NCLEX Tips and Tricks: Hacks and Must-Knows for Your Exam

Reviewed by Winona Suzanne Ball, RN, MHS• Updated: August 8th, 2024

Studying for your NCLEX can be stressful. Your future career as a nurse depends on passing the licensure examination. What are some ways to be confident on your Test Day?

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1
Plan and Prepare

Your education and clinical rotations covered everything you need to know as a new nurse. Now it’s time to apply that knowledge and organize it into the categories that will be on the exam.

The National Council of State Boards of Nursing (NCSBN) plans and administers the NCLEX. If you haven’t already downloaded a copy of your NCLEX-RN or NCLEX-PN Test Plan, do it right away. The Test Plan provides an overview of exam, details about each category and sub-category, and sample questions. The Test Plan is updated every two years, so you’ll find information about the current NCLEX for your RN or PN licensure.

Once you’ve studied the NCLEX Test Plan, make a calendar to cover the categories and understand how test items are constructed. These Nurse Plus articles are helpful:

NCLEX Study Guide

How to Develop Your Personal NCLEX Study Plan

Anatomy of an NCLEX Question

Types of NCLEX Questions and How They Are Written

Learn to “Speak NCLEX” Before Your Test Day

Goals for a successful NCLEX preparation include becoming familiar with the test items. The result: You’ll be relaxed and confident on Test Day!

2
Learn a Few Helpful Hints for NCLEX

NCLEX is not meant to be misleading. There are no “trick” questions. However, the test items are written to evaluate your knowledge of topics and ability to apply information that will allow you to provide safe client care. Some of the possible options will seem very close to the correct answer, as a way of determining your ability to analyze the situation.

If you are unsure about which response to choose, there are a few helpful hints that can increase your chances of selecting the BEST option. We can’t promise these tips will ensure that you pass—the preparation is up to you—but some general guidelines are useful if you are truly stuck.

“Nursing Books/References” by Laska Family Pictures is licensed under CC BY-NC-SA 2.0

NCLEX Is Written for the Perfect World!

Test items are based on textbook knowledge.
Do not answer based on your own or others’ experiences.
Don’t be tempted to think, “What if…?”
Assume that you have time to sit with the client and give them your full attention.

emergency room

Remember the Basics!

ABCs: Airway, Breathing, Circulation
Maslow’s Hierarchy of Needs
Common blood values: Electrolytes, CBC, and ABG
Cranial nerves: Number, Name, and Function

Know the Red Flags!

Avoid extreme and absolute choices like “always” and “never.”
If you’re faced with two options of ignoring a condition or treating it, choose to treat it (or notify the HCP).
Do not try to read into a question or interpret it. Only use the information that is given.

“Patient Damien” by mikecogh is licensed under CC BY-SA 2.0

Patient Safety Always Comes First!

If the question has words or phrases like PRIORITY, MOST IMPORTANT, or IMMEDIATE ACTION, choose the option that will result in patient harm or death if it’s not done.
For possible interventions, select the least invasive option first.
If uncertain about the correct action, choose the one that includes “stay with the patient.”

Photo credit: Pixabay

Let’s “Talk” About Communication: Do NOT!

Do NOT ask “Why?” questions to elicit a response.
Do NOT say “Don’t Worry!” if a client seems anxious or scared.
Do NOT ask “Yes” or “No” questions—except with possible self-harm.
Do NOT try to persuade the client.

Let’s “Talk” More About Communication: DO!

DO respond to the feelings behind the words.
DO allow for silence to let the client speak.
DO focus on the client’s nonverbal message.
DO provide information to the client.

Secondhand Information: The Correct Answer is ASSESS!

Comments from the client’s family
Reports from UAP or other team members
Laboratory results
Vital signs, ECG, X-rays, etc.

Default Answers: When you have a question about:

Reversal from normal findings, assess and report. Example: Rebound tenderness—client pain following the relief of pressure
Neuro clients: Head of bed is elevated 30-45 degrees
Rapid onset of confusion in the elderly: Assess for a UTI
GI complication or exacerbation: Make client NPO
Post-op risks: First 24 hours: Bleeding; First 48 hours: Infection
Fluid imbalances: Check daily weight
Sudden restlessness and decrease in consciousness: Assess respiratory status. The first sign of hypoxia is restlessness.

Photo credit: Pixabay

3
Think Like a Nurse

Which Client Should You Assess First?

NCLEX will have questions on prioritizing. Expect to see test items with a list of clients, ending with “Which client will you see or assess FIRST?” Always consider:

ABCs
Unstable vs Stable
Unexpected vs Expected
Actual vs Potential
Acute vs Chronic

How to Assign or Delegate Tasks?

Only RNs can “EAT” (Evaluate, Assess, Teach)
LPN/LVN: Assign stable clients with expected outcomes
UAP: Delegate standard, unchanging procedures or tasks

What are the Five Rights of Delegation?

RIGHT TASK: Legally appropriate, client stability
RIGHT CIRCUMSTANCE: Workload, appropriate resources and equipment
RIGHT PERSON: Scope of practice, knowledge and experience
RIGHT SUPERVISION: Clear instructions, intervene if necessary
RIGHT COMMUNICATION: Specific task, expected outcome, proper follow-up

Which order to follow in performing an assessment?

Adults: Inspection, Palpation, Percussion, Auscultation
Children AND Abdomen: Inspection, Auscultation, Percussion, Palpation: Palpation and percussion can alter bowel sounds, so the order is changed: Inspect, Auscultate, Percuss, then Palpate.

Credit: FirstAidForFree.com

Are you familiar with the Glasgow Coma Scale?

The range for each assessment is 3-15
Rule of Thumb: If less than 8, INTUBATE!
Decorticate response to noxious stimulation: Flexion toward the body’s “core.” Decorticate positioning involves the CORTEX of the brain.
Decerebrate response to noxious stimulation: Abnormal extension. Involves the cerebellar and brain stem: much more serious, indicating herniation.

Image credit: Pixabay

4
Learn the Hallmark Signs and Symptoms

Autoimmune Diseases:

Diabetes, Type 1: Three Ps: Polyuria, polydipsia, polyphagia
Guillain-Barré: Ascending muscle weakness, paralysis
Multiple Sclerosis: Fatigue, gait problems, spasticity
Rheumatoid Arthritis: Joint swelling, stiffness, and pain
Systemic Lupus Erythematosus: Butterfly rash

Cardiac and Circulatory Conditions:

Angina: Crushing chest pain relieved with NTG
Deep Vein Thrombosis (DVT): Homan’s sign
Kawasaki Syndrome: Strawberry tongue
Myocardial infarction: Crushing, stabbing pain radiating to left shoulder, neck, and arms. Unrelieved by NTG.

Endocrine Conditions:

Addison’s Disease: Bronze-like hyperpigmentation
Cushing’s Disease: Moon face and buffalo hump
Graves’ Disease: Exophthalmos
Osteoporosis: Widow’s hump, fractures

Gastro-Intestinal Conditions:

Appendicitis: Right lower quadrant pain, rebound tenderness
Cirrhosis of the Liver: Spider varices
Gastroesophageal Reflux Disease (GERD): Barrett’s esophagus
Pancreatitis: Cullen’s sign, Grey Turner’s spots
Pyloric Stenosis: Olive-like mass
Ulcerative Colitis: Recurrent bloody diarrhea

Infectious Diseases:

Chicken Pox: Vesicular rash
Cholera: Severe watery diarrhea
Covid-19: Fever, dry cough, fatigue, loss of taste/smell
Diphtheria: Thick gray membrane covering throat and tonsils
Epiglottitis: 4Ds: Drooling, Dysphonia, Dysphagia, and Distress
Measles: Kolpik’s spots
Meningitis (bacterial): Brudzinski’s sign, Kernig’s sign
Mononucleosis: Sore throat, cervical lymphadenopathy, fever
Pertussis: High-pitched “whooping” cough
Typhoid: Step-ladder fever, rose spots on abdomen

Neurological Conditions:

Alzheimer’s Disease: Progressive memory loss
Amyotrophic Lateral Sclerosis (ALS): Progressive loss of motor control
Epilepsy: Recurrent seizures
Hepatic Encephalopathy: Flapping tremors
Parkinson’s Disease: Resting tremor, bradykinesia, rigidity
Stroke: Difficulty speaking, one-sided weakness or paralysis

Non-Contagious (No Person-to-Person Transmission) Conditions:

Dengue Fever: Pain behind the eyes, headaches
Lyme Disease: Bull’s-eye rash
Malaria: Fever, shaking chills
Tetanus: Lockjaw, muscle cramping/stiffness

Respiratory Conditions:

Asthma: Expiratory wheezing
Emphysema: Barrel chest
Latent TB: Inspiratory stridor
Pneumonia: Rusty or pink frothy sputum
Pulmonary TB: Low-grade afternoon fever

Sensory Conditions:

Cataract: Opaque lens, painless vision loss, blurry vision
Glaucoma: Peripheral vision loss, tunnel vision, painful vision loss
Meniere’s Disease: Vertigo
Retinal Detachment: Curtain vision, flashes of light, floaters
Pull pinna down and back for children < 3 yrs. when instilling eardrops

Trauma and Injury:

Acute Spinal Cord Injury: Quadriplegia, paraplegia
Anaphylaxis: Sudden dyspnea, swollen tongue, dysphagia, loss of consciousness
Basilar Fracture: Otorrhea
Burns: Rule of 9s
Compartment Syndrome: Pain and Paresthesia
Orbital Fracture: Battle’s sign and raccoon eyes
Shock: Hypotension, tachycardia, tachypnea
Traumatic Brain Injury (TBI): Depends on severity. Loss of consciousness, cerebral edema, intracranial bleed, coma, vegetative state.

Urinary and Reproduction Conditions:

Benign Prostatic Hyperplasia (BPH): Difficulty starting and ending stream, nocturia
Chronic Kidney Disease (CKD): Edema, hypertension, shortness of breath
Cystitis: Frequency, urgency and burning on urination
Endometriosis: Painful periods, pelvic pain, excessive bleeding
Prostate Cancer: Change in urinary habits, nocturia, blood in urine
Renal failure: decreased urine output, fluid retention

Image credit: Pixabay

5
Step Five: It’s Up to YOU!

You’ll find many tips, hints, and tricks for passing your NCLEX. Everyone has a different learning style and strategy for retaining information. Our list is not meant to be comprehensive; it’s a way to get you thinking about how to organize your preparation. There is no way of knowing what test items will be on your examination.

The best approach is to:

Develop a solid study plan—and stick with it!
Take as many practice tests as possible. Keep track of questions and topics that you need to review.
Refer to your nursing books and notes to find out more about subjects you’re not familiar with.
Use flashcards, mnemonics, diagrams, or other learning tools to help you remember.
Learn about the different types of test items you’ll encounter on NCLEX.
Take time to understand how NCLEX test items are written, so you’ll be confident on your Test Day.

Everyone at Nurse Plus is cheering for you. Good luck in your nursing career!