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What to study in the last few days and hours before your NCLEX exam?

Updated on December 6, 2012

What portion of the NCLEX did you/do you feel the weakest on going into the exam?

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What the heck do I study?

As a nursing instructor and someone who has taken both the NCLEX-PN and NCLEX-RN examinations, I can tell you that this question is frequently talked about by student nurses as they approach and get ready for their big day: taking the NCLEX.

I already have a few hubs that you can check out about what to do a few days before the NCLEX and what you should do leading up to the NCLEX. However, in this hub, I am going to go over some areas that I think are of the greatest importance to review in the days and hours before entering your exam.

I must begin, however, by restating the famous quote which says “The man who thinks he knows everything truly knows nothing at all.” The NCLEX is one of those tests where you only need to know “a lot about a little and a little about a lot.” There is no way that you will know everything that comes at you on the NCLEX. You may get a drug that you don’t realize, or you may get some obscure lab test that your teacher never went over in class and wasn’t even in your basic textbook of nursing. That’s okay. You don’t have to answer every question correctly to pass. All you need to do is pass with minimum competency. If you were scoring in the high 60’s and 70’s on most of your practice tests, you have nothing to worry about. If you are scoring in the 50’s, believe it or not you can still pass (I have seen this happen NUMEROUS times, so don’t lose hope).

So, let’s get to it, shall we? Though you could get a test that doesn’t cover these items, these are some of the top things I would cover/go over before entering your exam:


Labs

If you walk into the NCLEX and get a question that requires you to know something about white blood cell (WBC) count and you don’t know what the normal white blood cell count is, then you might be in trouble. Some of the most important labs that you should know include all of the labs from a CBC (WBC, RBC, Platelets, Hemoglobin, Hematocrit, etc.). Answering lab questions should be a piece of cake if you know your labs. Labs are the thing that last looked at before walking into my exam and I think it was very beneficial.


Drugs


Look at some of the most basic and probably most tested drugs. Lasix, Digoxin, Lithium, Theophylline, Dilantin…you need to know these types of basic drugs on the exam. Why? Because there may be a drug that you don’t know that comes up on the exam (this happened to me during my RN exam), and to pass the pharmacology section, you need to know the basics about these drugs. You should know the probably most commonly tested features of drugs as well. Don’t know the signs and symptoms of lithium toxicity? Look it up. Don’t know about gingival hyperplasia with Dilantin? Review it. Don’t know about Lasix and the potential for hypokalemia? Well, if you don’t know that one, you should probably be a little scared right now…


Safety


Safety is a big part of the NCLEX. Why? Because the state wants to make sure that you know how to keep your patients safe so the facilities don’t get sued…just kidding. It is because it is important to understand how to keep your patients safe. For example, you should know that a patient with thrombocytopenia should be on fall precautions and should avoid IM injections. A patient taking Dilantin should have seizure precautions in place. A patient receiving a blood transfusion should have the unit of blood checked by two nurses in front of each other before administering. These are the types of ideas and concepts that you should review before your test.


Laws


While I was kidding about the safety and suing thing in the paragraph above, here is where the state really does want you to know about the law. Do you know what a battery is (intentional harmful or offensive touching of another without consent or privilege? How about assault (placing someone in fear of a harmful or offensive touching without consent or privilege) How about negligence (duty, beach, actual cause, proximate cause, damages)? False imprisonment (intentional confinement of another without their consent or privilege)? You need to know about these concepts. Review them. These are easy points if you get them on the exam.


Diseases


I will try to come up with a different hub at a later time for this because I want to cover this one in greater detail, but there are some diseases that are probably more likely to come up on the exam than others. For example, if I were a betting man, I would make sure that I knew about heart failure versus myocardial infarction, acute and chronic renal failure, Huntington’s and Parkinsons, diabetes mellitus type 1 and 2, peptic ulcers and GERD, burns/degrees/rule of 9’s, pressure ulcer staging, etc. There is probably a reason that your instructor went over these items so heavily in school. Sure, other diseases are likely to be tested, but don’t forget about the big diseases as you are likely to see some on the exam.


Procedures


If you were a top notch student in clinical rotation, now is your time to shine. Knowing how to insert a foley catheter, perform CPR, give a bed bath, monitor a chest tube drainage/pleurovac set, or perform a wound irrigation are all things that could potentially come up on the exam. Go over your skills checklists. You are bound to get some type of procedure(s) on your exam.


Charts


If there was a chart in your basic nursing textbook or in your review book, watch out! The things that are gone over in charts are some of the most frequently testing things on the NCLEX. Examples: APGAR scores, cranial nerves, cardiac enzymes after a myocardial infarction. These are all things that you should memorize, understand, or put on a flashcard for review. When I teach nursing school, I make use of charts and students have told me they have found them very useful.


The bottom line!


The bottom line is: be prepared. Though these are certainly things you should review, they are by no means a shortcut to succeeding on the exam. If you slouched through nursing school, there may be a snowball’s chance of you passing without studying, but don’t count on it. The students who listened to lecture and did the reading are the ones who will pass the first time. Don’t waste time or money having to repeat this test. Study your butt off so you can be on your way to a bigger paycheck, more flexible schedule, and a relatively stable career. Best of luck!


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