Rules to test By

•First rule…..No ‘rule’ will work 100% of the time, not all rules fit every question, and most importantly
– No rules will help you pass unless you know your content, master critical thinking and practice the
Decision Tree EVERY time with EVERY question.

•Remember Maslow – Physical needs before psychosocial needs. In most cases, pain is psychosocial. If
you have trouble thinking that treating pain comes after more direct physical needs, look for ABC answer
choices. If they can’t breathe or are hemorrhaging and you just medicate them, they will be pain free
when they die.

•ABC’s – when deciding between answers ask yourself if this could be an airway, breathing or circulation
problem. Symptoms ‘above the waist’ that may affect airway or their breathing, consider an answer that
reflects ABC’s. Circulation answers may be tempting. For instance chest pain….remember that unless
they can breathe, resolving or addressing circ answers won’t save them. So, a VALID A/B answer will take
priority over an also valid circ answer.

•No limits on time, resources, equipment or staff – for this exam you work at NCLEX Hospital. Never
discount an answer because you think staffing won’t allow it, or it would take too much time. This is
NOT the real world. If the ideal answer involves doing a study, having another nurse available to cover, or
a translator on standby – you have it.

•In most cases if you have a choice between assessing the pt. or the equipment, assess the pt.
Exceptions are drainage tubes like a foley, chest tube, NG etc. If the problem may be an
occluded/blocked tube causing the problem or symptom, check the patency of the tube FIRST.

•When considering Assess vs Implement, we generally assess before Implementing. Assessments gather
info/data, Implementations are actions based on the info/data. If an action gets you info or data, it is an
assessment. e.g. – Listen to lungs, obtain a chest X-ray, obtain or review labs.

•When considering an assessment option, if the assessment is wrong/ inappropriate or

redundant/wasting time, and an implementation addresses the topic of the question, eliminate the
assessment. If all assessments are wrong, you need to implement. Do NOT convince yourself the
assessment is OK just because your first thought was to assess. The same applies to implementations.

•With both assessments and implementations, ask yourself these questions:

-Why would I do it?

-What will happen if I do this? (you can only do 1 thing…choosing any option means you are
NOT doing the other options)

-Does it make sense? Is it the priority? What is the outcome?

- When given assessment items in a question stem, evaluate them as you are determining the topic.
Read through the stem, note what symptoms are given, what labs are abnormal, etc. See how they
apply to or identify what the question is asking. Then use answers to clarify or confirm topic. Use the
assessment(s) in the stem to determine if you have enough assessment data or do you need more

•Everything is by the book – correct answers are found in textbooks, not necessarily what you see at
work. You must forget work situations, real life limitations, what you see on the job and what the
policies and procedures are wherever you work or did clinical.

•Chain of Command – report up the nursing chain, not another department. For medical or ethical or
legal issues, report to the next person up the nursing ladder as described in the question or answer
choices.

•For answer choices like ‘consult another nurse manager’ or any option where you get any sort of
advice or input from someone else – remember, NCLEX wants to know what YOU would do, not what
someone else would do. Carefully consider the other options given for something appropriate that you
can do instead. Imagine you HAVE the knowledge or authority given to you by the question.

•Don’t jump to answers, don’t look to pick the right answer. Reword the topic in as few words as
possible. Use your answer choices to figure out the topic, or to clarify the topic.

•Don’t ignore an answer just because you don’t recognize it or its significance. Your lack of knowledge
does not invalidate an answer. If you don’t know, set it aside and evaluate the others. DO NOT make up
stories to force a wrong answer into a right one just because you don’t understand one of your options!
Evaluate answers with an open mind – Don’t be thinking one of the 3 HAS to be the right one just
because the 4th is unknown to you. **If you have CORRECTLY eliminated 3 answers, the one that’s left is
the answer, whether you ‘get it’ or not.

•Do not predict answers before seeing the answer choices you have to work with. You cannot answer a
question until you know the topic (what the question is asking).

•Don’t let a question intimidate you until you filter out unnecessary info and whittle the topic down to
the meat.

•Don’t let the info in the stem, or answer choices take you into the swamp. Navigate the question with
purpose and without distraction. Remember there is a difference between using critical thinking to
anticipate a real problem - and making up a story.

•Eliminate wrong answers first – clear out garbage first.

•You always have a Dr. order for any appropriate/correct answer.

•RN cannot delegate to LPNs or LNAs : assessment, teaching or evaluation/ nursing judgment – only the
RN can do these things.

•Safety is primary concern in NCLEX – safest solution, do no harm

 •See most unstable pt. first – start by eliminating stable pts. Then use ABCs. Consider stable vs unstable,
chronic vs acute, expected vs unexpected, potential vs actual, and ABC’s. NCLEX wants you to address
‘right here, right now’ as the priority.

•Positioning – we are trying to either prevent, or promote something. Picture positioning questions in
your mind. What are you trying to prevent or promote, and will the position described do it?

•Therapeutic communication – never ask “why”, look for an answer that may be asking why without
saying it. Validate their concerns/acknowledge concerns and feelings, don’t talk about yourself or what
‘we’re’ doing, don’t tell them not to worry, do give facts.

•Comma rule – answer choices with multiple parts, often separated by commas or the word ‘and’, must
be broken down. Each part must be correct for the whole answer to be correct. For the test, stop
reading as soon as you hit a wrong part. For practice, look at each part and ask “is this right?”

•When evaluating answer choices, ask “Does this make sense”, “If I do this, what will the outcome be?”
“What will happen if I do this?” “Why would I do this?” etc.

•Do one thing, then go home, or make one call, then get disconnected, or ask one question and you’re
done. Evaluate all answer choices. You cannot ‘multitask’, and you have only the choices given.
Whatever answer you select is the only thing you will do. The ones not selected will not get done by YOU
- but if it helps ease your mind, imagine another nurse is coming to do the rest. NCLEX wants to know if
you recognize the priority action/assessment that will save life or limb. It does not matter if the choice
you want, or that you feel would be the priority is not there – if it’s not there, it’s not a consideration.
Choose the one best answer that addresses the problem here and now. Choose the answer that best
represents the correct principle.

•Priority questions are just that – BEST, FIRST, MOST etc. None of the answers may be great, or all may
be good. Your job is to show you can select the best of what is given. Sometimes it helps, once you’ve
selected and answer, to go back and say…is it OK that I will NOT do each of these eliminated answers, I
still believe my choice to be the priority. Or ask ”What will happen if I do not choose the other 3”?

•When considering roommates, it’s usually about infection. You must consider both the pt. being
admitted to the room, and the pt already there. This includes moving pts. from one unit to another. It’s
not only obvious active infections. Certain diseases, illnesses and meds that make a person more
susceptible to infection can make them a risk to their ‘clean’ roommate. Enclosed, contained infections
like Lupus, pancreatitis or toxic hepatitis from overuse of Tylenol are not contagious.

•Time frames are important…are they in recovery room, just arrived on floor or 3 days post op? What is
the time between the event and the symptom?

•Know procedures/tests. Do they require a consent to be signed, NPO, special preps? Is there any
special care required after the procedure? What are the major complications and the symptoms of those
complications?
•If a treatment or test or procedure requires something to be stuck into a pt. (like a central line, or
biopsy) remember…”If you poke it, you can pop it” Be aware of things like pneumothorax, bowel or
bladder perforations etc.

•If you do not recognize a word, disease or med, don’t get stuck – just move on and see if it actually
matters. Do the same with an answer choice you don’t recognize, or the ‘call the doc’ option. Set it aside,
evaluate the rest, then consider the option you don’t know.

•If ‘call the doc’ is an option, consider if there is something you should assess or do before you call. Is
get a finger stick glucose an option? Will they ask about a glucose? If it is significant to the problem and
appropriate, do it before calling.

•Don’t “pass the buck”. Don’t have someone else do something YOU should do. Don’t pass on or
delegate a nsg job to another. EG – ask the wife to sit with the pt. There IS a difference between
delegating appropriately to another nurse or aide and passing the buck.

•Know labs, immunizations, normals, growth and development milestones, Erikson, normal physical
assessments at all ages. Know med families/categories, significant side effects, significant herbal
interactions, interactions with other meds, cross allergies and how the meds work to fix the problem.

Therapeutic communication

1. Respond to feeling or tone of the pt

2. Provide information

3. Do not ask "why" questions

4. Avoid "yes / no" questions

5. Do not focus on the nurse

6. Do not explore deep issues or feelings – you are not a therapist

7. Do not say, "don't worry"

****Translation of the Therapeutic Communication Rules*****

1. Respond to the feeling they have - acknowledge what they feel, respect it and do not minimize it.

2. Provide information - give facts

3. Do not ask "why " questions - asking why can be confrontational/challenging them.

4. Avoid "yes / no" questions - ask questions that allow them to open up/open ended questions.

5. Do not focus on the nurse/hospital - It's not about us, our opinions, what we've seen in other cases or
what we do. It's about this pts. needs, fears or opinions right here, right now.
6. Do not explore - don't try and dig down to deep psychological feelings or reasons. That is for
professional therapists to do:)

7. Do not say, "don't worry" - don't offer false reassurance.

Who do you see 1st?

-Eliminate stable pts. until you have the most unstable.

-Utilize ABC's

-Compare each pt. to the next, eliminating the more stable pt

-consider...

-Expected vs Unexpected

-Chronic vs Acute

-Potential vs Actual

Assignment strategies

RN: Pts. requiring Assessment, teaching, nsg judgment/eval

LPN/LVN: Stable pts. with predictable outcomes

- Recognizes abnormal from normal

- Knows sterile procedure

Nsg Aides: Standard unchanging procedures

- VS, O2 Sats, assist w/ADL's, etc.

**Floats: assign as you would an LPN/LVN

DT Decision Tree

1- What is the topic

-Confirm or identify topic using answer choices

2- Assessment/ Implementation

- Ass. gather info or data

- Imp's are actions based on info or data

3-Apply Maslow - Physical vs Psychosocial

 - Eliminate Psych/Soc answers

4-With the remaining answers, Apply ABC's

-Make sure the ABC answer makes sense/is appropriate

5- Evaluate the remaining options.

-If I do this what will happen? Is it a desired outcome?

DT

1.Topic

2.Assess vs Implement

3.Maslow

4.ABC’s

5.Evaluate the outcome

DTree notes

Rules and Tips, General Decision Tree

NCLEX is exam is textbook nursing - do NOT apply what you do or see at your

work. It must be by the book.

-This also applies to things like what an LPN/LVN or an aide can do. NCLEX uses national guidelines - state
practices may differ. Use the guidelines from the course book and this class.

-Your on line resources include video tapes of the course questions/explanations, and videos of content
review from the course book. These are found under toolbox in your syllabus - LOD review of class
questions, LOD content review.

-alternate question types can be practiced in your QBank

-No strategy will replace a strong content base. There are NO shortcuts for real knowledge – not for this
exam, and not at the bedside. We can give you tools to attack even a question you know nothing about
with confidence – but YOU must practice and do the work we advise to be successful.

-Critical thinking: applying knowledge you have to a specific situation. It often involves validating
information found in the stem.

-KNOW the Decision Tree! It is in your Course Book on pages 48 & 49.

-Correct answers are based on safest nursing judgment.

-Eliminate the wrong answers to get to the correct answer.

-DO NOT READ INTO QUESTIONS! Don't make up a story or ask "but what if...?"

-Background information is usually just distracting information. Do not let background information
distract you - sometimes the age, gender, or even some of the medical info is just not important and
distracts you into considering answers that do NOT solve the problem.

-Sometimes wrong answers reflect background information. Watch for a pattern like 3 answers all
directed toward an item in the stem, and 1 answer directed toward a different item. Sometime the odd
answer is actually addressing the real topic.

-Before you look at the answer choices, summarize the topic of each question into a phrase using your
own words. Sometimes you'll need to look at the answers to determine the question's topic.

-Next, First, Best, Most, Initial all indicate a prioritizing question.

-You get to do one thing and one thing only. Choose the answer that has the

greatest impact on the patient's problem.

-Do not get ahead of the process...1 step at a time

-The answer MUST make sense in the context of the question.

-The time frame in the question is important

-Choose the answer with the desired outcome

-Accuracy is MUCH more important than speed

-Make no assumptions when reading answer choices or the question.

-Get to the right answer by eliminating wrong answers first.

-Always read ALL answer choices before selecting you answer. Even if you think you know the answer,
evaluate ALL of them.

- Do not read things into an answer...don't say "what if", don't make up

stories. -sometimes we are tempted by a familiar answer because we do not recognize the correct
answer. If you have to make up stories to make an answer work stop, and rethink it.

-For this exam, you work in 'NCLEX Hospital'. You have all the time, staff,

resources and equipment to do the perfect answer. Forget the real world limits:)

-Priority questions ask you to see the 1 best thing of the answer choices.
-Think of doing ONE thing, then going home. You can make ONE call, ask ONE

Question or give one piece of information to a patient. Of 4 good or true answers, which is BEST? Of 4
bad answers, which carries the WORST outcome?

-It does NOT mean you wouldn't eventually do the other options...just that you know the FIRST thing to
do. We do not multitask for this exam. If it helps, imagine that another nurse will do the next thing

-All answers may be good, only 1 is BEST. What is the one assessment or the one implementation that
gives the best outcome, gets the most information or best addresses the real problem.

Step 1 Identify the Topic

-FIRST, identify the topic of the question. You must know what the question

really is before you can consider answers.

- Read only the stem of the question - do not look at answers until you identify the topic, and put it in
your own words.

-**Do not anticipate, guess or jump ahead to what you THINK the answer will be – your brain will get
stuck there and you will not be ‘open’ to a different answer! Just get the topic – nothing else.

-Use the answer choices to confirm, or identify the topic.

--answer choices can help us focus in on the actual topic

Step 2 Assess vs Implement-

--Assessments gather info or data. Actions that result in data/info, like ‘get an O2 Sat’, or ‘do a fingerstick’
are Assessments. They are actions that give you information.

-Assessments may be subjective or objective data.

-Implementations are actions based on assessments. Things like teaching, offering suggestions,
repositioning, starting an IV, reporting to supervisor, calling the doc – those are implementations. Before
we can take action we must have sufficient assessment to act safely.

-the question will give you information, and that may include nursing assessments like what the nurse
observes, pt history, pt complaints, lab data, etc. This may be enough information for you to
act/implement, or you may need more data before acting. The answer choices will help you decide.

-If there is assessment in the stem, and there are no assessment answers, then you don’t need any
further assessment. It doesn’t matter if you think you DO want more info, if it isn’t there as an option,
forget it!
-If there ARE assessment answers, ask if the assessment makes sense. Just because we generally assess
before implementing, does not mean that just ANY assessment will do If there is no appropriate/correct
assessment, you MUST implement.

-Validation simply means that you have some info in the stem, and you feel that more is needed to
confirm what you think is happening. So, if you have some assessment in the stem, and there is an
assessment answer that makes sense to do before taking any action – then you will select that.

-When considering implementations, the same principles apply. No matter how much you want to
implement, if there is no appropriate implementation answer, you need to look at assessing.

-Ask yourself why you would take this action, does it make sense in the situation they gave you, and
what will happen if you select this rather than any other answer.

-If the question asks what “action” would you take, this does NOT mean you will implement – remember,
‘actions’ may be either assessments OR implementations.

-If the answers are all Imp, or all assessments you can't eliminate answers based on Ass. Vs
Implementation, so you go to step 3, Maslow.

-keep moving through all the steps, if one doesn't apply, move right on to the next step

Step 3: Maslow!

- Physical needs take priority over psychosocial needs

-Select answers that reflect physical needs over those that reflect psychosocial needs.

-For this test, pain is considered Psychosocial. It's more important to stop the bleeding than to
reassure/comfort them - you can only do ONE thing.

-if we treat the pain, but we don't stop the bleeding...they will die. They will be pain-free, but still dead.

-Exceptions to this are pain from an MI and pain from kidney stones. With other significant pain
situations, like sickle cell crises, or a burn situation, carefully consider the other answers. If they are
inappropriate or wrong for the situation, then they may be looking for the pain answer. Think about
what the outcome will be as you consider each answer given.

-Teaching is psychosocial – If you are having an MI, treatment takes priority over teaching. P/S answers
generally will not save life or limb and for nclex your priority is to save them!

Step 4 ABC’s-

-When considering the physical answer choices, think ABC’s

-ABCs are the top priority. An airway problem takes priority over a breathing problem. A breathing
problem takes priority over a circulation problem.
-Just because something is an airway answer, doesn’t mean you just pick it – it must make sense, and be
valid or appropriate for the problem or situation in the stem. If not, eliminate it and consider other
answers.

-If an injury, side effect, reaction or complication effects anything above the waist, consider the
airway/breathing answers, if any.

Step 5: Evaluate outcomes:

-With each answer choice ask yourself – what will happen if I select this? Is it safe? Does it answer the
topic of the question?

***Not every question will use every step of the Tree, but you will

Always use step 1, Identify the Topic, and step 5: Evaluate the outcome of the answer choice. You have
many other strategies to consider for questions – keep them handy in your mind at all times. Kaplan
gives you the tools to succeed!

RN= assess, teaching, eval. ATE

LPN/LVN= stable pt, pred outcome

*can make judgement /determine

normal from abnormal

*can re-inforce RN's teaching

Aide/ UAP= standard unchanging procedures. Routine care

*can do enema's,

* tube feeds (after the RN checks residual or placement)

*routine -vs's, feeds, care

re-assigned RN= stable pt pred outcome

The GREAT THING ABOUT NURSES =)

One great thing about us nurses is that we are always ready for change. When least expected we may be
asked to go to another floor to help out, or take on an extra patient or two in an emergency. Being
flexible is a true asset and it will make not only your nursing career but also your life easier.

Decision Tree:

1. What is the topic?

Put ques in your on works

2. Label ans choices

Assess or Implemantation

3. Re-label ans choices

Physical or Psychosocial

eliminate psychosoc ans

ask do ans make sense?

do ABC's apply

4. All ans are Physical

Do ABC's apply

5. All ans are Psychosocial

ask What does each ans mean

Does it promote/prevent what we want

Does it ans the ques?

Therapeutic Communication:

1. Respond to feeling / tone

2. Provide info

3. Do not ask why questions

4. Watch yes/no ques

5. Do not focus on the nurse

6. Do not explore

7. Don't say don't worry

Sleep, appetite, energy, Interest & concentration are the 5 things we assess in a depressed patient