Two sample NCLEX questions

[psu_213, BSN, RN]

Recently a tech at work (who is a nursing student) was working on practice NCLEX questions from a book that will remain nameless. Every now and then she would ask me about a question. I found two of them particularly interesting.

1. First was about a low hemoglobin report.

Two of the answers really didn't make sense. I thought the correct answer was "monitor the patient and draw the next scheduled hemoglobin in 6 hours. Turns out, the "correct" answer was "prepare for an immediate transfusion of PRBCs."

2. Next asks about what to do if V-tach is seen on the monitor.

To me, none of the answers looked any good. The one the book said was "correct:" go to the medication dispensing machine and get an emergency dose of Lidocaine.

Now, for (1), I suppose they are really asking "what is a normal Hgb," and 8.9 is abnormal. However, I have never worked anywhere that transfuses 8.9. I ran into a similar question when I was working as a GN and preparing for my boards--I worked on a thoracic surgery floor that didn't transfuse until the low 7s; I could never understand questions that wanted you to transfuse at 8.0 (let alone 8.9). Although this question could be technically OKish.

As for (2)--this is 100%, always wrong. How do we know this not just psedo-V tach 2/2 teeth brushing? More importantly, starting CPR in a pulseless patient is more important that giving meds. I expressed my confusion to the tech who was studying, and she was not happy that she spent a good bit of money on a book written by people with a lot of letters after their names.

Thoughts?

[bugya90, ASN, BSN, LVN, RN]

Remember that the NCLEX is not about real world nursing. It is about making sure he student is competent enough to function as a first day new grad and not kill anyone. I was a LVN for 6 years before taking the RN NCLEX and it was very hard to get out of the real world working nurse attitude to be able to take the test as a student. NCLEX is not based on any company protocols. It is basic new grad level thinking.

[ruby_jane, BSN, RN]

Remember that the NCLEX is not about real world nursing. It is about making sure he student is competent enough to function as a first day new grad and not kill anyone. I was a LVN for 6 years before taking the RN NCLEX and it was very hard to get out of the real world working nurse attitude to be able to take the test as a student. NCLEX is not based on any company protocols. It is basic new grad level thinking.

Awesome answer. And in reality, you're picking the best choice of the answers you have. Although... question 1 assumes some kind of protocol without obtaining a doctor's orders, no?

[Sour Lemon]

They both sound really wrong to me, even for NCLEX world. I'm curious about the other options, though.

[bugya90, ASN, BSN, LVN, RN]

Awesome answer. And in reality, you're picking the best choice of the answers you have. Although... question 1 assumes some kind of protocol without obtaining a doctor's orders, no?

I don't think it assumes a doctors order because it said "prepare for". This could include making sure the contents are in the chart, getting the IV in, getting the IV pump, BP cuff and thermometer, etc. Depending on how your facility is set up it could take 5-15 minutes to gather the equipment for a transfusion before you ever even get the blood orders.

[nursej22, MSN, RN]

I would return that book and get my money back.

[MunoRN, RN]

Keep in mind these books aren't written using actual NCLEX questions, and sometimes the authors of these books aren't all that bright.

As a general rule, NCLEX questions are written to determine if you understand the nursing process and if you can prioritize properly. If the question doesn't confirm that adequate nursing assessment has already occurred then the answer is the one that includes assessment. Aside from the fact that 8.9 by itself isn't an indication to transfuse, the first step would be to correlate that lab finding with a nursing assessment to give that number context.

Same goes for the V-tach question, initial assessment would include determining whether the monitor is correct, but then assess the patient, I've had patients in a slower V-tach that stay in that rhythm for hours and just hanging out watching TV, so assessing how that finding on the monitor actually translates to the patient would typically be the correct answer on the NCLEX.

[psu_213, BSN, RN]

It is about making sure he student is competent enough to function as a first day new grad and not kill anyone.

By not starting CPR on someone in V tach, they will kill them (or at least prevent them from them from becoming un-dead).