A Comprehensive Study Guide for Mastering the NCLEX-RN

Proven test prep strategies for success on your first attempt to become an RN

The NCLEX-RN (National Council Licensure Examination for Registered Nurses) exam is a crucial milestone for aspiring Registered Nurses (RNs), designed to assess their readiness to provide safe and effective care in various healthcare settings. This standardized test, developed by the National Council of State Boards of Nursing (NCSBN), ensures that candidates have the necessary knowledge and clinical judgment to make sound decisions in patient care.

This study guide is your first step toward achieving success on the NCLEX-RN and launching your career as a Registered Nurse. With the right tools, strategies, and resources, you’ll be well-equipped to conquer the exam on your first attempt. In this article, you’ll find effective study techniques, a clear breakdown of key content areas, and tips for mastering the different types of test questions. By following these steps, you’ll not only deepen your understanding of essential nursing concepts but also cultivate the confidence to approach your exam with calm and clarity. Your journey to becoming a compassionate, skilled RN begins now—let’s prepare you to pass the NCLEX-RN and make a lasting impact in healthcare.

Overview of the NCLEX-RN Exam

Purpose of the NCLEX-RN

The primary purpose of the NCLEX-RN is to confirm that nursing graduates possess the competencies needed for safe and effective nursing practice at the entry-level. The exam evaluates a range of core areas, including patient management, pharmacology, and nursing procedures. Passing the NCLEX-RN indicates that a candidate is qualified to practice as a registered nurse, adhering to national standards for quality and safety in healthcare.

Exam Structure (Computer Adaptive Testing – CAT)

The NCLEX-RN is a computer-adaptive test (CAT) designed to assess a candidate’s ability to safely and effectively practice nursing at the entry-level. This means that the test adapts to the candidate’s responses. Correct answers lead to slightly more difficult questions, while incorrect answers prompt easier questions. This helps the exam determine the candidate’s level of competence based on their responses.

Number and Type of Questions

The number of questions varies, typically ranging from 85 to 150. The test may end at 85 questions if the computer has enough data to determine if you passed or failed. The maximum number of questions is 150, with a time limit of five hours. However, many candidates finish earlier. Question formats include multiple-choice, fill-in-the-blank, drag-and-drop, and hotspot questions, as well as case studies that assess critical thinking and decision-making abilities. The NCLEX-RN uses a logit score instead of a percentage. This score compares your abilities against the difficulty of the questions you answered, and if you pass, it means you have demonstrated the minimum competency required to safely practice as a nurse.

Passing Criteria and Scoring System

Candidates must meet a minimum competency threshold to pass, which is based on their ability to demonstrate safe and effective nursing care. The computer-adaptive test evaluates performance in real-time, adjusting question difficulty to measure the candidate’s knowledge and skills accurately. If a candidate answers enough questions correctly to show competency, they pass the exam; if not, they fail.

Importance of Exam Preparation

Building confidence through preparation

Preparing for the NCLEX-RN exam is not just about mastering content—it’s about building the confidence needed to approach the test with a calm and focused mindset. Thorough preparation ensures that you have the knowledge and skills required to succeed, reducing anxiety and helping you feel more in control on exam day. By following a well-structured study plan, you’ll feel empowered and ready to face the challenges of the exam with self-assurance.

Pass rates for first-time test takers

First-time test-takers who dedicate time to proper preparation significantly increase their chances of success. According to recent statistics, the pass rate for first-time NCLEX-RN candidates is typically higher than for repeat test-takers, highlighting the importance of effective study habits and comprehensive exam readiness. On average, first-time pass rates YTD for U.S. educated individuals is around 93%, reinforcing the positive impact of diligent preparation and a focused approach. With the right tools and mindset, you can join the ranks of successful test-takers and take the next step in your nursing career.

Section 1: Understanding the  Test Plan

Key NCLEX-RN content areas

The NCLEX-RN is designed to assess the knowledge, skills, and abilities required for safe and effective entry-level nursing practice. The test is divided into four major content areas, as outlined in the NCLEX-RN Test Plan. These content areas are integral to ensuring that a nurse is prepared to provide holistic, safe care across a variety of clinical settings. In addition, the test is designed to assess the candidate’s ability to apply these concepts in practice, ensuring a foundation of competency and clinical judgement.

1. Safe and Effective Care Environment

1. • Management of Care: This includes overseeing the care of patients, delegating tasks, and ensuring the safety of the healthcare environment.
   • Safety and Infection Control: Focuses on reducing the risk of harm to patients, which includes infection control practices and maintaining a safe care environment.

2. Health Promotion and Maintenance

1. • This area focuses on providing education to promote wellness, preventive healthcare, and guidance on issues such as growth and development across the lifespan.

3. Psychosocial Integrity

1. • This section covers supporting patients through mental health challenges, coping with stress, and providing emotional support for both patients and their families.

4. Physiological Integrity

1. • Basic Care and Comfort: Includes providing comfort and support, such as pain management and assistance with activities of daily living.
   • Pharmacological and Parenteral Therapies: Covers the administration of medications and understanding of pharmacology.
   • Reduction of Risk Potential: Involves recognizing potential health risks and taking action to prevent harm
   • Physiological Adaptation: Assesses a nurse’s ability to manage patients with acute and chronic conditions and how nurses respond to changes in a patient’s physiological state.

NCLEX-RN Test Plan Review

Recent updates to the NCLEX-RN exam reflect the ongoing evolution in nursing practice and the healthcare field. One significant change is the introduction of the Next Generation NCLEX (NGN), which emphasizes the assessment of clinical judgment skills. This shift is designed to align with the growing complexity of healthcare, requiring nurses to make critical decisions in real time. The NGN incorporates new question types, including matrix and grid-based questions, as well as a scoring system that rewards clinical decision-making and patient safety skills.

Additionally, the NCLEX-RN test plan continues to prioritize core nursing competencies such as safe and effective care, health promotion, and physiological integrity. The content has been refined to assess nurses’ abilities to handle real-world situations, with a greater emphasis on decision-making in complex scenarios. The updated test format, including computer-adaptive testing, ensures that the exam can more accurately evaluate a candidate’s proficiency across varying levels of difficulty. These updates reflect the NCSBN’s commitment to ensuring that new nurses are equipped to provide high-quality, patient-centered care in an increasingly complex healthcare environment.

Section 2: Study Strategies and Time Management

Effective study strategies and time management are key components in preparing for the NCLEX-RN exam. Developing a structured study plan and employing active learning techniques will not only help you retain essential information but also boost your confidence. By organizing your study time wisely and using techniques that promote deep understanding, you’ll be well-prepared to tackle the challenging exam content.

Developing an effective study plan

Creating an effective study plan is the foundation of successful NCLEX-RN preparation. A well-thought-out study schedule helps ensure that you cover all relevant content areas without feeling overwhelmed. Here are some essential steps to create an optimal study plan:

• Assess Your Current Knowledge: Start by evaluating your strengths and weaknesses. Take a diagnostic test or review the NCLEX-RN test plan to identify which areas need more focus.
• Set Realistic Goals: Break down your study material into manageable chunks. Set weekly and daily goals to track your progress and stay on target. Be sure to allow time for review as the exam approaches.
• Prioritize High-Yield Topics: Focus on content areas with the highest weight, such as Management of Care, Pharmacological and Parenteral Therapies, and Physiological Adaptation. These areas are not only heavily tested but also critical in real-world nursing practice.
• Include Time for Practice Questions: Incorporate daily practice questions to familiarize yourself with the test format and question types. This will help improve your test-taking skills and identify areas that require further review. Complete 100 questions daily in non-tutorial mode, with unseen questions. Create a quiz with just 10 questions at a time to review rationales after each quiz and take notes.
• Be Flexible: While consistency is key, life events and unexpected challenges will arise. Be prepared to adjust your study schedule as needed without losing sight of your ultimate goal.

Active Learning Techniques

Active learning techniques are vital for engaging with the material and developing critical thinking skills. Instead of passively reading, active learning promotes deeper understanding and retention. Here are some select but proven active learning strategies:

• Practice with NCLEX-RN Style Questions: Practice questions are one of the most effective ways to test your knowledge and learn how to apply it in different scenarios. Focus on understanding why answers are correct or incorrect rather than just memorizing facts.
• Use Concept Mapping: Concept maps are a powerful tool for organizing and visually connecting key nursing concepts. This technique helps you see relationships between topics, such as how symptoms relate to diseases or how interventions impact patient outcomes.
• Teach Back Method: Explaining what you’ve learned to someone else is an excellent way to solidify your understanding. This “teach back” method allows you to identify gaps in your knowledge and reinforce your understanding of complex concepts. This method is also a critical tool nurses can use with patients to confirm that they have explained things in a manner that patients understand.
• Active Recall and Spaced Repetition: Active recall involves testing yourself on the material without looking at your notes, often through prompting—while spaced repetition involves reviewing material at increasing intervals over time. Both methods help reinforce long-term retention and are critical in medical education.
• Simulate Real-Life Scenarios: Create practice cases or scenarios that mimic clinical situations. Simulation helps bridge the gap between theory and practice, improving both critical thinking and clinical judgment skills.

Incorporating these strategies into your study routine will help improve your understanding of nursing concepts and prepare you for the types of questions and scenarios you will encounter on the NCLEX-RN. By engaging with the material actively, you’ll be better equipped to apply your knowledge confidently on exam day and, more importantly, once you start practicing as a licensed nurse.

Section 3: Mastering NCLEX-RN Question Types

Mastering the different types of questions and understanding the structure of the NCLEX-RN is essential for effective exam preparation. With the implementation of Computer Adaptive Testing (CAT), the exam dynamically adjusts the difficulty of questions based on your responses. In addition, the NCLEX-RN includes a variety of question types that test your clinical reasoning, knowledge, and decision-making ability. Becoming familiar with these question formats will help you confidently navigate the test and perform at your best.

Understanding Computer Adaptive Testing (CAT)

The NCLEX-RN utilizes Computer Adaptive Testing (CAT), which customizes the exam based on the test-taker’s responses. This technology adapts to your skill level: if you answer a question correctly, the next one will be slightly more difficult, and if you answer incorrectly, the next question will be easier. The test continues until the system is 95% confident that you have either passed or failed based on your performance.

• Dynamic Question Difficulty: The adaptive nature of CAT ensures that questions are personalized to your ability level, providing a more accurate measure of your knowledge and skills.
• Variable Question Count: The NCLEX-RN consists of 85 to 150 questions. The exact number depends on how well you perform; if the system determines with a high degree of confidence that you have passed, the test may end after 85 questions.
• Test Accuracy: The adaptive format helps the exam better assess your competency by focusing on the areas where you need the most improvement, making the exam process more efficient.

Common Question Types on the NCLEX-RN

The NCLEX-RN features a variety of question formats designed to test your knowledge, clinical judgment, and ability to apply nursing concepts in practical situations. Familiarity with these question types and practicing them will help you develop the skills needed to excel on the NCLEX-RN, particularly in terms of critical thinking and decision-making under pressure.

These are some of the most common question types you will encounter:

1. Multiple Choice Questions: The most common question format, where you select the correct answer from several options. These questions test your ability to recall and apply specific knowledge in clinical scenarios.
2. Select All That Apply (SATA): These questions require you to choose multiple correct answers from a list. This format tests your ability to recognize all applicable nursing interventions, symptoms, or conditions associated with a particular clinical situation.
3. Prioritization Questions: These questions ask you to rank actions or interventions in order of importance. They assess your ability to prioritize tasks based on patient safety and clinical needs. Prioritization is a critical skill for nurses in real-world practice.
4. Hot Spot Questions: In these questions, you will be asked to click on a specific area of a diagram or image, such as identifying where a skin lesion is located or selecting the appropriate site for a nursing intervention. This tests your visual and clinical assessment skills.
5. Drag-and-Drop Questions: These questions require you to arrange items in a specific order, such as sequencing steps in a nursing procedure or matching a set of symptoms to a diagnosis. This format tests both your critical thinking and organizational skills.
6. Exhibit Questions: These questions present a scenario with additional information in the form of charts, patient histories, or lab results. You are required to analyze the exhibit and answer based on the provided data.

Section 4: Core Nursing Concepts for the NCLEX-RN

The NCLEX-RN exam assesses a variety of core nursing concepts that are essential for safe and effective patient care. These concepts are critical in helping nurses develop the necessary skills to make informed clinical decisions and provide high-quality care. Understanding these core nursing concepts is crucial for passing the NCLEX-RN and becoming a competent and compassionate nurse.

Below are some of the most important concepts that you should focus on during your preparation.

1. Safe and Effective Care Environment

This concept focuses on patient safety, providing a safe environment, and minimizing risks in the healthcare setting. It encompasses both management of care (such as delegation, supervision, and teamwork) and safety (including infection control, risk management, and disaster preparedness).

• Key areas to focus on: Infection control, safety protocols, disaster response, delegation, and patient advocacy.
• Why it’s important: This area tests your ability to create a safe environment and manage nursing care effectively, both of which are vital in everyday practice.

2. Health Promotion and Maintenance

This section involves promoting wellness, preventing illness, and assisting patients in managing their health conditions. It includes developmental stages, nutrition, prevention strategies, and patient education.

• Key areas to focus on: Growth and development, immunizations, health screenings, prenatal care, and patient education for chronic disease management.
• Why it’s important: Nurses must empower patients to adopt healthier lifestyles and manage their health proactively.

3. Psychosocial Integrity

This domain assesses your ability to provide emotional and psychological support to patients and families, address mental health issues, and manage stress or grief. It also involves assisting with coping mechanisms in difficult situations.

• Key areas to focus on: Mental health disorders, therapeutic communication, grief and loss, and crisis intervention.
• Why it’s important: Nurses often encounter patients in emotionally distressing circumstances. Understanding psychosocial integrity is key to providing compassionate, holistic care.

4. Physiological Integrity

The largest area of the exam, this domain focuses on managing physiological needs and includes basic care and comfort, pharmacological therapies, reduction of risk potential, and physiological adaptation.

• Key areas to focus on:
  • Basic care and comfort: Pain management, mobility, and activities of daily living.
  • Pharmacological and Parenteral therapies: Medication administration, patient education, and drug interactions.
  • Reduction of risk potential: Preventing complications such as infections or falls.
  • Physiological adaptation: Managing patients with complex conditions like diabetes, heart failure, or respiratory distress.
• Why it’s important: This section evaluates a nurse’s ability to manage acute and chronic conditions and provide patient-centered care across a range of clinical situations.

By focusing on these core concepts and understanding how they apply to real-world scenarios, you’ll be better prepared to answer questions that require both knowledge and clinical judgment. Properly mastering these concepts is essential not only for passing the NCLEX-RN but also for delivering high-quality patient care in any healthcare setting.

Section 5: Practice Exams and Self-Assessment

Effective preparation for the NCLEX-RN requires more than just studying content—it involves actively engaging with the material, assessing your understanding, and simulating exam conditions. Practice exams and regular self-assessments are essential tools in preparing for the NCLEX-RN, as they help you gauge your readiness, identify weak areas, and build confidence.

Importance of Practice Questions

Practice questions are a cornerstone of NCLEX-RN preparation. They help you familiarize yourself with the test format and question types, reinforcing your knowledge while improving test-taking strategies. Here are some reasons why practice questions are essential:

• Familiarization with Question Types: The NCLEX-RN includes a variety of question types, such as multiple-choice, Select All That Apply (SATA), and prioritization questions. By regularly practicing with these question types, you can better understand what is being asked and how to approach them effectively.
• Active Learning: Rather than passively reviewing material, answering practice questions requires you to apply knowledge in a practical setting. This form of active recall enhances retention and critical thinking skills, which are essential for the NCLEX-RN.
• Taking Full-Length Practice Exams Under Timed Conditions: Regular practice helps you get accustomed to the pacing of the exam. The NCLEX-RN is a time-sensitive exam, and practicing under timed conditions will help you manage your time efficiently on test day.
• Feedback and Review: For daily practices, you should review feedback and rationales at the end of each quiz of 10 questions. Candidates do not see answers and rationales after each question on the NCLEX, so we want to imitate this during our practices. Spend no more than 5-7 minutes to review rationales per question. Take one-line notes per question to keep key points concise.

Tracking Your Progress

Tracking your progress throughout your NCLEX-RN preparation is crucial to staying on target and identifying areas that need more focus. Here are some effective strategies for tracking progress:

• Diagnostic Tests: Take a diagnostic test at the start of your preparation to assess your baseline knowledge. This will help you identify weak areas and prioritize your study time.
• Daily and Weekly Goals: Set specific daily and weekly goals based on your study plan. Track your achievements to ensure you’re staying on schedule and focusing on high-yield topics.
• Review Performance: Regularly review your performance on practice exams to assess which areas are improving and which still need attention. If certain topics consistently appear to be weaknesses, allocate additional study time to those areas.
• Use NCLEX-RN Preparation Apps: Many preparation tools and apps, track your progress and provide analytics on your performance. These tools can highlight patterns in your mistakes and offer personalized recommendations. See examples below.

Simulating Test Day

Simulating test day is one of the most effective ways to prepare for the actual exam. It allows you to experience the test under conditions like the real thing, helping you manage anxiety and test-taking strategies. Here’s how to simulate test day effectively:

• Full-Length Practice Tests: Take full-length practice exams under timed conditions to replicate the actual NCLEX-RN experience. This will help you get used to the test’s pacing and build stamina for sitting through a lengthy exam.
• Simulate Test Environment: Choose a quiet, distraction-free environment for practice exams that closely mimics the testing center atmosphere. Avoid distractions like phones or interruptions to help condition your focus during the real exam.
• Practice with Computer Adaptive Testing (CAT): Since the NCLEX-RN uses CAT, it’s essential to practice with an adaptive testing platform. This will give you a feel for how the questions adjust based on your answers and help you practice managing varying levels of question difficulty.
• Stay Calm and Focused: Practice managing test anxiety by following the same rules you would on test day—no outside help, no cheating, and a fixed time limit for each question. This helps build your ability to maintain focus and perform well under pressure.

By incorporating practice exams, tracking progress, and simulating test day into your study routine, you’ll build confidence, sharpen your test-taking skills, and increase your chances of success on the NCLEX-RN exam.

NCLEX-RN Review Books and Apps

It’s well-known that the NCLEX-RN is a challenging test, but fortunately, there are numerous resources available to help you succeed. Among the most effective preparation tools are detailed test prep books, which provide structured study plans, practice questions, and comprehensive content reviews. These books and tools can break down complex material and give you the confidence needed to tackle the exam.

*** Please note that these are just references and we do not endorse any of these products in particular.

Review Books: traditional textbook style comprehensive learning guides

• Saunders Comprehensive Review for the NCLEX-RN Examination.
• Lippincott Q&A Review for NCLEX-RN.
• NCLEX-RN Questions & Answers Made Incredibly Easy.
• HESI Comprehensive Review for the NCLEX-RN Examination

Apps: mobile-friendly platforms for interactive learning

• UWorld Nursing: this paid app requires an active UWorld QBank subscription. It provides detailed explanations that include clinical reasoning behind correct and incorrect answer so students learn while they practice.
• Picmonic: this app provides mnemonic nursing videos, visual learning and spaced repetition quizzing to help students study smarter and retain more.
  

Websites: online web-based learning content

• Simplenursing.com: this website that provides 1,200+ animated videos, 900+ colorful study guides and 4,000 practice questions in an online format that is interactive.
• Hurst Review: this website provides different course options and interactive tools based on the NCSBN test plan that help students learn the essential skills needed to pass the NCLEX-RN.
• Nurse Achieve: this website provides thousands of NGN questions and their NCLEX readiness assessments are in the form of CAT assessments to prepare students to pass the NCLEX

Section 6: Test Day Tips

Preparing for the NCLEX-RN can feel overwhelming, but with the right approach on test day, you can stay calm, confident, and focused. The following sections will guide you through essential tips for handling the day before the exam, ensuring you bring everything needed, and managing any anxiety that may arise.

The Day Before the Exam

The day before the NCLEX-RN is just as crucial as the weeks of preparation leading up to it. Properly preparing yourself physically and mentally can make a big difference in your performance. Here are some tips for the day before:

• Review, Don’t Cram: Avoid trying to learn new information on the eve of the exam. Instead, do a light review of key concepts, especially those you may have struggled with during your practice exams. The goal is to reinforce your knowledge, not overwhelm yourself with last-minute cramming.
• Rest and Relax: Make sure to get a full night’s sleep. Lack of rest can impair your concentration and decision-making ability. Aim for at least 7-8 hours of sleep to ensure you wake up feeling refreshed and alert.
• Prepare Your Materials: Ensure all your exam-related materials are ready, including your identification, appointment confirmation, and any required documents. This will save you time and reduce stress on the morning of the test.
• Stay Calm: Engage in relaxation activities such as yoga, light stretching, or meditation to reduce stress and promote a sense of calm before bed.

What to Bring to the Testing Center

When you arrive at the testing center, it’s important to have everything you need to avoid unnecessary stress. Here’s a checklist of essential items to bring:

• Valid Identification: You’ll need to bring a government-issued photo ID, such as a driver’s license or passport. Make sure the name matches the one on your NCLEX application.
• NCLEX Authorization: Bring your authorization to test (ATT), which will be sent to you by your state’s nursing board.
• Comfortable Clothing: Dress in layers to accommodate temperature changes in the testing center. Comfort is key, so choose something that allows you to focus on the exam, not your attire.
• Personal Items: The testing center will provide a locker for your personal belongings, but you may bring a water bottle (check the testing center’s rules) and make sure to leave other items, like cell phones, in your locker.

Managing Exam-Day Anxiety

Feeling nervous before the NCLEX-RN is normal, but it’s important to manage your anxiety so you can perform at your best. Here are some strategies to help you stay calm and focused:

• Practice Relaxation Techniques: Breathing exercises, mindfulness, or visualization can help calm your nerves before and during the exam. Focus on slow, deep breaths to lower your heart rate and clear your mind.
• Positive Self-Talk: Remind yourself of the hard work you’ve put into preparing for the exam. Reassure yourself that you are ready and capable. Positive affirmations can shift your mindset and boost your confidence.
• Take Breaks When Needed: If you start feeling overwhelmed during the exam, use the computer’s break feature to take a short pause. Walk around for a few minutes to clear your head. A quick break can help reset your focus and give you a fresh perspective.
• Stay in the Moment: Don’t dwell on questions you’ve already answered or worry about those that are coming up. Stay focused on one question at a time to avoid becoming overwhelmed. Each question is an opportunity to demonstrate your knowledge.

By following these tips and preparing both physically and mentally, you’ll be ready to face the NCLEX-RN with confidence. Remember, it’s just one step on the path to becoming a licensed nurse, and with the right mindset, you’ll succeed.

Step-by-Step Guide to Register for the NCLEX-RN Exam

Registering for the NCLEX-RN (National Council Licensure Examination for Registered Nurses) involves several key steps. Each step ensures you meet the eligibility requirements and can sit for the exam. Below is a comprehensive guide to help you through the registration process.

Once you have completed your nursing program, the next step is applying for licensure with the state board of nursing where you plan to work. The state board will determine your eligibility to take the NCLEX-RN. To apply, follow these steps:

Step 1: Apply for Licensure/Registration with your Nursing Regulatory Body (NRB)

• Submit an application: Fill out your state board’s application for licensure.
• Submit your transcripts: You may need to provide proof of your nursing education, typically in the form of official transcripts sent directly from your nursing school to the board.
  • For students that graduated from California nursing programs who plan to apply for a CA RN license, your nursing program will validate your transcripts directly on the BRN website, so you do no need to submit your own transcripts.
• Background check: Complete any required background checks as part of your state’s licensing requirements.

Step 2: Receive Eligibility from Your NRB

• State board reviews your application and send you an Eligibility to Test (ETT).
• Once you have your ETT, you can register for the NCLEX-RN exam through Pearson VUE, the official testing agency for the NCLEX.

Step 3: Register with Pearson VUE

• Visit Pearson VUE’s NCLEX page and create an account if you don’t already have one.
• Schedule your exam: Log in to your Pearson VUE account, select the NCLEX-RN exam, and schedule your test date at a Pearson VUE testing center near you. You’ll also pay the exam fee at this time (around $200, though this can vary by state). The voucher you receive from your NCLEX Success Specialist will pay for this fee.

Step 4: Receive Authorization to Test (ATT)

• Once your registration and payment for Pearson VUE is completed, you will receive your ATT via email from Pearson VUE.
• Make sure that your personal information on the ATT matches your government issued ID you will be bringing to your testing center.

Step 5: Schedule Your NCLEX-RN Exam

• Use the ATT number on your ATT email on your Pearson VUE account.
• Pearson VUE offers numerous testing centers across the country. Make sure to select one that’s convenient for you.
• Once registered, start your preparation by reviewing this study guide again and collecting your study materials.
• Remember it’s best practice to test within 30 days of term ending to increase chances of passing your NCLEX-RN on your first attempt!

On the day of the exam

• Government-issued ID: A valid, unexpired photo ID (e.g., driver’s license or passport).
• Authorization to Test (ATT): The document you received from your state board.

Section 7: Post-Exam: What’s Next?

After completing the NCLEX-RN exam, it’s natural to feel a mix of relief, uncertainty, and anticipation. The post-exam phase is crucial, as it includes waiting for results, reflecting on your performance, and taking the necessary steps to move forward with your nursing career. Here’s what you can expect after taking the exam:

Understanding the NCLEX-RN Scoring Process

• Pass or Fail: The NCLEX is designed to assess whether you meet the minimum competency required for safe practice as an entry-level nurse. You’ll either pass or fail based on your performance throughout the exam. Once you finish the exam, you’ll receive a preliminary result indicating whether you’ve passed or not. However, this result is not official.
• Unsuccessful Outcome: If you do not pass, you will be provided with information on which areas need further improvement. You can retake the exam after waiting a prescribed period (usually 45 days). Use this time to reassess your study strategies and strengthen your weak areas.
• After completing the NCLEX-RN: the time it takes to receive your official results can vary depending on your state’s nursing board. Some states offer the Quick Results service, which allows you to receive your exam results within 48 hours for a small fee. Official results are typically posted within 2 to 4 weeks on the state board’s website. These results will indicate whether you’ve passed or failed and are the final word on your exam performance.

Next Steps After Passing the NCLEX-RN

If you’ve passed the NCLEX-RN, congratulations! Here’s what to do next:

• Apply for Your Nursing License: Once you pass, you’ll need to apply for your official nursing license through your state board of nursing. This is the final step to becoming a licensed registered nurse (RN). Some states may issue your license automatically after passing, while others require additional paperwork.

Next Steps After Failing the NCLEX-RN

If you didn’t pass the NCLEX-RN, don’t worry—many candidates face this challenge and ultimately succeed. Here’s what to do:

• Review Your Performance: Review the performance report provided by your state board. It will highlight the areas where you struggled, allowing you to focus your study efforts more effectively next time.
• Retake the Exam: You can retake the exam after a waiting period, typically 45 days. This gives you time to address your weak areas and prepare for a second attempt. Many candidates who don’t pass the first-time pass on their second attempt with more focused study.
• Consider Additional Support: If needed, seek out additional study resources such as review courses, study groups, or tutors to ensure better preparation before retaking the exam.

Eagle Gate College: Comprehensive NCLEX Support Services

Eagle Gate College provides a robust support system designed to empower nursing students as they prepare for the NCLEX exam. Their approach combines international coaching, data-driven strategies, and a structured support network that emphasizes individualized learning and test readiness. The college’s NCLEX team offers a variety of targeted services to guide students through each phase of their educational journey and ensure they are well-prepared for licensure.

Attributes of the support services

Personalized Learning Support

Eagle Gate College’s licensure team uses workshops, remediation sessions, group tutorials, and one-on-one asynchronous meetings to help students identify and address their personal learning needs. With guidance from international coaches, the team works closely with each student to improve course performance and proficiency in CMS topics. This personalized approach ensures that students build a strong foundation and confidence in their knowledge.

Data-Driven NCLEX Preparation

Eagle Gate College’s NCLEX preparation process emphasizes one-on-one, data-driven remediation to help students succeed on the exam. By using evidence-based methods and individualized data, the team collaborates with students to create customized remediation plans that target their specific areas of improvement. The team also assists with scheduling the NCLEX exam and voucher recommendations, ensuring each student is set up for success from the outset.

ATI Student Orientation and Faculty Support

The college collaborates with faculty to integrate ATI (Assessment Technologies Institute) resources into the curriculum, focusing on CMS practices and examination procedures. As part of this effort, Eagle Gate College has ATI champions who supports faculty members in implementing ATI tools effectively and scheduling CMS assessments and retakes within the curriculum. This comprehensive orientation enables students to familiarize themselves with ATI’s resources as they progress through their courses.

Initiatives and events to foster NCLEX success

Eagle Gate College organizes several initiatives to foster NCLEX readiness and celebrate student milestones. These include:

• Senior Day: Recognizes students’ achievements and provides guidance on planning for NCLEX preparation.
• NCLEX-RN Boot Camp: Offered four times per month, this program uses the clinical judgment model to relate nursing concepts to specific diseases, helping students apply knowledge in a clinical context.

Each term includes specialized boot camp review sessions that focus on clinical judgment and disease-related concepts, offered weekly to reinforce learning and readiness. Eagle Gate College’s NCLEX team and faculty work together to create an environment of support, collaboration, and preparation, helping each student reach their goal of becoming a licensed nurse. Through these comprehensive services, Eagle Gate College is committed to the success and confidence of its nursing graduates.

Are You Just Getting Started on Your Journey Towards Becoming an RN?

Congratulations on embarking on the incredible journey toward becoming a registered nurse by preparing for the NCLEX-RN! This journey is so much more than just memorizing content—it’s about discovering your inner strength, believing in your abilities, and realizing your potential to make a difference in the world. As you dive into your studies, know that each session is a step forward, each challenge a chance to grow, and every moment brings you closer to your dream.

As exam day approaches, stay grounded in the confidence you’ve built. Trust in your hard work and the countless hours you’ve dedicated to mastering the material. Every page you turn, every concept you understand, and every practice question you conquer is another stride toward your success. Keep your eyes on the prize and celebrate every small victory along the way. Whether it’s treating yourself to something special or simply taking a moment to appreciate how far you’ve come, stay motivated and remind yourself that you are fully prepared. You’ve already proven your dedication—now go show the world what you’re made of. Keep moving forward with determination and let your passion for nursing light the way.

Appendix: Sample Practice Questions

Here are 20 high-yield standard NCLEX-RN practice questions and a Next Gen case study designed to test your knowledge and provide rationales for better understanding. We’ve included questions in various formats to highlight the different ways these questions may be asked:

1. Multiple Choice. Question: A nurse is caring for a postoperative patient who is at risk for deep vein thrombosis (DVT). Which of the following is the priority nursing intervention to prevent DVT?

• A. Elevate the legs
• B. Administer anticoagulants as prescribed
• C. Encourage early ambulation
• D. Apply anti-embolism stockings.

Answer: C. Encourage early ambulation
Explanation: Early ambulation is the most effective way to prevent DVT by promoting circulation.

2. Select All That Apply (SATA). Question: Which of the following are common symptoms of hypoglycemia? Select all that apply.

• A. Tremors
• B. Sweating
• C. Increased thirst
• D. Confusion
• E. Vomiting

Answer: A, B, D
Explanation: Tremors, sweating, and confusion are classic signs of hypoglycemia. Increased thirst and vomiting are more common in hyperglycemia.

3. Multiple Choice. Question: A 65-year-old patient is receiving digoxin (Lanoxin) for atrial fibrillation. The nurse should monitor the patient for which of the following side effects of digoxin?

• A. Tinnitus
• B. Bradycardia
• C. Hypotension
• D. Hyperkalemia

Answer: B. Bradycardia
Explanation: Digoxin can cause bradycardia due to its effects on the heart’s electrical system.

4. Prioritization. Question: A nurse is caring for four patients. Which patient should the nurse assess first?

• A. A patient with a blood pressure of 110/70 mm Hg after receiving pain medication
• B. A patient with a respiratory rate of 20 breaths per minute who is complaining of chest pain
• C. A patient with a heart rate of 88 beats per minute who is post-operative day 1
• D. A patient with a fever of 101°F who is alert and oriented

Answer: B. A patient with a respiratory rate of 20 breaths per minute who is complaining of chest pain
Explanation: Chest pain is a priority due to the potential for a life-threatening condition like a myocardial infarction.

5. Multiple Choice. Question: The nurse is educating a patient with hypertension on the importance of adhering to prescribed antihypertensive medications. Which of the following statements by the patient indicates a need for further teaching?

• A. “I will monitor my blood pressure regularly.”
• B. “I will avoid eating too much salt.”
• C. “I can stop my medication once my blood pressure is normal.”
• D. “I will take my medication at the same time every day.”

Answer: C. “I can stop my medication once my blood pressure is normal.”
Explanation: Hypertension requires lifelong management, and stopping medication without consultation can lead to complications.

6. Multiple Choice. Question: A nurse is caring for a patient with a history of alcohol use disorder who is experiencing withdrawal. Which of the following is the priority nursing intervention?

• A. Administering benzodiazepines as prescribed
• B. Providing high-calorie meals
• C. Encouraging the patient to talk about their alcohol use
• D. Monitoring vital signs frequently

Answer: A. Administering benzodiazepines as prescribed
Explanation: Benzodiazepines are used to manage alcohol withdrawal symptoms, including seizures and anxiety.

7. Fill-in-the-Blank. Question: The nurse is caring for a patient with a history of chronic kidney disease. The nurse should monitor for an elevated level of __________, as this is a common indicator of renal dysfunction.

Answer: Creatinine
Explanation: Elevated creatinine levels indicate impaired kidney function.

8. Multiple Choice. Question: Which of the following is a normal finding in a 2-day-old infant?

• A. Jaundice
• B. Respiratory rate of 40 breaths per minute
• C. Blood pressure of 90/60 mm Hg
• D. Cyanosis of the hands and feet

Answer: B. Respiratory rate of 40 breaths per minute
Explanation: A respiratory rate of 40 breaths per minute is normal for a newborn.

9. Select All That Apply (SATA). Question: Which of the following are common risk factors for developing pressure ulcers? Select all that apply.

• A. Immobility
• B. Poor nutrition
• C. Incontinence
• D. Obesity
• E. Smoking

Answer: A, B, C, E
Explanation: Immobility, poor nutrition, incontinence, and smoking are significant risk factors for pressure ulcers.

10. Multiple Choice. Question: A patient who is receiving chemotherapy has a low white blood cell count. Which of the following interventions should the nurse include in the plan of care to reduce the risk of infection?

• A. Encourage a high-protein diet
• B. Implement reverse isolation precautions
• C. Instruct the patient to avoid all physical activity
• D. Administer antipyretics as needed

Answer: B. Implement reverse isolation precautions
Explanation: Reverse isolation precautions are important to protect immunocompromised patients from infection.

11. Multiple Choice. Question: A nurse is caring for a patient who is scheduled for surgery. The nurse should teach the patient about the purpose of preoperative antibiotics, which include:

• A. Reducing the risk of infection during surgery
• B. Preventing postoperative bleeding
• C. Ensuring proper wound healing
• D. Improving anesthesia effectiveness

Answer: A. Reducing the risk of infection during surgery
Explanation: Preoperative antibiotics help reduce the risk of postoperative infections.

12. Prioritization. Question: The nurse is caring for the following four patients. Which patient should the nurse assess first?

• A. A patient with a temperature of 101°F postoperative day 2
• B. A patient with an oxygen saturation of 90% and a respiratory rate of 28 breaths per minute
• C. A patient with a blood pressure of 135/85 mm Hg and stable vital signs
• D. A patient with a potassium level of 3.0 mEq/L and muscle weakness

Answer: B. A patient with an oxygen saturation of 90% and a respiratory rate of 28 breaths per minute
Explanation: This patient has signs of respiratory distress, which require immediate attention.

13. Multiple Choice. Question: A nurse is administering morphine to a patient with severe pain. Which of the following side effects should the nurse monitor for after administering morphine?

• A. Bradycardia
• B. Hypotension
• C. Tachypnea
• D. Nausea and vomiting

Answer: B. Hypotension
Explanation: Morphine can cause hypotension as a side effect due to its vasodilation properties.

14. Select All That Apply (SATA). Question: Which of the following are symptoms of dehydration in a pediatric patient? Select all that apply.

• A. Dry mouth
• B. Sunken fontanel
• C. Irritability
• D. Moist skin
• E. Weight loss

Answer: A, B, C, E
Explanation: Dry mouth, sunken fontanel, irritability, and weight loss are all signs of dehydration in children.

15. Multiple Choice. Question: A nurse is assessing a patient with diabetes who reports frequent urination and excessive thirst. The nurse should suspect:

• A. Hyperglycemia
• B. Hypoglycemia
• C. Diabetic ketoacidosis
• D. Insulin resistance

Answer: A. Hyperglycemia
Explanation: Frequent urination and excessive thirst are common symptoms of hyperglycemia due to high blood sugar levels.

16. Multiple Choice. Question: A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy. Which of the following should the nurse monitor to ensure the patient’s safety?

• A. Oxygen saturation levels
• B. Carbon dioxide retention
• C. Blood pressure changes
• D. Serum glucose levels

Answer: B. Carbon dioxide retention
Explanation: COPD patients may have impaired respiratory drive and could retain carbon dioxide, so it’s essential to monitor this.

17. Fill-in-the-Blank. Question: The nurse is preparing to administer a blood transfusion. The first action the nurse should take is to verify the patient’s __________ and blood type.

Answer: Identity
Explanation: Verifying the patient’s identity and blood type is critical to prevent transfusion reactions.

18. Multiple Choice. Question: A nurse is caring for a patient with a history of asthma. The patient is prescribed a bronchodilator. Which of the following should the nurse teach the patient to avoid?

• A. Taking the medication before exercise
• B. Using the medication on an empty stomach
• C. Overusing the medication during an asthma attack
• D. Rinsing the mouth after using the inhaler

Answer: C. Overusing the medication during an asthma attack
Explanation: Overusing a bronchodilator can lead to adverse effects and decreased effectiveness.

19. Select All That Apply (SATA). Question: Which of the following interventions should the nurse implement for a patient who is at risk for falls? Select all that apply.

• A. Keep the bed in the lowest position
• B. Use non-slip socks or footwear
• C. Place the call light within reach

Answers: A, B, C
Explanation: Keeping the bed in the lowest position helps reduce the risk of injury if the patient falls. Non-slip socks or footwear are crucial in preventing falls, and ensuring that the call light is within reach allows the patient to request assistance if needed.

20. Multiple Choice. Question: A nurse is caring for a patient who has been diagnosed with tuberculosis (TB) and is started on a regimen of rifampin and isoniazid. Which of the following side effects should the nurse educate the patient about regarding rifampin?

• A. Changes in urine color to orange
• B. Increased appetite
• C. Weight loss
• D. Photosensitivity

Answer: A. Changes in urine color to orange
Explanation: Rifampin can cause harmless changes in body fluids, such as urine, sweat, and tears, turning them orange. This side effect should be communicated to the patient to avoid alarm.

 

Next Gen Case Study

A nurse is caring for a female client on a medical-surgical unit.

History & Physical	Vital Signs	Diagnostic Results	Question 1 of 6   The nurse is reviewing the client’s electronic medical record. Which of the following client findings requires follow-up by the nurse?   Select all that apply.   A.       Breath sounds B.       Potassium Level C.       Chest x-ray D.      Oxygen saturation E.       Blood pressure F.       Temperature   Answer: A, C, D Rationale: When recognizing cues, the nurse should follow up on the client’s oxygen saturation, breath sounds, and chest x-ray results. The client’s oxygen saturation is less than the expected reference range of 95% to 100%, indicating hypoxia. Wheezing isa manifestation of airway obstruction which can be the result of narrowing of the airways, possibly due to mucous production or tumor. The client’s chest x-ray indicates a possible tumor in the right lung. The nurse should report these findings to the provider.
Day 1: The client reports hoarseness, increased shortness of breath, fatigue, recent weight loss, and a persistent cough, that has progressed over the past 6 months. The client reports their cough has worsened over the past 4 weeks and has become productive recently for rust-colored sputum. The client is alert and oriented to person, place, and time. Bilateral breath sounds with scattered inspiratory and expiratory wheezes are noted. Fingers with clubbing are noted. Past medical history: Client has a 21-year history of smoking cigarettes
History & Physical	Vital Signs	Diagnostic Results
Day 1:   Temperature 38○C (100.2○F) Blood pressure 114/56 mmHg Heart rate 78/min Respiratory rate 24/min Oxygen saturation 90% on room air
History & Physical	Vital Signs	Diagnostic Results
Day 1:   Hct 44% (37% to 47%) Hgb 15 g/dL (12 g/dL to 16 g/dL) Platelets 180,000/mm3 (150,000 to 400,000/mm3) Total WBC count 7,000/mm3 (5,000 to 10,000/mm3) Potassium 3.7 mEq/L (3.5 mEq/L to 5 mEq/L) Chest x-ray: soft tissue mass in right upper lobe

A nurse is caring for a female client on a medical-surgical unit.

History & Physical	Vital Signs	Diagnostic Results	Question 2 of 6   For each client finding in the electronic medical record (EMR), click to specify of the client finding is consistent with asthma, lung cancer, pneumonia, or COPD. Each client finding may support more than 1 disease process or none at all. There must be at least 1 selection in every column. There does not need to be a selection in every row.   Client Findings Asthma Lung Cancer Pneumonia COPD Report of quality of voice □ □ □ □ Finger characteristic □ □ □ □ Lung sounds □ □ □ □ Color of sputum □ □ □ □   Answer: Client Findings Asthma Lung Cancer Pneumonia COPD Report of quality of voice □ ■ □ □ Finger characteristic □ ■ □ ■ Lung sounds ■ ■ ■ ■ Color of sputum □ ■ ■ □   Rationale: The nurse should identify that the client lung sound findings (wheezing) in consistent with asthma, lung cancer, pneumonia, and COPD due to narrowed airways and inflammation. The nurse should recognize that client’s finger characteristics (clubbing) is consistent with lung cancer and COPD due to hypoxemia. The nurse should also identify that the client reported quality of voice (hoarseness) is consistent with lung cancer due to vocal cord irritation or laryngeal nerve damage. The nurse should understand that the client’s color sputum (rust-colored sputum) is consistent with lung cancer and pneumonia due to inflammation and/or bleeding.
Day 1: The client reports hoarseness, increased shortness of breath, fatigue, recent weight loss, and a persistent cough, that has progressed over the past 6 months. The client reports their cough has worsened over the past 4 weeks and has become productive recently for rust-colored sputum. The client is alert and oriented to person, place, and time. Bilateral breath sounds with scattered inspiratory and expiratory wheezes are noted. Fingers with clubbing are noted. Past medical history: Client has a 21-year history of smoking cigarettes
History & Physical	Vital Signs	Diagnostic Results
Day 1: Temperature 38○C (100.2○F) Blood pressure 114/56 mmHg Heart rate 78/min Respiratory rate 24/min Oxygen saturation 90% on room air
History & Physical	Vital Signs	Diagnostic Results
Day 1: Hct 44% (37% to 47%) Hgb 15 g/dL (12 g/dL to 16 g/dL) Platelets 180,000/mm3 (150,000 to 400,000/mm3) Total WBC count 7,000/mm3 (5,000 to 10,000/mm3) Potassium 3.7 mEq/L (3.5 mEq/L to 5 mEq/L) Chest x-ray: soft tissue mass in right upper lobe

The nurse has reviewed the diagnostic results from day 2, day 7, and the nurses’ notes from day 3.

History & Physical	Vital Signs	Diagnostic Results	Nurses’ Notes	Question 3 of 6   Drag words from the choices below to fill in each blank in the following sentence.   The client is at greatest risk for developing ________________ and _____________________   A.       Infection B.       Peripheral neuropathy C.       Bleeding D.      Nausea E.       Alopecia F.       Mucositis   Answer: A, C Rationale: When prioritizing care and forming a hypothesis, using the safe/risk reduction priority framework, the nurse should identify the client is at great risk for developing an infection and bleeding.   The client’s WBC count is less than the expected reference range, which places them at risk for infection.   The client’s platelet count is less than the expected reference range which places them at risk for bleeding.
Day 1: The client reports hoarseness, increased shortness of breath, fatigue, recent weight loss, and a persistent cough, that has progressed over the past 6 months. The client reports their cough has worsened over the past 4 weeks and has become productive recently for rust-colored sputum. The client is alert and oriented to person, place, and time. Bilateral breath sounds with scattered inspiratory and expiratory wheezes are noted. Fingers with clubbing are noted. Past medical history: Client has a 21-year history of smoking cigarettes
History & Physical	Vital Signs	Diagnostic Results	Nurses’ Notes
Day 1: Temperature 38○C (100.2○F) Blood pressure 114/56 mmHg Heart rate 78/min Respiratory rate 24/min Oxygen saturation 90% on room air
History & Physical	Vital Signs	Diagnostic Results	Nurses’ Notes
Day 1: Hct 44% (37% to 47%) Hgb 15 g/dL (12 g/dL to 16 g/dL) Platelets 180,000/mm3 (150,000 to 400,000/mm3) Total WBC count 7,000/mm3 (5,000 to 10,000/mm3) Potassium 3.7 mEq/L (3.5 mEq/L to 5 mEq/L) Chest x-ray: soft tissue mass in right upper lobe   Day 2: Biopsy of transthoracic fine-needle aspiration positive for non-small-cell carcinoma.   Day 7: Hct 30% (37% to 47%) Hgb 10 g/dL (12 g/dL to 16 g/dL) Platelets 100,000/mm3 (150,000 to 400,000/mm3) Total WBC count 3,200/mm3 (5,000 to 10,000/mm3)
History & Physical	Vital Signs	Diagnostic Results	Nurses’ Notes
Day 3: Chemotherapy started as prescribed.

The nurse has reviewed the diagnostic results from day 2, day 7, and the nurses’ notes from day 3.

History & Physical	Vital Signs	Diagnostic Results	Nurses’ Notes	Question 4 of 6   The nurse is planning care for the client. For each potential prescription, click to specify if the prescription is anticipated or contraindicated for the client.   Potential Prescription Anticipated Contraindicated Check the client’s WBC count daily ¡ ¡ Check the client’s rectal temperature daily ¡ ¡ Administer aspirin as needed for pain ¡ ¡ Restrict visitors who have an infection ¡ ¡ Insert an indwelling urinary catheter ¡ ¡   Answer: Potential Prescription Anticipated Contraindicated Check the client’s WBC count daily l ¡ Check the client’s rectal temperature daily ¡ l Administer aspirin as needed for pain ¡ l Restrict visitors who have an infection l ¡ Insert an indwelling urinary catheter ¡ l   Rationale: Nurse should anticipate checking WBC daily, and restricting visitors who have an infection since client is at risk for infection. Prescriptions that increase risk of bleeding like giving aspirin, taking rectal temperature, or inserting an indwelling catheter should be avoided.
Day 1: The client reports hoarseness, increased shortness of breath, fatigue, recent weight loss, and a persistent cough, that has progressed over the past 6 months. The client reports their cough has worsened over the past 4 weeks and has become productive recently for rust-colored sputum. The client is alert and oriented to person, place, and time. Bilateral breath sounds with scattered inspiratory and expiratory wheezes are noted. Fingers with clubbing are noted. Past medical history: Client has a 21-year history of smoking cigarettes
History & Physical	Vital Signs	Diagnostic Results	Nurses’ Notes
Day 1:   Temperature 38○C (100.2○F) Blood pressure 114/56 mmHg Heart rate 78/min Respiratory rate 24/min Oxygen saturation 90% on room air
History & Physical	Vital Signs	Diagnostic Results	Nurses’ Notes
Day 1: Hct 44% (37% to 47%) Hgb 15 g/dL (12 g/dL to 16 g/dL) Platelets 180,000/mm3 (150,000 to 400,000/mm3) Total WBC count 7,000/mm3 (5,000 to 10,000/mm3) Potassium 3.7 mEq/L (3.5 mEq/L to 5 mEq/L) Chest x-ray: soft tissue mass in right upper lobe   Day 2: Biopsy of transthoracic fine-needle aspiration positive for non-small-cell carcinoma.   Day 7: Hct 30% (37% to 47%) Hgb 10 g/dL (12 g/dL to 16 g/dL) Platelets 100,000/mm3 (150,000 to 400,000/mm3) Total WBC count 3,200/mm3 (5,000 to 10,000/mm3)
History & Physical	Vital Signs	Diagnostic Results	Nurses’ Notes
Day 3: Chemotherapy started as prescribed.

The nurse has reviewed the diagnostic results from day 2, day 7, and the nurses’ notes from day 3.

History & Physical	Vital Signs	Diagnostic Results	Nurses’ Notes	Question 5 of 6   The nurse is reviewing the client’s electronic medical record. Which of the following actions should the nurse take?   Select the 4 actions the nurse should expect to take.   A.       Schedule a chest x-ray B.       Check for manifestations of an infection C.       Send a sputum culture D.      Monitor vital signs once each day E.       Obtain blood cultures F.       Use clean technique for invasive procedures   Answer: A, B, C, E   Rationale: When taking actions, the nurse should expect to obtain blood and sputum cultures, schedule a chest x-ray, and check the client for manifestations of an infection. An elevated temperature and a neutrophil count of 298/mm3 are manifestations of neutropenic fever. The nurse should thoroughly assess the client to identify sources of the infection, such as a sore throat, urinary frequency, skin lesions, altered breath sounds, and expect to obtain cultures and a chest x-ray. The nurse should report the manifestations of an infection to the provider.
Day 1: The client reports hoarseness, increased shortness of breath, fatigue, recent weight loss, and a persistent cough, that has progressed over the past 6 months. The client reports their cough has worsened over the past 4 weeks and has become productive recently for rust-colored sputum. The client is alert and oriented to person, place, and time. Bilateral breath sounds with scattered inspiratory and expiratory wheezes are noted. Fingers with clubbing are noted.   Past medical history: Client has a 21-year history of smoking cigarettes
History & Physical	Vital Signs	Diagnostic Results	Nurses’ Notes
Day 1: Temperature 38○C (100.2○F) Blood pressure 114/56 mmHg Heart rate 78/min Respiratory rate 24/min Oxygen saturation 90% on room air   Day 10: Temperature 38.5○C (101.3○F) Blood pressure 104/66 mmHg Heart rate 108/min Respiratory rate 24/min Oxygen saturation 94% on room air
History & Physical	Vital Signs	Diagnostic Results	Nurses’ Notes
Day 1: Hct 44% (37% to 47%) Hgb 15 g/dL (12 g/dL to 16 g/dL) Platelets 180,000/mm3 (150,000 to 400,000/mm3) Total WBC count 7,000/mm3 (5,000 to 10,000/mm3) Potassium 3.7 mEq/L (3.5 mEq/L to 5 mEq/L) Chest x-ray: soft tissue mass in right upper lobe   Day 2: Biopsy of transthoracic fine-needle aspiration positive for non-small-cell carcinoma.   Day 7: Hct 30% (37% to 47%) Hgb 10 g/dL (12 g/dL to 16 g/dL) Platelets 100,000/mm3 (150,000 to 400,000/mm3) Total WBC count 3,200/mm3 (5,000 to 10,000/mm3) Day 10: Platelets 90,000/mm3 (150,000 to 400,000/mm3) Total WBC count 2,000/mm3 (5,000 to 10,000/mm3) Neutrophils 298/mm3 (2,500 to 8,000/mm3)
History & Physical	Vital Signs	Diagnostic Results	Nurses’ Notes
Day 3: Chemotherapy started as prescribed.

The nurse has reviewed the diagnostic results and vital signs from day 14 as well as the nurses’ notes from day 10.

History & Physical	Vital Signs	Diagnostic Results	Nurses’ Notes	Question 6 of 6   Click to highlight the findings that indicate an improvement in the client’s condition. To deselect a finding, click on the finding again.   Diagnostic Results Day 14: Hct 24% (37% to 47%) Hgb 8 g/dL (12 g/dL to 16 g/dL) Platelets 80,000/mm3 (150,000 to 400,000/mm3) Total WBC count 4,900/mm3 (5,000 to 10,000/mm3) Neutrophils 2,200/mm3 (2,500 to 8,000/mm3)   Vital Signs Day 14: Temperature 37.8○C (100○F) Blood pressure 108/62 mmHg Heart rate 88/min Respiratory rate 22/min Oxygen saturation 95% on room air       Answer: Diagnostic Results Day 14: Hct 24% (37% to 47%) Hgb 8 g/dL (12 g/dL to 16 g/dL) Platelets 80,000/mm3 (150,000 to 400,000/mm3) Total WBC count 4,900/mm3 (5,000 to 10,000/mm3) Neutrophils 2,200/mm3 (2,500 to 8,000/mm3)   Vital Signs Day 14: Temperature 37.8○C (100○F) Blood pressure 108/62 mmHg Heart rate 88/min Respiratory rate 22/min Oxygen saturation 95% on room air     Rationale: When evaluating outcomes, the nurse should identify that the client’s total WBC count, neutrophil count, temperature, and heart rate indicate an improvement on the client’s condition. The client’s WBC and neutrophil counts have increased, and the client’s temperature and heart rate have decreased. These findings indicate the neutropenic fever is resolving and the filgrastim treatment is effective in stimulating neutrophil production.
Day 1: The client reports hoarseness, increased shortness of breath, fatigue, recent weight loss, and a persistent cough, that has progressed over the past 6 months. The client reports their cough has worsened over the past 4 weeks and has become productive recently for rust-colored sputum. The client is alert and oriented to person, place, and time. Bilateral breath sounds with scattered inspiratory and expiratory wheezes are noted. Fingers with clubbing are noted.   Past medical history: Client has a 21-year history of smoking cigarettes
History & Physical	Vital Signs	Diagnostic Results	Nurses’ Notes
Day 1: Temperature 38○C (100.2○F) Blood pressure 114/56 mmHg Heart rate 78/min Respiratory rate 24/min Oxygen saturation 90% on room air   Day 10: Temperature 38.5○C (101.3○F) Blood pressure 104/66 mmHg Heart rate 108/min Respiratory rate 24/min Oxygen saturation 94% on room air   Day 14: Temperature 37.8○C (100○F) Blood pressure 108/62 mmHg Heart rate 88/min Respiratory rate 22/min Oxygen saturation 95% on room air
History & Physical	Vital Signs	Diagnostic Results	Nurses’ Notes
Day 1: Hct 44% (37% to 47%) Hgb 15 g/dL (12 g/dL to 16 g/dL) Platelets 180,000/mm3 (150,000 to 400,000/mm3) Total WBC count 7,000/mm3 (5,000 to 10,000/mm3) Potassium 3.7 mEq/L (3.5 mEq/L to 5 mEq/L) Chest x-ray: soft tissue mass in right upper lobe     Day 2: Biopsy of transthoracic fine-needle aspiration positive for non-small-cell carcinoma.   Day 7: Hct 30% (37% to 47%) Hgb 10 g/dL (12 g/dL to 16 g/dL) Platelets 100,000/mm3 (150,000 to 400,000/mm3) Total WBC count 3,200/mm3 (5,000 to 10,000/mm3)   Day 10: Platelets 90,000/mm3 (150,000 to 400,000/mm3) Total WBC count 2,000/mm3 (5,000 to 10,000/mm3) Neutrophils 298/mm3 (2,500 to 8,000/mm3)   Day 14: Hct 24% (37% to 47%) Hgb 8 g/dL (12 g/dL to 16 g/dL) Platelets 80,000/mm3 (150,000 to 400,000/mm3) Total WBC count 4,900/mm3 (5,000 to 10,000/mm3) Neutrophils 2,200/mm3 (2,500 to 8,000/mm3)
History & Physical	Vital Signs	Diagnostic Results	Nurses’ Notes
Day 3: Chemotherapy started as prescribed.   Day 10: Provider prescribed Filgrastim 300 mcg subcutaneous x1 24 hr following chemotherapy treatment. Administered as ordered.

Case Study Reference:

Assessment Technologies Institute. (2023). Learning system RN 3.0: Dynamic quizzes. Retrieved December 10, 2024.