1. Assess the Stem.

Isolate the stem/ what the question is actually asking you. Look at the background details only keep what is relevant to
answering the question, and disregard irrelevant information.

The answer to the question can often be discovered by looking closely at how words or actions are grouped. Scan
the stem and the answer choices for cues. Identifying these cues often leads to a correlation that connects the stem
to a particular answer choice.

When in doubt, always choose a nursing action that could prevent harm to the client. Even if you dont know
whether it is related to the stem, it is still a life-saving maneuver that, in all likelihood, is correct.

The same words may appear in the NCLEX question and in the correct answer. It may be the same word or a
synonym of the word.

Whenever undecided between two answers, analyze the differences between the two, which may be important, or
which answer is more complete.

Do not choose all of the above if there is even 1 wrong answer. Likewise, do not choose none of the above if there is
even one right answer.

2. Look out for key words. Key words can completely change the context of the situation.

Time: first, last, most important, immediate, before, during after, time elapsed, pre/post procedure.

May have to do with prioritization (most important, immediate)

May have to do with which step of an intervention you are in (before: looking for contraindications,
during: looking for complications during administration, After: looking for adverse effects related to the
intervention, or patient improvement). (aka pre/intra/post) You can eliminate answers that are not
appropriate to the current stage, such as contraindications when the medication has already been
administered, when you're looking for adverse effects/improvement after admin.

Time elapsed. The priority nursing action will change based on the time interval stipulated. Obviously, the
closer the client is to the origination of risk, the higher the risk for complications. Sometimes, the time
issue will be stated in terms of hours or days. In other instances, the physical location of the client will tell
you how long it has been since the origination of risk. Watch closely for whether the client is in the
recovery room, postsurgical unit, or somewhere else. The time issue buried in those words should help
you eliminate incorrect answers that dont match what is being asked.

Early verses late signs. What do you know about questions asking you to identify early and late signs and
symptoms? You should know they all have something in common. Early clinical manifestations are generalized
and nonspecific, whereas late signs are specific and serious. Eliminate incorrect answer choices using this
strategy.

Direction or magnitude. For instance, stop and concentrate on the terms intra versus inter; hyper versus
hypo; increase versus decrease; lesser versus greater; and gain versus lose. It is common to misread these terms y
simply skimming over them too quickly.

Trap words. Be wary of certain tricky words such as " Patient appears to be" (subjective, will need conclusive
assessment prior to intervention), or "which is mosty likely, least likely" as how to pertains to the answer choices

Misc. other things such Age, Sex, or other descriptive factors may be relevant or may be designed to distract.

3. Opposite answers
If two choices have opposites, like increased heart rate or decreased heart rate, one of the two choices is usually correct.
4. The Odd answer
The one answer that is different from the rest is apt to be the correct answer. (eliminate any related/synonymous answers)

5. Umbrella principle
If all answers seem to be correct and applicable, choose the one that includes all the choices in it. One answer is better
than all the others because it includes them.
6. Eliminate obvious answers
In questions asking for a single answer, some choices are obvious to be incorrect. You should be able to identify some of
these incorrect responses if they are/have:

The same idea. eliminate choices that have the same concept or idea. these choices are just reworded but if you
analyze them carefully, they are actually one and the same. However keep the Umbrella principle in mind!

Absolute answers. choices containing the words all, never, always, and the like are usually incorrect.

Unrelated to the question. Eliminate choices that do not relate to the subject of the question. This requires
careful assessment of the stem of the question, and disregarding unrelated information in the question.

Rule out an option if you know it is associated with something else. For example, you may
not know about the laboratory values for warfarin therapy, but you do know the laboratory values for heparin and
aspirin. Those values can be eliminated because you are using what you know.

After eliminating the obvious incorrect answers, analyze the remaining choices and select the option that best
answers the stem.

7. Prioritize based on patients needs

Questions containing the words initial, first, priority- is asking for your prioritizing skills. The choices are usually all
correct but only one should be done first. When prioritizing, you should always remember the following:

ABCs- use ABCs (airway, breathing and circulation). Patients with airway problems or interventions to provide
airway management are top priority.

It is not unusual to want to care for the client who, in your mind, is the sickest. However, this may be an
inappropriate choice in triage situations. Clients who are so sick that they cannot be saved should not be treated
first.

Many times you may feel empathy for innocent victims of injury and want to console them and check them quickly
before moving on to learned strategies. An example of this might be a rape victim or a child who has been
neglected. Psychological issues are always secondary and never take priority over facilitation of physiologic safety.

Never perform ABC checks blindly without considering whether ABC issues are acute versus chronic or stable
versus unstable. For example, a client who is quadriplegic and receiving ventilation has chronic airway/breathing
problems. However, if there is not an acute consideration such as pneumonia, the client should be considered
chronic and stable. This client would not be the nurses first priority.

Maslows hierarchy of needs- Keep in mind that physiological safety will always be more important than
anything psychological. Hierarchy starts with physiological needs (i.e. waste elimination), then safety and security,
then love and belonging, self-esteem, and finally self-actualization.

Nursing process- Assessment should always be done before planning anything or instituting interventions. Unless
the question already has subjective and objective data about the patient, assessment is at the top of the list. Never
solely trust equipment (ie. heart monitor showing v-fib when pt has pulse, or low pulse-ox reading can be erroneous)
or assisting personnel findings, you still must perform assessment before intervention. A.D.P.I.E.

Patient first before equipment- if a patient is attached to an equipment and sudden removal of the equipment
causes problems, primary assessment and interventions should be directed to the patient and not to the equipment.

8. Documentation/Instruction, fact vs. opinion.

Youll encounter questions that will ask you to choose the instruction or documentation that is most accurate. Choosing an
answer that is most complete will typically result in the least room for error and subsequent delivery of safe and effective
care. To help you determine which answer is most complete, evaluate answers based on how much objectivity (fact) versus
subjectivity (opinion) there is in the answer choices. A specific value, like a blood pressure, is factual, whereas a
clients report of past incidences of high blood pressure is subjective. Responses that are subjective are
generally not correct.
9. Communication
We have tendency to use the same communication skills regardless of whether the client has anxiety, depression,
schizophrenia, bipolar disorder or obsessive-compulsive disorder. Everyone wants to use empathetic listening and
everyone wants to be caring. Unfortunately, these are not therapeutic responses for all disorders and every situation.

Responses that are open-ended acknowledge the clients feelings, encourage more information, and express
acceptance . This approach is appropriate for the client who has anxiety, a knowledge deficit, or depression.

Reality orientation is important for the client with paranoia and delusions.

Distraction may be more appropriate for the client with obsessive-compulsive disorder.

10. Delegation

The delivery of safe and effective care is always the driving force behind delegation of tasks and client-care
assignments. Any other option will be incorrect.

RNs perform all client teaching. No matter how simple, Always.

RNs should perform all admission assessments so that an accurate baseline is established. This includes the first
set of vital signs, all aspects of the first physical assessment, and a health history.

Client-care assignments are made by the RN, not by support staff. Client-care assignments should remain
unchanged unless there is an authentic issue of client-care safety or the safety of a health care provider.

An assistive personnel (AP) can perform tasks such as taking vital signs, range-of-motion exercises, bathing, bed
making, obtaining urine specimens, enemas, and blood glucose monitoring. An AP cannot interpret results
or perform any task beyond the skill level of any certification already attained.

All communication between the RN and support staff should be direct, objective, and complete to ensure the
highest level of safe and effective care delivery.

11. Use SBAR when relaying information to a primary care provider, Situation (whats going on currently), Background
(of the patient), Assessment (your findings), Recommendation (what you want done about it).
12. Misc.

Seldom will a correct answer have the nurse physically leave the client. Choose an answer that keeps the nurse
with the client.

Usually, do not call the physician unless you've exhausted all nursing interventions that pertain to the situation.