Master the NCLEX

By Peterson's

Master the NCLEX-PN is a comprehensive source of information to help readers score their best on the licensing exam to become a practical nurse. With a review of the Practical Nursing studies content in outline form, this self-tutor guide gives students the most effective practice with the content they can expect to see on the actual exam. It provides information about basic nursing concepts, nursing procedures, and pharmacology plus details on nursing specialties. It also includes in-depth subject reviews covering all sections of the tests, 2 full-length practice tests with detailed answer explanations, listing of state boards of nursing as well as professional organizations, proven test-taking strategies and study techniques, and helpful Web resources for health, education, and job information.

• Language: English
• Publisher: Peterson's
• Release date: Oct 19, 2009
• ISBN: 9780768929003

Book preview

Peterson’s

Master the

NCLEX-PN

4th Edition

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BEFORE YOU BEGIN

Special Study Feature

Summing It Up

Each section ends with a point-by-point summary that captures the most important information in the chapter. The summaries are a convenient way to review these points one last time before the exam.

How to Get the Most Out of Your Review

You will need to set aside at least three weeks of study to get the most out of your exam review. Begin by reading the Top 10 Strategies to Raise Your Score, and then plan your schedule so that you can dedicate 1 to 2 hours every day to your review.

A good plan of study is to review one chapter each day and complete the exercises that accompany it to see how well you have mastered that material. When you have finished your review of all the subjects, take the Practice Tests. This will help you assess how well you do on each Practice Test. After taking each test, review any topics with which you are still having trouble before taking the next test. This will help you sharpen your test-taking skills.

Top 10 Strategies to Raise Your Score

In taking the NCLEX-PN exam, some strategies are more useful than others. The following tips will help you raise your score.

1. Create a study plan and stick to it. The right study plan will help you get the most out of this book in the time that you have.

2. Review key test elements daily for several weeks before the exam. Reread the Test Plan to be sure that you understand the categories and subcategories, and reread the information about alternate test formats.

3. Complete all the exercises in this book. Doing so will help you recognize your areas of strength and discover which areas need improvement.

4. If possible, visit the test center before the day of the exam. This will help you become familiar with the location and how long it takes to travel there. On the day of the exam, leave plenty of time to get to the test center in case the buses/subways/trains are running late, the weather is bad, or parking your car is a problem.

5. Avoid cramming the night before the exam. This will only make you feel more nervous. It is not likely to help you learn enough to make a difference on your test score.

6. Relax the night before the test. Try to take your mind off the exam for a while. Go to a movie or hang out with a friend—but not with someone who will be taking the test with you.

7. Place your Authorization to Test (ATT) and two forms of identification where you will see them in the morning before leaving for the test center. You will not be able to take the exam without these documents.

8. Listen to what the test administrator tells you, and pay attention to the tutorial. Don’t worry, however: You don’t need to be a computer whiz to take the test.

9. Read every word of every question on the exam. Pay attention to details. They provide clues to the answer and help prevent you from selecting the wrong answer choice.

10. Don’t spend too much time on any one question. You have up to 5 hours to complete your exam—but you still can’t afford to spend too much time on any one question. Try to maintain a steady pace of about 1 minute per question. If you take more than 2 minutes per question, you won’t get to all the questions in the allotted time.

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You’re Well On Your Way To Success!

Remember that knowledge is power. Using Peterson’s Master the NCLEX-PN will help you become familiar with the kind of content that appears in the actual NCLEX-PN exam. We look forward to helping you obtain your PN certification. Good luck!

ALL ABOUT THE NCLEX-PN EXAM

About Practical Nursing and the Job Outlook

The practical nursing profession began in the late 1800s. Women were trained for careers as home attendants caring for invalids, the elderly, and children in home settings. The profession moved outside the home during World Wars I and II, when the country had an acute need for nurses to care for wounded soldiers. In the 1940s, the National Association of Practical Nurse Education was formed. The organization developed a curriculum for Licensed Practical Nurses (LPNs), and in the late 1950s, the National League for Nursing began accrediting LPN schools in addition to those that trained registered nurses (RNs).

Today, more than 1,500 state nursing board-approved training programs for practical nurses/vocational nurses (PN/VNs) are offered through vocational and technical schools and community and junior colleges. Some high schools, hospitals, colleges, and universities also offer PN/VN programs. Most are one year long and most cost about $2,000. Admission generally requires a high school diploma or its equivalent. Programs are typically one-third class work and two-thirds clinical work, but class content is just as important as gaining clinical experience. Courses usually cover basic nursing concepts and client-care subjects, including anatomy, physiology, pediatrics, obstetrics, psychiatric nursing, drug therapy, medical-surgical nursing, nutrition, and first aid.

Becoming Licensed

A PN’s scope of practice is defined by the rules and regulations of the State Board of Nursing of each state. To obtain a license, a PN/VN must pass the NCLEX-PN exam developed by the National Council of State Boards of Nursing (NCSBN), Inc. This is a national test with no state-specific sections.

To practice in a state other than the one in which you are originally licensed, a PN must apply to the new state’s Board of Nursing for licensure. Through Interstate Endorsement, the license is usually granted after checking the PN’s records, without the PN having to retake the NLCEX-PN. Requirements vary from state to state, however, so be sure to check with a state’s Board of Nursing for its licensing conditions and process.

The Nurse Licensure Compact (NLC) is another means of gaining mutual recognition licensure. Through the NLC, a nurse holds a license in the state in which he or she lives but may practice, both in-person and via the Internet, in other states that belong to the NLC. Currently, twenty-three states are a part of the NLC. PN/VNs interested in obtaining information about the NLC should contact the Board of Nursing in the state in which they live. Appendix A of this book provides contact information for the Boards of Nursing for each state in the NLC.

The Job Outlook

PN/VNs work in many different settings. According to the U.S. Bureau of Labor Statistics, about 26 percent of PN/VNs work in hospitals, 26 percent in nursing care facilities, and 12 percent in doctors’ offices. The remaining 36 percent work for home health-care services, employment services, residential care facilities, community care facilities for the elderly, outpatient care centers, and federal, state, and local government agencies. A PN/VN’s job is to provide basic care under the supervision of doctors and RNs.

In general, a PN/VN’s duties may include:

• gathering client health information

• taking vital signs

• changing dressings

• performing routine laboratory tests

• teaching clients good health habits

• teaching family members how to care for an ill relative

• helping clients with bathing, dressing, and personal hygiene

Duties may also depend on one’s job setting. As a home health-care aide, a PN/VN may prepare meals for a client. In a doctor’s office or clinic, a PN/VN may make appointments and keep medical records. However, as more procedures are performed in doctor’s offices and outpatient facilities, PN/VNs have begun taking on direct care responsibilities for clients undergoing these procedures. PN/VNs who work in nursing homes may evaluate clients and develop care plans. In some states, PN/VNs may also administer prescribed medications and intravenous fluids.

In 2006, employment opportunities for PN/VNs numbered 749,000. The U.S. Bureau of Labor Statistics (BLS) predicts that by 2016, the nation will need another 105,000 PN/VNs: an increase of 14 percent. Practical nursing is now a fast-growing occupation in part because of the long-term care needs of a growing population of older people. Home health-care services, nursing care facilities, and doctors’ offices and clinics are expected to offer an increasing number of opportunities for PV/VNs.

Salaries for PV/VNs are also rising. According to the BLS, in 2006, the median annual salary of PN/VNs was $36,500—$10,000 more than the median just five years earlier. Employment services that provide nursing staff on a contract basis offered the highest potential earnings, a median annual income, $42,110, and doctors’ offices offered the lowest median annual income, at $32,710. Annual earnings are expected to continue rising as the demand for PN/VNs exceeds supply in the next five to ten years.

Exam Basics

NCSBN conducts periodic surveys of the tasks performed by practicing PNs and the knowledge and skills they need to perform them. This information becomes the basis of the Test Plan and the questions for the exam. Both the NCLEX-RN and NCLEX-PN exams are computer-based tests; they are not available in paper form.

You don’t need to be especially computer savvy to take the test. The test administrator will show you how to use the computer, and you will be presented with sample questions to help you get a little practice before you start the actual exam. There are twenty-five pretest questions, which are not scored.

NCLEX-PN tests are administered only at Pearson Professional Centers. There is no minimum time for completing the exam, but the maximum time is 5 hours. The 5-hour limit includes time to take a tutorial, which explains the alternate item formats and provides sample questions.

Taking a Computer-Adaptive Test

The NCLEX-PN exam is a computer-adaptive test (CAT). This means that the computer program adjusts to the ability level of the candidate taking the test. As a result, no two tests are exactly alike, but each will test the range of topics and percentage of test items in the Test Plan.

All PN/VN candidates answer at least 85 questions (maximum 205). However, the number of questions you receive on your exam does not affect your score. The length of your exam is determined by your responses. The questions alternate between difficult and easy until the computer program determines your testing level—the point at which you answer approximately one half of the questions incorrectly. At this point, your exam will end. The computer then calculates with 95 percent certainty that your ability is either above or below the passing standard.

With a CAT, you see only one question at a time on the computer screen. Once you select an answer and press NEXT, you cannot return to a question to review it. You want to be sure that you’ve answered correctly, but try not to spend more than 1 minute on any question or you will run out of time. The average is 60 to 70 seconds per test item.

How the NCLEX-PN is Scored

According to the NCSBN, the passing standard is the minimum level of ability required for safe and effective entry-level nursing practice. The passing standard is not based on a standard minimum number of questions answered correctly. Rather, it is reviewed every three years based on an appraisal of the previous three years of tests and on surveys and information from the education and nursing fields. Whether a test taker passes or fails the exam depends on whether his or her ability, as demonstrated by answering questions, is above or below the passing standard.

Registering for Your Exam

To register for the NCLEX-PN, you must first check with the State Board of Nursing of the state in which you want to practice. You do not have to take the test in that state, however. States vary in procedure. Depending on your state’s requirements, you may register directly at the test site, www.vue.com/nclex, or by phone or mail.

Test takers who have special needs must request testing accommodation before registering for the exam. The Board of Nursing in the state in which the exam will be taken handles these accommodations.

After you register for the exam, you will receive an Authorization to Test (ATT) form. Be sure to note the range of validity dates listed on the ATT. You must schedule and take your exam during this time period or you will need to reapply for another ATT. If you want to take the exam outside the United States, you must pay an international scheduling fee. A Value Added Tax (VAT) may also apply.

To be admitted to the test center, you need two valid forms of identification (at least one must be a photo ID) and your ATT. Both items must include your signature. Before your exam, you will be digitally fingerprinted and photographed, and you will be required to provide your signature. This information accompanies your exam results.

The NCLEX-PN Test Plan

The NCLEX-PN exam is built on a Client Needs structure that provides a universal method of defining competency in all nursing settings and that corresponds to state laws and rules. The Test Plan includes the following four Client Needs categories:

1. Safe and Effective Care Environment

• Coordinated Care

• Safety and Infection Control

2. Health Promotion and Maintenance

3. Psychosocial Integrity

4. Physiological Integrity

• Basic Care and Comfort

• Pharmacological Therapy

• Reduction of Risk Potential

• Physiological Adaptation

Safe and Effective Care Environment

The Safe and Effective Care Environment category assesses the candidate’s ability to provide nursing care that contributes to the enhancement of the health-care delivery setting and protects clients and health-care personnel. This category includes questions about advocacy, client-care assignments, continuity of care, performance improvement, and the referral process.

The Coordinated Care subcategory is concerned with the PN’s ability to collaborate with health-care team members to provide effective client care. Topics include:

• advance directives

• continuity of care

• advocacy

• establishing priorities

• client-care assignments

• ethical practice

• client rights

• informed consent

• concepts of management

• legal responsibilities and supervision

• performance improvement (quality assurance)

• confidentiality

• consultation with health-care team members

• referral process

• resource management

The Safety and Infection Control subcategory is concerned with protecting team members, clients, and clients’ family members and friends from health and environmental hazards. Topics include:

• accident/error/injury prevention

• handling hazardous and infectious materials

• home safety

• safe use of equipment

Health Promotion and Maintenance

This category relates to the stages of human growth and development and with preventing health problems and early detection of health problems. The PN/VN must be familiar with the aging process, data collection methods, family planning, health promotion, screening programs, lifestyle choices, and self-care.

Psychosocial Integrity

Psychosocial Integrity is concerned with the emotional, mental, and social well-being of clients. The PN/VN is expected to aid clients and their families and significant others in coping with and solving problems such as end-of-life decisions, grief, mental illness, substance abuse, suicide, and violence.

Physiological Integrity

This category is concerned with clients’ physical well-being. The PN/VN aids in promoting physical health and well-being by providing care and comfort, reducing risk potential for clients, and assisting clients with the management of health alterations.

The Basic Care and Comfort subcategory is concerned with the activities of daily living. Topics may include:

• assistive devices

• nutrition and oral hydration

• elimination

• palliative/comfort care

• mobility/immobility

• personal hygiene

• nonpharmacological comfort

• rest and sleep

The Pharmacological Therapies subcategory concerns the administration of medications. Topics may include:

• adverse effects and side effects

• pharmacological actions

• pharmacological agents

• medication administration

The Reduction of Risk Potential subcategory assesses the knowledge, skills, and abilities necessary to prevent clients from developing complications or health problems related to treatments, procedures, or existing conditions. Topics may include:

• diagnostic tests

• therapeutic procedures

• laboratory values

• vital signs

• potential for alterations in body systems

• potential for complications (diagnostic tests/treatments/procedures/surgery)

The Physiological Adaptation subcategory deals with acute, chronic, and life-threatening problems related to physical health. Topics may include:

• alterations in body systems

• medical emergencies

• basic pathophysiology

• radiation therapy

• fluid and electrolyte imbalances

• unexpected response to therapies

Percentage of Exam Items

On the NCLEX-PN, percentages are assigned to each category and subcategory of the Client Needs structure. The following table provides the specific percentages as determined by the NCSBN, which oversees the test:

NCLEX-PN exam questions are primarily application and analysis, which means that you need to apply what you have learned in class and in your clinical experience to make decisions based on real-life situations.

Integrated Nursing Processes

The NCLEX-PN is designed to assess a test taker’s knowledge of the four Integrated Processes fundamental to the work of the PN/VN at the same time it evaluates his or her skills in the Client Needs categories. For example, test items that fall under the Reduction of Risk Potential subcategory of Physiological Integrity may also assess the candidate’s knowledge of ways to change a client’s harmful behavior (such as drinking alcohol while pregnant).

1. Clinical Problem-Solving Process (Nursing Process)—This includes data collection, planning, implementation, and evaluation of clients.

2. Caring—The PN/VN must establish an atmosphere of respect and trust with clients, their families, and their significant others to bring about the desired therapeutic outcomes.

3. Communication and Documentation—Handwritten and/or electronic records and nonverbal interactions are related to client care. Certain standards of practice and accountability apply in documenting this information.

4. Teaching and Learning—PN/VNs interact with clients, their families, and their significant others to promote positive behavioral changes in the client.

What to Expect on the Exam

In 2003, the NSCBN added alternate formats to the standard one-answer multiple-choice format of the NCLEX-PN. This allows test takers to demonstrate what they know in ways other than answering multiple-choice questions. For example, a fill-in-the-blank question requires test takers to enter a number after performing a calculation. According to the NCSBN, most candidates receive a minimum-length test that includes at least one or two alternate-format items. Let’s take a look at the types of question formats you may encounter on the exam.

Multiple Choice: One Answer

Most exam questions on the NCLEX-PN are multiple-choice questions with four answer choices. You may choose only one answer for these questions. The answer choices are marked with circles.

Multiple Response

Multiple-response exam questions require that you select as many correct answers as apply. The answer choices are marked by boxes that you must check.

Fill in the Blank

Fill-in-the-blank exam questions require you to perform a math calculation to find the answer. A calculator button appears on the lower right corner of the screen; you must click on it to open it. You may use either the mouse or the computer’s keypad to perform calculations. The computer program allows you to input only numbers and a decimal point in the answer box.

Hot Spot

Hot Spot exam questions present a problem and a figure. To answer the question, you must place the cursor on the area of the figure that corresponds to your answer choice. Clicking on the figure will place an X on that area as your answer.

Chart/Exhibit

Chart/Exhibit exam questions require you to examine a chart or an exhibit on the screen that illustrates a problem. You must click on the Exhibit button at the bottom of the screen to open the figure. Then, click on each tab at the top of the exhibit screen and read the information presented. After you have read the information on the first tab, click on the second tab and the first one will close. When you click on the third tab, the second tab will close. If you need to reread information within the tabs, you canreopen previous tabs by clicking on them.

Drag and Drop/Ordered Response

Drag-and-Drop exam questions ask you to place items in a specific order, such as order of priority. Unordered items appear in a column on the left of your screen. To answer this type of question, you must move each item to the column on the right of the screen and arrange all the items in the correct order. You may either click on each item and drag it to the column on the right or highlight the item and click on the arrow key pointing to the column on the right. You can also use the keyboard arrow keys to rearrange items once you have moved all of them to the column on the right.

Top 10 Strategies for Choosing the Right Answer

Each NCLEX-PN exam includes some questions that the NCSBN is testing for validity before it places them in the official test item pool. You won’t know which of the exam questions are not included in your score—so be sure that you answer all exam questions to the best of your ability.

Most exam questions consist of a case statement or situation, the question itself, and the answer choices. Here are ten time-tested techniques that will help you score high on the exam.

1. Answer only what the question asks; don’t read information into the question. If the question asks you to identify one of the developmental stages of the physical growth of a toddler, don’t become confused by an answer choice dealing with motor skills. Read each word of every case statement and question carefully, and be sure you can identify exactly what the question is asking for before you choose your answer.

2. Analyze case statements and questions for signal words that prioritize. These include first, immediate, initial, next, primary, best, essential, highest priority, and most important. When you see any of these words or phrases or others like them, you know that the question is asking you to indicate some type of order.

3. Use the nursing process when asked to determine what action to take first. If the client has not been fully assessed, then the answer is likely to involve making an assessment, such as taking blood pressure, assessing respirations, determining urine output, and so on. After assessing, a nurse must plan—and questions about prioritizing care often appear on the exam. Implementation and evaluation questions are not as likely to be confusing.

4. If the question relates to a client’s most important needs, use Maslow’s Hierarchy of Needs. Physiological needs—airways, breathing, and oxygen—always come first. If the question doesn’t relate to physiological needs, then look for an answer that relates to client safety. Remember that checking the client comes before checking the equipment.

5. Avoid answer choices that employ absolutes. Signal words for such answer choices include all, always, every, never, none, and only.

6. If several answers seem to be correct in a multiple-choice question, look for the broadest answer. The broadest, most general answer will likely encompass the ideas of the more specific answer choices. For example:

What symptoms would a nurse expect to observe if a client has the flu?

(1) A wet productive cough

(2) A headache

(3) A fever accompanied by headache and extreme fatigue

(4) A high fever

Answer choices (2) and (4) are both flu symptoms, so you might choose one of them. However, the correct answer is (3), which includes both of these symptoms along with a third flu symptom.

7. In a standard multiple-choice question with similar answer choices, use the process of elimination to determine the correct answer. Let’s say that three of the answer choices for a question about communicating with a mother about the care of a newborn relate to how the mother should deal with other siblings, and only one answer describes nursing the newborn. The one about nursing is most likely the correct answer.

8. Know the antidotes to common drugs. Memorize antidotes such as magnesium sulfate (calcium gluconate), heparin (protamine sulfate), and Coumadin (vitamin K or aquamephyton).

9. Memorize lab values. The exam will not provide charts of values, so take time in your test preparation to memorize them. In addition to hemoglobin (12–18 g/dl), white blood count (5000–10,000 mm³), and platelets (150,000–400,000), make sure you know lab values for sodium, potassium, calcium, blood gases, and glucose levels. Also memorize the implications of high or low values and which diseases they are associated with.

10. If you run out of time, don’t guess at answers. The NCSBN recommends against guessing when pressed for time. Unlike paper-and-pencil tests in which guessing may help your score, guessing on a CAT, such as the NCLEX-PN, may actually lower your score.

Eight Areas Commonly Tested on the Exam

Nurses who have recently taken the NCLEX-PN list eight hot topics that are emphasized on the exam.

1. Therapeutic communication—The nurse’s job is to help the client understand what his or her problem is and what options are available, not to give false reassurance or advice. It is better to ask clients to clarify what they say or what they would like than to suggest what they should do.

2. Prioritizing care—The nurse must be able to determine which problems are most urgent.

3. PN/VN responsibilities—In answering exam questions, make sure that you take into account that the nurse must make necessary assessments and meet important safety and physiological needs before an RN or MD is called.

4.