Test Taking Strategies

Dena Evans, MPH, BSN, RN

Assistant Professor
Department of Nursing
Reference
 Nugent, B.M., & Vitale, B.A. (2004).
Test success: Test-taking
techniques for beginning nursing
students (4th ed.). Philadelphia, PA:
F.A. Davis.
What are your concerns?
 Test anxiety
 Failure
 Drawing a blank
 Attitude
The Reality
 You were selected to participate in
this program because of your ability
to achieve excellence.
 Nursing tests will be unlike any tests
you have ever taken.
 Nursing tests require more than just
“recall” of knowledge. They require
critical thinking.
First step

EMPOWERMENT
Empowerment
 Challenge negative thoughts
 Used controlled breathing
 Desensitize yourself to the fear
response
 Perform muscle relaxation
 Over prepare for each test
 Exercise regularly
Before and During the Test
 Manage your daily routine before the test
 Manage your study habits before the test
 Manage your travel on the day of the test
 Manage the supplies you will need for the
test
 Manage your own personal comfort
 Manage the test environment
 Maintain a positive mental attitude
THE MULTIPLE CHOICE
QUESTION
Components of a MCQ
 It is objective
 It has more than one answer
 In nursing, a MCQ can have a good
answer, a better answer, an even
better answer, but you need to pick
the BEST answer.
 Only one item is correct.
Components
 The entire question is called an
“item”
 Each item is made up of a “stem”
that asks the question
 Under each stem you will find your
“options.”
 Since only one option is correct, the
other options are referred to as
“distractors.”
 Sample
 What should the nurse do
Ste
m immediately before performing any
procedure?
a) Shut the door
b) Wash the hands Correct Item
Options
c) Close the curtain
d) Drape the patient
Sample 2—You try
 When providing care to a patient with
a nasogastric tube, the nurse
recognizes that the tube goes into
the:
a) Stomach
b) Bronchi
c) Trachea
d) Duodenum
The stem
 Should present a problem in a clear
and concise manner.
 It should have all of the details you
need to answer the question.
 It can be a complete or an
incomplete sentence.
 You must also consider stem polarity
when selecting the correct option.
Stem Polarity
 Can be positive or negative
 A stem with a positive polarity will ask
you to pick out the option that is true.
 A stem with a negative polarity will
ask you to pick out the option that is
not true.
 By understanding the polarity of the
question, you can eliminate wrong
answers.
Positive Polarity
 This question is concerned with the
truth, a fact, a principle.
 This question attempts to determine
if you are able to understand, apply
or differentiate correct information.
 Example
Positive Polarity Stem
 Which intervention most accurately
supports the concept of informed
consent?
a) Obtaining the patient’s signature
b) Explaining what is being done and why
c) Involving the family in the teaching
plan
d) Teaching preoperative deep breathing
and coughing
Negative Polarity
 Concerned with what is false.
 Asks a question with a negative statement.
 Typically uses words like “except,” “not,”
or “never.”
 May use other words like “contraindicated,”
“unacceptable,” “least,” or “avoid.”
 Requires that you recognize exceptions to
the rule.
Negative Polarity Stem
 On what part of the body should the
nurse avoid using soap when patient
a patient?
a) Eyes
b) Back
c) Under the breasts
d) Glans of the penis
You pick—Is this positive or
negative?
 Range of motion (ROM) exercises
should NOT be done:
a) For comatose patients
b) On limbs that are paralyzed
c) Beyond the point of resistance
d) For patients with chronic joint diseases
Positive or Negative
 What position would be
contraindicated for the patient who
has dyspnea:
a) Supine
b) Contour
c) Fowler’s
d) Orthopaedic
One More
 An older adult who is dying starts to
cry and says, “I was always
concerned about myself first and I
hurt so many people during my life.”
What is the underlying feeling being
expressed by the patient?
a) Ambivalence
b) Sadness
c) Anger
d) Guilt
THE OPTIONS
A, B, C, D and sometimes E
 Only one option in a MCQ is correct
 The typical number is 4-5 which
reduces the likelihood of guessing.
 An option can be a sentence, it can
complete the sentence started with
the stem, it can be an incomplete
sentence or it can be a single word.
The Sentence Option
 Before performing a procedure, what
should the nurse do first:
a) Raise the patient’s bed to it highest
position
b) Collect the equipment for the
procedure
c) Position the client for the procedure
d) Explain the procedure to the client
 The “complete the sentence
option.”
 The primary etiology of obesity is a:
a) Lack of balance in the variety of
nutrients
b) Glandular disorder that prevents
weight loss
c) Caloric intake that exceeds metabolic
needs
d) Psychologic problem that causes
overeating
The incomplete sentence option (missing
parts of speech subject and verb)

 Which intervention is common when

caring for all patients with infections?
a) Donning a mask
b) Wearing a gown
c) Washing the hands
d) Keeping visitors out
The one word wonder
 Which word best describes feelings
associated with a child in Erickson’s
stage of autonomy versus shame and
doubt?
a) Hers
b) Mine
c) Theirs
d) Nobody’s
THE NURSING PROCESS
Your blueprint for success
 Five steps:
1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation
Test Questions
 Are written to test your knowledge of
a specific concept, skill or theory from
the perspective of the nursing
process.
 The nursing process is your blueprint
for critical thinking!
ASSESSMENT
First Step-Assessment
 Collecting data
 Physical examination, interviewing,
reviewing
Sample--Assessment
 While making rounds, the nurse finds
a patient on the floor in the hall.
What should be the nurse’s initial
response?
a) Inspect the patient for injury
b) Transfer the patient back to bed
c) Move the patient to the closest chair
d) Report the incident to the nursing
supervisor
DIAGNOSIS
Second Step—
Analysis/Diagnosis
 Validate how your data are related
 Cluster data
 Interpret data
 Identify the need for additional data
 Identify nursing diagnoses
 Communicate the diagnoses to others
 Maslow’s hierarchy and Gordon’s
Functional Health Patters—useful
here.
Sample--Diagnosis
 A patient had a stroke that resulted in paralysis of
the right side. When clustering data the nurse
grouped the following data together: drooling of
saliva and slurred speech. Which information
would be the most significant to include with this
clustered data?
a) Excessive aphasia
b) Difficulty swallowing
c) Inability to perform ADLs
d) Incontinence of urine and stool

Remember your ABCs

Sample—Diagnosis
Interpret Data
 A patient has a loss of appetite, has
difficulty falling asleep, and has lost
interest in activities of daily living.
Which feeling reflects these
adaptations?
a) Anger
b) Denial
c) Depression
d) Acceptance
PLANNING
Third Step--Planning
 Involve the patient
 Set goals
 Establish outcomes
 Establish priorities
 Plan appropriate interventions
 Anticipate patient needs
 Recognize the need to collaborate
 Coordinate care with other disciplines
Critical words to look for
 “Achieve,” “desired,” “plan,”
“effective,” “goal,” “priority,”
“develop,” “formulate,” “establish,”
“collaborate,” “determine.”
 All of these indicate that your
question is a planning question.
 You mess up on a planning question
when you select options that:
Don’t mess up the plan!
 Don’t include the patient
 Contain inappropriate goals
 Misidentify priorities
 Reflect goals that are unrealistic or
unmeasurable
 Fail to include family members or
significant others
 Fail to coordinate and collaborate
with other health team members
Sample—Planning Question
ID Goals
 The nurse is caring for a patient with
a new temporary colostomy. Which
would be a realistic short-term goal
for this patient?
a) The patient’s bowel will function within 2 days
b) The patient will have regular bowel elimination
c) The patient will be at risk for impaired skin integrity
d) The patient’s skin will remain intact around the stoma

Patient centered, specific (measurable), realistic and

achievable within the time frame.
Sample—Planning Question
Set Priorities
 A patient has just returned from
surgery with an IV and does not have
a gag reflex. Which planned
intervention takes priority:
a) Ensure adequacy of air exchange
b) Observe the dressing for drainage
c) Check for infiltration
d) Monitor vital signs

Remember your ABCs.

IMPLEMENTATION
Fourth Step--Implementation
 Recognize steps in the process
 Implement a procedure or treatment
 Identify or respond to life-threatening or adverse
effects
 Prepare a patient for procedure, treatment,
surgery
 Identify or use concepts associated with teaching,
motivation, communication.
 Recognize the relationship between a procedure
and an expected outcome.
 Recognize when to document or report patient
care and responses
Critical words to look for
 “dependent,” “independent,”
“interdependent,” “change,” “assist,”
“counsel,” “teach,” “give,” “supervise,”
“procedure,” “treatment,” “reassess,”
“facilitate,” “delegate,” “implement.”
 All indicate an implementation
question
 You mess up when you select an
option that…..
Don’t mess up!
 Implements actions outside of your scope of practice
 Fails to identify or respond to life-threatening situations
 Fails to reassess the patient
 Fails to modify interventions based on changing patient
needs
 Fails to identify that you need additional assistance to
provide safe care
 Reflects a lack of knowledge to safely implement
interventions
 Fails to document accurately the patient’s response
 Delegate inappropriately
Sample--Implementation
 The primary nurse assigns a staff
nurse to insert an indwelling urinary
(Foley) catheter. What is the first
thing that the staff nurse should do?
a) Explain the procedure to the patient
b) Gather all equipment at the bedside
c) Check the physician’s order
d) Wash hands thoroughly
Sample --Implementation
 A patient has an order for a 2-gram
sodium diet. What should the nurse
teach this patient to avoid?
a) Salt
b) Sugar
c) Liquids
d) Margarine

Teaching = implementation
 Sample--Intervention
 What is the underlying rationale for
turning a patient every 2 hours?
a) To relieve pressure
b) To assess skin condition
c) To ensure the skin is clean and dry
d) To provide massage to bony
prominences
Implementing safe effective care
LAST BUT NOT LEAST--
EVALUATION
Evaluation
 Identify steps in the evaluation process
 Identify actual outcomes as desired or undesired
 Identify whether an outcome has been met or not
 Identify progress or lack of progress towards an
outcome or a goal
 Recognize that the process of evaluation is
continuous
 Recognize that the nursing process is dynamic
and cyclical.
Critical Words
 “expected,” “met,” “desired,”
“compared,” “succeeded,” “failed,”
“achieved,” “modified,” “reassess,”
“ineffective,” “effective,”
“compliance,” “noncompliance.”
 All indicate an evaluation question
 You mess up when options are
selected that:
Don’t mess up!
 Do not thoroughly and accurately reassess
the patient after care is given.
 Fail to appropriately cluster new data
(what step is this from?)
 Fail to determine the significance of new
data
 Come to inappropriate or inaccurate
conclusions
 Fail to modify the plan of care based on
changing patient needs or circumstances.
Sample --Evaluation
 A patient on a bland diet complains about a
poor appetite. What would be the MOST
effective way to determine whether the
patient’s nutritional needs have been met?
a) Institute a 3-day food intake study
b) Weigh the patient at the end of the
week
c) Request an order for a dietary
assessment
d) Compare a current weight with the
weight history
Sample -- Evaluation
A FEW HINTS
Before you answer
 Break it down
 Rephrase in your own words
 Read each option carefully (it may
contain some correct information but
not all.
 Identify polarity
 Identify key words in the stem that
set a priority (rank)
 Identify clues in the stem
More
 Identify patient-centered options
 Identify determiners (always, never,)
they limit your options
 Identify opposites in options—one will
be the correct answer or you can
eliminate both
 Look for equally plausible or unique
options
 Identify the global option
More
 Identify duplicate facts among the
options
 Identify options that deny patient
feelings, concerns or needs (these
are wrong).
A few final thoughts
 Arrive on time for your tests
 Bring the right tools
 Understand all of the directions before you
begin
 Manage your time wisely
 *Avoid reading into the question
 Make educated guesses
 Maintain a positive mental attitude
 Check your answers and answer sheet