NCLEX Test-Taking Strategy Tip

Tip #3: Read the stem correctly.

Make sure you understand exactly what information the question is asking. Determine whether the question is stated in a positive (true) or negative (false) format.

Watch for words that provide direction to the question. A positive or true stem may include the following: "indicates the client understands," "the best nursing action is," "the preoperative teaching would include," or "the best nursing assignment is." Also watch for words in the stem that have a negative meaning so that the question is asking for a response that is not accurate or is false. Phrases such as "is contraindicated," "the client should avoid," "indicate the client does not understand," "does not occur," and "indicates [medication, equipment, nursing action] is not working" are negative indicators. The question is asking for information that is not accurate or actions the nurse would not take. The following words or phrases change the direction of the question: except, never, avoid, least, contraindicated, would not occur. It may help to rephrase the question in your own words to better understand what information is being requested.

Example: Clients with arteriosclerotic heart disease (ASHD) go through several stages before becoming severely compromised. In considering the pathophysiology of heart disease, the nurse would identify what physical response that does not occur in the early stages of ASHD?
1. Decreased urine output
2. Dyspnea on exercise
3. Anginal pain relieved by rest
4. Increased serum triglyceride levels

Rephrase the question: What is not a characteristic finding in the early stages of ASHD? It is important to identify the key point ''early stages of ASHD" and the key words "does not occur." If you miss these essential points, you do not understand the question, and chances are you will not choose the correct answer. The correct answer is option 1; a decrease in urine output occurs when cardiac disease is advanced enough to cause a severe decrease in cardiac output and renal perfusion. All the other options occur earlier in ASHD.

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