Understand How to Breakdown NCLEX Questions

Written By Rhoda Sommer

Wondering how to breakdown NCLEX questions

Before we get sidetracked this month about the NCLEX, let's learn how to break down NCLEX questions. Since we last discussed this, many students have told me it does not work. However, it does if you ask a critical thinking question before answering it. Why? Because you use critical thinking to find the answer to the question. Knowing who your client is, what the condition does to the body, and what the question is asking for; from the information provided in the question makes picking the answer easy. But it will not be accessible if you go squirel chasing like dogs do in the backyard or, if you go down a rabbit hole of second guessing yourself. I have had students do this to the point of getting lost and unable to return.

Keywords for NCLEX Test Strategies:

Who is my client? How does that limit my answer?

Let’s talk about our client, and how that would limit my answers. What if the client were of childbearing age? What assessment would you want to know, and which priority assessment would be needed if they went to the radiology department for an x-ray? Why, of course I’d need to know: are they pregnant? Or, is there any chance of being pregnant? So, how would this affect my answers if the client were an infant? First, the client is smaller, and not all procedures are done the same way on an infant (for example, CPR pulse point). If I am getting a pulse for CPR on an adult, we do this at the carotid, but on an infant, we find the pulse at the brachial. If my client is a Jehovah’s Witness, this changes their care if they need blood. So, always find out who your client is. Sometimes, it is implied, like if the client is on a second day post-operative. The question states it is his second day post-operative, meaning the client is post-operative.

Let’s try to break down a few questions. Make sure to keep in mind, these four things to look out for:

Who is the client

Condition

What the question wants

Symptoms


A.) The nurse in a long-term care facility assesses a client experiencing chest pain. The nurse would interpret that the pain is most likely caused by myocardial infarction (MI) based on what assessment finding?


  1. The client is not experiencing dyspnea.

  2. The client is not experiencing nausea or vomiting.

  3. The pain has not been relieved by rest and nitroglycerin tablets.

  4. The client says the pain began while opening a stuck dresser drawer.

A. The question came from Saunders' Comprehensive Review for the NCLEX-RN® Examination, 9th Edition online test.


My client lives in a long-term care facility, where most clients are elderly. The first critical thinking question I need to ask is whether being elderly changes the assessment findings to determine an MI. No, it does not in this case, but it could in other questions. So, we know the client who is not relieved by rest and nitroglycerin tablets most likely is having an MI. The other answers are symptoms of an MI or a cause of angina.

Who is the client

Condition

What the question wants

Symptoms

B.) The nurse is caring for a postoperative client who has had an adrenalectomy. What would the nurse check for during the client's focused assessment?

  1. Bilateral exophthalmos

  2. Signs and symptoms of hypovolemia

  3. Signs and symptoms of hypocalcemia

  4. Peripheral edema

B. The question came from Saunders' Comprehensive Review for the NCLEX-RN® Examination, 9th Edition online test.

The information about who the client is, makes a difference. The answer would have differed if the client had not had the surgery. One is Cushing's, and the other is Addison's assessment because there is no cortisol. Because this client has no adrenal gland, the body does not make cortisol. The client is an Addison's client. We look for the signs and symptoms of Addison's. Addison's clients experience low fluids or dehydration, which reflects the answer—Hypovolemia, of course.

Here is a practice question to determine who the client is and whether that matters in the answer. I will not highlight all the parts of the question this time, as I did for the other two above. You need to be able to answer them on your own. What answer did you come down to?

Who is the client

Condition

What the question wants

Symptoms


C.) A home care nurse is making home visits to an older client with urinary incontinence who is very concerned about the incontinent episodes. Which finding by the nurse indicates that the client has an environmental barrier to normal voiding?

  1. The presence of hand railings in the bathroom

  2. Having one bathroom on each floor of the home

  3. The bathroom is located on the second floor, and the bedroom is on the first floor.

  4. Night-light present in the hall between the bedroom and bathroom

C. The question came from Saunders' Comprehensive Review for the NCLEX-RN® Examination, 9th Edition online test.



Now, the question is how going upstairs and downstairs affects the patient’s ability to get to the bathroom. From there, you should find the correct answer. The second-floor bathroom would be a problem for an elderly client who has issues walking up and down the stairs. The stairs are a fall risk for an elderly client. The elderly client is more likely to have arthritis and joint issues. So, the second-floor bathroom is the answer. What about the other answers? They all help get around the toilet and hallway.

Here are a couple more questions. You can do these yourself, but I will tell you the answer at the end of this section.


D.) A client is attached to a cardiac monitor, and the nurse notes the presence of this cardiac rhythm on the monitor. The nurse quickly assesses the client, knowing that this rhythm indicates which of the following? Refer to figure.

A cardiac strip

  1. Atrial fibrillation

  2. Ventricular fibrillation (VF)

  3. Ventricular tachycardia (VT)

  4. Premature ventricular complexes

The answer is: Ventricular tachycardia (VT)

D. The question came from Saunders' Comprehensive Review for the NCLEX-RN® Examination, 9th Edition online test.

E.) A client is complaining of knee pain. The knee is swollen, reddened, and warm to the touch. Which conditions is the nurse interpreting the client's signs and symptoms as compatible with? Select all that apply.

  1. Infection

  2. Recent injury

  3. Inflammation

  4. Degenerative disease

  5. Delayed growth

E. The question came from Saunders' Comprehensive Review for the NCLEX-RN® Examination, 9th Edition online test.

The answers are: Infection, recent injury, and inflammation.

F.) A client with type 2 diabetes mellitus has a blood glucose level greater than 600 mg/dL (34.3 mmol/L) and is complaining of polydipsia, polyuria, weight loss, and weakness. The nurse reviews the primary health care provider's documentation and expects to note which diagnosis.

  1. Hypoglycemia

  2. Pheochromocytoma

  3. Hyperosmolar hyperglycemic syndrome (HHS)

  4. Diabetic ketoacidosis (DKA)

F. The question came from Saunders' Comprehensive Review for the NCLEX-RN® Examination, 9th Edition online test.

The answer is: Hyperosmolar hyperglycemic syndrome (HHS) due to the client being type 2 diabetic.

Study Tip!

Tip: Want more practice? Go to Saunders' 9th edition and ask for recognize cues questions only! They are not in Next Gen format, but they help you learn how to work with the questions. If you need more help, email me with questions you need help figuring out based on who the client is.


What is the condition? Or, What is the procedure? 

With this part of the NCLEX test, we must pay attention to what we know about the condition and procedure. If the question says they have Multiple Myeloma, what do you know about this condition?  I know that the plasma cells in the bone proliferate.  Plasma cells proliferating pushes the mineral out of the bone, causing demineralization of the bone and hypercalcemia in the bloodstream. With cell death, the uric acid level climbs. I can answer questions about signs, symptoms, and the labs I need to monitor because I know what happens in the body. 

But what if the question asks about a procedure such as a liver biopsy? What do I know that happens with this procedure? The liver is very vascular and will bleed easily. So I need to be able to control the bleeding, but how? Lay the client on the side of the liver on a rolled-up towel to apply pressure after the biopsy. When you find the condition or procedure, ask yourself how it changes the client’s body’s function or appearance. That information can lead you to labs, and signs and symptoms. Next Gen questions use these labs, and signs and symptoms to get you to assess the first question of the evolving case study.

We can work through some questions together to get used to doing this. If you have trouble, just practice. If you need help, email me.

Who is the client

Condition

What the question wants

Symptoms

G.) A home care nurse visits a client to provide follow-up evaluation and care for a leg ulcer. After removing the dressing, the nurse notes that the ulcer is pale and deep and that the surrounding tissue is cool to the touch. The nurse would document that these findings identify which type of ulcer?

  1. A stage 1 ulcer

  2. A vascular ulcer

  3. A venous stasis ulcer

  4. An arterial ulcer

G. The question came from Saunders' Comprehensive Review for the NCLEX-RN® Examination, 9th Edition online test.

Arterial ulcers are small, deep, round wounds that can have a pale, non-granulating base and cool, hairless skin around them. They are often found on the feet, especially at the tips of the toes, heels, and pressure points on the soles. Arterial ulcers can also appear black, gray, brown, or yellow, and have well-defined edges. The surrounding skin may also feel tight or itchy.

The answer is:C

H.) A client recovering from an exacerbation of left-sided heart failure is experiencing activity intolerance. Which change in vital signs during activity would best indicate that the client tolerates mild exercise?

  1. Oxygen saturation decreased from 96% to 91%.

  2. Pulse rate increased from 80 to 104 beats per minute

  3. Blood pressure decreased from 140/86 to 112/72 mm Hg

  4. The respiratory rate increased from 16 to 19 breaths per minute

H). The question came from Saunders' Comprehensive Review for the NCLEX-RN® Examination, 9th Edition online test.


The condition is an exacerbation of left-sided heart failure, which is the heart not pumping efficiently. An exacerbation worsens up to and includes pulmonary edema symptoms. All of these cause symptoms of being unable to walk across the room to go to the bathroom in the hospital or walk down the hall. Some patients can only do their grooming or bathing with help. They run out of energy. They are weak and turn pale and experience a drop in blood pressure. This is called activity intolerance. So, if they have improved, the vitals will be within the normal range.

The answer is: D

I.) A client with diabetes mellitus is being discharged following treatment for hyperosmolar hyperglycemic syndrome (HHS) precipitated by acute illness. The client tells the nurse, "I will call my doctor the next time I can't eat for more than a day or so." Which statement reflects the most appropriate analysis of this client's level of knowledge?

  1. The client needs immediate education before discharge.

  2. The client requires follow-up teaching regarding the administration of oral antidiabetics.

  3. The client's statement is inaccurate, and the client needs to be scheduled for outpatient diabetic counseling.

  4. The client's statement needs to be more accurate, and the client needs to be scheduled for educational home health visits.

I. The question came from Saunders' Comprehensive Review for the NCLEX-RN® Examination, 9th Edition online test.

The condition is diabetes Mellitus with Hyperosmolar Hyperglycemic Syndrome (HHS). It is caused by acute infection. Want a statement that shows an appropriate analysis of the client’s statement? The client said he would notify the MD if more than 24 hours passed that they could not hold down fluid or food. It needs to be 4 hours, not 24 hours!

The answer is: A

What is this next question wanting? The information that the question wants is found in the last sentence. It is asking for the labs that would be affected by multiple myeloma. We know two from what I said about it: hypercalcemia and hyperuricemia. If the question asked about the nurse's priority action in caring for a client with a liver biopsy, the priority is to prevent bleeding. I have not read the answers yet, but I have my answer before answering the question with the answers supplied. 

Who is the client

Condition

What does the question want?

Positioning

MD orders

Symptoms


J.) The nurse assigned to the care of an unconscious client is making initial daily rounds. On entering the client's room, the nurse observes that the client is lying supine in bed, with the head of the bed elevated approximately 5 degrees. The nasogastric tube feeding is running at 70 mL/hr as prescribed. The nurse assesses the client and auscultates adventitious breath sounds. Which judgment would the nurse formulate for the client?


  1. Impaired nutritional intake

  2. Increased risk for aspiration

  3. Increased likelihood for injury

  4. Susceptibility to fluid volume deficit

J. The question came from Saunders' Comprehensive Review for the NCLEX-RN® Examination, 9th Edition online test.


My client is unconscious, and was lying supine in bed with the head elevated at 5 degrees. The NG feeding is running at 70 ml/hour—Auscultates adventitious breath sounds. We need to define some items. Unconscious and unable to communicate or change their position. The prone position is flat on his back in this case, with his head up 5 degrees. He has an NG feeding tube- that goes down the throat into the stomach for feeding, going at 70 mls/hour. The client has adventitious breath sounds: crackles, rales, rhonchi, wheezing, etc. So, in what condition would this information be used to its fullest? If I take the answers and work my way through them, I can find the correct answer. There is susceptibility to fluid volume deficit. I know volume deficit does not have adventitious breath sounds. Increased likelihood for injury has nothing to do with laying supine with head elevated at 5 degrees. Impaired nutritional intake does not include adventitious breathing, nor do any of the other items. However, the increased aspiration risk includes adventitious breathing, fluids going, and a head elevated at 5 degrees. The rule for feedings is that the head of the bed should be up at least 30 degrees. 

The answer is: B

K.) A client who has a spinal cord injury that resulted in paraplegia experiences a sudden onset of severe headache and nausea. The client is diaphoretic with piloerection and has flushing of the skin. The client's systolic blood pressure (BP) is 210 mm Hg. What would the nurse immediately suspect?


  1. Return of spinal shock

  2. Malignant hypertension

  3. Impending brain attack (stroke)

  4. Autonomic dysreflexia (hyperreflexia)

K. The question came from Saunders' Comprehensive Review for the NCLEX-RN® Examination, 9th Edition online test.


My client is anybody. The condition is spinal cord injury and paraplegia. Symptoms are sudden onset of severe headache and nausea, diaphoretic with piloerection, and flushing of the skin. His blood pressure is 210 mg HG. What would the nurse expect? Two items come into play with this condition: spinal cord injury/paraplegia and BP is 210 mm Hg. These symptoms rule out stroke. So, what causes the BP to rise when the client gets a sudden headache and nausea? Autonomic dysreflexia or hyperreflexia!

The answer is: D

The following is your question to do by yourself. (Remember to find your keywords!)


L.) During routine nursing assessment after hypophysectomy, a client complains of thirst and frequent urination. Knowing the expected complications of this surgery, what would the nurse assess next?

  1. Serum glucose

  2. Blood pressure

  3. Respiratory rate

  4. Urine specific gravity

L. The question came from Saunders' Comprehensive Review for the NCLEX-RN® Examination, 9th Edition online test.

The answer is D: urine-specific gravity due to surgery has a complication of Diabetes Inspidus.

References:

If you need help, please contact me by email at: rhodasommer@oneononenclextutoring.com

Comment below!

Is there something I should have covered that you would like information on? Do you need help with any of the resource links I have provided?

Please comment in the comment section. Maybe someone else thinks the same thing and is afraid to speak up. Be brave and tell me what you need to know.

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This fully updated and revised edition is tracked to the latest NCLEX-RN exam, and comes complete with deep content review, study tips, and top test-taking strategies. You also get access to online flashcards and two practice exams with answer explanations to flesh out your technique and study.

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Rhoda Sommer https://oneononetips.com
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