The National Council of State Boards of Nursing designed the National Council Licensure Examination -- or NCLEX -- to test not just candidates' nursing knowledge, but their critical-thinking skills. Because the application of knowledge and judgment in a clinical situation is so important, NCSBN poses questions which require test-takers to prioritize patients and decide sequences of actions. These can challenge freshly graduated nursing candidates due to their complexity. However, a few basic nursing principles and test-taking guidelines can guide a candidate through the difficult straits.
When going through study and practice materials, NCLEX candidates should focus on questions that ask which patient to treat first. The NCLEX is situational. Sometimes it presents situations that are dire, such as a nurse who must choose whether to treat a baby gasping for air, a baby with an irregular heart beat or one with swelling in its anterior fontanel. All of these are causes for emergency action, and any nurse faced with this choice would be highly distressed. However, remembering the ABCs of nursing -- airway, breathing circulation -- a basic principle in nursing school, will guide a candidate through the question. The NCLEX is looking to make sure test-takers understand which situations present are most imminently fatal.
Hierarchy of Needs
Nurses are guided by their patients needs. Maslow's hierarchy of needs states that physiologic needs followed by safety and security are the two most basic. Therefore, many NCLEX questions test to see if in a described situation, nursing candidates can identify that among their many choices of action, keeping their patient alive and safe are always the top priorities. The phrase, "keep them breathing, keep them safe" is used in many study materials For example, in a question where a nurse must prioritize which patient to treat, one possible answer might have a patient yelling for help, when patients with more critical situations are also among the choices. The yelling patient's panic is usually classified as a psychological need, while physical acuity -- such as a difficulty breathing or third-degree burns -- gets priority.
Registered nurses are decision makers while licensed practical or licensed vocational nurses can only help perform nursing interventions. The NCLEX wants to see that nurses understand their scope of practice and the importance of their decision-making abilities and roles. That's why many NCLEX questions list four patients with specific needs and ask testing candidates which patient can be delegated to an LPN. Some questions ask which patient can only be seen by an RN. The process is the same in both situations -- the nursing candidate must identify which patients require an RN's decision-making skills.
One of the key principles in medicine is that a conscious, lucid patient has the right to make her own medical decisions -- even if they aren't advisable. That's why NCLEX sometimes asks questions where a patient needs urgent treatment, and several answers list the interventions the patient needs. However, one answer involves getting patient consent to treatment or making the patient aware of her choices. Questions may also focus on a patient who makes a choice contrary to the medical requirements to sustain her life. These questions test a nursing candidate's ability to identify and prioritize the steps required by law and ethics.