Focus on Students: Anatomy of NCLEX Questions

Do you remember the first time you heard the words "NCLEX style questions"? Your first formal introduction to NCLEX was most likely during nursing school orientation. Unfortunately, the nursing faculty did not realize students were overwhelmed with new information and were not concerned with a type of question. In teaching nursing school, I found students would often use the same strategies and study habits that have been successful in other college courses. However, students realize after the first exam just how different NCLEX style questions are from exams taken in the past. This article will demystify NCLEX questions and increase the confidence of nursing students, at any level, to tackle nursing exams- including the official NCLEX.

For students preparing to take the actual NCLEX- pay close attention to the article "tips". Nursing instructors do not always understand how to write an NCLEX question and you will need to stray from the nursing exams you are used to taking.

An NCLEX question has 3 parts- a stem, a key, and distractors. The stem asks a question or requires completion of a question pertaining to the client. The question stem will provide all the necessary information you need to answer the test item.

The Stem

Stem Tips

The key and distractors are the options available for answering the NCLEX item. The answer options are multiple choice and may be in a "select all that apply" format. The answer key is the item's correct answer. It is important to understand the concept behind distractors.

The Distractors

Let's go back to our sample stem and add a key and distractors.

Example 1

The nurse is assessing a client with exacerbation of congestive heart failure. Which of the following symptom would the nurse expect to find?

Rationale

Although low hematocrit sounds very plausible, it is not a common symptom of CHF exacerbation. Weight gain is common due to fluid retention and diarrhea is not a symptom typically associated with CHF.

Tip

I am going to travel back to my days in nursing school and predict the overthinking details many of you added to the question stem

Remember

The question stem will provide all the necessary and pertinent information needed to identify the correct answer. It is a common pitfall to add additional information to the stem.

Example 2

The nurse is teaching a caregiver how to administer bolus enteral feedings. The nurse identified a need for additional teaching with the caregiver states

Rationale

Gastric contents should not be discarded and need to be readministered after checking residual. Discarding gastric contents increases risk for electrolyte imbalances.

Tip

Many nursing school exams and practice NCLEX questions provide more detail that the official NCLEX. Exams questions in nursing school often provide detailed gender, age and other information in the stem. Again, when taking the official NCLEX, it is important to avoid reading details into the questions.

For Example

Nursing school stem- "A 48-year-old male presented to the emergency room after falling off a ramp while working and broke his right femur. Which of the following assessment is most important for the nurse?"

NCLEX stem- An adult client presents to the emergency room with a broken femur. Which of the following would be essential for the nurse to assess?

Final Tip

Did you know the National Council of State Boards of Nursing (NCSBN) publishes a detailed NCLEX test plan just for students? The detailed plan is published to prepare students to successfully take the NCLEX exam. The publication also includes example test items for practice. You can explore the student test plan at Test Plans | NCSBN.

What about NCLEX style questions still mystify you? What future article topics would help you prepare for NCLEX?