#NurseNatNCLEXStudy: 8 Fundamental Tips for Passing the NCLEX-RN

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A few days after the delivery of my baby girl, I found out that I passed the NCLEX-RN on the second attempt! I was so happy and relieved. Having written the exam twice now, I definitely have a few tips to share for those who are either preparing to write the exam or have recently failed and can’t figure out what to do. Trust me, I’ve been there. In this post, I will be talking about the top 8 fundamental tips I used to help me pass my NCLEX on the second attempt.

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Tip numbero uno, purchase a review guide! I cannot stress enough how helpful it was to review an NCLEX guide.

Nursing school does not prepare you for the exam, so don’t just rely on your old notes and textbooks. Alone, they won’t do you any good.

Here is why you should purchase a review guide:

  • Large practice question bank and tests that are just as challenging as the actual exam
  • Study strategies and tips
  • Test taking strategies and tips
    • strategies that do and don’t work on the exam
    • critical thinking strategies
  • Online resources (such as timed practice tests that mimic the NCLEX CAT format)
  • Some guides are very comprehensive if your nursing foundation is shaky; other guides offer short and concise nursing content review and focus more on practice questions and test taking skills
  • Everything you need to know about the NCLEX-RN
    • how to apply and schedule your exam
    • how the computer adaptive test (CAT) works
    • the different types of questions you will see
    • breakdown of what categories will be covered on the exam
    • NCLEX answers vs. real-world nursing answers

It is also important to understand that the questions you come across on the exam are very different from the ones you see in nursing school. In fact, lots of test takers have to relearn how to read a question and figure out what the question is actually asking. Also, it may be impossible to know everything so when you come across a question that you can’t really answer with confidence, you’ll need to use those test taking skills and strategies to help you through it.

My favourite review guide is Saunders Comprehensive Review for the NCLEX-RN Examination and Kaplan NCLEX-RN Prep Plus.

I chose Saunders for the comprehensive component. The explanations are very detailed and thorough but just concise enough to not take up too much of your time. It covers a lot of nursing content with review questions and explanations at the end of each chapter. Make sure to schedule your exam months ahead because this is quite a hefty book to finish!

Kaplan focuses more on test-taking strategies and practice questions.

The test taking strategies truly made all the difference on my second attempt at the exam.

Plus, it provides explanations for wrong and right answers and gives you the most for you money.

Besides Kaplan and Saunders, there are many other guides that you can chose from:

  1. Kaplan NCLEX-RN Prep Plus
  2. NCLEX-RN Questions & Answers made Incredibly Easy
  3. Lippincott Q&A Review NCLEX-RN
  4. Mosby’s Comprehensive Review of Nursing for the NCLEX-RN Examination
  5. HESI Comprehensive Review for the NCLEX-RN Examination
  6. DAVIS’s Q7A Review for NCLEX-RN
  7. …many more!

Developing a schedule and setting short & long term goals is very important to keep you on track and make sure that you have covered everything you need to know for the NCLEX. If you want to go even further, daily checklists are great too.

This is an example of my monthly study schedule when I was preparing for the exam.

And here is an example of a daily study checklist and schedule.

And here is a checklist that breaks down the exam content into categories and the percentages of each category that will appear on the exam. As I go on to study each chapter and answer practice questions, I make sure to check off any areas of the exam that I have covered. This helps me manage my time with each category so that I can cover everything before the exam date.

Feel free to use these templates or create something similar yourself!

On another note, I highly recommend reading the 2019 NCLEX-RN Test Plan for a breakdown of the NCLEX exam on the NCSBN website.

Do you know your learning style?

Identifying your learning style helps you develop a study plan and optimize your learning and retention of information. My learning style is visual. When I read a question, I tend to create a scene in my head. I benefit best from watching youtube videos and images.

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There are 7 different learning styles:

  1. Visual (Spatial)
  2. Aural (auditory-musical)
  3. verbal (linguistic)
  4. Physical (kinesthetic)
  5. Logical (mathematical)
  6. Social (interpersonal)
  7. Solitary (intrapersonal)

Everyone learns differently. In fact, some people learn through a combination of learning styles. Get to know your learning style, understand it and utilize it to your advantage when preparing for the NCLEX.

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It’s true what they say, practice, practice, practice!

You have to do at least 100 questions per day for you to feel comfortable with the way the NCLEX formats their questions. And I can assure you that the more questions you answer, the more you will get right.

Aside from answering questions from your review guides mentioned in tip #1, I also recommend using online question banks such as UWorld. I love UWorld, and this is why:

  • 2000+ questions that are just as challenging as the NCLEX
    • Two self-assessments that are timed (100 questions each)
    • Lots of different question formats such as “select-all-that-apply”, “placing the answers in the correct order” type questions that are pretty tricky to master
    • You can also create your own customizable exams
  • In-depth rationales for both wrong and right answers
  • Create your own flash cards
  • Great illustrations for visual learners
  • Performance and improvement tracking
    • Identifies your strengths and weaknesses in easy to read graphs
    • Compares progress with others
  • Flexible subscriptions for your needs
    • 60 day, 90 day, or 180 day Qbank subscriptions
    • Renewals of subscriptions at a lower price

Whatever your resource may be, make sure to answer as many questions as you can!

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If you’re hoping that question about tracheostomy suctioning won’t show up on your exam, think again! That’s called “relying on false hope.” The NCLEX covers a wide range of nursing content using many different question formats.

If you are aware that you’re a little shady on an area of nursing practice, don’t avoid it! Identify your problem areas, learn about them and check them off your list! You’ll be glad you did.

Not only do you need to identify your weaknesses in nursing content, but you also need to know your weaknesses in test-taking skills. For example, if you know you’re terrible at select-all-that-apply type questions, focus more on answering those types of questions. Take them head on!

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And by that I mean, don’t just memorize the content!

Yes, lab values such as electrolytes or the therapeutic drug levels for digoxin are good to memorize but go deeper.

The NCLEX-RN won’t just test you on knowledge and comprehension level questions that involve recall or recognition. It is designed to test your ability to make competent nursing judgments.

Understand what happens if the patient were to experience an overdose on digoxin and what to do in those situations. As a entry level nurse, you need to show them that you will safely know what to do if those ranges or levels are not within limits.

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Invite some former classmates or good friends you’ve made in nursing school for a study session a few times per week. Sharing information and insight from others really improves your understanding on the content.

Here are some benefits to studying in a group:

  • Prevents Procrastination: You are accountable to show up with your notes to the study group. Now that your group members are depending on you, it makes it harder to put off your studying to last minute.
  • Fills in missing information or notes: Share information, gain insight, and ask or answer questions. Communication between your group members is key to effective learning.
  • Makes studying more fun and interesting: Joining a study group can help eliminate the lonely study blues you get when you’re at home all by yourself. Change your study environment and find some motivation and inspiration from your study peers.
  • Faster learning: Difficult concepts might be time consuming to understand alone. Who knows, maybe someone in your group might be an expert on that subject. It wouldn’t hurt to show up and ask.
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That being said, aside from using the review guides and study groups mentioned above, you can also enroll in NCLEX-RN Prep Courses offered by colleges and universities. If you enjoy learning in a classroom with others, this might be best for you.

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Last and arguably most important, self-care. It can be easy to neglect your self when it comes to preparing for your nursing boards. Make sure to create a study schedule that gives you time to eat a nutritious meal, meet with friends, take naps or indulge in your favourite hobbies.

Deal with your stress if you’re an anxious test taker. Here are some ways to help reduce stress and keep you healthy for your big day:

  • Exercise, Yoga, Take a walk
  • Take supplements
  • Aroma therapy such as lighting a candle
  • Soothing music
  • Reduce caffeine intake – consider decaf or a healthy fruit
  • Journaling or other forms of self-expression such as painting
  • Talk and/or laugh with a friend or loved one and share your feelings
  • Deep breathing exercises
  • Mindfulness
  • Meditation
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Extra Notes: “Passing the NCLEX in 75 Questions.

You don’t have to pass the NCLEX with the minimum amount of questions and it doesn’t make you any less of a nurse if you pass with the entire 265 questions.

Sure, your butt might be a little sore from sitting there for the whole 6 hours but what matters is that you passed! I found that I got slumped trying to pass the NCLEX in 75 questions to the point where that was all I focused on. When I wrote my exam and answered more than 75 questions, I started to get nervous and upset – almost as if I had already failed the exam.

As long as the computer continues to give you questions, you still have a chance at passing. Do not be discouraged. Keep answering those questions with that same confidence and determination you had with the first 75 questions and I assure you, you will do just fine.

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And of course, no one wants to pay another $300 to do this exam again! And don’t get me started on all those feelings that accompany failure… I’ve been through it too.

But I can’t stress enough how important it is to not put yourself down if you don’t pass on the first try. This “failure” does not mean that you are not a good enough nurse or person. Do not give up. Take those 45 days to reassess your study techniques and test taking strategies. Give some of the tips mentioned above a try, and don’t forget to allocate some time everyday during your 45 days to indulge in self-care and forgiveness.

To those who are preparing to write the NCLEX-RN, I wish you the best of luck!

And as always, thanks for reading.

Life Saving Skills Every Parent Should Know: CPR & AED for Infants

Becoming a mother or father encompasses a tremendous responsibility, and that involves keeping your children safe from harm. This is why I decided to write a post about CPR and the use of the AED for infants (newborn to one year old) in hopes of raising awareness of this important life saving skill (that hopefully, you never have to use).

This is a in-depth step by step guide on how to perform CPR and use the AED on your infant if a situation ever arises.

It is important to note that this post does not replace courses with licensed first aid & CPR instructors. Instead, this post is meant to encourage you to enroll in a licensed class and supplement your learning. I have taken classes with the Red Cross and St. John Ambulance and their instructors are passionate and informative. I highly recommend them.

What is CPR?

CPR stands for cardiopulmonary resuscitation. CPR is needed when the heart, circulation, and respiration cease. The goal of CPR is to provide adequate blood perfusion to the brain, the heart, and vital organs by manually compressing the heart to pump blood. In doing so, you will decrease the likelihood of organ damage due to lack of oxygen.

Steps on How to Perform CPR on an Infant

Note: An infant is considered a newborn to one year old.

Scene: You find your baby unconscious in the play room.

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Step 1: Assess the scene and make sure it is safe to approach.

As you approach your infant, you need to make sure the scene is safe to enter. Of course, in this situation, you are at home and your infant is in the playroom.

Take note of their environment and the objects around them.

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Assessing the scene and looking for cues will help you figure out what has happened, and guide you in your next steps of action.

Step 2: Try to stimulate the infant to wake up.

Elicit a response by trying the following:

– Flick the bottom of their feet

– Gently stroking the infant

Note: Never shake an infant due to the risk of shaken baby syndrome which can result in severe brain damage.

Step 3: If the infant does not respond, call for help.

If you are alone, call 911 for help and if possible, do not leave the infant’s side.

If someone is with you, get them to call 911 and find an AED (Automated External Defibrillator) while you provide care. In a home setting, finding an AED may be very difficult!

Step 4: Assess for breathing and pulse simultaneously for no more than 10 seconds.

Put your ear to the infants mouth and nose and listen for breathing sounds.

Watch their chest for up and down breathing movement.

At the same time, place your index finger and middle finger together and feel for the brachial or femoral pulse.

The brachial pulse is felt at the inner part of the infant’s arm, just above the elbow.

The femoral pulse can be felt in the inner and upper thigh.

You should be listening for breathing, watching the chest for rise and fall, and feeling for a pulse all at the same time and as quickly as possible.

Step 5: If there is no breathing, give a rescue breath.

Cover the infants mouth and nose entirely with your mouth and deliver one breath to see if the infant’s chest rises.

If it does not rise, the infant may have an obstructed airway (such as chocking). If that is the case, you will give 2 back thrusts with the palm of your hand after delivering compressions using the 2 finger technique (more detail below). Make sure to tilt the infant head downwards to allow gravity to help dislodge the foreign object out of their airway.

If the chest rises, their airway is clear. Deliver a second breath.

Note: Each rescue breath should last 1 second long, and make the chest rise.

Step 6: If the infant remains unresponsive, begin compressions.

Two Types of Compression Techniques for Infants:

1. 2-Finger Compression

Place your index and middle finger of one hand on the lower part of the sternum (in the middle of the chest, just below the nipple line) while your other hand supports the infant’s back. Use this technique when you are delivering back thrusts.

When to use this technique: When you are the only rescuer on site or if your hands are too small to encircle the chest of the infant

2. 2-Thumb Encircling Hands Technique

Preferred compression technique because it results in improved cardiac perfusion

Place both your thumbs on the middle third of the infant’s sternum (just below the nipple line) while encircling and supporting the infant’s back with both hands.

When to use this technique: This is the preferred compression technique. Use this technique if you can encircle the infant’s chest with both your hands. If the infant is very small, or your hands and thumbs are too large, you can put your thumbs on top of each other and compress that way.

Note: Avoid compression of the xyphoid portion of the sternum – compression here can damage the infant’s liver

How to Compress and Ventilate

If you are by yourself, compress 30 times and follow with 2 breaths (compression – ventilation ratio: 30:2)

Compress about 1/3 deep or 1 1/2 inches deep of the infant’s chest at a rate of 100-120 per minute.

If you are with another rescuer, they can help you. Instead of 30 compressions, deliver 15 compressions, and provide 2 breaths. Then you and the other rescuer can take turns compressing and giving rescue breaths at a ratio of 15:2. Also, while one person is performing CPR, the other can find and set up an AED.

Having another rescuer allows you to take turns and rotate. Compressions can get tiring, especially if you are the only rescuer waiting for help. As you get tired, your compressions may become sloppy and ineffective. It is shown that high quality compressions along with the AED are the two most critical interventions in saving a life so make sure you are doing them right. Always use the help whenever it is available.

Step 7: Continue CPR if infant remains unresponsive, and until help or the AED arrives

As you continue compressing and giving 2 breaths, make sure to reassess the infant every 2 minutes (after 5 cycles of CPR) or until help arrives. Which ever comes first.

If you are alone and performing CPR, reassess the infant every 2 minutes. If the infant is still not responsive, try to find an AED. Of course, if you are at home, continue CPR until help arrives.

When the AED arrives, apply the pads and wait for the automated instructions while you continue performing CPR.

How to use an AED on an Infant

AED stands for automated external defibrillator and can be found in public spaces for emergency use. It is a user-friendly and smart portable electronic device. It analyzes the person’s heart rhythm and determines if the heart rhythm is irregular (aka dysrhythmia). If the AED senses that the heart rhythm is irregular, it will deliver an electrical shock to restore the heart’s dysrhythmia to its normal rhythm. AEDs will only shock and correct a dysrhythmia. It will not start one that has already stopped such as in asystole.

In cases where the AED does not sense an irregular rhythm that it can shock, you should resume manual compressions and rescue breaths until the AED senses a shockable rhythm. Then reassess the infant every 2 minutes of CPR until the AED delivers a shock or until you see any spontaneous movement from the infant.

It is important to use the AED immediately when it arrives, even in the middle of performing CPR, and even if the AED that you have is not intended for children. Research has shown that survival rates increase when CPR and defibrillation occurs within 3-5 minutes of cardiac arrest.

When the AED is turned on, it will automatically instruct you. Listen to its instructions as it tries to sense a shockable rhythm. If there is a shockable rhythm, it will notify you to stay clear before shocking. “Clear” means do not touch the infant while the AED is delivering a shock.

AED Pad Placement on an Infant (Newborn to 1 Year old)

If there are pediatric AED pads or a pediatric dose attentuator on the AED you have on hand, it can be used for newborn babies and up to 8 years old.

Adults pads can also be used on children if that is all you have. But it is important to ensure that the AED pads do not overlap or touch each other during placement on the infant or child’s chest. This is due to the way the AED delivers the shock. If the pads overlap or touch, the shock delivered will not pass through the heart as it was intended to. Instead, the shock will just transfer from one pad to the other.

Sandwich the Heart

If all you have is an adult AED, place one adult pad in the middle of the infant’s chest and then place the other pad in the middle of their back, as if you are “sandwiching” the heart.

Cardiac Arrest in Children

Children often go into respiratory distress and bradycardia (heart rate drops to 60 or less beats per minute; normal for an infant is 80-160 beats per minute) before going into cardiac arrest. Even with a pulse, health care professionals will initiate compressions right away in preparation for a potential cardiac arrest. They will treat an infant with respiratory distress and a low heart rate as if they were “pulseless“, despite the presence of a pulse.

Signs & Symptoms of Respiratory Distress in Children

If your child is experiencing any or a combination of the following signs and symptoms, they may be experiencing respiratory distress:

  • Nasal Flaring
  • Noisy breathing
  • Rapid and/or shallow breathing
  • Shortness of breath
  • Brief periods of not breathing (also known as apnea)
  • Bluish colour of the skin and mucous membranes (gums and mouth, eyelids, hands and feet, nail beds) (also known as cyanosis)
  • Clammy skin (cool and sweaty skin)
  • Chest wall retractions (when the infant’s chest pulls in with each breath)
  • Mood Changes (difficult to arouse or keep awake, or fussier than usual)
  • Change in body position (positioning themselves in a way that makes it easier for them to breathe)

What to do if you notice the above signs and symptoms in your infant:

Stay calm, stay with your child, and reassure them.

Call for help (911) or take your child to the nearest emergency department if they are in distress.

Be ready to perform CPR if your infant becomes unconscious.

And my best advice to parents is to trust your instincts! If you feel like something just isn’t right, get help.

I hope you never have to use any of these skills in real life on an infant, especially your own, but these things do happen. Babies can choke on their food or toys, accidentally fall into a pool or slip under the water during bath time… And it can all happen so fast and so suddenly. As a new mom who has taken the CPR course many times, I can sincerely say that I have piece of mind knowing that I am definitely prepared when and if the time ever comes. And you should too.

As always, thanks for reading.