NCLEX Integrated Processes
On this page
Where this fits in the test plan
Integrated Processes is about 0% of the items you will see. That percentage is worth taking literally when you plan revision time: a category at 0% deserves roughly 0% of your question practice, not equal time with everything else.
| Topic | Focus | Study time |
|---|---|---|
| The Nursing Process high yield | The order that decides the answer | 10 min |
| Documentation and Reporting | Objective, timely and defensible | 9 min |
| Teaching and Learning | Readiness, method and evaluation | 10 min |
| Culture, Spirituality and Caring | Asking rather than assuming | 9 min |
The Nursing Process
The order that decides the answer
When a question asks what to do first and no client is in immediate danger, the nursing process supplies the order. Assessment nearly always precedes intervention.
Subtopics: Assessment · Analysis · Planning · Implementation · Evaluation
Assessment
Collecting subjective and objective data. Auscultating, palpating, inspecting, asking and reviewing results are all assessment.
Analysis
Interpreting the data and identifying the client problem. This is the step where the nurse decides what the data mean.
Planning
Setting measurable, client-centred, time-bound goals. A goal is written in terms of what the client will do, not what the nurse will do.
Implementation and evaluation
Carrying out the plan, then measuring the client’s response against the stated goal and revising if it was not met.
High-yield points
- If one option assesses and the client is stable, choose the assessment.
- Exceptions where you act first: obstructed airway, cardiac arrest, active haemorrhage, and a client actively harming themselves.
- A monitor alarm is answered by assessing the client, not the equipment.
- Goals are measurable: ‘the client will ambulate 20 metres with a walker by day two’ rather than ‘the client will improve mobility’.
- Evaluation asks whether the goal was met, partially met or not met, and what to change.
Documentation and Reporting
Objective, timely and defensible
Documentation items reward the objective, factual entry and reject anything that interprets, blames or is written in advance.
Subtopics: Charting principles · Error correction · Handoff · Electronic records
Objective charting
Record what was observed, measured and said, using the client’s own words in quotation marks. Avoid conclusions such as ‘appears intoxicated’.
Timeliness
Chart as close to the event as possible. Never chart before providing care, and never chart for another nurse.
Error correction
Draw a single line through the entry, write the correction with date, time and initials. Never erase, obliterate or use correction fluid.
Late entries
Label a late entry as such with the current date and time and the time of the event it describes.
High-yield points
- Do not chart that an incident report was completed.
- Do not chart in advance, even for a routine task.
- Use only approved abbreviations; some abbreviations are prohibited for safety.
- Never share electronic record credentials or leave a session open.
- Document refusals along with the teaching given about the risk.
- If it is not documented, the safest assumption is that it was not done.
Teaching and Learning
Readiness, method and evaluation
Teaching items test whether you assess readiness before teaching and whether you evaluate with teach-back rather than a yes or no question.
Subtopics: Learning readiness · Domains of learning · Teaching methods · Evaluating understanding
Readiness first
A client in pain, in severe anxiety, or who does not yet accept the diagnosis cannot learn. Address the barrier, then teach.
Three domains
Cognitive is knowing, psychomotor is doing, affective is valuing. Match the method: explanation for cognitive, demonstration and return demonstration for psychomotor, discussion for affective.
Teach-back
Ask the client to explain in their own words or to demonstrate the skill. ‘Do you understand?’ evaluates nothing.
Adult learning
Adults learn best when the content is relevant to an immediate problem, builds on what they already know, and involves them actively.
High-yield points
- The best evaluation of psychomotor learning is a return demonstration.
- Teach in short sessions and prioritise the survival skills the client needs first.
- Involve the caregiver when the client will depend on them at home.
- Written materials at about a fifth to sixth grade level, with pictures where possible.
- Reinforcement of teaching may be delegated to a licensed practical nurse; the initial teaching may not.
Culture, Spirituality and Caring
Asking rather than assuming
The safest answer in this topic is nearly always the one that asks the client about their preferences instead of acting on a generalisation.
Subtopics: Cultural assessment · Interpreters · Spiritual care · Caring behaviours
Ask, do not assume
Cultural groups are not uniform. Ask the individual client what matters to them about diet, modesty, decision-making, touch and end-of-life practices.
Interpreters
Use a trained medical interpreter. Family members, especially children, should not interpret clinical information or consent.
Spiritual care
Assess whether spiritual practice matters to the client, facilitate access to their chosen support, and do not impose or debate beliefs.
Caring behaviours
Presence, active listening, respecting dignity and privacy, and following through on commitments.
High-yield points
- Speak to and look at the client, not the interpreter.
- Ask about who makes health decisions in the family, as this varies widely.
- Accommodate dietary and modesty preferences where clinically possible.
- Never dismiss a complementary practice; ask about it and check for interactions.
- Do not pray with a client if you are not comfortable; offer to contact chaplaincy instead.
More NCLEX practice and review
Everything on this site tagged NCLEX lives in the NCLEX category.