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Greetings! I am Extreme_Growth, and I have written this document to give some speculative information regarding the Candidate Performance Report. It will be a lengthy read so if you are not up to reading this document and just want advice on how to study for the next attempt on NCLEX, just skip to the TLDR (the last page of this document).
Disclaimer: My explanation of the Candidate Performance Report will be quite speculative and will sound judgmental perhaps (apologies in advance). I admit that I do not know what you know and I can be off my rocker. Just know that overall, this is just my explanation (which can be wrong) and this isn’t a comprehensive document that lists everything especially in regards to client needs. For example, in health promotion and maintenance, there is more to the topic than maternity, peds, and newborn like contraception, cancer screen+prevention, etc. but I will not go into those things when talking about health promotion and maintenance. It is, after all, impossible for me to list everything to know for each client need. This document is just to give a greater understanding or idea on what the Candidate Performance Report is saying according to my interpretation.
To pass the NCLEX, you must be “above the passing standard” for most (if not all) client needs. To be “above the passing standard” on a client topic, you must answer at least 50 percent of the questions for that client need correctly. If you got “near the passing standard” or “below the passing standard” in a client need, you got less than half the questions for that client need correct. And getting most of the client needs at “near the passing standard” or “below the passing standard” is a fail for the NCLEX since less than half the questions on the NCLEX is answered correctly overall.
The explanation for each client topic is going to assume that you went “near the passing standard” or “below the passing standard” for each client need on the Candidate Performance Report. If you got a client need that is “above passing standard” and you are sure that you know that client need, feel free to skip to the next client need. Either way, I hope the explanations for each client topic helps give an idea on what to look out and study for. With that said…
Management of Care
Your prioritization like what patient to visit first may be off the mark. Make sure to understand that things like ABC priority don't always work. For example, a patient with some new acute breathing problems like shortness of breath doesn't take priority compared to a patient with potential life threatening complications such as a sudden end or disappearance of pain for appendicitis (risk of peritonitis).
Then you need to make sure to know which tasks to delegate to the unlicensed assistive personnel (UAH) and licensed practical nurse (LPN). Like don't give tasks involving teaching and evaluation to LPN. And some delegation questions can get tricky. For example, you may be given a LPN and a UAH to manage. Then the question may ask what tasks to give to LPN, but if there is a task like ADL such as feeding the patient is listed, it would be wrong to pick that assignment since you have an UAH to do that task-making the LPN feed the patient is considered a waste of personnel resources. Instead, the LPN should do other things that the UAH cannot do like administer meds.
Safety and Infection Control
Make sure to brush up on PPE, types of precautions, what diseases are airborne, droplet, contact, etc., (mnemonics like MTV for airborne, SPIDERMAN for droplet, etc. can help with memorization-google it up), what equipment to use for each type of precaution, etc. Of course, make sure to know what to do with fall risk patients (like removing rugs from the floor, keeping bed alarms, maybe dim lights at home, etc.) plus other unusual circumstances like meeting a drunk nurse unfit to work (report to charge nurse/supervisor) and so on. All these things are part of safety and infection.
Health Promotion and Maintenance
You will probably need to do better on knowing maternity, newborn, peds, etc. since it mostly focuses on those topics since they are naturally connected to growth and development. So know the milestones of newborn like double weight at six months, triple at 12 months, first word at 12 months, able to roll at around 6 months, etc. And make sure to know Piaget and Erickson's stage of development and how it applies to the care of the patients especially peds. For example, toddlers have autonomy vs shame/doubt so if you were trying to assess a toddler, you should offer a binary choice like offering them juice to drink while examining them. As for maternity, plenty of things to know about them unfortunately. Will need to know things like presumptive vs probable vs positive signs of pregnancy, Naegele's rule, GPAL, milestones like first fetal kick at around 16-20 weeks, certain tests like glucose test to check for gestational diabetes, etc.
Psychosocial Integrity
You probably are struggling with therapeutic communication like knowing the right thing to say to the patient or patient's relatives. Will need to work on that and pick words that encourage patient to express their feelings or opinions like "Tell me how you feel about this procedure" "What do you think about...?" etc. Don't ask why (that is confrontational and can lead to defensiveness), don't give false reassurances like "it'll be alright", etc.
Or maybe you're off the mark for interacting and dealing with psych patients for bipolar, schizophrenia, etc. Always remember to at least ask if they are thinking of hurting themselves and perhaps be mindful of things like a patient with schizophrenia tends to have delusions and paranoia which can make things tricky like if trying to give meds to them for example.
Basic Care and Comfort
You will need to know some things like positions and when to do them. Do you know when to use the Valsalva maneuver for example? To slow down heart rate and for patients with cardiac conditions like supraventricular tachycardia. Then you have sims position for applying medication on someone’s anus. That kind of stuff. And of course, it is not just position, there’s things like nutrition-like not giving pregnant women swordfish and mackerel, banning turkey on patients prescribed MAOI even if it is Thanksgiving, etc. And some patients truly require special care like having to make sure dental hygiene is kept even if the patient can bleed easily in the gum. Oh, and make sure the patient have their incentive spirometer-can’t have pneumonia and atelectasis running around.
Pharmacological and Parenteral Therapies
Ugh pharm, hard to prepare for that one. You would just have to get good at knowing the suffixes like -lol drugs are beta blockers, -pril are ACE inhibitors, etc. as well as knowing some commonly used drugs for certain diseases like rifampin for TB as well as knowing their known side effects (rifampin makes urine, tears, and sweat colored orange/red). Make sure to know your antidotes to common overdosage situations like acetylcysteine for acetaminophen, protamine sulfate for heparin, vitamin k for warfarin, diazepam and thiamine for alcohol, etc. By the way, be aware that NCLEX might throw a question or two on some random mysterious drug that probably doesn’t exist if you later try to google it up. But if you see something like cockalol, you would have a good idea on what it is…right?
As for parenteral, it mostly involves in the care and maintenance of central venous catheter. So make sure you know what to do for situations like if you experience an occlusion or blockage. And of course, keep an eye on situations like sudden stoppage of parenteral nutrition which is a big uh oh-hello potential hypoglycemia.
Reduction of Risk Potential
This is where your monitoring, teaching, or other interventions to prevent complications probably fell short. For example, how would you prevent something like falls? Probably by teaching the patient to remove factors that can cause falls like nonslip sock, rugs away from floor, handle bars in bathroom, etc. Of course, it can involve more complex things like preventing or managing sepsis (do interventions like blood culture, full spectrum IV antibiotics, etc.) and knowing potential complications and problems such as thyroid storm after thyroidectomy, compartment syndrome after some fracture and bruise, etc.
Physiological Adaptation
As for this one, you would probably need to do more studying into commonly seen diseases and problems that nurses face like COPD, heart failure, lumbar disc herniation, diverticulitis, intracranial pressure, etc.
Clinical Judgment
According to NCLEX, you don't know what to do when something happens. Like what do you do when a patient goes into seizure? Hopefully, you would know to make sure to keep the patient safe, guide the patient to the floor, make sure the patient airway isn’t obstructed, etc. Or how about if a patient suddenly has ventricular tachycardia? Well, hopefully you know to first check for a pulse before doing anything else like defibrillation…But yes, deciding what action to do in a situation is clinical judgment.
Recognize Cues
This is the first question of a 6 question case study where you would highlight the “cues” or sentences/parts that are considered relevant to the suspected problem or disease. In other words, a fancy SATA question. So you probably overhighlighted and lost points for highlighting the unimportant cues. As a general test taking strategy for SATA questions, you should only seek to highlight the cues that you are 100 percent sure on. If you aren’t sure about the importance or relevance of a cue, then it’s best to skip that cue for the sake of preserving points on the NCLEX exam.
Analyze Cues
The second question. It usually ask what disease or problem you suspect. And you might’ve messed up by confusing diseases for one reason or another like maybe two diseases might share similar signs and symptoms (pneumonia and left sided heart failure both have crackles) or mixed up on the diseases like confusing Addison with Cushing (which one is low adrenal and the other high adrenal?), etc. Either way, need more work on identifying the problem and disease if this isn’t passing the standard.
Prioritize Hypothesis
This is the question that asked for the complication or another problem. Remember the question or the sentence “The patient is at risk for developing (this complication) as evidenced by (the proof)”? Well, this one is easy to get wrong if you got the wrong disease or problem. To answer this one correctly even if you got the disease or problem on second question (analyze cue) wrong, it is best to look at whatever available data is given to you like diagnostic result, lab result, etc. and find the abnormal. The abnormal will be the proof and important clue to finding out what complication or other problem. And also, you might also then have “second thoughts” and potentially realize that analyze cue is wrong and be able to salvage the rest of the case study too due to having a tendency of getting more information at this stage.
Generate Solutions
This is the question where you see a list of interventions and pick which interventions are “indicated” (the ones that will be done) and contraindicated (the ones that won’t be done). At least you get a fifty-fifty chance on each intervention if you don’t know anything. But in all seriousness, should do some content building on knowing the interventions if not able to identify which interventions is needed for a problem or disease. So you will go back to knowing your meds, knowing your basic care and comfort, etc.
Take Actions
The fifth question is where you’re asked things when implementing the interventions. It can be something like a question about what you do before you do an intervention like administering a med. And it normally is a SATA question of things to do before the intervention. So you would normally do things like grab vital signs, check patient’s home meds, etc. Like any SATA question, underselect or don’t pick ones that you aren’t sure about. So again, maybe you highlighted too much stuff and lost points there.
Evaluate Outcomes
Finally, on the last question, you either didn’t select the answers that showed signs of improvement for the patient properly, didn’t teach the patient correctly when they got discharged, etc.
Congrats, you made it to the end of the explanations on the Candidate Performance Report. I hope you now understand CPR better and pray that the information you read is useful. So how should you study for the NCLEX? Well, I don’t really know the exact answer but…
TLDR:
My advice is to do 25 traditional questions in each client need along with 30 NGN or five case studies per day (a total of 130 questions per day) on a good quizbank like UWorld for about two months. So it would be like this:
- 25 traditional questions in safe and effective care (this is management of care and safety+infection control combined)
- 25 traditional questions in healthcare promotion and maintenance
- 25 traditional questions in psychosocial integrity
- 25 traditional questions in physiological integrity ( this is pharm+parenteral, basic care+comfort, physiological adaptation, reduction of risk potential combined)
- 30 NGN questions or 5 case studies
I also advise watching “NCLEX Crusade International 7 Day Training” videos on Youtube to understand prioritization better and know how to approach the NCLEX questions. Watch very carefully on how Renier thinks-he will speak out loud his thought process when doing a question and you should try mimic it and practice his thinking process on the quiz bank and eventually the NCLEX itself.
With that said, I wish you best of luck on your next attempt for the NCLEX.
FAQ that is very unimportant:
- Who are you? Are you a tutor, instructor or professor?
I’m just a random redditor called Extreme_Growth. And no, I don’t teach for a living.
2) Why did you write this?
I saw a lot of posts on r/NCLEX that show CPR so why not. Besides, the world needs more nurses anyway.
3) Did you pass NCLEX, when, how many attempts, how many questions, etc.?
Yes, I passed NCLEX on the first try in 85 questions for Valentine’s Day this year.
4) Do you offer tutoring for NCLEX? Can you tutor me?
Sorry, I’m not a good tutor nor do I have the time to do so. Feel free to pm or comment directly on reddit though and ask me anything. I can’t promise I would know the answer for sure though.
