Why NCLEX Exam and Real-World Nursing are NOT the Same

Nursing rational for the NCLEX Exam is NOT real-world nursing.

I am a registered nurse with over 12 years of healthcare experience.  I have vast experience preparing nurses to pass the NCLEX exam.  I am board certified through American Association of Critical Care Nurses and American Health Information Management Association.  I have worked in emergency medicine, cardio thoracic surgical services, nursing education, and nursing informatics.  I will discuss why you should not use your real-world nursing experience to answer NCLEX exam questions.

Imagine you are a nurse taking care of an elderly patient.  The patient appears disheveled and is anxious and confused.  Now imagine that during the fourth day of admission you approach the patient to administer their medications.  You notice that the patient’s armband is missing.  What is the BEST action that you should take?  This are the type of question you will see on the NCLEX exam.

1.      Have the patient’s roommate verify the patient’s name.

2.      Ask the patient to tell you their full name and date of birth.

3.      Ask another nurse to verify the patient’s name.

4.      Look in the chart at the picture of the patient.

Elderly Patient
How to pass NCLEX exam

In real life you may have to deal with a patient that frequently removes their armband.  And of course getting a new armband is like getting a full 30 minute lunch break…it just is not going to happen anytime soon.  Not to mention you have 10 other patients to pass medications and you are already 30 minutes behind because your patient with C-Diff needed to be cleaned up again.  Don’t be fooled by these type of questions on the NCLEX exam.

What are YOU going to do on the NCLEX exam?

Now in real life when you are in this situation you think to yourself…I will just ask another nurse to verify the patient’s name.  After all, someone had to give them their medications yesterday.  When you think about it, in real-world nursing most places don’t have a picture of their patients.  So the most logical real-world answer is to get another nurse to verify the patient, right?  NO, well not at least on the NCLEX exam.

NCLEX exam is expecting you to do what is taught in nursing text books.  NCLEX exam answers are based off of best practices.  The correct answer is look in the chart at the picture of the patient.  Does this answer require you to stop what you are doing? YES.  Does this answer require you to get even further behind passing your morning medications?  YES.  Does this answer ensure patient safety and the right thing to do?  YES.

I don’t have very good luck.  If I were in this situation and took the word of Nurse Jackie, she would later tell me “Oh that is Mr. Smith.  I thought you were pointing to Mr. Jones.  Mr. Jones always takes off his armband.  Mr. Smith has never done that before.”  While standing in the unemployment line after being fired I would then reconsider taking the time to go look at that picture that is in the chart.  You can find other NCLEX exam case scenarios and test prep material at www.NCLEXPreceptor.com

So what are YOU going to do?  I trust that YOU are going to look at the patient’s picture in the chart because it ensures patient safety and is a nursing best practice.  You are NOT going to do what they “usually” do on the unit at work.  As a board certified progressive care nurse I understand the stresses of nursing.  I work daily with other nurses that have felt the same way.  What I have found is that when nurses do what is best for the patient you are more likely to have better patient outcomes and advance the profession of nursing.

Learn NOT to use your nursing experience to pass the NCLEX exam. Review practice questions to pass the NCLEX exam.  Don’t use work experience to pass the NCLEX exam.  Use best practices on the NCLEX exam.

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 Post some examples of bad habits or bad nursing practices that you see at your job?

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2 thoughts on “Why NCLEX Exam and Real-World Nursing are NOT the Same

  1. I see nurses pass medications for memory and chart on the paper after med pass. I know some of our patients are long term but med orders change. I am not sure what to do

    1. It is an unsafe practice to pass medications from memory. It is easy to get patients mixed up or the wrong dose. This is one of the reason I support barcoded medication administration.

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