I've been an RN for 22 yrs and have to take the NCLEX

Dear Nurse Beth Advice Column - The following letter submitted anonymously in search for answers. Join the conversation!

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Specializes in Tele, ICU, Staff Development.

Dear Need to Study,

What a great question! I'm sure a lot, if not all, of us experienced nurses would cringe at the thought of having to take the NCLEX again.

But you can do this, and this isn't just rah-rah cheerleading. It's because resources are available that weren't 22 years ago. There's a lot of resources and support for you right here on site, just a few of which are listed at the end of this post.

Practice

You can take an NCLEX review course and you can take practice tests with Kaplan or UWorld or nursing.com to get an idea and practice with test questions. You will get a score that's a pretty fair indicator of your predicted NCLEX score.

Experience is a hindrance

I think one challenge for you is not over-thinking the answers due to your real-life experience. Questions are based on textbook knowledge, not clinical experience. The questions are also straight-forward and not designed to trick you.

For example, yes, a post-op patient with sudden onset of shortness of breath and sense of impending doom could be having an MI or panic attack, but reading the clues in the stem (post-op, sense of doom) points you to textbook PE.

I see examples of this all the time when I sit down with experienced nurses who have taken a Relias (used to be Prophecy) assessment to demonstrate competency in their speciality as part of being hired.

The nurse may miss a question and say "Well, I didn't know a side effect of IVP Lasix is tinnitus (who knew?) because I've never once seen that in a patient."

Another challenge is reviewing all speciality areas, which may mean L&D and psych, depending where you have not worked in 22 years ?

Don't throw away points

Be razor-sharp with conversion calculations. There's no excuse for missing math problems and decimal point errors.  

Read carefully. NCLEX questions are well-written to avoid double negatives and multiple-multiples, but you might get a question such as "Which order should a nurse not question for their nauseated patient?" with the right answer being zofran and not dexamethasone. 

Prepare for and expect questions on therapeutic responses, teach-back patient teaching,  diversity, sexual orientation and gender identity.

Basics

Expect basic pharmacology, such as questions on digoxin and diuretics, which are potassium-sparing, which are not. 

Is warfarin or LMWH recommended for prophylactic DVT? What drug reverses heparin? Which foods are high potassium and which have high Vitamin K?

What lab levels are associated with renal function, which labs are associated with liver function and pathology?

Is bloody sputum after a bronchoscopy expected or reportable? Positioning after a liver biopsy and best activity for a patient with schizophrenia?

I hope this jogged your memory where all of this is stored in your brain, albeit a while ago ? Best wishes,

Nurse Beth

Resources

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