NCLEX-RN

The NCSBN Board of Directors voted to raise the passing standard for the NCLEX-RN Examination at its meeting on Dec. 10, 2009

Media Contact: Dawn M. Kappel
Director, Marketing and Communications
312.525.3667 direct
312.279.1034 fax
dkappel@ncsbn.org

FOR IMMEDIATE RELEASE

CHICAGO - The National Council of State Boards of Nursing, Inc. (NCSBN) voted on Dec. 10, 2009, to raise the passing standard for the NCLEX-RN Examination (the National Council Licensure Examination for Registered Nurses). The new passing standard is -0.16 logits on the NCLEX-RN logistic scale, 0.05 logits higher than the previous standard of -0.21. The new passing standard will take effect on April 1, 2010, in conjunction with the 2010 NCLEX-RN Test Plan.

After consideration of all available information, the NCSBN Board of Directors determined that safe and effective entry-level RN practice requires a greater level of knowledge, skills, and abilities than was required in 2007, when NCSBN implemented the current standard. The passing standard was increased in response to changes in U.S. health care delivery and nursing practice that have resulted in the greater acuity of clients seen by entry-level RNs.

The Board of Directors used multiple sources of information to guide its evaluation and discussion regarding the change in passing standard. As part of this process, NCSBN convened an expert panel of nine nurses to perform a criterion-referenced standard setting procedure. The panel's findings supported the creation of a higher passing standard. NCSBN also considered the results of national surveys of nursing professionals including nursing educators, directors of nursing in acute care settings and administrators of long-term care facilities.

In accordance with a motion adopted by the 1989 NCSBN Delegate Assembly, the NCSBN Board of Directors evaluates the passing standard for the NCLEX-RN examination every three years to protect the public by ensuring minimal competence for entry-level RNs. NCSBN coordinates the passing standard analysis with the three-year cycle of test plan evaluation. This three-year cycle was developed to keep the test plan and passing standard current. A PDF of the 2010 NCLEX-RN Test Plan is available free of charge from the NCSBN Web sitehttps://www.ncsbn.org/2010_NCLEX_RN_TestPlan.pdf.

The National Council of State Boards of Nursing (NCSBN) is a not-for-profit organization whose members include the boards of nursing in the 50 states, the District of Columbia and four U.S. territories — American Samoa, Guam, Northern Mariana Islands and the Virgin Islands. There are also four associate members.

Mission: The National Council of State Boards of Nursing (NCSBN), composed of Member Boards, provides leadership to advance regulatory excellence for public protection.

Practice Questions

31. A nurse if reviewing a patient’s chart and notices that the patient suffers from conjunctivitis. Which of the following microorganisms is related to this condition?

A: Yersinia pestis
B: Helicobacter pyroli
C: Vibrio cholera
D: Hemophilus aegyptius

32. A nurse if reviewing a patient’s chart and notices that the patient suffers from Lyme disease. Which of the following microorganisms is related to this condition?

A: Borrelia burgdorferi
B: Streptococcus pyrogens
C: Bacilus anthracis
D: Enterococcus faecalis

33. A fragile 87 year-old female has recently been admitted to the hospital with increased confusion and falls over last 2 weeks. She is also noted to have a mild left hemiparesis. Which of the following tests is most likely to be performed?

A: FBC (full blood count)
B: ECG (electrocardiogram)
C: Thyroid function tests
D: CT scan

34. A 84 year-old male has been loosing mobility and gaining weight over the last 2 months. The patient also has the heater running in his house 24 hours a day, even on warm days. Which of the following tests is most likely to be performed?

A: FBC (full blood count)
B: ECG (electrocardiogram)
C: Thyroid function tests
D: CT scan

35. A 20 year-old female attending college is found unconscious in her dorm room. She has a fever and a noticeable rash. She has just been admitted to the hospital. Which of the following tests is most likely to be performed first?

A: Blood sugar check
B: CT scan
C: Blood cultures
D: Arterial blood gases

36. A 28 year old male has been found wandering around in a confused pattern. The male is sweaty and pale. Which of the following tests is most likely to be performed first?

A: Blood sugar check
B: CT scan
C: Blood cultures
D: Arterial blood gases

37. A mother is inquiring about her child’s ability to potty train. Which of the following factors is the most important aspect of toilet training?

A: The age of the child
B: The child ability to understand instruction.
C: The overall mental and physical abilities of the child.
D: Frequent attempts with positive reinforcement.

38. A parent calls the pediatric clinic and is frantic about the bottle of cleaning fluid her child drank 20 minutes. Which of the following is the most important instruction the nurse can give the parent?

A: This too shall pass.
B: Take the child immediately to the ER
C: Contact the Poison Control Center quickly
D: Give the child syrup of ipecac

39. A nurse is administering a shot of Vitamin K to a 30 day-old infant. Which of the following target areas is the most appropriate?

A: Gluteus maximus
B: Gluteus minimus
C: Vastus lateralis
D: Vastus medialis

40. A nurse has just started her rounds delivering medication. A new patient on her rounds is a 4 year-old boy who is non-verbal. This child does not have on any identification. What should the nurse do?

A: Contact the provider
B: Ask the child to write their name on paper.
C: Ask a co-worker about the identification of the child.
D: Ask the father who is in the room the child’s name.

Answer Key 31-40.

31. (D) Choice A is linked to Plague, Choice B is linked to peptic ulcers, Choice C is linked to Cholera.
32. (A) Choice B is linked to Rheumatic fever, Choice C is linked to Anthrax, Choice D is linked to Endocarditis.
33. (D) A CT scan would be performed for further investigation of the hemiparesis.
34. (C) Weight gain and poor temperature tolerance indicate something may be wrong with the thyroid function.
35. (C) Blood cultures would be performed to investigate the fever and rash symptoms.
36. (A) With a history of diabetes, the first response should be to check blood sugar levels.
37. (C) Age is not the greatest factor in potty training. The overall mental and physical abilities of the child is the most important factor.
38. (C) The poison control center will have an exact plan of action for this child.
39. (C) Vastus lateralis is the most appropriate location.
40. (D) In this case you are able to determine the name of the child by the father’s statement. You should not withhold the medication from the child following identification.

Practice Questions

21. A 65 year old man has been admitted to the hospital for spinal stenosis surgery. When does the discharge training and planning begin for this patient?

A: Following surgery
B: Upon admit
C: Within 48 hours of discharge
D: Preoperative discussion

22. A child is 5 years old and has been recently admitted into the hospital. According to Erickson which of the following stages is the child in?

A: Trust vs. mistrust
B: Initiative vs. guilt
C: Autonomy vs. shame
D: Intimacy vs. isolation

23. A toddler is 16 months old and has been recently admitted into the hospital. According to Erickson which of the following stages is the toddler in?

A: Trust vs. mistrust
B: Initiative vs. guilt
C: Autonomy vs. shame
D: Intimacy vs. isolation

24. A young adult is 20 years old and has been recently admitted into the hospital. According to Erickson which of the following stages is the adult in?

A: Trust vs. mistrust
B: Initiative vs. guilt
C: Autonomy vs. shame
D: Intimacy vs. isolation

25. A nurse is making rounds taking vital signs. Which of the following vital signs is abnormal?

A: 11 year old male – 90 b.p.m, 22 resp/min. , 100/70 mm Hg
B: 13 year old female – 105 b.p.m., 22 resp/min., 105/60 mm Hg
C: 5 year old male- 102 b.p.m, 24 resp/min., 90/65 mm Hg
D: 6 year old female- 100 b.p.m., 26 resp/min., 90/70mm Hg

26. When you are taking a patient’s history, she tells you she has been depressed and is dealing with an anxiety disorder. Which of the following medications would the patient most likely be taking?

A: Elavil
B: Calcitonin
C: Pergolide
D: Verapamil

27. Which of the following conditions would a nurse not administer erythromycin?

A: Campylobacterial infection
B: Legionnaire’s disease
C: Pneumonia
D: Multiple Sclerosis

28. A patient’s chart indicates a history of hyperkalemia. Which of the following would you not expect to see with this patient if this condition were acute?

A: Decreased HR
B: Paresthesias
C: Muscle weakness of the extremities
D: Migranes

29. A patient’s chart indicates a history of ketoacidosis. Which of the following would you not expect to see with this patient if this condition were acute?

A: Vomiting
B: Extreme Thirst
C: Weight gain
D: Acetone breath smell

30. A patient’s chart indicates a history of meningitis. Which of the following would you not expect to see with this patient if this condition were acute?

A: Increased appetite
B: Vomiting
C: Fever
D: Poor tolerance of light

Answer Key 21-30.

21. (B) Discharge education begins upon admit.
22. (B) Initiative vs. guilt- 3-6 years old
23. (A) Trust vs. Mistrust- 12-18 months old
24. (D) Intimacy vs. isolation- 18-35 years old
25. (B) HR and Respirations are slightly increased. BP is down.
26. (A) Elavil is a tricyclic antidepressant.
27. (D) Erythromycin is used to treat conditions A-C.
28. (D) Answer choices A-C were symptoms of acute hyperkalemia.
29. (C) Weight loss would be expected.
30. (A) Loss of appetite would be expected.

Practice Questions

11. A new mother has some questions about (PKU). Which of the following statements made by a nurse is not correct regarding PKU?

A: A Guthrie test can check the necessary lab values.
B: The urine has a high concentration of phenylpyruvic acid
C: Mental deficits are often present with PKU.
D: The effects of PKU are reversible.

12. A patient has taken an overdose of aspirin. Which of the following should a nurse most closely monitor for during acute management of this patient?

A: Onset of pulmonary edema
B: Metabolic alkalosis
C: Respiratory alkalosis
D: Parkinson’s disease type symptoms

13. A fifty-year-old blind and deaf patient has been admitted to your floor. As the charge nurse your primary responsibility for this patient is?

A: Let others know about the patient’s deficits.
B: Communicate with your supervisor your patient safety concerns.
C: Continuously update the patient on the social environment.
D: Provide a secure environment for the patient.

14. A patient is getting discharged from a SNF facility. The patient has a history of severe COPD and PVD. The patient is primarily concerned about their ability to breath easily. Which of the following would be the best instruction for this patient?

A: Deep breathing techniques to increase O2 levels.
B: Cough regularly and deeply to clear airway passages.
C: Cough following bronchodilator utilization
D: Decrease CO2 levels by increase oxygen take output during meals.

15. A nurse is caring for an infant that has recently been diagnosed with a congenital heart defect. Which of the following clinical signs would most likely be present?

A: Slow pulse rate
B: Weight gain
C: Decreased systolic pressure
D: Irregular WBC lab values

16. A mother has recently been informed that her child has Down’s syndrome. You will be assigned to care for the child at shift change. Which of the following characteristics is not associated with Down’s syndrome?

A: Simian crease
B: Brachycephaly
C: Oily skin
D: Hypotonicity

17. A patient has recently experienced a (MI) within the last 4 hours. Which of the following medications would most like be administered?

A: Streptokinase
B: Atropine
C: Acetaminophen
D: Coumadin

18. A patient asks a nurse, “My doctor recommended I increase my intake of folic acid. What type of foods contain the highest concentration of folic acids?”

A: Green vegetables and liver
B: Yellow vegetables and red meat
C: Carrots
D: Milk

19. A nurse is putting together a presentation on meningitis. Which of the following microorganisms has noted been linked to meningitis in humans?

A: S. pneumonia
B: H. influenza
C: N. meningitis
D: Cl. difficile

20. A nurse is administering blood to a patient who has a low hemoglobin count. The patient asks how long to RBC’s last in my body? The correct response is.

A: The life span of RBC is 45 days.
B: The life span of RBC is 60 days.
C: The life span of RBC is 90 days.
D: The life span of RBC is 120 days.

Answer Key 11-20.

11. (D) The effects of PKU stay with the infant throughout their life.
12. (D) Aspirin overdose can lead to metabolic acidosis and cause pulmonary edema development.
13. (D) This patient’s safety is your primary concern.
14. (C) The bronchodilator will allow a more productive cough.
15. (B) Weight gain is associated with CHF and congenital heart deficits.
16. (C) The skin would be dry and not oily.
17. (A) Streptokinase is a clot busting drug and the best choice in this situation.
18. (A) Green vegetables and liver are a great source of folic acid.
19. (D) Cl. difficile has not been linked to meningitis.
20. (D) RBC’s last for 120 days in the body.

Practice Questions

1. A nurse is reviewing a patient’s medication during shift change. Which of the following medication would be contraindicated if the patient were pregnant? Note: More than one answer may be correct.

A: Coumadin
B: Finasteride
C: Celebrex
D: Catapress
E: Habitrol
F: Clofazimine

2. A nurse is reviewing a patient’s PMH. The history indicates photosensitive reactions to medications. Which of the following drugs has not been associated with photosensitive reactions? Note: More than one answer may be correct.

A: Cipro
B: Sulfonamide
C: Noroxin
D: Bactrim
E: Accutane
F: Nitrodur

3. A patient tells you that her urine is starting to look discolored. If you believe this change is due to medication, which of the following patient’s medication does not cause urine discoloration?

A: Sulfasalazine
B: Levodopa
C: Phenolphthalein
D: Aspirin

4. You are responsible for reviewing the nursing unit’s refrigerator. If you found the following drug in the refrigerator it should be removed from the refrigerator’s contents?

A: Corgard
B: Humulin (injection)
C: Urokinase
D: Epogen (injection)

5. A 34 year old female has recently been diagnosed with an autoimmune disease. She has also recently discovered that she is pregnant. Which of the following is the only immunoglobulin that will provide protection to the fetus in the womb?

A: IgA
B: IgD
C: IgE
D: IgG

6. A second year nursing student has just suffered a needlestick while working with a patient that is positive for AIDS. Which of the following is the most important action that nursing student should take?

A: Immediately see a social worker
B: Start prophylactic AZT treatment
C: Start prophylactic Pentamide treatment
D: Seek counseling

7. A thirty five year old male has been an insulin-dependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect?

A: Atherosclerosis
B: Diabetic nephropathy
C: Autonomic neuropathy
D: Somatic neuropathy

8. You are taking the history of a 14 year old girl who has a (BMI) of 18. The girl reports inability to eat, induced vomiting and severe constipation. Which of the following would you most likely suspect?

A: Multiple sclerosis
B: Anorexia nervosa
C: Bulimia
D: Systemic sclerosis

9. A 24 year old female is admitted to the ER for confusion. This patient has a history of a myeloma diagnosis, constipation, intense abdominal pain, and polyuria. Which of the following would you most likely suspect?

A: Diverticulosis
B: Hypercalcaemia
C: Hypocalcaemia
D: Irritable bowel syndrome

10. Rho gam is most often used to treat____ mothers that have a ____ infant.

A: RH positive, RH positive
B: RH positive, RH negative
C: RH negative, RH positive
D: RH negative, RH negative

Answer Key

1. (A) and (B) are both contraindicated with pregnancy.
2. (F) All of the others have can cause photosensitivity reactions.
3. (D) All of the others can cause urine discoloration.
4. (A) Corgard could be removed from the refigerator.
5. (D) IgG is the only immunoglobulin that can cross the placental barrier.
6. (B) AZT treatment is the most critical innervention.
7. (C) Autonomic neuropathy can cause inability to urinate.
8. (B) All of the clinical signs and systems point to a condition of anorexia nervosa.
9. (B) Hypercalcaemia can cause polyuria, severe abdominal pain, and confusion.
10. (C) Rho gam prevents the production of anti-RH antibodies in the mother that has a Rh positive fetus.