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More By This Developer. MA Notes: Pocket Guide. Saunders Nursing Drug Handbook. Dosage Calculations Made Easy. You Might Also Like. Ocular Disease Handbook. Fill-in-the-Blank Questions Fill-in-the-blank questions may ask you to perform a medication calculation, determine an intravenous flow rate, or calculate an intake or output record on a client.
You will need to type only a number your answer in the answer box. If the question requires rounding the answer, this needs to be performed at the end of the calculation. The rules for rounding an answer are described in the tutorial provided by the NCSBN and are also provided in the specific question on the computer screen.
In addition, you must type in a decimal point if necessary. See Box for an example. The nurse prepares how many. Fill in the blank. Record your answer using one decimal place. Answer: In this question, you need to focus on the subject, mL per dose, and use the formula for calculating a medication dose. When the dose is determined, you will need to type your numeric answer in the answer box.
Always follow the specific directions noted on the computer screen. Also, remember that there will be an on- screen calculator on the computer for your use. Multiple-Response Questions For a multiple-response question, you will be asked to select or check all of the options, such as nursing interventions, that relate to the information in the question.
In these question types, there may be 1 correct answer, there may be more than 1 correct answer, or all answers could be correct. No partial credit is given for correct selections. You need to do exactly as the question asks, which will be to select all of the options that apply. Box Multiple-Response Question The emergency department nurse is caring for a child suspected of acute epiglottitis. Which interventions apply in the care of the child? Select all that apply.
Maintain the child in a supine position. In a multiple-response question, you will be asked to select or check all of the options, such as interventions, that relate to the information in the question. Focus on the subject, interventions for the child with suspected acute epiglottitis. To answer this question, recall that acute epiglottitis is a serious obstructive inflammatory process that requires immediate intervention and that airway patency is a priority.
Auscultating lung sounds allows the nurse to obtain information about airway patency without causing further airway compromise by examining the throat. Examination of the throat with a tongue depressor or attempting to obtain a throat culture is contraindicated because the examination can precipitate further obstruction. A lateral neck and chest x-ray is obtained to determine the degree of obstruction, if present.
To reduce respiratory distress, the child should sit upright. The child is placed on an oxygen saturation monitor to monitor oxygenation status. Tracheostomy and intubation may be necessary if respiratory distress is severe. Remember to follow the specific directions given on the computer screen. Ordered-Response Questions In this type of question, you will be asked to use the computer mouse to drag and drop your nursing actions in order of priority.
Information will be presented in a question and, based on the data, you need to determine what you will do first, second, third, and so forth. The unordered options will be located in boxes on the left side of the screen, and you need to move all options in order of priority to ordered- response boxes to the right side of the screen. Specific directions for moving the options are provided with the question. See Figure for an example. These type of practice questions are located on the accompanying Evolve site.
Figure or Hot Spot Questions A question with a picture or graphic will ask you to answer the question based on the picture or graphic.
The question could contain a chart, a table, or a figure or illustration. You also may be asked to use the computer mouse to point and click on a specific area in the visual. A chart, table, figure, or illustration may appear in any type of question, including a multiple-choice question.
Box Figure Question A client who experienced a myocardial infarction is being monitored via cardiac telemetry. The nurse notes the sudden onset of this cardiac rhythm on the monitor refer to figure and immediately takes which action? Initiates cardiopulmonary resuscitation CPR. Continues to monitor the client and then contacts the cardiologist. Answer: 2 This question requires you to identify the cardiac rhythm, and then determine the priority nursing action.
Note the strategic word, immediately. This cardiac rhythm identifies a coarse ventricular fibrillation VF. The goals of treatment are to terminate VF promptly and to convert it to an organized rhythm. If a defibrillator is not readily available, CPR is initiated until the defibrillator arrives.
Options 1, 3, and 4 are incorrect actions and delay lifesaving treatment. You will be provided with tabs or buttons that you need to click to obtain the information needed to answer the question. A prompt or message will appear that will indicate the need to click on a tab or button.
The nurse determines that oral contraceptives are contraindicated because of which documented items? Refer to chart.
Focus on the subject, the item s that are a contraindication to the use of oral contraceptives. Oral contraceptives are contraindicated in women with a history of any of the following: thrombophlebitis and thromboembolic disorders, cardiovascular or cerebrovascular diseases including stroke , any estrogen- dependent cancer or breast cancer, benign or malignant liver tumors, impaired liver function, hypertension, and diabetes mellitus with vascular involvement.
Item 2 is a thromboembolic disorder with associated thrombophlebitis. Items 3 and 4 are cardiovascular diseases. The medications the client is taking are not specific contraindications to oral contraceptives. Item 11 has components that are contraindicated; of note is that this client has polycythemia, which is a thromboembolic disorder and therefore is contraindicated for the use of oral contraceptives. Graphic Item Option Questions In this type of question, the option selections will be pictures rather than text.
You will need to use the computer mouse to click on the option that represents your answer choice. Box Graphic Item Option Question The nurse should place the client in which position to administer an enema? Refer to the figures in 1 to 4. Answer: 2 This question requires you to select the picture that represents your answer choice. Focus on the subject, the position for administering an enema.
This position allows the enema solution to flow downward by gravity along the natural curve of the sigmoid colon and rectum, improving the retention of solution. Option 1 is a prone position. Option 3 is a dorsal recumbent position.
Option 4 is a supine position. Audio Questions Audio questions will require listening to a sound to answer the question. These questions will prompt you to use the headset provided and to click on the sound icon. You will be able to click on the volume button to adjust the volume to your comfort level, and you will be able to listen to the sound as many times as necessary.
Content examples include, but are not limited to, various lung sounds, heart sounds, or bowel sounds. Examples of this question type are located on the accompanying Evolve site Fig. Video Questions Video questions will require viewing of an animation or video clip to answer the question.
These questions will prompt you to click on the video icon. There may be sound associated with the animation and video, in which case you will be prompted to use the headset. Content examples include, but are not limited to, assessment techniques, nursing procedures, or communication skills.
Additionally, case studies may accompany some question types. You are encouraged to access www. An enhanced multiple-response question is similar to a multiple-choice question in that it usually allows more than one option to be chosen.
The difference is that an enhanced multiple-response question presents a long list of options. The NCLEX examination committee has not yet provided specific information as to how these question types will be presented. An example of one way they may be presented can be located in Box Michael tells the nurse that Victoria has not been able to tolerate any physical activity and that when she tries to do something she tires very easily.
On assessment, the nurse notes that Victoria exhibits shortness of breath on exertion;. Victoria is hospitalized. Her current home medications include betaxolol hydrochloride for glaucoma and glimepiride for type 2 diabetes mellitus. She also takes over-the-counter hydroxyaluminum sodium carbonate to help prevent acid indigestion. Heart failure is diagnosed. In addition to the medication that Victoria takes at home, the following medications are prescribed: captopril, furosemide, metoprolol, and digoxin.
What should the nurse discuss with the team? The need for respiratory treatments. That the antacid could affect the absorption of digoxin. That metoprolol may mask symptoms of hypoglycemia. That the antacid must be used with caution in clients with glaucoma. That potential systemic side effects of betaxolol hydrochloride include heart failure. That betaxolol hydrochloride may contribute to hypertension when taken with the newly prescribed medications.
Answer: 1, 2, 3, 4, 5, 7 Victoria is 76 years of age. In addition to her age, her poor respiratory status and inability to tolerate activity place her at risk for falls. These factors require implementing a plan of care that will meet her needs. Antacids increase the digoxin level by increasing digoxin absorption or bioavailability. Antacids also decrease the absorption of captopril. However, antacids are not a concern in clients with glaucoma. Ophthalmic beta blockers can have additive therapeutic or adverse effects when given with systemically administered beta blockers or other cardiovascular medications.
Toxic reactions to beta blockers are rare but primarily involve the cardiovascular system. Symptoms include bradycardia, cardiac failure, hypotension, and bronchospasm. Treatment involves discontinuation of the medication and supportive care e. In addition, the nonselective beta blockers can interfere with the normal responses to hypoglycemia, such as tremor, tachycardia, and nervousness, in essence masking the signs and symptoms of hypoglycemia.
Hypotension is more likely than hypertension in clients taking beta-blocker medications. On review of the laboratory data, the nurse notes the following:. Complete the following sentences by choosing from the dropdown lists. Other side effects associated with ACE inhibitors include headache, dizziness, fatigue, insomnia, and weight loss.
Digoxin is a cardiac glycoside and would require clarification about administration if the pulse were below 60 beats per minute or if she were showing signs of toxicity. Glimepiride is used to manage blood glucose levels and would require clarification about administration if the blood glucose was low.
Furosemide is a diuretic. Although the nurse would monitor for a drop in BP in the client receiving furosemide, the primary concern is hypokalemia.
Shortness of breath has subsided, and vital signs are stable. Her color is pale, but she is showing no signs of respiratory compromise.
She still has bilateral crackles in the lower lobes with no expectoration of mucus. The nurse prepares to administer morning medications to Victoria. What assessment is unnecessary before administering the digoxin?
Enter the assessment in the box below. Digoxin is a cardiac glycoside. It will decrease the heart rate and could affect the heart rhythm.
If the pulse is slower than 60 or greater than bpm, the digoxin is withheld and the primary health care provider or cardiologist is notified. It is not necessary to check the pedal pulses before administering the digoxin. The nurse would also check the morning digoxin level to. Gastrointestinal disturbances are early signs of digoxin toxicity, so the nurse would assess the client for any discomfort.
Visual disturbances are also signs of digoxin toxicity, so the nurse would assess the client for these disturbances. In this type of question, you will need to select a response from a drop-down menu. Dynamic Exhibit and Constructed Response A constructed response is a type of open-ended question that requires a short- answer response. The answer is constructed using information that can be found in a dynamic exhibit, such as a case study. Enhanced Hot Spots An enhanced hot spot question may presented in various ways.
This question type could include an exhibit, a case study, assessment data or other information, or a figure in which you may need to use the mouse and cursor and point and click to locations as asked in the question. An enhanced hot spot may also ask you to highlight specific information. Box NGN Item: Enhanced Hot Spot Which areas should the nurse place the stethoscope to check the right bronchovesicular breath sounds, the left bronchovesicular breath sounds, the right vesicular breath sounds, the left vesicular breath sounds, and the bronchial breath sounds?
Five areas need to be selected to answer this question. Three types of breath sounds are considered normal in certain parts of the thorax.
These include vesicular, bronchovesicular, and bronchial. These breath sounds should be clear to auscultation. Bronchial breath sounds are located over the trachea. Bronchovesicular breath sounds are located over the main bronchi. Vesicular breath sounds are located over the lesser bronchi, bronchioles, and lobes.
Extended Drag and Drop There are various ways in which extended drag and drop question types will be presented. An extended drag and drop question will provide you with several pieces of specific information and will ask you to order that information into the correct order of action or placement. Drag each client to the most appropriate health care provider. A client who requires frequent transfusion. A client with respiratory failure A client receiving continuous tube feedings.
A client who requires a bed bath and on a mechanical ventilator. A client requiring abdominal wound A client who requires hourly pulse irrigations and dressing changes every 3 and blood pressure measurements.
The nurse must determine the most appropriate assignment based on the education and skills of the health care provider and the needs of the client. In general, noninvasive interventions, such as skin care, range-of-motion exercises, ambulation, grooming, and hygiene measures, can be assigned to the AP.
In general, a LPN or vocational nurse VN can perform not only the tasks that a AP can perform but also certain invasive tasks, such as dressing changes, wound irrigations, tube feedings, colostomy irrigations, suctioning, urinary catheterization, and medication administration oral, subcutaneous, intramuscular, and selected piggyback medications , according to the education and job description of the LPN or VN. The LPN or VN can also review with the client teaching plans that were initiated by the registered nurse.
A registered nurse can perform the tasks that an LPN or VN can perform and is responsible for assessment and planning care, initiating teaching, and administering medications intravenously. Highlighting Items These items present data pertinent to a client case, and asks the student to highlight the information that requires follow-up. Box NGN Item: Highlighting Item The nurse is assessing a male client admitted 1 day ago for newly diagnosed type 2 diabetes mellitus.
Clinical findings are noted below. Click on the finding that would be essential to follow up on to highlight it. Highlight only findings that require follow-up. To deselect, click the finding again.
With newly diagnosed type 2 diabetes mellitus, the client is at risk for diabetic ketoacidosis or hyperglycemic hyperosmolar non-ketotic syndrome, both of which can lead to hypovolemia and shock. The blood pressure has remained stable for this client but is declining. At this time, it does not require further follow-up. The pulse rate has increased significantly since admission, and is a sign of hypovolemia, which is a finding that should be addressed.
The respiratory rate is slightly elevated and should be addressed early on because this is a sensitive indicator of fluid status. The capillary glucose and serum glucose levels at each of the timepoints has been elevated, and an intervention is required to address this abnormality.
The serum potassium level was within the normal range initially but has decreased since admission and is now at a critical level. This requires follow-up because of the risks associated with hypokalemia. The urine output has steadily decreased and could be an indicator of hypovolemia, and therefore requires follow-up. The temperature is normal and does not require follow-up. Matrix Items These items present data regarding a client, and may ask the student to select actions that are essential, nonessential, and contraindicated.
How should the nurse proceed to implement a quality improvement program? For each action below, click to specify whether the action would be: Indicated: An action that the nurse should take to resolve the problem Nonessential: An action that the nurse could take without harming the client, but the action would not be likely to address the problem Contraindicated: An action that could harm the client and should not be taken.
Quality improvement, also known as performance improvement, focuses on processes or systems that significantly contribute to client safety and effective client care outcomes; criteria are used to monitor outcomes of care and to determine the need for change to improve the quality of care. If the nurse notes a particular problem, such as an increase in the CLABSIs, the nurse should collect data about the problem.
This should include information such as the primary and secondary diagnoses of the clients developing the infection, the type and location of IV catheters being used, the site of the catheter, IV site dressings being used, frequency of assessment and methods of care to the IV site, and length of time that the IV catheter was inserted.
Once these data are collected and analyzed, the nurse should examine evidence-based practice protocols to identify the best practices for care to IV sites to prevent infection. These practices can then be implemented and followed by evaluation of results based on the evidence-based practice protocols used.
Collecting identifying client information is contraindicated because of client confidentiality and is unnecessary in this quality improvement effort.
Noting the mental status of the client can be done but is not likely to address the problem. Noting the types of medications being infused can also be done but will not address the problem of IV site infection. Although it is helpful to know the expected duration of the IV site, this information does not change infection control practices in managing the IV site and is therefore considered a nonessential action. Refer to the Evolve site for practice with these question types.
This exam simulates the look of the real exam and provides the candidate with practice for the NCLEX. The initial step in the registration process is to submit an application to the state board of nursing in the state in which you intend to obtain licensure. You need to obtain information from the board of nursing regarding the specific registration process, because the process may vary from state to state. Following the registration instructions and completing the registration forms precisely and accurately are important.
Registration forms not properly completed or not accompanied by the proper fees in the required method of payment will be returned to you and will delay testing. You must pay a fee for taking the examination; you also may have to pay additional fees to the board of nursing in the state in which you are applying. You cannot make an appointment until you receive an ATT form. Note the validity dates on the ATT form, and schedule a testing date and time before the expiration date on the ATT form.
The NCLEX Examination Candidate Bulletin provides you with the directions for scheduling an appointment; you do not have to take the examination in the same state in which you are seeking licensure.
The ATT form contains important information, including your test authorization number, candidate identification number, and validity date. You need to take your ATT form to the testing center on the day of your examination. You will not be admitted to the examination if you do not have it.
Changing Your Appointment If for any reason you need to change your appointment to test, you can make the change on the candidate Web site or by calling candidate services. Refer to the NCLEX Examination Candidate Bulletin for this contact information and other important procedures for canceling and changing an appointment.
If you fail to arrive for the examination or fail to cancel your appointment to test without providing appropriate notice, you will forfeit your examination fee and your ATT. This information will be reported to the board of nursing in the state in which you have applied for licensure, and you will be required to register and pay the testing fees again.
Day of the Examination It is important that you arrive at the testing center at least 30 minutes before the test is scheduled. If you arrive late for the scheduled testing appointment, you may be required to forfeit your examination appointment. If it is necessary to forfeit your appointment, you will need to reregister for the examination and pay an additional fee.
The board of nursing will be notified that you did not take the test. A few days before your scheduled date of testing, take the time to drive to the testing center to determine its exact location, the length of time required to arrive at that destination, and any potential obstacles that might delay you, such as road construction, traffic, or parking sites. All acceptable identification must be valid and not expired and contain a photograph and signature in English. According to the NCSBN guidelines, any name discrepancies require legal documentation, such as a marriage license, divorce decree, or court action legal name change.
Testing Accommodations If you require testing accommodations, you should contact the board of nursing before submitting a registration form. The board of nursing will provide the procedures for the request.
The board of nursing must authorize testing accommodations. Following board of nursing approval, the NCSBN reviews the requested accommodations and must approve the request. If the request is approved, the candidate will be notified and provided the procedure for registering for and scheduling the examination. Testing Center The testing center is designed to ensure complete security of the testing process.
Strict candidate identification requirements have been established. You will be asked to read the rules related to testing.
A digital fingerprint and palm vein print will be taken. A digital signature and photograph will also be taken at the testing center. In addition, if you leave the testing room for any reason, you may be required to perform these identity confirmation procedures again to be readmitted to the room.
Personal belongings are not allowed in the testing room; all electronic devices must be placed in a sealable bag provided by the test administrator and kept in a locker. Any evidence of tampering with the bag could result in the need to report the incident and test cancellation. A locker and locker key will be provided for you;.
In addition, the testing center will not assume responsibility for your personal belongings. The testing waiting areas are generally small; friends or family members who accompany you are not permitted to wait in the testing center while you are taking the examination.
Once you have completed the admission process, the test administrator will escort you to the assigned computer. You will be seated at an individual workspace area that includes computer equipment, appropriate lighting, an erasable note board, and a marker. No items, including unauthorized scratch paper, are allowed into the testing room. Eating, drinking, or the use of tobacco is not allowed in the testing room.
You will be observed at all times by the test administrator while taking the examination. In addition, video and audio recordings of all test sessions are made.
The testing center has no control over the sounds made by typing on the computer by others. If these sounds are distracting, raise your hand to summon the test administrator.
Earplugs are available on request. You must follow the directions given by the testing center staff and must remain seated during the test except when authorized to leave. If you think that you have a problem with the computer, need a clean note board, need to take a break, or need the test administrator for any reason, you must raise your hand. You are also encouraged to access the NCSBN candidate Web site to obtain additional information about the physical environment of the testing center and to view a virtual tour of the testing center.
Testing Time The maximum testing time is 6 hours; this period includes the tutorial, the sample items, all breaks, and the examination. All breaks are optional. The first optional break will be offered after 2 hours of testing.
The second optional break is offered after 3. Remember that all breaks count against testing time. If you take a break, you must leave the testing room, and when you return you may be required to perform identity confirmation procedures to be readmitted.
Length of the Examination The minimum number of questions that you will need to answer is Of these 75 questions, 60 will be operational scored questions and 15 will be pretest unscored questions. The Wills Latest developments in the treatment and management of patients Eye as well as the book also includes some of the recent major clinical trials in which macular degeneration and retinal vein occlusion are worth mentioning.
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