this kaplan nclex-rn study guide with cd very helpful. it had just about eveything that the online review covered right there in the book.
i'd purchased a few testing tools...mosby's online cat & their nclex-rn review book/cd...but didn't like it. i found their website not so user friendly & their nclex-rn book to have the same old comprehensive questions that i got in school. it had none of the so called 'new integrative' questions. so i did take the kaplan review course at the advice an professor because they did offer the new style question in their review...& i'm glad that i did. i'd learned in their course that many lpns & graduate nurses who work prior to taking the exam fail the nclex-rn the first time out. said individuals fail due to answering question based on 'the real world' instead that of the "perfect nclex-rn world!'
i went with kaplan's nclex-rn online review & q-bank where i worked at my own pace...it was expensive as hell ($418.00 plus s&h)...but well worth it...considering the amount of money put-out for my nursing education in order to further my career!!! they had literally thousands of exam practice questions...both in the book, online, & on cd. they also review these questions after you've taken their practice tests. they also have video seminars that also go over these exam questions with rationales. sometimes...it helps to have the rationales verbalized & not just written when you go to review each exam. and then they also have video review on such topics as assistive devices, chest tubes, ng tubes, etc.
at the risk of 'giving away' some *secrets*, kaplan mainly stress how to read the questions properly & how to answer & how *not* to answer them. they suggest that you read the question once, don't predict or look for the answer before giving all of the choices a review. don't answer questions on a hunch or feeling...but have confidence in what you do know as a graduate nurse! they stress that recall or recognition & comprehension questions are *not* the minimum competency question required to pass. they stress that assess & analyses questions are of the *critical thinking* & therefore considered above the competency passing level. no matter how many questions you answer, 50% of the questions you do answer have to be above that minimum competency level. once you've done that, the machine will cut off on you. mind you, 15 questions will be *experimental* questions & you can literally pass the exam having answered 50% above competency level with 60 out of 75 questions overall.
the test is designed to start-out at a medium level questions....question right at the minimum competency level. keep in mind...the more questions you've answered correctly, the more difficult the exam questions are suppose to become!!! you'll notice they'll go from comprehensive/recollect to the assessive/analyses types. so you'd really want to walk away from the nclex-rn feeling like that was the hardest exam ever!!! that *is* a good sign!!! there are several ways of passing & failing the test.
- answer 50% question above competency minimum by the 75th question & the machine will cut off & you've passed .
- answer 50% question below competency minimum by the 75th question & the machine will cut off & you've failed .
- answer strings of correct answers at or slightly above the starting medium level question...then start answering string below that level. this will cause the machine to continue to give you more questions in order to give a chance to redeem or prove yourself...if that's the case, then you've passed...but if you don't, then it's a fail. this can take you through to question 265. again, if you answered 50% above or below the minimum, the machine will cut off... it doesn't matter whether you've got the last question right or wrong either.
- should you run out of time before you complete the exam, the machine is program to look at how many you've answered correctly towards the end. the only way of passing the exam is to have the last 60 question answered correctly in a row...which is every hard to do.
kaplan then teaches you to decide if the question has enough info in the stem to warrant implementation...if not...you'll have to assess further. stick with the nursing process model...assess prior to planning, implementing, & evaluating. should the stem of the question give you enough info...then the answer will be an implementation. if the stem of the question is vague, then your answer will be an assessment. also, you have to remember maslow's hierarchy of needs & where the physical needs supercede the psychosocial. for the purpose of the nclex-rn, pain is considered a psychosocial rather than physical need.
that said, some questions will have all assessment or all implementation as answers. in this case, you'll have to go with the *best* answer. how to come-up with that is by process of elimination. read each answer & ask yourself...."what will the outcome be?" "is this a true statement?" if it is...then consider that answer response...but if it's false...then throw it out. "does it follow the abcs?" when following the abcs... "will the answer choices make sense?" i.e....if the question is based on a circulation problem & you see a resp & a circulation choice among the four answers...then by all means pick the circulatory answer because it fits with the stem of the question/situation (use your common sense or *critical thinking* skills here). ask yourself..."would a prudent nurse do this or not?" oh & when you see a question that suggests "further teaching is necessary" or a senrio where you the rn know an uap or a lpn is performing something inappropriately, then you'll be looking for an answer with a "negative" or "wrong" statement. read each answer & ask yourself..."is this a true statement?" & if it is...then throw that statement out.
as far as delegation, kaplan stresses that the rn is ultimately responsible for all tasks delegated.
now i know from experience, lpns can be given a lot of tasks that require assessment/gathering, planning, & evaluating loads of information...but in terms of the nclex-rn...they
can't do any assessing, planning, evaluation, or initial teaching. that is entirely the role of the rn on that exam! also, lpns can only be given patients that are hemodynamically *stable*. they can't be given any patients that require constant monitoring for evaluation purposes. lpns are only allowed to implement written orders from mds/apns & follow instructions given to them by the rns in charge to cover their patients. as far as the uaps (unlicensed assistive personnel)...they can only be given the most basic of psychomotor nsg tasks like taking vital signs on stable patients...assisting with adls & ambulating patients for therapy & again...no assessing, planning, & evaluation...etc.
another thing....mds/apns/nsg mgt/other interdisciplinary dept/personnel such as msw/chaplins/resp/occup/physical therapists are *always* available to the nclex-rn staff nsg! these people are multiple & fruitful...but remember this....
*do not pass the buck to them*
!!! you have to assume that there are standing....if not written orders for your patients...remember...this is a *perfect world*. if you see in your answer choice where "call the physician", "contact a supervisor from another dept", "refer grieving families to the chaplin", for example, before you've exhausted everything that you as the rn can do for the patient...don't pick those answers. if though, you read that everything was done for the patient, i.e. o2 was started, the patient was repositioned, high vent alarms & you've disconnect the patient & started bagging...then & only then do you contact the physician, supervisor, resp therapist...etc. you may be asked questions on what to do for a patient based on their abgs or common labs...you'll have to know the normals & what's expected when they're abnormal & know where to go from there. the only other time that you will "pass the buck" is when an uap or a lpn observed something wrong with another rn's patient. you are not suppose to assess that patient since you don't know that patient's base vitals & situation. only then would you inform either that rn or contact your supervisor (staying within your chain of command)...or both. i've seen questions that suggest an uap of 12 years or a lpn of 20 years observes a new grad rn do something that they know (or feel) isn't right. what do you do? confront said nurse, observed said nurse in their duties, or ask the reporting personnel to elaborate on how they come to feel this way. unless what the uap/lpn seen is unsafe...then you as the rn would ask that reporting personnel to explain their concerns further.
sorry about you not passing the first time, but if you buy the kaplan guide, i'm sure you'll do just fine the next time out!