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NCLEX questions and most questions leading to the test are a beast of their own. After you receive your license, if you continue on to getting a certification, the items are more straight forward. But the importance of the NCLEX question is breaking it down to understand the information given and the question being asked. The question I’m using for the example comes from Lippincott Q&A Review for NCLEX-RN edition 11 by Diane M. Billings and Desiree Hensel. There are more updated editions available.
The Question
“A client with Crohn’s disease has concentrated urine; decrease urinary output; dry skin with decrease turgor; hypotension; and weak thready pulses. The nurse should do which of the following first?”
#1 Read the question all the way.
Before doing anything, read the question in its entirety. If you skim the question or try to look at the answers first, you could fall into one of the traps. NCLEX questions are like no other questions, some are straight forward, and some seem like they are straight forward, but aren’t. So slow down, take your time, and read the question.
#2 Identify the question.
Go back to the item and identify the question. Typically the problem can be found at the end of the question. But once again, read through and note what the question is asking. In the example, the question being asked is, “nurse should do which of the following first?”. Identifying the issue, you can see the category of the question, this one is looking at the priority of the nurse. A priority question will use keywords like first, or priority. You are looking for the most important thing, based on the patient and the information given in the body of the test objective.
#3 Identify the patient.
The patient will change the answer and the situation. Is the patient a child, infant, adult, or elderly, does the patient have a diagnosis. A child with chickenpox and an adult with chickenpox will change the urgency. Priorities change, and information that follows will guide you to a different answer. In this scenario, the patient is a client with Crohn’s disease. Unless the question states an age or identifies the patient as older or younger or your lectures have been on a distinct age group, you can expect the item to be about an adult.
#4 Identify the given information and what does the information tell you? Does all the information fit together?
The next piece of the question to look for is the information. This part will go over the specifics of the patient and the symptoms. The Crohn’s disease patient here has the following: concentrated urine; decreased urinary output; dry skin with decrease turgor; hypotension; and weak thready pulses. All the information about the patient asks yourself if it all focuses on one problem or if one or two details might mean a second problem. In this example, the patient with Crohn’s disease began having diarrhea, which caused dehydration. All the symptoms that are discussed all point to dehydration. Be careful if whoever made the question throw-in one or two details that lead to another answer. Still, when you go back to the problem, you realize it doesn’t answer the question being asked.
#5 Go back to the question.
After reviewing the detail of the patient, in a multiple-choice question, you will either come to two different answers. Both of these could be correct when you look at the details. If you find the two potential solutions go back to the question. You want to answer the question asked, or you will fall into the trap and answer the wrong question correctly. Another situation you might come down too is two similar answers. If two solutions are identical, one of them is the right answer. In the example, if two options are IV fluids or encouraging the patient to drink. Both of the solutions will help to hydrate the patient, which is the problem stated. But go back to the question asked. The question is asking about priority, both will aide the patient in hydration, but IV fluids will hydrate the patient faster and is the more relevant solution.
Remember to read the read question in its entirely. Identify the parts of the issues so you know the who and what of the problem. Before answering, go back to the subject to make sure you are solving the correct question. Many wrong test items, when reviewed, could have been additional points of I reread the question.