How to Prepare for the NCLEX-RN Exam

Here’s a scenario for you: On the day of the test, you are very eager to sit in front of your computer and start the ball rolling. But half-way through the process, you feel like you’re dealing with out-of-this-world questions and wished that you paid more attention to your clinical instructor as she discussed JPEG feeding.

It’s really overwhelming to take an examination if you are not fully prepared. And by that, I am referring to being prepared in holistic way, i.e., mentally, emotionally, physically, psychologically, and spiritually. If you are used to having a “50-50” chance of passing your quizzes or final examinations in school, the NCLEX is not to be taken lightly. You need to give it your best when it comes to NCLEX prep. After all, this is going to be your ticket to your professional life, so you need to be successful.

So, what’s the formula to ace this test? Well, there are a lot of study aides, CDs, and textbooks that will tell you how to study for NCLEX. They are all fantastic because it is authored by nursing experts, some of which were even former textbook authors of nursing textbooks. But despite all the resources and materials available in the market (not the mention enrolling in a review center), some still fail to achieve the passing rate.

I cannot guarantee that you will pass by following the strategies that I write here. All I can say is that, it can help you eliminate your doubts and enhance your test-taking skills for whatever inevitable scenarios you may encounter during the test. Bottomline is, these are strategies in acing the NCLEX, but the key to your NCLEX prep lies to how much you are dedicated, focused, and aimed towards becoming a registered nurse.

It’s either you know or you don’t know

This is no brainer. The moment you read the question, you anticipate the right answer to appear on the choices. This is only applicable if you know the concept that is being discussed. That’s why your classmates who were more attentive during nursing school have more chances of passing the test than those classmates who drifts away to NeverLand.

If you know the answers to the questions 100% of the time on the NCLEX, you don’t need a formula. Your stacked knowledge of the nursing concepts will resurface during the test and can save you from losing certain points in your NLCEX score.

So basically, preparation for the NCLEX starts at nursing school. If you are still a student and you’re reading this, it’s the best time for you to start. But if you have finished nursing school already, well, it’s not yet too late for you. You still have what it takes to become a registered nurse.

Thus this guide is written to help you in many ways. This guide is divided into sections:

I. General Strategies

In this section, we will be talking about some of the most time-tested and effective ways of preparing oneself in taking examinations.

II. Test-Taking Skills

As I have mentioned beforehand, the best way to answer a question in NCLEX is when you know the answers to the questions. But, if you don’t know the answers to the questions, there are formulas can help you in finding them. A full-length discussion of these strategies shall be tackled in this section.

III. NCLEX Pitfalls: Things To Avoid

Briefly, this section will help you find those negative attitudes within yourself and other detractors that can pull you down if you are preparing or studying for the NCLEX.

IV. This is the day!

Finally, this section will guide you on what should be the best activities for you to accomplish as the day of the examination comes close.

I. General Strategies

Davis’ Q&A for the NCLEX-RN Examination recommends the PQRST approach to master studying and I am endorsing this method of preparation. To help you remember, just think of the PQRST of the EKG strip. This time the letters stands for:

Positive mindset
Questions to assess and build your knowledge
Review of strengths and weaknesses
Stress reduction
Taking the test

Positive mindset. Positivity can lead to success. Claim that you will pass the test. Use positive self-talk and self-reassurance. You have accomplished much and you are ready for the final step. Study with enthusiasm, sincerity, and determination, keeping your goal in mind. Visualizing your goal can keep you motivated. Smile. You know what you are doing! Smiling reduces facial tension and stress and can help you feel better about yourself.

Questions to assess and build your knowledge. Technically, this is not the time to study for new concepts. You’ve done that on your 4 years of nursing school! This time is allocated for taking practice questions that will improve your testing performance; you become test-wise in learning how to read a question and eliminate incorrect options! Make sure that when you answer test questions, you not only learn the correct answer but most importantly the rationale behind this choice of answer. This way you will be maximizing your study time to learn new information as well. Don’t also forget to include practicing questions at the computer from 1 to 5 hours. Do this a few times during your review, varying the time periods. This practice allows acclimating yourself to the rigors of taking the NCLEX-RN exam at the computer.

Review of strengths and weaknesses.  By doing practice questions every day, you will be able to evaluate your high and low points. Don’t get discouraged if you obtained a low score. Check on the items or areas where you got incorrect answers and make an effort to study on this further. When reviewing your strengths and weaknesses, reflect back on your self-discipline. Consider what has worked for you in studying and staying focused and what seems to be a deterrent to concentration.

Stress reduction. Do not neglect in taking care of yourself. You have come so far and now you’ve come to the final step in the making of a professional nurse. Do not allow this opportunity to pass on you. Focus on using stress reduction strategies. These include but are not limited to positive self-talk, mental rehearsal, progressive muscle relaxation, deep breathing, and repositioning. Never deprived yourself of sleep and eating nutritious food. You need all the energy in this endeavour.

Taking the test. The day before the test, do something you enjoy and avoid last-minute cramming. Keep your usual routine. Avoid alcoholic beverages and excess amounts of caffeine. Alcohol is a depressant and can reduce your ability to think clearly. Caffeine can reduce your concentration and attention span by over stimulating your body. Plan to get at least 8 hours of sleep, going to bed at your regular time. Use a relaxation strategy that you found successful during your preparation. Give yourself positive affirmation that you are ready and believe that you will be successful!

II. Test-Taking Skills

I always tell my students that there is no sure-fire strategy in preparing and acing the examination compared to a good study habits and possessing adequate knowledge of the content or topics. Nevertheless, the following test-taking tips can somehow augment your chances in answering MCQs. But if you have thorough knowledge of the content, use good testing skills, and can apply your knowledge, you will pass the exam. Remember that testing skills, like any other skill, improve with practice.

Read the test question carefully. It is recommended that in a 100-item MCQ test, the examinee must read and understand fully a test item for 2-minutes. This will allow the examinee to read through the test question, the stem, and the distractors and be able to organize his/her thoughts and come up with a generalization on what is the test item all about. Be guided of the following questions while you are going through this phase:

  • What is the question asking?
  • Does the question include keywords?
  • Is there relevant information in the stem?
  • How would I ask this question (in my own words)?
  • How would I answer this question (in my own words)?

Find Keywords. Alright, reading through the whole test item will sometimes give you a headache. One strategy that eliminates this problem is looking for keywords that will lessen the burden on reading the lengthy manuscript. As you read along, try to locate for these words because they make a difference with regard to what the question is asking about.

  • COMMON STRATEGIC WORDSbest, early or late, first, immediately, initial, most appropriate or less appropriate, most likely or least likely.
  • COMMON STRATEGIC WORDS THAT INDICATE THE NEED TO PRIORITIZE: best, essential, first, highest priority, immediate, initial, most appropriate or less appropriate, most likely or least likely, most important, next,      primary, vital.

Adopt the Process of Elimination. As mentioned earlier, you have to eliminate three distractors (75%) in order to come up with the correct answer. By doing this, here are some tips:

  • Eliminating the comparative or alike options. Look for options that are similar or alike as the situation/stem of the question asks for. You can then eliminate this as the possible answer.
  • Eliminate words that contain closed-ended words. Closed-ended words infer a fixed or extreme meaning and these types of options are usually incorrect. Examples of these words are: all, always, every, must, none, never, and only.
  • The “odd answer out” strategy. This strategy obviously allows the examinee to look for the answer that differs from the other options. If the question is asking for assessing, your answer should have words describing the process of assessment such as identify, observe, monitor or look for. If the question asks for the best intervention, then you will look for words in the options that display nursing skills or nursing actions.
  • Look for opposites. Most often, you will see options that are written in opposite manner. For example, applying heat compress and applying ice compress, vasodialtion and vasoconstriction, etc. If you have these as your distractors, one of these options is usually correct.

Prioritizing Patient Care. This type of test question is very tricky since most of the distractors are correct but you have to apply prioritization. Here are ways to simplify this aspect:

  • Use your ABCs and CABs. That’s right – Airway, Breathing, and Circulation. However, the American Heart Association have recently published in October 2012 a new protocol on performing the CPR that its now promoting Circulation first, ensure adequate Airway, and lastly to provide effective Breathing in order to achieve the goal of effective tissue perfusion.
  • The ever-reliable Maslow’s Hierarchy of Needs. Time immemorial that this pyramid of human needs have been utilized in prioritizing patient care. It is always safe to choose physiological needs (needs for survival) first and foremost over safety and security, love and belongingness, self-esteem, and self-actualization. There are some questions, particularly which of psychiatric nursing, that answering client’s needs on safety and security takes precedence over physiological needs because the client can pose harm to self and others if not duly managed.
  • Of course, the Nursing Process. As nurses, we have to be religious in practicing the nursing process in all our patient care. The five steps of this process will guide us in prioritizing nursing actions: Assessment, Analysis, Planning, Interventions, and Evaluation.

III. NCLEX Pitfalls: Things To Avoid

A. Avoid answering NCLEX-RN examination questions according to real-life experiences that may be different from the textbook content.

You may have provided nursing care to a patient before with diagnosis similar to the one being described in the question, and literally, you patterned your own nursing care to the patient situation. This is a big mistake. Another one is when you rely much on your experiences of doing actual nursing procedures that you based your answers thru these experiences.

The questions being asked in the NCLEX-RN examination is designed so that the content of the examination is directly related to content in textbooks that you have used during your education and on national standards of care and best nursing practices. Therefore, sometimes what you may have experienced in “real-life situations” may not be what is currently being taught; rather, your experiences could be based on time-saving shortcuts, old information, or procedures and practices specific to a health-care agency.

B. Avoid reading meaning into the questions.

Read the question and the answer options, simply read what is written. The situation already provides you more information than needed to answer the specific question. Do not ask, “What if . . . ?” or you may add more twist to the situation. Focus on the information provided and do not add more details. Although you should not read meaning into the question, make sure that you are reading the entire question and not missing pertinent information. Most often, test-takers select the wrong option if an important piece of information is missed in either the situation or the options.

C. Avoid becoming frustrated or anxious.

I may say that the thought of taking the NCLEX is a nerve-wracking experience, but do not allow too much stress to ruin your chance of becoming a professional registered nurse. Tone down your anxiety levels and use this to your advantage. Mild to moderate anxiety can be your driving force to get you going. Use visualization often, seeing yourself as the competent nurse performing professional nursing care. Expect that there may be information that you do not know and use all the strategies that you have learned to arrive at the best option among the items.

IV. This is the day!

The morning of the test, eat a healthy breakfast that includes a protein. Carbohydrate loading, though recommended by some, should be avoided if this is not your usual routine. While it may give you an immediate energy boost, it can cause a rebound effect of fatigue once the carbohydrates have been metabolized. Dress for comfort, in layers that can be easily removed or added based on the environmental temperature. Finally, during the exam remain focused and concentrate on the exam. Use the headphones if easily distracted. Do not be concerned if others finish before you. Each person has his or her own speed for taking tests. The computer will stop anywhere between 75 and 265 items, depending on your performance. Continue to use positive self-talk during the exam. You have prepared and studied. You can pass the NCLEX-RN exam!

Related Exams and Resources:
NCLEX-RN Study GuideAn overview of the best study guides available.
NCLEX-RN Practice Test
Registered Nurse Certification
Nursing Schools