunes store by searching at Lippincott NCLEX). Reduce or eliminate stressful situations. Students who are juggling multiple responsibilities (such as working, managing a family, taking courses, planning a wedding, or caring for elderly parents) may find it difficult to find time to study or to concentrate when studying. Managing a variety of stressful situations puts students at risk for failing exams. If possible, reduce the number of stressful situations you are involved in during the time you are preparing to take the NCLEX-RN exam. Table 3.2 Content Mastery and Test-Taking Skill Self-Analysis Table 3.3 Factors Associated with Risk of Failure on NCLEX-RN Develop effective study skills. Study skills enable you to acquire, organize, remember, and use the information you need to take the NCLEX-RN. These skills include outlining, summarizing, applying, synthesizing, reviewing, and practicing test-taking strategies. Use these study skills each time you prepare for an exam. Use study skills with which you are familiar and that have worked well for you in the past. Recall effective study behaviors that you used in nursing school, such as reviewing highlighted text, outlines, or content maps. Study to learn, not to memorize. The NCLEX-RN tests application and analysis of knowledge. When reviewing content, continually ask yourself, “How is this information used in client care?” “What clinical decision-making will be required of this information?” and “What is the role of the nurse in using this information?” Being able to apply information, rather than just being able to list or recognize information, is one of the most important study skills to master. Study for “deep learning,” not surface learning, which emphasizes only comprehension and short-term recall. Identify your learning and study-style preferences. Each student has a preferred way of learning. For example, some students prefer learning material by listening; they are considered auditory learners. If this describes your preference, you will benefit from reviewing taped notes or class lectures. Some students learn best in a visual mode. They learn by reading, reviewing slide presentations, or looking at illustrations. For these visual learners, reading and looking at images is helpful. Kinesthetic learners, those who like to touch and manipulate to learn, benefit from working with models and manikins to reinforce their learning. While you likely have one learning style and study preference, using a variety of styles will enhance the study experience. If English is not your first language, focus on developing your language skills (Hansen and Beaver, 2012). Make note cards of words that are unfamiliar or keep a list of words from practice tests that you do not know, and review these words. Study with a friend for whom English is the native language, and discuss practice questions to understand meaning of the words and the nursing context. Using concept maps is another useful strategy when studying about particular health problems. Some students prefer to study alone, whereas others benefit from study groups; know which approach works best for you and develop your study plan accordingly. If you participate in a study group, limit the group size to about seven people. The group should develop norms for working together that focus on understanding and applying nursing content, rather than memorizing facts. Every member must come prepared to contribute. Study the most difficult material before bedtime. Research indicates that sleeping consolidates information in your memory (Shellenbarger, 2011). Anticipate questions. As you study, formulate questions around the content. Practice giving a rationale for your answer to these questions. If you work in a study group, have each member contribute questions that the entire group answers. Frequent testing solidifies learning. Study common, not unique, nursing care situations. The NCLEX-RN tests minimum competence for nursing practice; therefore, focus on common health problems and client needs. Review the RN Practice Analysis, published by the National Council of State Boards of Nursing, and the current licensing exam test plan to determine common nursing care activities. Both can be found at the NCSBN website at (National Council of State Boards of Nursing, Inc., 2013). Study broad concepts, rather than insignificant details. Be sure you understand the underlying pathophysiology and nursing implications across the life span for broad concepts such as oxygenation, perfusion, comfort, delegation, and so on. Answers to test questions can be derived from understanding the basic concept and then determining how to implement nursing care for specific client needs. Simulate test taking. The comprehensive tests in Part Three of this book and the CD-ROM are designed to simulate the random order in which questions appear in the NCLEX-RN. Use these resources to focus on areas of common concern in nursing care rather than on the traditional content delineation of adult, pediatric, psychiatric, and childbearing clients. Make additional copies of answer sheets, and retake the exams on which you had low scores. Use the Content Mastery and Test-Taking Skill Self-Analysis table (Table 3.2 and at the back of the book) to review the reason you have missed a question. Refining Your Test-Taking Strategies Knowing how to take a test is as important as knowing the content being tested. Strategies for taking tests can be learned and used to improve test scores. Here are some suggestions for building a repertoire of effective test-taking strategies: Understand the type of test item and the cognitive level and related thinking processes. (See Chapter 2 for more information on question types and cognitive levels found on the NCLEX-RN exam.) Understand which integrated process (step of the nursing process, caring, communication, documentation, teaching/learning) is being tested. For example, as you read the question, determine whether the question is asking you to set priorities (planning) or judge outcomes (evaluation). Understand client needs. As you read the question, consider the question in the context of client needs. Be sure to understand if the question is asking you to determine what to do “first” or to select the nursing action that is “best.” Understand the age of the client noted in the test question. If relevant to answering the question, the age of the client will be specified; consider what information about that age-group will be important to answering the question. If the age of the client is not specified, assume that the client is an adult and base your answers on principles of adult growth and development. Read the question carefully. This is one of the most important aspects of effective test taking. Read the stem carefully; do not rush. Ask yourself, “What is this question asking?” and “What is the expected response?” If necessary, rephrase the question in your own words, but do not change the meaning of the question when putting the question in your own words, as this is one of the reasons for obtaining an incorrect response. Do not read meaning into a question that is not intended, and do not make a question more difficult than it is. If you do not understand the question, try to figure it out. If, for example, the question is asking about the fluid balance needs of a client with pheochromocytoma and you do not remember what pheochromocytoma is, then try to answer the question based on your knowledge of the concept of fluid balance. The exam questions reflect U.S. and Canadian nursing practice standards and are not written to test knowledge of procedures or practices at specific health care agencies. Thus, it is important to answer the question from the framework of best nursing practice, not unique practices or procedures that are specific to one clinical agency. For example, “code blue” may be a specific term for a cardiac arrest in one agency, but not in another, or there may be specific steps in the procedure for intravenous line care at each agency. When answering the question, refer to evidence-based practices more than your personal clinical experiences. Determine if the question is asking you to set priorities or place steps of a procedure in a particular order. Read the stem of the question carefully and be clear about the priority (first, last) or order (first, last) in which you are to answer the question. Base your answer on commonly used nursing frameworks for setting priorities, such as the nursing process: assess, plan, implement, evaluate; Maslow's hierarchy of needs: physiological, safety and security; love and belonging, self-esteem; self-actualization; principles of emergency care: breathing, bleeding, circulation; principles of triage: resuscitation, emergent, urgent, less urgent, nonurgent; fire response priorities: rescue, alarm, confine, extinguish; role of the nurse vs. role of the primary care provider, vs. role of the licensed practical nurse (LPN) and unlicensed assistive personnel (UAP); or procedures for delegation: scope of practice, workload, ability, follow-up. Look for key words that provide clues to the correct answer. For instance, words such as “except,” “not,” and “but” can change the meaning of a question; words such as “first,” “next,” and “most” ask you to establish a priority or use an order or sequence of steps; key words such as “most likely” or “least likely” are asking you to determine a probability of a successful outcome. When the question asks you to “select all that apply,” be sure you are considering each option as having the possibility of being correct, and have ruled out the ones you have not selected as being incorrect. Be certain you understand the meaning of all words in the question. If you see a word you do not know, try to figure out its meaning from a familiar base of the word or from the context of the question. Attempt to answer the question before you see the answers, and then look for the answer(s) (hot spot and graphics) that is/are similar to the one(s) you generated. Eliminate answers that you know are not correct. Base answers on nursing knowledge. Remember that the NCLEX-RN is used to test for safe practice and that you have learned the information needed to answer the question. If you do not know an answer, make a reasonable guess. Hunches and intuition are often correct. Do not waste time and energy; give yourself permission to not know every question, and move on to the next one. In CAT, you must answer each question before the next item is administered, and because the level of difficulty will be adjusted as you answer each question, it is likely that you will know the answer to one of the next questions. Learn to pace yourself. Pacing has been noted to be an important test- taking skill (Thomas & Baker, 2011). Pacing involves spending an appropriate time on each question as well as monitoring the time during the test. Test takers who do not pace themselves may end up guessing rapidly and then do not answer the question correctly. Use the comprehensive tests in this book to time yourself and develop an appropriate pace for yourself. Strategies for Managing Test Anxiety All test takers experience some anxiety. A certain amount of anxiety is motivating; extreme anxiety contributes significantly to poor test performance by causing test takers to change answers, lose concentration, misread or misunderstand questions, or become unable to control the pace of their response to the questions. Be prepared to control unwanted anxiety using the suggestions below. Anxiety can be managed by both physical and mental activities. Practice anxiety management strategies while you are taking the comprehensive examinations in this book, and use them with each exam you take in school or elsewhere. Practicing managing test anxiety when taking “low stakes” tests, such as classroom tests, will make managing test anxiety much easier when you are taking the “high stakes” tests, such as course or program final exams and, of course, the licensing exam. Commonly used anxiety management strategies include Mental rehearsal—Mental rehearsal involves reviewing the events and environment during the examination. Anticipate how you will feel, what the setting will be like, how you will take the exam, what the computer screen will look like, and how you will talk to yourself during the exam. Visualize your success. Rehearse what you will do if you have test anxiety. Relaxation exercises—Relaxation exercises involve tensing and relaxing various muscle groups to relieve the physical effects of anxiety. Practice systematically contracting and relaxing muscle groups from your toes to your neck to release energy for concentration. You can do these exercises during the exam to promote relaxation. Smile! Smiling relaxes tense facial muscles and reminds you to maintain a positive attitude. Deep breathing—Taking deep breaths by inhaling slowly while counting to 5 and then exhaling slowly while counting to 10 increases oxygen flow to the lungs and brain. Deep breathing also decreases tension and helps manage anxiety by focusing your thoughts on the breathing and away from worries. Positive self-talk—Talking to yourself in a positive way serves to correct negative thoughts (eg, “I can't pass this test” and “I don't know the answers to any of these questions”) and reinforces a positive self-concept. Replace negative thoughts with positive ones, for example, tell yourself, “I can do this,” “I studied well and am prepared,” or “I can figure this out.” Visualize yourself as a nurse— you have passed the test! Distraction—Thinking about something else can clear your mind of negative or unwanted thoughts. Think of something fun, something you enjoy. Plan now what you will think about to distract yourself during the exam. Concentration—During the exam, be prepared to concentrate. Have tunnel vision. Do not worry if others finish the test before you. Remember that everyone has his or her own speed for taking tests and that each test is individualized. Do not rush; you will have plenty of time. Focus; do not let noises from the keyboard next to you divert your attention. Do not become overwhelmed by the testing environment. Use positive self-talk as you begin the exam. Some students become bored during the exam and then become careless as they answer questions toward the end of the exam. Practice taking tests of at least 265 questions and discover how long you can focus your attention on the test questions. Practice taking breaks if you begin to lose your concentration. Evaluating Your Progress The last step of your study plan is to check your progress. Review all of your responses using the tear-out Content Mastery and Test-Taking Skill Self-Analysis table (at the back of the book) to identify the number of incorrect responses, the reasons for not answering the question correctly, and how many questions in any one clinical area or categories of client needs you have missed. Note if your scores on the practice and comprehensive tests improve. Do not spend time on content you have mastered, on areas in which you obtained high scores on the practice exam, or on areas with which you feel confident. Use the results of your evaluation to set priorities for study on areas needing additional review. As noted above, evaluate your study skills, your test-taking abilities, and the use of test-anxiety management strategies as you take each test throughout your academic program. Doing so now will prepare you to test for success. Tips from Students Who Have Passed the NCLEX-RN® Students who have successfully passed the NCLEX-RN offer these tips for preparing for, and taking, this exam: Study regularly several months before taking the exam. Be sure you are well prepared. Accept responsibility for your study plan—being prepared is up to you! Practice taking randomly generated test questions. Most students are accustomed to taking teacher-made exams that cover several topics in the same content area. When taking the NCLEX-RN examination, however, each question will come from a different topic or content area, and you will need to be prepared to shift your focus to a different practice area for each question. Use practice questions until you can score at least 75% on the exam. Use practice exams with at least 2,000 questions, so you test yourself with a wide range of content and types of questions. Use a timer to determine how many questions you can answer in a specified amount of time. Use the timer to be sure you are keeping a steady pace, but not rushing through the test. Schedule to take the exam when YOU are ready, but as soon after graduation as is feasible (National Council of State Boards of Nursing, 2013). Candidates who take the exam before they are prepared are not as successful. You are in control of when you take the exam! Make sure you know the date, time, and place the exam will be given; how to get to the exam site; how long it takes to drive there; and where you can park. Do locate the exam site, drive to it, and see the room where the exam will be given. Exam sites may be located in small offices in shopping centers and could be difficult to find. Visualize yourself in the room taking the test. Use mental rehearsal to practice anxiety-managing strategies. Organize the information you will need to bring to the testing center the night before the exam. You will need to present your Authorization to Test. You will also need to provide required identification. Make sure you are physically prepared. Get enough rest before the examination; fatigue can impair concentration. If you work, it may be advisable not to work the day before the exam; if you work on a shift that is different from the time of the exam, adjust your work schedule several days ahead of time. Avoid planning time-consuming activities (eg, weddings, vacation trips) immediately before the exam. Do not use any drugs you usually do not use (including caffeine and nicotine), and do not use alcohol for 2 days before the exam. Eat regular meals before the exam. Remember that high-carbohydrate foods provide energy, but excessive sugar and caffeine can cause hyperactivity. Experts recommend that prior to taking a test, test takers eat high-fiber, high- carbohydrate foods that are slow to digest, such as oatmeal. Eating well- balanced meals the week before the test is also helpful; the diet should include fruits and vegetables; avoid meals high in meat, eggs, and cheese (Shellenbarger, 2011). Dress comfortably, in layers that can be added or removed according to your comfort level. The authors of this review book and CD-ROM offer you our best wishes for success on all of the exams you will be taking throughout your academic career. We are confident that your review and preparation have given you a good foundation for a positive testing experience! References Breckenridge, D. M., Wolf, Z. R., & Roszkowski, M. J. (2012). Risk assessment profile and strategies for success instrument: Determining prelicensure nursing students' risk for academic success. Journal of Nursing Education, 51(3), 160–166. Hansen, E. & Beaver, S. (2012). Faculty support for ESL nursing students: action plan for success. Nursing Education Perspectives, 33(4), 246–250. National Council of State Boards of Nursing. (2007). The NCLEX Delay Pass Rate Study. Retrieved October 6, 2012, from Shellenbarger, S. (2011). Toughest exam question: what is the best way to study? Wall Street Journal, October 26, D1. Thomas, M. H., & Baker, S. S. (2011). NCLEX-RN Success, evidence-based strategies. Nurse Educator, 36(6), 246–249. PART 2 Practice Tests 1 The Nursing Care of the Childbearing Family Test 1: Antepartal Care The Preconception Client The Pregnant Client Receiving Prenatal Care The Pregnant Client in Childbirth Preparation Classes The Pregnant Client with Risk Factors Managing Care Quality and Safety Answers, Rationales, and Test-Taking Strategies The Preconception Client 1. A client has obtained Plan B (levonorgestrel 0.75 mg, 2 tablets) as emergency contraception. After unprotected intercourse, the client calls the clinic to ask questions about taking the contraceptives. The nurse realizes the client needs further explanation when she makes which of the following responses? 1. “I can wait 3 to 4 days after intercourse to start taking these to prevent pregnancy.” 2. “My boyfriend can buy Plan B from the pharmacy if he is over 18 years old.” 3. “The birth control works by preventing ovulation or fertilization of the egg.” 4. “I may feel nauseated and have breast tenderness or a headache after using the contraceptive.” 2. An antenatal G 2, T 1, P 0, Ab 0, L 1 client is discussing her postpartum plans for birth control with her health care provider. In analyzing the available choices, which of the following factors has the greatest impact on her birth control options? 1. Satisfaction with prior methods. 2. Preference of sexual partner. 3. Breast-or bottle-feeding plan. 4. Desire for another child in 2 years. 3. After the nurse instructs a 20-year-old nulligravid client on how to perform a breast self-examination, which of the following client statements indicates that the teaching has been successful? 1. “I should perform breast self-examination on the day my menstrual flow begins.” 2. “It's important that I perform breast self-examination on the same day each month.” 3. “If I notice that one of my breasts is much smaller than the other, I shouldn't worry.” 4. “If there is discharge from my nipples, I should call my health care provider.” 4. Which of the following would be important to include in the teaching plan for the client who wants more information on ovulation and fertility management? 1. The ovum survives for 96 hours after ovulation, making conception possible during this time. 2. The basal body temperature falls at least 0.2°F (0.17°C) after ovulation has occurred. 3. Ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual cycle. 4. Most women can tell they have ovulated because of severe pain and thick, scant cervical mucus. 5. Which of the following instructions about activities during menstruation would the nurse include when counseling an adolescent who has just begun to menstruate? 1. Take a mild analgesic if needed for menstrual pain. 2. Avoid cold foods if menstrual pain persists. 3. Stop exercise while menstruating. 4. Avoid sexual intercourse while menstruating. 6. After conducting a class for female adolescents about human reproduction, which of the following statements indicates that the school nurse's teaching has been effective? 1. “Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes, resulting in pregnancy.” 2. “I won't become pregnant if I abstain from intercourse during the last 14 days of my menstrual cycle.” 3. “Sperms from a healthy male usually remain viable in the female reproductive tract for 96 hours.” 4. “After an ovum is fertilized by a sperm, the ovum then contains 21 pairs of chromosomes.” 7. A 20-year-old nulligravid client expresses a desire to learn more about the symptothermal method of family planning. Which of the following would the nurse include in the teaching plan? 1. This method has a 50% failure rate during the first year of use. 2. Couples must abstain from coitus for 5 days after the menses. 3. Cervical mucus is carefully monitored for changes. 4. The male partner uses condoms for significant effectiveness. 8. Before advising a 24-year-old client desiring oral contraceptives for family planning, the nurse would assess the client for signs and symptoms of which of the following? 1. Anemia. 2. Hypertension. 3. Dysmenorrhea. 4. Acne vulgaris. 9. After instructing a 20-year-old nulligravid client about adverse effects of oral contraceptives, the nurse determines that further instruction is needed when the client states which of the following as an adverse effect? 1. Weight gain. 2. Nausea. 3. Headache. 4. Ovarian cancer. 10. A 22-year-old nulligravid client tells the nurse that she and her husband have been considering using condoms for family planning. Which of the following instructions should the nurse include about the use of condoms as a method for family planning? 1. Using a spermicide with the condom offers added protection against pregnancy. 2. Natural skin condoms protect against sexually transmitted diseases. 3. The typical failure rate for couples using condoms is about 25%. 4. Condom users commonly report penile gland sensitivity. 11. Which of the following would the nurse include in the teaching plan for a 32-year-old female client requesting information about using a diaphragm for family planning? 1. Douching with an acidic solution after intercourse is recommended. 2. Diaphragms should not be used if the client develops acute cervicitis. 3. The diaphragm should be washed in a weak solution of bleach and water. 4. The diaphragm should be left in place for 2 hours after intercourse. 12. After being examined and fitted for a diaphragm, a 24-year-old client receives instructions about its use. Which of the following client statements indicates a need for further teaching? 1. “I can continue to use the diaphragm for about 2 to 3 years if I keep it protected in the case.” 2. “If I get pregnant, I will have to be refitted for another diaphragm after childbirth.” 3. “Before inserting the diaphragm, I should coat the rim with contraceptive jelly.” 4. “If I gain or lose 20 lb (9.1 kg), I can still use the same diaphragm.” 13. A 22-year-old client tells the nurse that she and her husband are trying to conceive a baby. When teaching the client about reducing the incidence of neural tube defects, the nurse would emphasize the need for increasing the intake of which of the following foods? Select all that apply. 1. Leafy green vegetables. 2. Strawberries. 3. Beans. 4. Milk. 5. Sunflower seeds. 6. Lentils. 14. A couple is inquiring about vasectomy as a permanent method of contraception. Which teaching statement would the nurse include in the teaching plan? 1. “Another method of contraception is needed until the sperm count is 0.” 2. “Vasectomy is easily reversed if children are desired in the future.” 3. “Vasectomy is contraindicated in males with prior history of cardiac disease.” 4. “Vasectomy requires only a yearly follow-up once the procedure is completed.” 15. A 39-year-old multigravid client asks the nurse for information about female sterilization with a tubal ligation. Which of the following client statements indicates effective teaching? 1. “My fallopian tubes will be tied off through a small abdominal incision.” 2. “Reversal of a tubal ligation is easily done, with a pregnancy success rate of 80%.” 3. “After this procedure, I must abstain from intercourse for at least 3 weeks.” 4. “Both of my ovaries will be removed during the tubal ligation procedure.” 16. A 23-year-old nulliparous client visiting the clinic for a routine examination tells the nurse that she desires to use the basal body temperature method for family planning. The nurse should instruct the client to do which of the following? 1. Check the cervical mucus to see if it is thick and sparse. 2. Take her temperature at the same time every morning before getting out of bed. 3. Document ovulation when her temperature decreases at least 1°F (0.56°C). 4. Avoid coitus for 10 days after a slight rise in temperature. 17. A couple visiting the infertility clinic for the first time states that they have been trying to conceive for the past 2 years without success. After a history and physical examination of both partners, the nurse determines that an appropriate outcome for the couple would be to accomplish which of the following by the end of this visit? 1. Choose an appropriate infertility treatment method. 2. Acknowledge that only 50% of infertile couples achieve a pregnancy. 3. Discuss alternative methods of having a family, such as adoption. 4. Describe each of the potential causes and possible treatment modalities. 18. A client is scheduled to have in vitro fertilization (IVF) as an infertility treatment. Which of the following client statements about IVF indicates that the client understands this procedure? 1. “IVF requires supplemental estrogen to enhance the implantation process.” 2. “The pregnancy rate with IVF is higher than that with gamete intrafallopian transfer.” 3. “IVF involves bypassing the blocked or absent fallopian tubes.” 4. “Both ova and sperm are instilled into the open end of a fallopian tube.” 19. A 20-year-old primigravid client tells the nurse that her mother had a friend who died from hemorrhage about 10 years ago during a vaginal birth. Which of the following responses would be most helpful? 1. “Today's modern technology has resulted in a low maternal mortality rate.” 2. “Don't concern yourself with things that happened in the past.” 3. “In North America, mothers seldom die in childbirth.” 4. “What is it that concerns you about pregnancy, labor, and childbirth?” 20. A 19-year-old nulligravid client visiting the clinic for a routine examination asks the nurse about cervical mucus changes that occur during the menstrual cycle. Which of the following statements would the nurse expect to include in the client's teaching plan? 1. About midway through the menstrual cycle, cervical mucus is thick and sticky. 2. During ovulation, the cervix remains dry without any mucus production. 3. As ovulation approaches, cervical mucus is abundant and clear. 4. Cervical mucus disappears immediately after ovulation, resuming with menses. 21. When instructing a client about the proper use of condoms for pregnancy prevention, which of the following instructions would be included to ensure maximum effectiveness? 1. Place the condom over the erect penis before coitus. 2. Withdraw the condom after coitus when the penis is flaccid. 3. Ensure that the condom is pulled tightly over the penis before coitus. 4. Obtain a prescription for a condom with nonoxynol 9. 22. A multigravid client will be using medroxyprogesterone acetate (Depo-