10 Crucial Tips to Never Fail the Next Generation NCLEX Again

If you failed the Next Generation NCLEX, you’ve come to the right place. 

You may have even failed it several times and are feeling frustrated at the moment. But no worries, because I’ve got your back.

What you need to do is let the tears flow, have a mental health day, and get ready to pick yourself back up!

And by picking yourself back up, I mean listening to this episode to find out the ten crucial tips you need to never fail the NGN again.

Are you ready?

Let’s dive in.

Tip #1: Assess Unless in Distress

As a nurse, you cannot diagnose. Do not act without assessing and getting the information. Do not act without a healthcare provider’s order. You have to take a look at the multiple choices in front of you and eliminate intervention choices and focus on the assessment choices unless the scenario warrants you to act upon the patient’s distress. If the patient is not in distress, then you will focus on gathering information.

Here’s an example: A nurse is preparing to administer metoprolol 50mg at 10:00 am. The nurse took the blood pressure, which was 77/44 mmHg. The patient is alert and responsive. Which of the following actions should the nurse take next?

1. Retake the patient’s blood pressure.
2. Administer the anti-hypertensive medication.
3. Call the provider immediately.
4. Hold the medication.

In this scenario, there is no indication that the patient is in distress since it directly stated that the patient is alert and responsive. The first step is to know that metoprolol is an anti-hypertensive medication. The second step is knowing that an anti-hypertensive medication should not be given if the blood pressure is too low. A patient that has low blood pressure would normally not be alert and responsive so the nurse should assess by retaking the patient’s blood pressure medication. The nurse should not just take action and hold the medication without the provider’s order. The provider should be called after retaking the patient’s blood pressure.

Tip #2: Don’t Bring Your Medical or Hospital Experience Into the Question

If you were a CNA or LPN, you may look at the question and say that you are familiar with this scenario and would choose an answer based on your experience. Unfortunately, what we do in the real world may not be applicable to every question.

Here’s a scenario: As a previous hemodialysis nurse years ago, I provided catheter care but my LPN coworker was not allowed to provide catheter care. Whereas in Pennsylvania, LPNs can provide catheter care. I would not be able to look at the exam and make the assumption that LPNs cannot provide catheter care at all just because this was the case at my hospital. The NCLEX exam is not going to bring scenarios that may differ from state to state. Every scenario mentioned on the NCLEX will be universal across all states.

Tip #3: Don’t Pressure Yourself to Memorize Everything From Your Comprehensive Review

The NCLEX exam is not expecting you to memorize everything. There is no way to know every patient’s condition and what is going on with everyone, especially as a brand new nurse-to-be. Even if you have a great memory, you will still encounter a patient with an unknown condition, and as a nurse, it’s essential to be able to assess properly.

The NCLEX won’t provide you with questions for an experienced nurse. The goal is to read the scenario in each question and be able to answer it as a new nursing graduate. If you focus too hard on comprehensive review, you should now prioritize test-taking strategy and get yourself acquainted with improving your critical thinking skills.

Tip #4: When It Comes to Psych Questions, Prioritize Safety

In general, you should prioritize the patient’s safety in any scenario. Test takers tend to look at psych questions and jump straight to the psych multiple choices and overlook the detail that concerns the safety of the patient. 

For example, a patient is prescribed Haldol to treat mental disorders, such as schizophrenia. If the nurse was listening to the patient’s concerns and noted that the patient started having a seizure, the nurse must prioritize the patient’s safety before the patient’s concerns.

Tip #5: Get Comfortable With Prioritization and Delegation

There are plenty of books to help you get acquainted. I also have a video on this to help you understand it better. 

Do not delegate what you can EAT. We have heard this time and time again in nursing school, and now it’s time for a refresher. Do not delegate Evaluation, Assessment, and Teaching.

Remember that you cannot transfer accountability when you delegate a task or patient to another staff member. 

The five rights of delegation are the right task, right circumstance, right person, right supervision, and right direction and communication. Use the five rights to answer the NCLEX question in order to eliminate some of the multiple choices. Do not delegate tasks for patients that are unstable.

Tip #6: Create an NCLEX Study Plan

You will not be able to retake the NCLEX exam for at least 45 days after failing. So create a plan, choose the exam date, and then make sure you stick to it! 

Test takers tend to delay the date and keep pushing it off, especially repeat test takers. If you plan to take it 60 days later, stick to it. Your plan should include daily studies with breaks. Don’t push yourself to study 10 hours straight every day. Don’t push yourself to the point where you end up going crazy. Spend a week on each topic.

Tip #7: Know Your ABCs – Airway, Breathing, and Circulation

You should prioritize patients that have airway problems or require airway management. Are there possible airway obstructions? The airway is clear if the patient is able to speak normally with normal breathing patterns.

For breathing assessment, the nurse should know that the normal respiratory rate is between 12 to 20 breaths per minute. Bradypnea and tachypnea indicate the patient’s condition is deteriorating and you must prioritize the patient. If the patient is in respiratory distress, you must take action to stabilize them.

Circulation assessment includes assessing the patient’s capillary refill time. You should also inspect the skin for adequate oxygenation. Are there blue discolorations of the skin? Is the skin warm to the touch or cold and sweaty? 

You can also use the level of consciousness to determine the patient’s status. Is the patient awake, able to respond in a conversation, respond to pain? Or is the patient unresponsive? The nurse must also know that a low blood pressure can indicate the deteriorating condition of the patient. Keep these tips in mind when addressing a NCLEX question and remember to prioritize the patient’s airway, breathing, and circulation.

Tip #8: Know Maslow’s Hierarchy of Needs

For Physiological Needs, if the patient is having problems breathing, then you must prioritize this need over the others. 

For Safety and Security Needs, falls, medication safety, and infection risks should be addressed. 

For Love and Belonging Needs, support from family and friends should be highlighted. Family visiting the patient can make the patient feel cared for. 

For Self-Esteem Needs, recognizing the patient’s accomplishments and encouraging independence can help address these needs. 

For Self-Actualization Needs, encouraging the patient to engage in activities. Setting recovery goals can also play a role in helping patients achieve personal growth.

You should prioritize the patient’s needs from the bottom to the top. Love and belonging should not be addressed before physiological needs. When looking at the multiple choices, make a selection based on which need should be prioritized first.

Tip #9: Get Comfortable With “Select All That Applies” Questions

It becomes overwhelming to look at each choice and have to decide which and how many are the correct answers. Treat each option as a true or false statement in order to eliminate the incorrect choice. 

Tip #10: Address Your Weaknesses

Focus on the areas that require the most improvement. Take practice NCLEX exams to identify your strengths and weaknesses. Here are the NCLEX Client Needs Strategies:

1. Safe and Effective Care Environment
2. Management of Care
3. Safety and Infection Control
4. Health Promotion and Maintenance
5. Psychosocial Integrity
6. Physiological Integrity
7. Basic Care and Comfort
8. Pharmacological and Parenteral Therapies
9. Reduction of Risk Potential
10. Physiological Adaptation

Give yourself a pat on the back and reward yourself for the sections that you excelled in. Then create a game plan to address the categories that you need to improve in.