NCLEX-RN For Dummies with Online Practice Tests (2020)

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NCLEX-RN For Dummies®, 2nd Edition with Online Practice
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NCLEX-RN For Dummies® with
Online Practice
To view this book's Cheat Sheet, simply go to www.dummies.com
and search for “NCLEX-RN For Dummies Cheat Sheet” in the
Search box.
Table of Contents
Cover
Introduction
About This Book
Foolish Assumptions
Icons Used in This Book
Beyond the Book
Where to Go from Here
Part 1: Demystifying the Complexity of the NCLEX-RN
Chapter 1: Meet the NCLEX-RN: Your Ticket to Getting a
License
The Big Deal behind the Big Exam
You Must Remember This: Nursing Basics to Know by Heart
The NCLEX-RN — Not Your Average CAT Scan!
Thinking the NCLEX-RN Way
When All Is Said and Done
Chapter 2: Preparing for T-Day: Paperwork and Whatnot
How Long Should I Wait after I Graduate? Deciding When to Test
Applying to Take the NCLEX-RN
Scheduling the Time and Place
Planning Ahead for the Big Day
Help, My Car Won’t Start! Rescheduling the Test
Chapter 3: The NCLEX-RN Blueprint
Considering the Four Main Categories of Client Needs
Queuing Up Question Types
Chapter 4: Buffing Up: Study Tips and Test-Taking Strategies
Setting Up an NCLEX-RN Study Schedule
Identifying Your Weak Points and Hitting the Books
Remembering Dear Maslow and His Needs
Applying the Nursing Process in Test Questions

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Dissecting the Questions and Finding Keywords
Developing Critical-Thinking Strategies
Avoiding Test Question Pitfalls
Part 2: Testing Your Knowledge of Client Needs
Chapter 5: Management of Care
First Things First: Knowing Your Patient’s Rights
Rallying the Troops: Managing Care
Recognizing Legal Rights and Nursing Responsibilities
Knowing Where to Get the Support You Need
Chapter 6: Safety and Infection Control
Preventing Accidents and Injuries
Disaster Planning and Emergency Response
Keeping Infectious Bugs at Bay
Keeping Clients Down in a Way That Lifts Them Up
Accidents Happen: Knowing the Next Steps and Preparing an
Incident Report
Code Pink: Understanding the Protocol for Infant Abduction
Chapter 7: Health Promotion and Maintenance
Surveying the Stages of Growth and Development
To Your Clients’ Health! Promoting Well-Being
Creating and Implementing Care Plans
Handling High-Risk Behavior and Alternate Lifestyle Choices
Preparing Patients to Leave Your Care
Chapter 8: Psychosocial Integrity
Looking Beyond the Surface: Factors That Influence Behavior
Coping, Counseling, and Crisis Intervention
Helping Patients through Grief and Loss
Caring for Patients with Abuse Issues
Chapter 9: Basic Care and Comfort
Giving Patients First What They Need Most
Ensuring Adequate Nutrition and Hydration
Resting Easy, Sleeping Soundly
Keeping ’em Clean: Personal Hygiene
Understanding the Process of Elimination
Wading through Irrigations
Providing Holistic Care with Alternative and Complementary
Medicine
Decreasing Pain without Pills
Helping Patients Get Around (and What to Do if They Can’t)

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Chapter 10: Meditating on Meds: Pharmacological and
Parenteral Therapies
Remembering the Factors You Must Verify before Giving Meds
Medicating Patients Safely
Using Medicine to Manage Pain
Giving Meds and More with a Stick and a Poke: Parenteral
Therapy
Chapter 11: Reduction of Risk
Interpreting Lab Results without a Hitch
Recognizing the Main Diagnostic Assessments
Being Ready for the Bumps: Complications with Testing and
Treating
Taking a Load Off: Therapeutic Procedures and Diagnostic Tests
Administering Conscious Sedation Safely
Chapter 12: Physiological Adaptation
Understanding What’s Normal So You Know What Isn’t
Anticipating the Results of Imbalance
Pathophysiology: Recognizing and Managing Illness and Disease
Taking a Patient for Tests and Therapy
Part 3: Just What You Were Looking For: A Full-Length Practice Test
Chapter 13: A Story of Blood, Chills, and Pain: A Practice
NCLEX-RN
Chapter 14: The Answers to All Your Questions (and
Explanations to Boot)
Answers and Explanations
Answer Key
Part 4: The Part of Tens
Chapter 15: Ten Myths about the NCLEX-RN
Length Matters
Every Question Counts
Computer Savvy Is Essential
You Can’t Stop ’til You’re Done
The Test Plays Off Your Weakness
You Have to Wait Eons to Retake a Failed Test
Your First Instinct Is Probably Wrong
The Same Question Popped Up Twice
Your Test Schedule Chooses You
Choice (3) Is the Magic Answer, and Other Multiple-Choice Fails
Chapter 16: Ten Common Phrases Found in NCLEX-RN
Questions
Assessment and Priority

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Diagnosis
Planning and Assigning Care
The Teaching Plan
Outcomes and Goals
Best Response
Priority Action
Interventions
Further Teaching
Chapter 17: Ten Rules to Remember When Prepping for the
NCLEX-RN
Read Each Question in Its Entirety
Don’t Read into the Question
Answer Questions with the Ideal Situation in Mind
Avoid Changing Your Answers
Don’t Call the Doctor until You’re Sure You Need To
Avoid Answers That Make You Choose All or Nothing
Don’t Memorize Facts, Questions, or Other Useless Trivia
Don’t Think You Can Be Ready without Hard Work
Know Your Strengths and Weaknesses
Be Kind to Yourself
Part 5: Appendixes
Appendix A: Additional Info about Exam and Licensing
Logistics
Identifying Individual State and Territory Licensing Requirements
Testing and Licensing Information Arranged by State and U.S.
Territory
Appendix B: Information for International Nurses Moving to the
United States
Following the Two-Step Process for Becoming Eligible to Take the
NCLEX-RN
Taking the NCLEX-RN Abroad
Navigating Nursing Roles in the U.S.
Getting Accustomed to U.S. Cultural Values
Communicating Therapeutically
Applying U.S. Nursing Know-How to the NCLEX-RN
Appendix C: Glossary of Nursing Terms
Index
About the Authors
Advertisement Page
Connect with Dummies

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End User License Agreement
List of Tables
Chapter 3
TABLE 3-1 Percentage Breakdown of NCLEX-RN Content
Chapter 6
TABLE 6-1 Common Infectious Conditions and Precautions
Chapter 10
TABLE 10-1 Endings Common to Drug Classifications
TABLE 10-2 Solutions and Their Applications
Chapter 11
TABLE 11-1 Normal Blood Values
TABLE 11-2 White Blood Cell Values
TABLE 11-3 Normal Urine Values
TABLE 11-4 Normal Values for Adult Vital Signs
TABLE 11-5 Normal Values for Newborn Vital Signs
TABLE 11-6 Normal Values for Toddler Vital Signs
List of Illustrations
Chapter 3
FIGURE 3-1: Locate where to place the defibrillator paddles to help this
man.
FIGURE 3-2: Place the defibrillator paddles as indicated.
FIGURE 3-3: Locate where the fingers should be placed to take a radial
pulse.
FIGURE 3-4: For a radial pulse, place the fingers as indicated.
Chapter 4
FIGURE 4-1: Maslow’s hierarchy of needs.
Chapter 12
FIGURE 12-1: An infectious illness chain of events.

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Introduction
Welcome to NCLEX-RN For Dummies. Don’t worry, you’re definitely not dumb for
picking up this book. Like millions of other future nurses worldwide, you want
straightforward advice and information without having to carry around 4,000-question test
prep books. Trust me, you don’t want to tackle the NCLEX-RN without understanding
how the test is put together and what it’s really all about.
The NCLEX-RN is one important test. Clearly, you need a readable, concise, structured
resource to help you tackle the exam. You’ve come to the right place. NCLEX-RN For
Dummies puts everything you need to know to conquer the exam at your fingertips. I give
you a complete review of concepts covered on the test and provide insight on how to avoid
the pitfalls that the test developers have designed to test your knowledge. And I do all this
in an enjoyable, easy-to-understand way.
I take NCLEX-RN test prep one step farther by guiding you through some of the more
difficult areas of the exam and sharing techniques for answering questions when you don’t
know the answers. I even cover what you need to do throughout the exam process, from
registration to test day, and how you become licensed in a state of your choice in the
United States or its territories. I also share information about compact or multistate
nursing licensing. If you’re coming from an international school to practice nursing in the
United States, I tell you what you need to do, too.
You may have heard horror stories about the NCLEX-RN, perhaps about how you have to
take it on a computer or how the questions get more difficult as you go along. Yes, the
NCLEX-RN is no walk in the park, but it’s not the hardest test you’re ever going to take.
The NCLEX-RN measures minimal competency and your clinical judgment, and the fact
that you’ve graduated from nursing school is an indication that you’ve attained minimal
knowledge competency already. From there, the NCLEX-RN expects you to be able to
read carefully and quickly and then apply what you know from your nursing program
classes to the situation presented in the question. You already have the nursing knowledge
you need to succeed on the NCLEX-RN — you just have to apply your critical thinking
skills to each situation to come up with the right answers. This book helps you refine those
skills and apply them to the questions on the examination. Reading through this book and
doing the practice questions (and I provide a lot of them both in the book and online) can
give you a pretty good idea of what you’ll face on test day.
About This Book
I suspect you aren’t eagerly anticipating sitting for the NCLEX-RN, and you probably
aren’t looking forward to studying for it, either. The good news is that you already know
everything you need to know for this exam, so studying is just identifying and sharpening
your weak areas. What I do in this book is give you some points to concentrate on. I make
the preparation process easier for you by breaking down the information you need to know
into easy-to-process bites.
Each chapter of NCLEX-RN For Dummies includes sample questions that illustrate just
how the NCLEX-RN tests particular concepts. I want you to be comfortable with the way
the NCLEX-RN phrases questions and expresses answer choices, so the sample questions
read just like actual test questions. This book also gives you access to two practice exams:
The exam that appears in the book is complete with answers and rationales, and the exam

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online presents the questions in a manner similar to the actual exam. (I provide the
answers and rationales for these questions, too.) Each of the practice exams contains 250
questions.
There’s no silver bullet for passing this exam, but you can start out on the right foot by
considering my advice for how to study and relax before you go in for the test. Time is of
the essence when taking the NCLEX-RN, so I provide techniques for answering particular
kinds of questions in the shortest amount of time. I also show you how to quickly
eliminate incorrect answers and make educated guesses. The key to success on the test is
harnessing your ability to draw upon the knowledge you picked up in school and think
through the questions and answers. Knowing what the question is asking and then picking
the right answer is the key to success, and this book helps you do just that.
Sounds simple, doesn’t it? Actually, it is simple; it’s all in how you approach the exam.
With so many review books on the market and so many questions to prepare for, you may
be asking yourself, “What’s the best way to review for this exam?” Well, the best way is
to follow my advice and work through the chapters in this book. Focusing on the topics I
cover and reviewing the sample questions and answers should leave you feeling
completely prepared to tackle the exam.
Doctor is a broad term encompassing a variety of disciplines and degrees. For
simplicity, I use doctor throughout this book to refer to a client’s medical provider,
who may be a physician, a nurse practitioner, and so on.
Foolish Assumptions
While writing this book, I made a few assumptions about you — namely, who you are and
why you picked up this book. I assume that
You’ve graduated from nursing school and are seriously considering taking the
NCLEX-RN soon. (In fact, the sooner you take it after graduation, the better!)
You aren’t a dummy; you graduated from nursing school, which is a huge
accomplishment in itself. You just know little about the NCLEX-RN and want to
increase your chances of being successful and passing on the first try.
You’ve picked up this book primarily because you want to practice your chosen
profession as soon as possible, and passing the NCLEX-RN is the only way to get
there!
Icons Used in This Book
I use icons throughout this book to call your attention to important tidbits of information.
Here’s the rundown of what each graphic icon highlights:

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You guessed it! This icon marks stuff you should remember. It’s also
information that you should review if you find yourself with a few extra minutes of
study time.
This icon marks useful bits of information that may come in handy when you
study for or take the NCLEX-RN.
This icon identifies questions resembling those on the actual NCLEX-RN.
The Warning icon alerts you to potentially dangerous situations.
Beyond the Book
In addition to what you’re reading right now, this book comes with a free access-anywhere
Cheat Sheet that includes tips to help you prepare for the NCLEX-RN. To get this Cheat
Sheet, simply go to www.dummies.com and type NCLEX-RN For Dummies Cheat
Sheet in the Search box.
You also get access to two full-length online practice tests (the one in this book and a
unique one) and hundreds of flashcards. To gain access to the online practice, all you have
to do is register. Just follow these simple steps:
1. Register your book or ebook at Dummies.com to get your PIN. Go to
www.dummies.com/go/getaccess.
2. Select your product from the drop-down list on that page.
3. Follow the prompts to validate your product, and then check your email for a
confirmation message that includes your PIN and instructions for logging in.
If you do not receive this email within two hours, please check your spam folder before
contacting us through our Technical Support website at
http://support.wiley.com or by phone at 877-762-2974.
Now you’re ready to go! You can come back to the practice material as often as you want
— simply log on with the username and password you created during your initial login.
No need to enter the access code a second time.
Your registration is good for one year from the day you activate your PIN.

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As this book goes to press, the worldwide COVID-19 pandemic has
necessitated some temporary changes in how the NCLEX-RN is administered.
Check out the Downloads tab on the NCLEX-RN page at dummies.com for a
resource outlining those changes.
Where to Go from Here
If you bought this book or are thinking about it, you must be planning to take the NCLEX-
RN. But just buying this book doesn’t help you much if it just sits on your bookshelf
gathering dust. To get the full benefit, you have to open it up, read it, and work through
the sample questions.
Everyone has different strengths and weaknesses, so this book is designed to be read in a
way that best suits you. For example, if you feel that you know everything about how to
take the NCLEX-RN, from how it’s designed to how to tackle questions, then you can
skip to Part 2 and the chapters that address client needs. If you’re very comfortable with
client needs and are an excellent caregiver but are unsure about the test, then you’re better
off focusing on Part 1. To get the most out of the book as a study tool, I suggest that you
take a more thorough approach to the subject and read the whole thing. But regardless of
your overall approach, this book is designed in a way that allows you to skim through the
sections that you know a lot about (perhaps hitting just the example questions) and focus
on sections about which you’re not as confident.
If you’re considering taking the test for a trial run before you crack this book and really
start studying, I recommend against it. Taking the test without studying first is just a waste
of your time and money. To get the most out of your NCLEX-RN experience, review all
the client needs, know what the test is looking for, and then take the practice
examinations. The practice exams show you which areas are your strengths and which
areas you need to focus your attention on. I suggest you take the one in the book first, see
which areas are your weakest, brush up on those areas, and then proceed online for the
other practice exam.
In the end, how you use this book is up to you. You’re the one taking the test, and you’re
the one who has to decide what you study and how much time you set aside to do so.

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Chapter 1
Meet the NCLEX-RN: Your Ticket
to Getting a License
IN THIS CHAPTER
Recalling nursing basics
Understanding this type of test
Approaching the NCLEX-RN with a plan
Handling the aftermath — both good and bad
Congratulations! You graduated from nursing school and you’re almost ready to start
practicing as a “real nurse.” Only one thing stands in your way: the NCLEX-RN, which is
prepared and administered by the National Council of State Boards of Nursing (NCSBN)
to every nursing school graduate in the 50 United States, the District of Columbia, and
five U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico,
and the U.S. Virgin Islands).
A passing grade on this exam is your ticket to a new career; without it, you can’t practice
nursing. From your current vantage point, passing the NCLEX-RN may look like a huge
obstacle — one you may be afraid you can’t overcome.
Take heart! I’m here to give you the confidence and knowledge you need to conquer the
NCLEX-RN. In this chapter, I familiarize you with the test plan, talk about computer
adaptive testing, and share what the NCLEX-RN really wants from you. I also tell you
how to identify the correct answers to test questions by recognizing keywords and figuring
out what the question is asking and give you an idea of what to expect after the exam.
The Big Deal behind the Big Exam
The NCLEX-RN has only one objective: to determine whether you can safely
operate as an entry-level nurse in the state in which you’ve chosen to practice. It
isn’t a test of your IQ or how fast you can start an IV. It is looking at your clinical
judgment: Do you know what to do in clinical situations? In other words, can you
think critically? The NCLEX-RN doesn’t predict how successful your nursing
career will be or whether you’ll become a nurse leader. All you have to do is
demonstrate that you have the clinical knowledge and judgment necessary to
provide safe and effective care necessary to meet the needs of the types of clients
you’ll encounter in the healthcare workplace. And in order to get your license, you
must pass the test.

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NCLEX-RN: THE NEXT GENERATION
You may have heard of the Next Generation NCLEX (NGN), a new version of the exam the
NCSBN is developing in an attempt to better test the complexities of clinical judgment new
nurses encounter. As part of this process, some candidates receive an extra, completely
voluntary section on new question types at the end of their NCLEX exam. You can read
more about the NGN at www.ncsbn.org/next-generation-nclex.htm.
Sometimes students think that the NCLEX-RN is a certification examination; it’s not. A
certification examination is one that certifies a certain body of knowledge by an
organization that’s accredited to do so. In the case of the NCLEX-RN, you’re tested on
your ability to practice as a nurse. When you pass, you’re issued a license by the state, and
once you’re licensed, you can go out and get the job of your dreams.
Here’s a little-known secret: If you graduated from a school of nursing, you
can pass the NCLEX-RN. Nursing schools are evaluated on how well their
graduates perform on the exam, so they’re reluctant to graduate students who can’t
demonstrate potential for success on the NCLEX-RN. So if you graduated, you
have what it takes. Kudos!
The NCLEX-RN is much less complicated than most exams you’ve taken in school, less
difficult than most of your clinical rotations, and far less time-consuming than all the
papers you’ve written, care plans you’ve devised, and other requirements you met in order
to even be eligible to take this test.
The NCSBN actually conducts a study every three years to determine what entry-level
nurses do, what responsibilities they’re given, where they work, and what type of care is
required to meet the needs of the client. In this way, the council can tailor the test
questions to reflect what new nurses actually experience in their first jobs.
The people who write the NCLEX-RN questions are looking for basic safety,
competent decision-making, and logical prioritizing. Keep those topics foremost in
your mind!
You Must Remember This: Nursing
Basics to Know by Heart
If nursing were just inputting data and outputting care plans, computers could replace live
people. But nursing is much more than applying the nursing process to a disease process;
it involves the care, feeding, and nurturing of people. The NCSBN, in its somewhat
convoluted way, has broken these principles down into what it calls integrated processes.
(Yes, it’s a fancy name for something basic, but after years of nursing school, you should

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be used to that.) What these four integrated processes — caring, communication,
documentation, and teaching — boil down to is really very simple:
Caring: Caring puts people above equipment or paperwork. Look at your patient
before you look at machines, lab results, or even nursing processes. See the person
first.
Communication: Therapeutic communication skills help you immeasurably in
dealing with everyone from your patients to lab technicians. Never underestimate the
power of effective communication while working as a nurse; failure to communicate
well may not only harm your patient but also make your life miserable. (Check out
Chapter 8 for more on therapeutic communication.)
Documentation: Documenting care given and the patient’s response to it is both a
legal requirement and one of the major communication methods between healthcare
workers.
Teaching: As a nurse, you teach patients, their caretakers, and other team members
every day.
You can be a good technical nurse without integrating these concepts into your nursing
care, but nursing is more than curing sick people; it’s caring for them, communicating
with them, and teaching them.
The four integrated processes appear on the NCLEX-RN in the form of
practical applications. Keeping in mind all the theories and practices that you know
from nursing school, you should recognize the following themes in exam questions:
Patient safety is always a top priority.
Remembering the client’s ABCs (airway, breathing, circulation) is essential.
Physiological needs should be met before other needs.
Doing what it takes to meet patient needs comes before other tasks.
A thorough assessment is necessary before undertaking other steps of the nursing
process.
Part of the first step in the nursing process is assessing the patient’s emotional status.
Assess the patient’s readiness to learn before designing a teaching program.
Denial and disbelieving are generally the first responses to news of a loss or
anticipated loss.
Nurses must deliver care in a nonjudgmental manner.
The NCLEX-RN — Not Your Average
CAT Scan!

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At some point in nursing school, you learned what a CAT scan is, right? Well, the
NCLEX-RN is a CAT exam, but that doesn’t mean what you think. In this case, CAT
stands for computerized adaptive testing.
The NCLEX-RN is no longer a paper-and-pencil exam. Instead, the test is administered on
computers, which allow for more reliable test results because the questions can be targeted
to your ability (as judged by your answer to each question). Therefore, not everyone gets
the same test. The test items that you see are specifically chosen based on the answer you
give to the preceding question. Using your most recent response, the testing program
searches the item bank for a question that has a degree of difficulty that’s equal to your
ability. This process goes on until you answer enough questions to make it clear that your
ability is either above or below the passing standard. This question process is why some
people get 75 questions and pass and others get 75 questions and fail. So the length of
your exam is not a predictor of a pass or fail result — don’t even waste your time trying to
predict whether you’ve passed or failed!
When you take the test, you get anywhere from 75 to 265 questions, all presented in
random order. Of these questions, 15 are considered experimental items and are not scored
because the NCLEX-RN people use them to determine whether they want to subject future
test takers to those questions, depending on how you do on them. The NCLEX-RN scores
only questions that have been tested for reliability, so some of the questions you get may
not actually impact your score. Don’t panic if you get a question that you can’t seem to
grasp; it may just be one of the experimental items. On the other hand, don’t assume that
every difficult question is an experimental one and disregard it by taking an uneducated
guess.
Questions appear one at a time on your computer screen. You can view each question as
long as you like, but you can’t go back to previous questions. You also can’t skip
questions. After you choose your answer, you’re asked to confirm your choice by pressing
the <NEXT> button. You can’t go on until you confirm your answer, but you can review
the question and change your answer as many times as you like before you submit it.
Another logistical issue to keep in mind come exam day is that the test is
timed. You have up to six hours to complete the NCLEX-RN, with two
prescheduled breaks that you may either take or opt out of. (One minute per
question is more than enough time to complete the exam ahead of the six-hour
limit, so don’t panic.) If you do run out of time for the test, the good news is that
you still might pass! That’s because the test is evaluated by whether you were
above the passing standard for the last 60 questions. So missing a question or two
but staying above the passing standard down the stretch means you still pass!
The computer tells you when your scheduled breaks begin, but you may break for as long
as you like. From my own experience and that of all the nursing professionals I know, I
urge you to take your breaks — don’t just sit at the computer. Leave the room and do deep
breathing exercises, or just take a walk around the test center outside the testing area.
During the breaks, don’t review your answers with other candidates or check your notes;
you’re not allowed to do either, and doing so anyway will definitely increase everyone’s
anxiety because you’ll all be convinced that another person was right!
Thinking the NCLEX-RN Way

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Students who take the NCLEX-RN often say that it’s the hardest test they’ve ever taken. Is
this a logical statement? The NCLEX-RN is primarily made up of multiple-choice and
select-all-that-apply questions based on nursing knowledge, and it tests your ability to
make clinical decisions based on information provided. Sound familiar? The NCLEX-RN
really isn’t that different from many other tests that you’ve already taken and passed.
Primarily isn’t the same as entirely. The NCLEX features other nontraditional
types of questions, such as hot spot and case study, which I cover in Chapter 3.
The following sections give you an overview of some question-answering strategies and
example questions to practice on. You can read more about these topics, including the
keywords technique I use throughout, in Chapter 4.
Getting to the root of the question
The NCLEX-RN primarily consists of application questions that, when you get right down
to it, simply ask, “What would you do in a certain situation?” Most of the situations
presented on the NCLEX-RN could really happen, and you’re asked to solve problems
using a technique called critical thinking. Critical thinking is just a buzzword for making a
decision based on observing, identifying the problem, deciding what’s most important,
recovering past knowledge (what you learned in school), and applying that knowledge to
the situation presented. That doesn’t sound so hard, does it?
The questions ask only about the particular situation presented. Most students’
biggest mistake is adding information that isn’t necessary or even appropriate to the
questions. Remember, answer only the question that appears on the screen, using
only the information you’re given. Don’t add anything!
The following is an example of a typical critical-thinking question. The answer
explanation that follows it walks you through the answer process:
A nurse is discussing long-term care with the parents of a child with a
ventriculoperitoneal shunt. Which of the following should be included to prevent
complications from the shunt?
(1) Restrict all childhood activities.
(2) Have the child wear a protective helmet.
(3) Any signs of illness must receive immediate attention.
(4) Avoid placing the child in a side-lying position.
Use keywords to figure out what the question is truly asking. In this case, the keywords
are long-term care, child with ventriculoperitoneal shunt, and should be included to
prevent complications from the shunt. In this situation, the nurse is discussing long-term
care, so the correct answer is something that needs to be done in order to maintain the

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child at an optimal level of function. Which of the choices is most likely to do that?
Restricting all activities couldn’t possibly maintain optimal function in a child. A
protective helmet doesn’t protect a ventriculoperitoneal shunt because it’s an internal
device. Reporting any signs of illness for medical attention is a must because a
ventriculoperitoneal shunt can become infected. Avoiding side-lying positioning is a
short-term intervention in the recovery period, not in the discharge plan.
So which of the choices answers the question? Of course, it’s Choice (3). Even if you
don’t know what a ventriculoperitoneal shunt is, you can come to this answer by thinking
the NCLEX-RN way. Read the question and ask yourself, “What’s the main point of the
question, and what knowledge do I need to use to choose the best answer?” By focusing
on long-term care and what’s best for a child, you can eliminate the wrong answers.
Navigating the grand inquisition, or the integrated
exam
No matter what answers you have in your head, you may see something totally unexpected
on the exam. The questions may be very different from the ones that you’re used to getting
in nursing school. You need to become “test wise” for the NCLEX-RN, which means that
you need to know how to navigate through complex information.
Tests in nursing involve complex information that has not only depth but also breadth. In
addition to its own body of knowledge, nursing draws from a variety of disciplines. The
content tested on the NCLEX-RN is what I call integrated, which means that it isn’t
divided into separate categories, such as medical, surgical, psychiatric, pediatric, and
obstetric nursing. It isn’t even limited to nursing classes — you may see questions about
chemistry, biology, and all the other courses you took as a student. Questions on the exam
may include a combination of these disciplines, as in this example:
A pregnant woman presents in the emergency room with complaints of severe
headache for two days, some episodes of double vision, and an observation that her
rings have become tight lately. She has a history of hypertension and is on a sodium-
restricted diet. Which of the following assessments would the nurse report to the
physician immediately?
(1) BP 130/88
(2) Proteinuria 2+ on dipstick
(3) Fetal heart rate of 146 with good variability
(4) 2+ nonpitting edema of the feet
Look for keywords: pregnant woman, complaints of severe headache for two days, double
vision, rings have become tight, history of hypertension, sodium-restricted diet, and which
of the following assessments would the nurse report to the physician. This question is
integrated because it tests your knowledge of different systems. Could the pregnancy be
affecting the hypertension? Could the hypertension affect the pregnancy? The answer to
those questions is “yes.” So which assessment finding is the most abnormal? Or, in other
words, which finding needs immediate medical attention?
Choice (1) isn’t an abnormal finding based on standard normal blood pressure values in
adults of 100/70 to 140/90. Choice (2) is abnormal because urine should never contain

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protein; it’s an indication that the renal function is impaired. Choice (3) is normal; fetal
heart rates range from 120 to 160 beats per minute. And as for Choice (4), nonpitting
edema of the feet in pregnancy is a common discomfort related to increased pressure on
the venous return by the growing uterus.
With this information gathered from thoroughly examining each answer option, you can
easily decide which finding should be reported to the physician. Choice (2) is correct
because it indicates abnormal renal function needing immediate evaluation and treatment.
Isn’t this easy? Or at least easier than you thought it was going to be?
Regardless of the primary diagnosis of this patient, the abnormal finding impacts her well-
being the same way. Don’t let the fact that questions contain integrated content distract
you from what you already know!
Avoiding test-taking missteps
Sometimes, a question pops up that looks like one you’ve seen already. It may
be because several questions address similar symptoms, diseases, or problems and
yet address different aspects of nursing care. Also, an experimental (unscored) item
may have content similar to an operational (scored) item. Don’t assume that a
similar question indicates that you answered the first one incorrectly. Always
answer each question as if it were the only question on the test; pay no mind to
previous questions.
Try not to go into the examination with any preconceived notions about what you’ll see on
it. You need to use proper test-taking techniques (the ones you pick up in this book)
throughout the entire examination. In my experience, most nursing students are able to
easily reduce the number of possible answer options to two. But contrary to popular belief,
you will only find one correct answer for each multiple-choice question on the
examination. You need to use everything that you’ve taken away from your nursing
program — including effective study and test-taking techniques and a positive mental
attitude — to conquer the multiple-choice exam.
Chapter 15 has information on other popular misconceptions about the NCLEX.
Finding the real question behind the long scenario
You get settled in your seat and log onto the test; everything’s looking good, you’re
feeling good, and you get the following question:
A paraplegic client with a T10 injury from a skiing accident, as well as other
trauma-related problems, is recovering from the injuries and getting ready to transfer
from the acute care unit to a rehabilitation unit. When a nurse offers to assist in getting
ready for the move, the client throws the suitcase on the floor and says, “You nurses
around here don’t want to help me with anything.” Which of the following responses is
the most appropriate for the nurse to give?
(1) “You know I want to help you; I offered.”

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(2) “I’ll pick these things up for you and come back later.”
(3) “You seem pretty angry today. Going to rehabilitation may be scary for you.”
(4) “When you get to rehabilitation, they won’t let you behave like a spoiled brat.”
You read this question, and you’re ready to get out of your seat and leave the testing
facility immediately. But you shouldn’t panic. Although this question has multiple
sentences and this patient appears to have multiple issues, you can apply a methodology to
finding the real question hidden under all this detail. (Throughout this book, I guide you
through dissecting this type of question in order to find out what you’re really being
asked.)
Yes, the client has many things going on, but the key is what the client is saying. As you
take this question apart, you should always focus on the feelings that are underlying a
particular action. The keywords for this question are paraplegic, ready for transfer, rehab
unit, and “You nurses around here don’t want to help me with anything.” Choices (1) and
(4) are confrontational and inappropriate coming from a nurse. Although offering to pick
up the client’s belongings, Choice (2), is a nice thing to do, it doesn’t address the situation,
and it reveals the nurse’s assumption that the patient can’t pick the things up. So the
correct answer is Choice (3). The trauma and the T10 injury have nothing to do with the
correct answer except to tell you the patient may have a serious back injury.
Although I can’t guarantee that you won’t see a question like this one right off
the bat, the questions should start out rather simple and get increasingly more
difficult as you go through the exam. As you prove your ability to answer more-
difficult questions, you get increasingly challenging ones until the computer
decides that you have a minimal competency for nursing and doesn’t present any
more questions.
Keeping your cool when answering select-all-that-apply
questions
Select-all-that-apply questions tend to throw students into a panic. Really, they’re
basically the same as multiple-choice questions; the difference is any number of the facts
you know about the subject may appear in the list. You already know the information; just
mark what you know and ignore the rest. Make a list on your white board and use it to
answer the question. Head to Chapter 4 to read about select-all-that-apply questions.
Here’s a simple example:
Which of the following actions or conditions may be a secondary cause of lung
cancer? Select all that apply.
(1) Genetics
(2) Occupational exposures
(3) Smoking a pipe

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(4) Smoking cigarettes
Keywords are actions or conditions and secondary cause of lung cancer. The correct
answers are Choices (1), (2), and (3). As many as 90 percent of clients with lung cancer
smoke cigarettes or have smoked them in the past, making cigarette smoking the number
one cause of the disease. So Choice (4) isn’t a secondary cause. The other answers may in
fact cause lung cancer.
When All Is Said and Done
You’re sitting at a computer taking an exam when all of the sudden, the computer goes
blank. (And no, it’s not a power failure.) What do you do? Stay calm and don’t panic. The
test shuts off automatically without warning when you’ve answered enough questions to
determine your ability to provide safe basic care for patients. A screen appears stating that
“Your test is concluded.” You’re then required to answer several exit questions, which are
just multiple-choice questions about your examination experience. They don’t count
toward your results.
After you leave the not-so-horrific chamber of testing horrors, you get to sit on pins and
needles for two to six weeks until the state board of nursing mails your results to you.
Every computer exam is scored twice — once by the computer testing center and again
after it’s transmitted to Pearson professional centers. I highly recommend that you put
your books aside when you get home from the exam, go outside and play, and let your
mind roam free (at least of the exam) for the next few weeks. There’s no sense worrying
when you can’t light a fire under the nursing board anyway.
You can’t become licensed until you get the official mailed results. But if you’re afraid
you’ll go crazy waiting to find out whether you passed, you may be able to get an early
look at your results unofficially. Pearson offers a Quick Results service in some states that
gives you your early results in two business days (for a minimal cost). If your state posts
new licensees on its website, you also may be able to find out there. Otherwise, you just
have to wait for the mailed results.
Hey, nurse? Yeah, you!
If you passed the exam, you’re officially a registered nurse — congratulations! Now
comes the fun part … you can go out and get a real job. Because this book is about taking
the exam, I don’t get into how to go out and get the job. (You’ll have to find another book
to help you do that.) But I want to be the first to offer congratulations and wish you a long
and happy career as an RN.
So, you failed — it’s not the end of the world
You may not want to read this particular section right now, but you probably should so
that you know what happens if you fail the NCELX-RN exam. When you have to tell your
family, friends, supervisor, and co-workers that you didn’t pass the licensing examination,
you may feel like you’re the only person who ever failed this test in the entire world. I
assure you, you’re not alone. If you were, I wouldn’t have an NCLEX tutoring business.
If you fail the exam, you receive a diagnostic profile from the NCSBN that tells you how
many questions you answered on the examination. (The more questions you answered, the
closer you came to meeting the passing standard; see the section “The NCLEX-RN — Not
Your Average CAT Scan!” earlier in this chapter for details on how the computer adaptive
test measures your competency.) The diagnostic profile helps you identify your strengths

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and weakness so that you know where to concentrate your study habits when you prepare
to take the examination again. However, it doesn’t give you the questions you missed or
by how much you missed the passing mark.
Many people who fail the first time are disheartened enough to ask, “Should I take the test
again?” Absolutely! You’ve completed your education to become a registered nurse, so
don’t throw away all that work and planning. Think back to the stages of grieving —
that’s exactly what you’re going through. After you get through the stages of grieving,
you’re ready to go back and take the exam again. After all, you really want to be a nurse!
You can’t retake the examination for 45 days. So schedule your next attempt, and allow
yourself enough time to prepare for it. Then figure out why you failed this round.
Although it may involve painful self-examination, you need to know why you failed so
that you can establish a plan for success the next time. You should prepare differently this
time because, well, obviously your old plan didn’t work. You need to start fresh with a
new plan of action.
You get only so many tries to pass the exam – for example, Indiana allows
three failed attempts before you’re required to pursue remediation. A remedy could
include taking an accredited NCLEX-RN prep program or refresher course. With a
written letter of completion from that program and a 95% pass rate guarantee sent
to the board of nursing, you should then be able to take the NCLEX-RN again.
The good thing about retaking the test is that you’ve already seen it — and that’s a major
advantage! You know exactly what to prepare for. The computer (clever machine that it
is) remembers what questions you were given before, so you won’t receive any of the
same questions, but the content and style of the questions and the types of answer choices
don’t change. So you shouldn’t have any surprises the second time. (Note: The machine
just knows which questions you had the last time. It does not specifically give you the
content you missed previously to make you fail again.)
Second-time test takers sometimes have test anxiety when going back the second time.
Remember, having a good study plan and knowing the content is a way to work around
anxiety, but you may also want to come up with an anxiety test plan. What will you do if
you become anxious and need to relax — make sure you’re wearing a calming scent?
Practice deep-breathing exercises? Something else?
There’s no substitute for mastering nursing content. Go through your review
books again, and become expert in reading the questions and being able to
effectively answer what’s being asked. Practice your test-taking strategies, too.
(Throughout this book, I give you strategies to help you succeed whether it’s your
first test or not. Chapter 4 is a good place to start.)
As you gear up for your next attempt at the NCLEX-RN, follow this simple advice. It may
seem obvious, but it will help you be more relaxed when you take the exam again:
Choose to take the test at the time of the day when you’re most alert.
Choose a familiar testing site.

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Chapter 2
Preparing for T-Day: Paperwork
and Whatnot
IN THIS CHAPTER
Evaluating when to take the test
Completing and submitting applications
Making your testing appointment
Covering all your bases on test day
Rescheduling your NCLEX-RN
As if taking the NCLEX-RN doesn’t give you enough things to worry over, you also have
to think about the logistics of the exam — the paperwork required just to be allowed to
take the test, the fees you have to fork over (even though it may seem fairer to have
someone pay you to take the test), and the potential for sudden changes to your test-taking
plans (like what happens if you break out in chickenpox the morning of the exam).
One important point to note before you apply for the exam is that you must have graduated
with a nursing degree in order to take it (such as an ASN or BSN). If you still have one
more course to take, you must complete it before you can file for your application;
otherwise, your application will be rejected. The board of nursing doesn’t care that you’re
only two basket weaving credits short of graduation; no diploma, no boards. If you have
transfer credits from another school, make sure that they’ve all been accepted and applied
to your academic record. In fact, it’s a good idea to sit down with your advisor one last
time before your last semester to make sure that everything really is in order for
graduation.
In this chapter, I walk you through the application process, tell you how to find a
scheduling center, and explain what you need to know to get to that scheduled exam.
How Long Should I Wait after I
Graduate? Deciding When to Test
How soon after graduation you take the exam is up to you, with some caveats. Some
eager-beaver types want to take the test 14 minutes after graduation, while others are still
dragging their feet 14 months from graduation. Each state has its own rules — of course!
— about how long after graduation you need to wait before taking the test, but most states
require you to wait 45 days. Refer to Appendix A for specific testing information about
your state.

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I suggest that you take the exam as soon as you graduate if possible because all
that information you crammed into your brain is still fresh. Many students wait
months before taking the exam because they feel that they aren’t prepared. But the
longer you procrastinate, the more you have to study, and the less chance you have
of passing on your first try. Most nursing schools provide review courses, so if
you’re a recent graduate, you’ve probably honed your test-taking skills in the last
few years, and your test-taking ability is at its peak. And the sooner you pass the
NCLEX-RN, the sooner you can start work, start helping people, and buy yourself
that new fancy car — or pay off your student loans!
That being said, if you aren’t getting the scores the NCLEX prep course you’re
taking suggests, plan to take more time. No school, family member, or faculty
member can tell when you’re ready just because everyone else is taking it.
Everyone else isn’t you. Don’t even let a potential new job tell you when to take
the test.
Of course, if you’ve delayed getting transcripts, sending in your fees, and paying your
campus parking tickets, you may find yourself taking your test later rather than sooner.
You must take the exam while your Authorization to Test (ATT) is valid, so the clock
starts ticking after you get your ATT. (For more on the ATT, see “Scheduling the Time
and Place” later in this chapter.) Check your calendar for weddings, births (presumably
you’ll know whether you or your partner will be giving birth any time soon; you’re almost
a nurse, for heaven’s sake!), vacations, moving plans, and other personal events and
factors that may delay your taking the exam after you have your ATT in hand.
Plan to take the exam before you get too involved in a new job as a graduate
nurse. Job requirements usually take up a significant amount of your time,
especially when you’re a new employee. Accepting a position but not starting the
job until you actually take the exam may be in your best interest. In this period of
acute nursing shortages, healthcare agencies want people to start working right
away, but your best bet may be to take the time to study for the exam first. Get it
over with, and then start the job with a clear focus on beginning your new career.
Each state determines the requirements for graduate nurses pending licensure.
If you’re working as a new graduate nurse, you must be aware of the state rules
governing your practice. Check with your local state board for requirements for
new graduates and to find out whether you can get a temporary permit in the state
in which you choose to work.

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Applying to Take the NCLEX-RN
Applying to take the NCLEX-RN may be easy or hard, depending on the size of your
nursing school and how much help it can offer you in filling out your paperwork. At some
schools, you may just be handed the paperwork in your last semester and told to take care
of it; in others, the whole class may go over the paperwork together. (Send your nursing
instructors flowers if that’s the kind of program you’re in.) In order to take the NCLEX-
RN, you need to apply to two places: your state board of nursing for licensure and Pearson
VUE, the company that contracts with nursing boards to administer the test.
Completing the application process
Every state has its own application and way to apply. Depending on the state,
you may be able to apply online only, on paper only, or through either method.
Know your state (see Appendix A for information on each state).
Here’s how the application process works.
1. Apply to your nursing board either online or on paper.
Every state charges a fee with this application.
2. Meet the requirements of your board of nursing (BON) or Nursing Regulatory
Board (NRB), as it appears on some state websites.
Some states require a school transcript as proof you’ve completed the program; flip
to the later section “Tying up academic loose ends” for more on that process. You
also need to get your criminal history done and your fingerprints taken to be eligible
to take the test. States differ in how they take care of this process.
3. Register with Pearson VUE.
Pearson VUE sends you your ATT. Then you can schedule your test either online or
by phone (check out “Scheduling the Time and Place” later in this chapter for more
on the scheduling process).
You can complete your application to Pearson VUE over the phone by dialing 1-866-49-
NCLEX. Have a credit card handy (Visa, MasterCard, or American Express) to pay your
fees immediately. If you’d rather not talk to a live person, you can register online. Get
your credit card out and go to the NCLEX-RN candidate website at
www.vue.com/nclex.
If you need to contact Pearson by mail, the general address and email address are
NCLEX-RN Examination Program
Pearson Professional Testing
5601 Green Valley Drive
Bloomington, MN 55437-1099

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Email: vuepearsonprofessionaltesting@vue.com
Paying your dues
There’s no such thing as a free lunch … or a free nursing license! The cost of a license
varies from state to state, but the examination fee for the NCLEX-RN is $200. (Yep, you
read that correctly — you have to pay a license fee and a test fee.) Appendix A lists the
fees for each state. You know that your money has been received and your credit cards
accepted when you receive a card from your state board of nursing stating that all your
information has been received and you’re ready to go. If you don’t hear from the state
board in a reasonable amount of time (and three hours isn’t a reasonable amount of time),
call to make sure that your application was received.
Hitting a bump: Potential problems with the licensure
application
Problems are inevitable. Life is full of them. So don’t be surprised to experience a glitch
or two when you’re trying to get your paperwork all filled in, sent, and processed. Many
problems arise when people (this may mean you) don’t read the instructions — all the
instructions. In your rush to complete application paperwork and get it out of your house
and out of your sight, don’t overlook some major requirement; correcting the error can
hold you up even more.
Tying up academic loose ends
Some states require that your permanent transcript be mailed with your
application. You can get an official sealed student copy of your transcript from
your school’s registrar, but you can’t always get it the same day you request it, so
put in the request before you actually need the transcript. (I emphasize the point of
an official sealed student copy because a licensing agency may not accept an
opened unofficial transcript. You can’t just copy your grades for the last three years
of classes and send them in.)
If your school has closed since you’ve left and you still need a transcript, find
out who the school transferred the responsibility of dealing with its transcripts for
past graduates to and contact that organization. All states have a State Board of
Education; if needed, you can contact it if you need assistance in getting your
transcript.
You can also avoid problems with your application by making sure that you’ve met all the
requirements for graduation. Some students truly do get all the way to the end of their
senior years and start planning graduation parties and inviting friends and family to the big
event just to find out that they’ve been ill-advised and still need to take those infamous
electives or that one math course that they put off for two or three years. If you think this
misstep doesn’t happen to otherwise intelligent people, think again!
Have you been delinquent during your college years? If so, pay up! If you owe any library
fines or have any unpaid parking tickets, your school can delay the release of your

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