Some thoughts on the NCLEX

[sully75]

I passed the NCLEX last week with 75 questions. I thought I'd share some observations quickly (now I'm job hunting, which is my new nightmare!)

-So here's my NCLEX theory: if you are doing really well, like you are going to pass in 75 questions, they are just going to throw ridiculous questions at you. No matter how well prepared you are, you are just not going to get every one of them right. Honestly, out of 75 questions, I felt like I got 3 questions where I was pretty sure I knew the answer. Even then, I wasn't sure.

Ok so my theory is that if you are getting those higher level, bizarre questions, you are doing really well. I don't think they expect you to get more than 50% of them right. Maybe even less. If they throw a crazy one at you, and you get it wrong, they give you a slightly less crazy one. Get that one right, and you are back to the crazy one. Guess right on that one, then they give you an even more insane one. Guess right on that one, and they are going to give you an impossible one.

So if you keep on that track, you are going to feel like you are 100% failing. But really the scary thing is if you feel like you know the answer to every question. That's how you know you are doing not that great.

When it got to question 75 I was sure that I was absolutely failing, but then the computer shut off. I was pretty sure I passed, only because I didn't think I'd fail outright at 75 questions. I thought they'd play with me for a while before I failed.

So anyway, point being: eliminate choices. If you can throw out 2 choices, you are down to 50% chance of right or wrong. At those high level questions, if you can get 50%, it's my feeling that you are going to pass, even if you have no idea what they are talking about.

Things that helped a lot:

Mnemosyne, this incredibly awesome flashcard program:

Welcome to the Mnemosyne Project | The Mnemosyne Project

Seriously, you have to use this. Saved me. Just dump anything you want to learn in it, in the form of a question. It will quiz you, and depending on how well you do, it will ask you again shortly (if you can't remember it) or in a day or more (if you got it correct, without effort). It's so good.

Seriously, download this program.

Ok here's a link to my mnemosyne database:

Mnemosyne NCLEX.mem - File Shared from Box.net - Free Online File Storage

I take no responsibility at all for the info in there. It helped me a lot, but I was dumping stuff into it as I went, so there may be errors. Use at your own risk.

For pharm, they are going to give you crazy stuff you have no idea about. However, they may make 3 of the choices things that you do know. So, being familiar with the normal stuff is essential.

I made up a list from a couple of other lists, and from questions I got on practice. I think I got part of it from a thread called "63 key drugs" here, but I can't remember (again, all this was done in a fog of studying). Again, use at your own risk. Assume all the info is wrong. If I were you, I'd erase all my notes and put your own in. The act of looking up these drugs and making this spreadsheet were what really helped me.

Ok here's that:

NCLEX MEDS.xls - File Shared from Box.net - Free Online File Storage

Remember, all the info is wrong, so you should double check everything.

Meds: know your darn insulins (that's in the mnemosyne database), digoxin, lasix, beta blockers and how they differ from other hypertensives, MAOIs, drug-food interactions, immunizations. Know which drugs are nephro and ototoxic (definitely!!!)

If I were you, and I didnt' know any meds at all (I seriously didn't, before I started studying 6 or so weeks before the test, I might go through that list of drugs, maybe 5 at a time, and read about them, specifically, taking notes on each one. Lehne might be good for that. Honestly I was all over the place in my studying and wasted a lot of time on it, but I couldn't find a good list of drugs to study. So...hopefully that will help you.

Also, there's a chapter in Lehne, that tells you how different receptors work (anti-cholinergic/cholinergic/nicotinic, etc). It would be good to integrate that. I kinda thought about it in a very crude fashion, and it was helpful.

If you know the basics solidly, that's better than knowing tons of hard stuff badly.

There's a thread here called "my study notes" or something like that. It's awesome. Ok, just found it...here it is:

Best study guide (my notes) - Nursing for Nurses

I made it into a word doc:

Someones great study guide.doc - File Shared from Box.net - Free Online File Storage

So so great. I also put some of it into the mnemosyne database. Know this stuff backwards and forwards.

Here's a list of signs that was pretty helpful:

harlequin sign - definition of harlequin sign in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia.

and reflexes:

reflex - definition of reflex in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia.

Oh and re: study guides, I started with Saunders, bought Lipincott (I think) 5000 questions (something like that), Exam Cram 5 tests (that was a waste of money), and I had a bunch of Prentice-Hall Reviews and Rationales for individual subjects (these were great for school, but for NCLEX prep were kind of a waste of time...actually a total waste). Oh and the Kaplan test strategies book, which is, for what it is, really good.

By far the best book I found was the Mosby Illustrated Study Guide for the NCLEX:

Amazon.com: Illustrated Study Guide for the NCLEX-RN

So so good. Really helpful funny little drawings for certain things, the exact right amount of info, and it's pretty easy to read (Saunders language is really painful to read after a while...everything is seperated into individual sentences, it drove me crazy).

I wish I'd had the Mosby book way earlier in my studying. I got it a week before the test but it helped a ton. It also has great med sections for each chapter. It's like half the size of Saunders, but way better in my mind.

That said, the Saunders CD is really great. The questions are harder than the ones in the book (which are a little too easy I think).

Another thing: No practice test really has anything to do with the NCLEX. The questions on the real NCLEX are weirder than anything you find in a book. Even Kaplan. I guess if you took the hardest Kaplan questions, and subtracted the other 80%, and made the whole test like that, that's kind of what it was like. That's why you have to get really good at guessing, because you are just not going to know the answers to all of them, and you have to accept that without freaking out.

That's all I got. Hope that helps.

[caliotter3]

:ancong!:

[sully75]

god that was a ramble.

couple more things to know backwards and forwards:

know your L&D stuff backwards and forwards

Know the order of maneuvers (totally blanking on the name) to find out where the baby is in the womb

Dig toxicity

med calcs, do a bunch, not that hard, get you some points

antidotes, particularly coumadin and warfarin

know your veal chop (it's on the study guide I posted)

definitely MAOIs, drug and food interactions

really know your allergy stuff (banana allergy=latex allergy, etc) the more obscure the better

Oh yeah, the "random fact throwing thread" is worth a couple of hours of reading through. If you don't know something on there, look it up. I made it through about 20 pages of that before I got bored. Learned a ton.

Partly I think finding crude ways of organizing really intricate info is helpful. Like immunizations...so confusing. Every single one is different, but a number of them are like 2 4 6 months. Then there are a few that are after 1 year. Or whatever. I've already forgotten (that's what I was looking at in the car before I went into the test). But try to at least bunch them into groups. Then if you have time figure out each little detail. But start with crude knowledge and pair it down.

Ok I'm going to stop. HOpe that helps.

[sully75]

oh yeah

Fetal heart rate. Awesome thing on that study guide, a better explanation pasted on the bottom of the word doc.

Pasted here:

Glad it's helping.... Tessa about the 311 take 120-160 as the general base, so take 120-30 = 90 then 160-130 = 130 so the HR range for an infant is 90-130 (that's the 3 of the 311 formula) then take 90-10 = 80 and 130-10=120 so the HR range for a toddler is 80-120 then subtract 10 from 80 and 120 to get a HR range for a preschooler of 70-110 and the other #s written next to these figures, are the RR for these age groups... hopefully that doesn't confuse you more..

Think: 311

(Fetal HR 120-160)

HR RR

-[30] 90-130 Infant 30-60

-[10] 80-120 Toddler 20-30

-[10] 70-110 Preschooler 16-22

For blood pressure, I think it's

70/50

90/55

100/60

112/65

(double check this, I'm forgetting, possibly).

But if you start with 70/50, add 20, 10 and 12 to the systolic. The diastolic moves up in 5s. Pretty easy to remember that way.

[sfroebel]

Thanks a bunch and CONGRATS!!!

[sully75]

Sorry, if it's not clear, you have to download the mnemosyne program, and then download the database and open it (from the file menu) into the program.

[kgh31386, BSN, MSN, RN]

I kinda have to disagree on the "you have to feel like you're failing and not know stuff to be doing well". And the whole "hardest Kaplan questions" thing. Kaplan was just like any other practice test...you gotta leave it up to the individual to judge that really. I passed in 75 questions and felt pretty confident on most of the answers, and they weren't weird. 21 select all that apply, lung sound questions, a bunch of OB and Psych and I thought it was fine, actually kind of just like another test in school. What I'm trying to say is...everyone will be different. If you feel like you're doing well, you just might be doing well lol. Don't stress about the difficulty of the question...because it's just one person's view of that question. A lot of people pass in 75 questions and think it's pretty easy......so don't worry if you feel confident.

[sully75]

That's cool. I'm sure everyone's test is different. Most people from my program seemed to feel pretty much the same after talking about it though.

I had one question out of 75 where I felt pretty confident I knew the answer, even that one was a little weird.

Most people I've spoken to were sure they were failing at 75.

Anyway, I'm sure it's different for everyone.

[sully75]

I realized that the mnemosyne file I uploaded had some of the categories shut off (you can do that to study certain things). I re-uploaded it and I think it's working now, you should have more questions if you use it.

Very interested if any of this was helpful for anyone.

[jessicanne]

Thank you SO much!! I don't finish until May, but I saved everything you gave for when I'm ready to start studying for the NCLEX! This is great information and I will try and incorporate it into my studying during the school year as well. THANK YOU!!

[jtanga]

Hmm so you said its kinda bizarre question. Is it more on content? prioritization? One of my friend told me its the test is not about pathology. Its more on management etc.

[sully75]

Hmm so you said its kinda bizarre question. Is it more on content? prioritization? One of my friend told me its the test is not about pathology. Its more on management etc.

It's all fading into memory at this point, but I would say expect strange questions on all those topics. Most important thing to me is be emotionally prepared to guess between two answers.