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The new and improved NCLEX exam

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Did anybody else go wide-eyed and slack-jawed when they took the NCLEX? I remember sitting there in front of the computer, wondering how the heck I was supposed to pick the “best” answer out of the ones in front of me, and repeating “airway…breathing…circulation” over and over, like a mantra. If anyone had done a CAT scan of my head before the NCLEX, it would’ve looked something like this:

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Ten minutes into the NCLEX, it looked a bit like this:

really-losing-it-during-nclex

Seems to me they could’ve made it a little less tricky and a bit more true to life. Like the following “improved” NCLEX exam (inspired by Allie Brosh, creator of the Better Pain Scale):

The Improved NCLEX Exam

1. You enter a room and find your patient unresponsive, dusky in color and with no visible respirations. Your first action is to:

a. Call a Code Blue
b. Stimulate the patient in an attempt to arouse him or her
c. Take your own pulse

2. Two patients are calling at the same time. Which should be your first priority?

a. The patient who is in pain
b. The patient who wants a bedpan
c. The patient who is being attacked by a grizzly bear while on fire

3. What falls into the scope of practice of the registered nurse (RN)?

a. Incision and drainage of an abscess at bedside
b. Assessment of a patient’s condition and formulation of a nursing care plan
c. Lunch whenever the opportunity presents itself

4. Choose the correct order of actions (RACE) when you have discovered a fire on your unit:

a. Resist, Argue, Cry a Lot, Escape
b. Ruminate Anxiously while Chewing Escitalopram
c. Run Away Crying “Eeeeeeeee!”*

5. A seriously intoxicated patient has a serum potassium level of 1.8, has uncontrollable shaking of the extremities and is shouting obscenities at nursing staff. Which is the most likely nursing diagnosis for this patient?

a. Risk for impaired cardiac function secondary to electrolyte imbalance
b. Risk for aspiration secondary to inhaled vomitus
c. Risk for a serious butt-kicking delivered, Jackie Chan-style, by the bedside nurse

Scoring Guide: If you picked anything but all c’s, you are not ready.

*Many, many thanks to GruntDoc for popularizing this phrase.

Agatha Lellis
Agatha Lellis is a nurse whose coffee is brought to her every morning by a chipmunk. Bluebirds help her to dress, and small woodland creatures sing her to sleep each night. She writes a monthly advice column, "Ask Aunt Agatha," here on Scrubs; you can send her questions to be answered at askauntieaggie@gmail.com.

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