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Ultimate Guide: 60 NCLEX Strategies to Use in Answering Questions (2016 UPDATE:

Revised for 2016. Includes over 1000 New Practice Questions)

by phildigital (https://brilliantnurse.com/author/phildigital/). Posted on November 12, 2015

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12
NOV

NCLEX STRATEGIES FOR FIRST TIME & REPEAT EXAM TAKERS

NCLEX Strategies: In a standard four-answer NCLEX multiple-choice question, if you can
systematically eliminate false answers, you can reduce the four-answer question to a two-
answer one and thereby make your chances as good as those in the true-false type of question;
that is, the odds will favor your guessing half of the answers correctly.

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Other questions will ask you to select all that apply from five to seven options by clicking in
the correct boxes to select the answers (multipleresponse questions). In the alternate items,
you may see charts and tables, or you may find pictures and graphs requiring identification of a
correct location (hot spot) by either point-and-click or fill-in-the-blank.

In the items requiring a calculation, determine which numbers are needed to figure out the
correct numerical answer and use the drop-down calculator to fill in the blank. Another
alternate item is the drag and dropordered response, in which you are asked to arrange all
the correct responses in priority order: identify action or factor that you think should be first,
then identify which should be last.

We think that the following NCLEX Strategies will assist you to narrow down your choices
systematically and intelligently:-

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HOME / BROWSE 75 FREE NCLEX QUESTIONS (/SHOP/75-FREE-NCLEX-QUESTIONS/)
1. Always, all, everyone, never, none, only, every, must. Answers that include global words
such as these 2 should be viewed with caution because they imply that there are no
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Example: Nurses should exercise caution in interviewing clients who have an alcohol
use/dependency problem because:
957
1. These clients always exaggerate. 1
Shares
2. These clients are never consistent.

A good NCLEX Strategy is that any such suggested answer should be looked at with care
because any exception will make that a false response. A more reasonable answer to 2 the
preceding might be Clients who have an alcohol use/ dependency problem may not be reliable
historians.

2.Broadest, most comprehensive answers. Choose the answer that includes all the others,
which is referred to here as the umbrella effect.
Example: A main nursing function in group therapy is to:

1. Help clients give and receive feedback in the group 3

2. Encourage clients to bring up their concerns.

3. Facilitate group interaction among the members.
4. Remind clients to address their comments to the group.

Number 3 is the best choice because all the other choices fall under it.

3. Test how reasonable the answer is by posing a specific situation to yourself. For example,
the question might read, The best approach when interviewing children who have irrational
fears is to: (1) Help them analyze why they feel this way. Ask yourself if it is reasonable to use
Freudian analysis with 2-year-old children.
4.Focus on the client. Good NCLEX Strategy Usually the reason for doing something with a
client is not to preserve the good reputation of the doctor, hospital, or nurse, or to enforce
rules. Wrong choices would focus on enlisting the clients cooperation for the purpose of
fulfilling orders or because it is the rule.

On seeing a client out of bed against orders, instead of just saying, Its against doctors orders for
you to get up, you might better respond by focusing on how the client is reacting to the
restriction on mobility, by saying, for example, I can see that you want to get up and that it is
upsetting to you to be in bed now. Let me help you get back to bed safely and see what I can do for
you. Examples of client-centered options are: acknowledging, offering a choice, and determining
preferences.

5. Eliminate any answer that takes for granted that anyone is unworthy or ignorant. For
example, in the question, The client should not be told the full extent of her condition because .
. ., a poor response would be, . . . she would not understand. Choose an answer that focuses on
the client as a worthy human being.

6. When you do not know the best answer, and need to guess, look for the answer that may
be different from the others. For example, if all choices but one are stated in milligrams and the
exception reads 1 g, that choice may be a distractor or the best choice.

7. Read the question carefully to see if a negative modifier is used. If the question asks,
Which of the following is least helpful, be sure to gear your thinking accordingly. Emphasize a
key word such as least, contraindicated, or avoid as you read the questions. In this type of
question, a correct answer may reflect something that is false.

8. Do not look for a pattern in the correct answers. If you have already selected option 3 for
several questions in a row, do not be reluctant to choose option 3 again, if you think that it is
the correct response.

9. Look for the choices that you know either are correct or may be incorrect. Good NCLEX
Strategy You can save time and narrow your selection by using this strategy. This strategy is
also useful when the question requires you to select all options that apply. Read each option
and determine if it is correct or not; if correct, click on the box to the left of the option. There is
no partial credit if you select some but not all that apply.
10. In eliminating potentially wrong psychosocial answers, remember to look for examples of
what has been included in the nontherapeutic responses (e.g., denying feelings, false
reassurance, changing the subject).

11. Wrong choices tend to be either very brief or very long and involved.

12. Better psychosocial nursing responses to select are those responses that

(a) focus on feelings (unless safety is at stake!): How did that make you feel?
(b) reflect the clients comments: You say that made you angry;
(c) communicate acceptance of the client by the nurse rather than criticism or a value judgment;
(d) acknowledge the client: I see that you are wincing; and
(e) stay in the hereand- now: What will help now?

13. Look for the average, acceptable, safe, common, typical, garden variety responses, not
the exception to the rule, esoteric, or controversial responses.

14. Eliminate the response that may be the best for a physician to make. Good NCLEX Strategy
Look for an RN role-appropriate psychosocial response; for example, psychiatrists analyze
the past, and nurses in general focus on present feelings and situations.

15. Look for similarities and groupings in responses and the one-of-a-kind key idea in
multiple-choice responses.

Example: At which activity would it be important to protect the client who is on phenothiazines
from the side effects of this drug?

1. Sunday church services.

2. A twilight concert.
3. A midday movie in the theater.
4. A luncheon picnic on the hospital grounds.

Choices 1, 2, and 3 all involve indoor activities. Choice 4 involves outdoor exposure during the
height of the suns rays. Clients need to be protected
against photosensitivity and burns when on phenothiazines.
16. Be sure to note whether the question asks for what is the first or initial response to be
made or action to be taken by the nurse. The choices listed may all be correct, but in this
situation selecting the response with the highest priority is important. If the question asks for
an immediate action, probably all answers are correct and you need to choose the priority
answer. Identify words that set a priority: best, main, primary, greatest, most.

17. When you do not know the specific facts called for in a question, use your skills of
reasoning; One of the best NCLEX Strategy here! for example, when an answer involves
amounts or time (mainly numbers) and you do not know the answer and cannot find any basis
for reasoning (all else being equal), avoid the extreme responses (the highest or lowest
numerical values).

18. Give special attention to questions in which each word counts. The purpose of this type of
question may be not only to test your knowledge but also to see if you can read accurately and
find the main point (e.g., early vs. late sign of shock). In such questions, each answer may be a
profusion of words, but there may be one or two words that make the critical difference. If the
option has several aspects, all the parts must be correct for that answer to be correct. If you can
eliminate one aspect in an answer, you can eliminate the other options with that aspect.

19. All else being equal, select the response that you best understand. Long-winded
statements are likely to be included as distractors and may be a lot of words signifying little or
nothing, such as criteria involved in implementing conceptual referents for standardizing
protocol. You may want to eliminate unusual or highly technical language. Relate the situation
to something that is familiar to you.
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20. Select all that apply questions require that all correct responses must be selected to get
credit. First pick out key words (write them down, if that is helpful to you). Translate, into your
own words, the gist of what is asked in the question. You might close your eyes at this point and
see if the answer pops into mind. Then, skim the answer choices, looking for the response that
corresponds to what first came into your mind. Key ideas or themes to look for in psychosocial
responses have been covered in this sectionfor example, look for a feeling response,
acceptance, acknowledgment of the client, and reflection.

21. Look for the best answer, not the right answer; This might seem to be an obvious NCLEX
Strategy but its well worth noting for example, incorrect action may be the best answer if the
stem asks for an action that is not appropriate (e.g., Which of the following is an inappropriate
action? can be rephrased to say Which action is wrong?).
22. To narrow down the choices, first find two contradictory options; for example, hypo
hyper, flexextend, givewithhold, dilateconstrict, increasedecrease, bradycardia
tachycardia; then focus on which one may be the correct or best choice. 1

23. Focus on the age-appropriate answer (e.g., When caring for a toddler, with what safety
issue should the nurse be concerned?).

24. Time sequence points to the best choice. For example, ask yourself when is this taking
place (e.g., prenatal or postpartum; preoperative or postoperative; before, during, or after;
early or late; immediately?).

25. In medication administration questions, apply the 5 rights:

Right Medication
Right Route
Right Client
Right Dosage
Right Time

26. When more than one answer looks right, choose the first step of the nursing process
(assess before implement). Assessment words and phrases indicate priority:

Ascertain
Assess
Check
Collect
Detect
Determine
Find out
Identify
Look
Monitor
Observe
Obtain information
Recognize

27. Isolate the verbs from the rest of the question (e.g., ask is better than tell, give, or ignore).
28. Do not overlook the obvious answer: KIS (Keep It Simple). For example, the best answer for
what to do when there is a malodor in the room of a client with a colostomy is to check the
stoma for fecal leakage. If it smells like feces, check for feces.

29. As you read what is given for assessment findings (e.g., signs and symptoms) ask yourself:
Is this OK? or is it not OK?

30. When two options are correct, choose the one that covers them both (i.e., incorporates the
other, like a telescope).

Example: Two hours after a liver biopsy, the nurse finds the client lying on the left side. What is
the best nursing action at this time?

1. Check for bleeding.

2. Turn the client onto the right side.

Both options are correct, but choose option 2 because it incorporates option 1; it is possible to
check for bleeding while turning the client over onto the right side (where the liver is), to put
pressure on the site (as a preventive measure when postbiopsy bleeding is possible).

31. Look at root words to give you a clue: for example, hemi = one half (hemianopsia = half
without vision). Break down unfamiliar words in the stem.

32. Remember Maslowsoma before psyche physiological needs are before psychosocial
needs (i.e., physical needs first). Use Maslows hierarchy to establish priorities when more than
one answer looks correct.

Example: What is the priority nursing care for a client after ECT?

1. Reorient to time and place.

2. Put the side rails up.
3. Explain that memory loss is an expected outcome.

When all three options are good (as in this case), select the physical aspect of care first (option
2) rather than either of the two psychosocial options.

33. Think safety as the best choice when more than one answer could be right. Safety is a
priority. See the preceding example, where putting side rails up is a safety action.
34. Visualize the condition, behavior, situation, and the options to help you choose the best
answer. Form a mental image (e.g., what flexion looks like versus extension); visualize and
sound out the answers (e.g., to eliminate trite clichs or authoritarian- sounding responses
such as Thats not allowed here).

35. Would that you could that the ideal be possible. Choose an answer for the ideal, not
real, world. Do not rely solely on real-world experiences to answer NCLEX questions (i.e., on
the examination, answer as if you have all the time, all the staff, and all the equipment).

36. When in doubt as to which answer is best, use the process of elimination first (e.g.,
eliminate what you know is incorrect) to narrow your choice to two options. The best choice
will provide an answer to what the question is asking.

37. Apply the ABCS when the question calls for priorities:

Airway
Breathing
Circulation
Safety

38. An important goal is to maximize client actions. For example, choose options that have
indicator words for encourage:

Reinforce
Support
Facilitate
Assist
Help
Aid
Foster

39. Try to turn options into true-or-false responses if possible in order to narrow down to
two possible options. For example, when a question asks about adjusting insulin dosage, ask
yourself, What is true about adjusting the dose? Is it true or false that dosage is increased
when the client has an infection? (True). Is it true or false that dosage is decreased when blood
glucose level increases? (False). If you find no true answers, look at the choices for a maybe
answer.
40. Use acronyms and memory aids to help remember theory in selecting an answer. SWISS
management of Cushings syndrome:

Sugar (hyperglycemia)
Water (fluid retention)
Infection (prone to )
Sodium (retention)
Sex changes (no menses)

Five Ps of assessing fracture:

Pain
Pallor
Pulselessness
Paresthesia
Paralysis

WOUND2 healingaffected by:

Wound dimensions
Overweight
Undiagnosed infections
Nutritional deficiencies
Diabetes, Disabilities (e.g., immunosuppressed)

41. Reword the question if the stem says further teaching is necessary (e.g., the best answer
will have an incorrect statement).

42. Recognize what is normal. For example, are the data presented normal, or is the
sign/symptom presented an Uh-oh! (meaning that a problem exists)?

43. Do not delegate functions of assessment, evaluation, and nursing judgment to a Licensed
Vocational/Practical Nurse (LVN/LPN) or CNA (Certified Nursing Assistant) (e.g., do not
delegate: admitting a client from the OR to the unit; establishing a plan of care; teaching or
giving telephone advice; handling invasive lines).
44. Do delegate activities to an LVN/LPN or CNA for clients who are stable with predictable
outcomes (e.g., help ambulate a client who is 2 days postsurgery). Do delegate to an LVN/LPN
or CNA activities that involve standard, unchanging procedures (e.g., take vital signs after
ambulation, do clean catheterizations, simple dressing changes, suction chronic tracheostomies
using clean technique).

45. In positioning a client, decide what you are trying to prevent (e.g., contractures) or
promote (e.g., venous return).

46. To help decide in which position to place a client, form a mental image of each position in
the options (e.g., picture supine, high Fowlers, semi-Fowlers, Sims, prone, Trendelenburg,
lithotomy, dorsal recumbent).

47. When none of the options looks good, identify the nursing concept implied in the options
given (e.g., risk factors for infection).

48. When in doubt, first reread the question stem to obtain clues, then reread the options.
When you come across a question that is about unfamiliar nursing content (e.g., paracentesis),
first ask yourself, What is the topic of the question?, then What do the answer choices
mean?, and then reword the question using the clues from the options.

Example: What is most important for the nurse to ask a client immediately after a
paracentesis?

1. Are you in pain?

2. Do you feel dizzy?
3. Does your underwear fit better around the belt line?
4. Do you need to urinate?

The first clue is in the question stem: most important, immediately after. Then, based on
rereading the options, you can reword the question to, What is an untoward reaction
(complication) after this procedure? The answer choices relate to expected outcomes (1, 3), a
question that is not relevant to ask after the procedure (4), and a complication (2), which is the
correct option.

49. Recognize expected outcomes of drugs and treatments/procedures.

Example: What will indicate improvement in the
condition of the client who has anorexia nervosa?

1. The client has gained weight.

2. The client weighs herself every day.
3. The client eats all the foods served to her.
4. The client asks the parents to bring her favorite foods.

Choose the option that shows progress toward the goal (in this condition, it is weight gain that
is expected).

50. When you do not know the answer, choose what will cause the least harm.
Example: The nurse suspects abdominal wound dehiscence when lifting the edges of the
clients dressings. What should the nurse do next?

1. Tell the client to remain quiet and not cough.

2. Offer a warm drink to help relax the client.
3. Place the client with feet elevated.
4. Change the dressing.

Option 1 is the best answer, because it will not add damage that could happen with changing
the position or the dressing.

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51. Take care of the client first, not the equipment or the family (unless a family member is the
focus of the question).

52. If one option has generally, usually, tends to but other options do not have these
qualifiers, use the one option that does have the qualifier as the best answer.

53. Identify clues in the stem, that is, look for a similar word or phrase used in the stem and in
one of the options. For example, if the question states that the client is on an intermediate-
acting insulin (NPH), and the stem asks for its peak action, look for a middle time. Among
choices of 4, 6 to 12, 12 to 14, or 15 to 18 hours after the injection, choose 6 to 12 hours (as the
midpoint).

54. If two options are similar, neither can be the answer because both are distractors.

Example: What might the nurse expect to see when a client with cirrhosis is hospitalized with
ascites?

1. Client is likely to be anorexic.

2. Clients intake will be poor, especially if served large portions.
You can eliminate both of these options because they are saying the same thing in different
words: the client is likely to not be interested in eating.

55. Dont pass the buckthink what is a nursing action that an RN can do before calling the
MD.

Example: After surgery, a client with diabetes complains of nausea, and appears lethargic and
flushed, with BP 108/78, P 100, R 24 and deep. What is the next action?

1. Call the MD.

2. Check the clients glucose.
3. Give an antiemetic.
4. Change the IV infusion rate.

The nurse should assess (option 2) before calling the MD (who may then order an antiemetic,
option 3, and alter the IV infusion rate, option 4).

56. Focus on key words in the stem of the question as your clue:

Best
Essential
Highest
Immediate
Least likely
Most
Most appropriate
Most likely
Vital

57. Action does not always mean choose an implementation type of answer. The question
may ask: What is the best nursing action? However, the answer may be an assessment
option.
Example: What is the best action for the nurse to take when a mother at the clinic reports that
her child who has diabetes is hyperglycemic in the
morning (215 mg/dL), although the child has been well controlled with NPH and regular insulin
before breakfast and dinner?

1. Suggest that the mother give the bedtime snack earlier.

2. Suggest that the insulin be given later in the evening.
3. Suggest that they continue with the same regimen.
4. Check the blood sugar now, and suggest that the mother check it during the night.

Choose check, which is an assessment response (option 4), although the question (the stem)
is phrased as an implementation (best action is an implementation).

58. Remember the nursing hierarchy. Go to the next line of nursing authority (e.g., staff
charge nurse; LPN/LVN staff nurse) when the question asks to whom to report a situation.
For example, if the question is about an LVN/LPN, the best answer is to report to the staff
nurse.

59. When the question includes laboratory values, ask yourself whether the given value is
Uh-oh! (meaning too high or too low), or Uh-huh (meaning not a particular problem). For
example, a serum K+ of 8.5 is Uh-oh! (too high).

60. Prevention is a key concept (e.g., when the question deals with infection control, and in
health teaching).

Example: The primary objective in ileostomy teaching with a client during the early
postoperative period is to:

1. Facilitate maintenance of intake and output records.

2. Control unpleasant odors.
3. Prevent skin excoriation around the stoma.
4. Reduce the risk of postoperative wound infection.

Choose prevention (option 3), which in turn may prevent contamination of the abdominal
incision (option 4). Options 1 and 2 are secondary objectives.
There may be more NCLEX strategy tips that can work for different case scenarios but with
diligent study and practice along with the pointers above, theres a very good chance of
prevailing and passing the exam on your next attempt. NCLEX is a pass/fail exam meaning
that all you ave to do is prepare and study enough to pass. It doesnt make a difference if you
pass with 75 Questions or 265 Once you pass, youre ready for licensure in your chosen state.
This guide is also useful for Canadian students taking the NCLEX in Canada for the first time in
2015 as it will give you a breakdown of the exam layout and serve as a study blueprint. For
those taking the exam soon, we wish you all the very best. Go forth and prevail!

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This entry was posted in NCLEX Strategy (https://brilliantnurse.com/category/nclex-strategy/) and tagged

HESI Exams (https://brilliantnurse.com/tag/hesi-exams/), NCLEX Alternate Questions
(https://brilliantnurse.com/tag/nclex-alternate-questions/), NCLEX Strategy
(https://brilliantnurse.com/tag/nclex-strategy/), NCLEX Test (https://brilliantnurse.com/tag/nclex-test/).
by phildigital

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5 THOUGHTS ON ULTIMATE GUIDE: 60 NCLEX STRATEGIES TO USE IN ANSWERING

QUESTIONS (2016 UPDATE: REVISED FOR 2016. INCLUDES OVER 1000 NEW PRACTICE
QUESTIONS)

Alina Uzquiano says:

Excelent, thanks

JUNE 23, 2015 AT 1:33 PM (HTTPS://BRILLIANTNURSE.COM/NCLEX-STRATEGIES/#COMMENT-6351)

REPLY (HTTPS://BRILLIANTNURSE.COM/NCLEX-STRATEGIES/?REPLYTOCOM=6351#RESPOND)

Jessie Douglas (http://brilliantnurse.com/nclex-strategies/) says:

This is very helpful

AUGUST 27, 2015 AT 4:52 PM (HTTPS://BRILLIANTNURSE.COM/NCLEX-STRATEGIES/#COMMENT-8938)

REPLY (HTTPS://BRILLIANTNURSE.COM/NCLEX-STRATEGIES/?REPLYTOCOM=8938#RESPOND)
deo toki says:
very helpful. thank you so much.

NOVEMBER 4, 2015 AT 3:52 PM (HTTPS://BRILLIANTNURSE.COM/NCLEX-STRATEGIES/#COMMENT-11656)

REPLY (HTTPS://BRILLIANTNURSE.COM/NCLEX-STRATEGIES/?REPLYTOCOM=11656#RESPOND)

Haja Kamara (http://google) says:

Thanks for these strategies. I am taking my boards this month.

DECEMBER 3, 2015 AT 12:54 AM (HTTPS://BRILLIANTNURSE.COM/NCLEX-STRATEGIES/#COMMENT-12361)

REPLY (HTTPS://BRILLIANTNURSE.COM/NCLEX-STRATEGIES/?REPLYTOCOM=12361#RESPOND)

Arnetter says:
This is great information!!!! Im currently preparing to take the NCLEX. I will use these
techniques to answer the questions

APRIL 8, 2016 AT 7:37 PM (HTTPS://BRILLIANTNURSE.COM/NCLEX-STRATEGIES/#COMMENT-13019)

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