Taking and Passing Tests

J o s e p h T. C a t a l a n o

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Learning Objectives
After completing this chapter, the reader will be able to: Discuss the importance of a positive attitude when taking examinations. Recognize the importance of careful reading of questions and answers. Use critical thinking in identifying the key information sought in the question stem. Apply key test-taking strategies to help improve examination grades where the students knowledge may be lacking.

TEST-TAKING STRATEGIES
Knowledge First
he multiple-choice question test format is one of the most commonly used. Of course the best way to get a good grade on any exam is to know the material. There is no substitute for knowledge. However, some individuals seem always to do well on multiple-choice question tests, whereas others seem to have problems with that test format. The individuals who always do well are not necessarily more intelligent than you; rather, they may have intuitively mastered some of the strategies or tricks necessary to do well on multiple-choice tests. Fortunately, once you become aware of these strategies and master them, you also will be able to improve your scores on this type of examination format. Knowing the material is the most important determinant of your grade on an exam. However, knowing how to take a multiplechoice examination and optimizing the selection of the correct answers is a skill that will help you score higher than you might otherwise have.

The best way to get a good grade on any exam is to know the material. There is no substitute for knowledge.

Strategy in Action
When mastery of test taking skills is combined with knowledge of the key material, the probability of passing any exam, including the National Council Licensure Examination (NCLEX), increases

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greatly. The following section lists and describes these important test-taking strategies that can be used when taking classroom exams, the NCLEX, or certification exams. Strategies 1 to 11 work best when you know the material pretty well and you are fairly confident about the correct answer. Strategies 12 to 34 can be used when you are unsure of the material or do not have a clue about what the question is asking. A number of sample questions throughout the chapter demonstrate how the particular test taking strategy might help you answer the question. Try to answer the question the best you can before checking the answer at the end of the chapter. STRATEGY 1. Think positive and avoid test anxiety. The night and morning before the exam, sit back, relax, and say the following to yourself: I am intelligent and I will pass. Ill show the instructor that I can do it. I can do well on this exam. Avoid negative people; dont even talk to them! STRATEGY 2. Cover up the answers and read the question carefully, trying to formulate your own answer. Looking at the answers right away pulls your attention away from the question. As you read the question and answers, try to understand what knowledge the question is asking for. Clarify the Question. Look for and make a mental note of any key words, qualifiers, or statements that may help select the correct answer or eliminate the incorrect ones. Ask yourself: What is this question really asking? Rephrase it in your own words. It will usually be about a disease process, client problem or nursing action, or a symptom. Look at the details. Is it asking for a nursing action? A client response? A family response? Every word counts. If the question provides information about client age, gender, or marital status, it is probably important in selecting the correct answer, especially on the NCLEX. Restate the Question. Ask yourself, What information do I need to have to answer this question? Is there information in the client situation I can use to answer the question? What type of information is the question stem asking me for? Restate the question in your own words to see if you really understand it. Create a mental pool of answers before you look at the answers given to the question. Then see

if any of your answers are similar to those that are provided. One Question at a Time. Treat each question individually. Use only the information that is provided for that particular question in answering. Even though there may be client situations somewhere else in the examination that are similar to the one you are currently working on, avoid returning mentally to these previous items for help. You should also be careful about reading into a question information that is not actually provided. Avoid making clients in the questions sicker than they already are. Avoid recalling exceptions or unusual clients that you may have encountered in your clinical rotations when trying to answer questions.

Remember that there are no staffing shortages or lack of equipment in the NCLEX hospital. If the question mentions a piece of equipment, you can use it in the answer. By and large, questions on the NCLEX ask for textbook levels of knowledge of the material. Instructors will often give you study guides that outline the type of material they will include on their tests. Lets practice restating the question and figuring out what knowledge is required: 1. A client is admitted with sudden acute respiratory syndrome (SARS). Which statement made by the client indicates that additional teaching is required? 2. A postpartum client is being sent home with a prescription for methylergonovine (Methergine) 0.4 mg. What should the nurse include in the discharge teaching plan? STRATEGY 3. Uncover the answers one by one and ask yourself, Does it answer the question? Eliminate the incorrect answers and then leave them alone. Read all the answers carefully. Priority-type questions may have more than one correct answer. Many

Avoid making clients in the questions sicker than they already are. Avoid recalling exceptions or unusual clients that you may have encountered in your clinical rotations when trying to answer questions.

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mistakes are made on this type of examination because the person taking the test did not read all parts of the question carefully. Look for the most specific answer to the question. Restate this question, figure out what knowledge is needed, and then make a mental pool of answers before looking at the answers given: 3. Identify the nursing action that is most effective in preventing autonomic dysreflexia in a client with a spinal cord injury. a. Give the client a PRN dose of oxazepam (Serax) before PT (possible) b. Keep the client in the sitting position as much as possible (no) c. Encourage a fluid intake of at least 1000 mL per day (no) d. Maintain the patency of the urinary catheter (possible) 4. A 22-year-old woman is brought into the ER for a fractured radius by her boyfriend who said she fell off the sofa when napping. The nurse finds new injuries on top of old injures upon exam. How should the nurse chart these findings? a. Three new and four old ecchymotic areas located on right and left arms (possible) b. Many injuries on arms from physical abuse (no) c. Ecchymotic areas on both arms from unknown reasons (possible) d. Several injuries on arms from what looks like a baseball bat (no) STRATEGY 4. Make sure you are actually seeing the words in the question and the answers. Picture what the words are saying about the question and examine the root words, suffixes and prefixes. A large percentage of mistakes are made because test takers misread the question. Sample question for strategy 4: 5. A client who was in an automobile accident has been in skeletal traction for 10 days. Identify the complication the nurse will anticipate for this client. a. Orthostatic hypotension b. Diarrhea c. Muscular hypertrophy d. Decreased level of consciousness STRATEGY 5. Take the time to do the test well the first time. After you select an answer, go back and reread the question to make sure they match. On your

class tests, do not go back at the end and reread all the questions and answers. Mark the ones you are unsure of as you go through the first time and then go back and look only at those. You cannot do this on the NCLEX because once an answer is selected, the question cannot be accessed again. Sample question for strategy 5: 6. Select the nursing action that is most helpful in relieving the pain from an episiotomy in a 1 day postpartum client. a. Increase fluid intake to 2000 to 3000 mL per day. b. Encourage the client to breast-feed the infant every 3 hours or on demand. c. Apply cold compresses to the perineum every 2 hours. d. Administer methylergonovine (Methergine) as prescribed PRN. STRATEGY 6. Dont spend a lot of time on questions you dont know. Manage your time wisely, but dont rushuse all the available time. Generally allow 1 minute per question. If you are spending more than 2 minutes on any question, put an answer down and move on to the next question if you are taking the NCLEX or, on classroom tests, put a mark by the question and come back to it later on. Although the NCLEX examination, strictly speaking, is not timed, the graduate is never sure how many questions will need to be answered. If you plan on taking all 265 questions in 6 hours, you will need approximately 80 seconds per question. Actually, most individuals who take this type of test average approximately 45 seconds per question; thus, it is likely that you will be finished well before the time limit is reached. Take a watch along to the examination. Theoretically, you could sit in front of the computer screen for 6 hours with the same question. There is a mandatory 10-minute break at 212 hours and another optional break at 4 hours. Of course, breaks can be taken any time during the exam, but that time is lost from the total allowed time. STRATEGY 7. Dont change your answers! Trust your intuition. When a question and the answers are read for the first time, an intuitive connection is made between the right and left hemispheres of the brain. The end result is that the first answer selected is usually the best choice. Educational psychologists

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have shown that test takers change the wrong answer to the correct answer only around 1% of the time. Most of the time they change the correct answer to the wrong answer or one wrong answer to another wrong answer.

who were just started on antibiotics. A client newly diagnosed with diabetes will require different care than a 10-year diabetic. Sample question for strategy 8: 7. Identify the assessment of a client who had a neuroblastoma removed 3 hours ago that would require immediate intervention by the nurse. a. Diminished appetite b. Pinkish tinged urine c. Temperature of 99.8F d. Dressing saturated with bright red blood STRATEGY 9. Look for priority or qualifying words in the question stem. Some important words can help determine what type of information is being elicited in the answer. Some of these words are: First Best Most Initial Better Fastest Highest priority

Dont change your answers! Trust your intuition.

When you read a question too many times, you may start to read into it elements that are really not there. On the NCLEX, once an answer is selected, it cannot be changed, but on class tests, change answers only when you are 100 percent sure that the answer you are changing to is correct. If there is any doubt at all, dont change your answer. STRATEGY 8. Pay attention to where the client is in the recovery/disease process. One day postoperative clients have different needs than 4 day post op clients. The assessments of clients who have been on antibiotics for a week will be different from clients

When words like these appear in the question stem, it is an indication that more than one of the choices are correct and perhaps all four of them are correct. The task then becomes selecting the one answer that should be first or the answer that ought to receive the highest priority. Remember Maslows hierarchy of needs (physiological and safety have highest priority), the ABCs (airway, breathing, circulation) of cardiopulmonary resuscitation (CPR), and nursing process. The first step in the nursing process is always assessment, so if you have a question asking about what the nurse should do first, look for the answer with an assessment in it. Remember to always assess the client before the equipment. Sample questions for strategy 9: 8. A client is admitted with the symptoms of anthrax infection, including fever of 102F, severe dyspnea, tachypnea, and chest pain. Which nursing diagnosis has highest priority? a. Anxiety related to fear of death b. Pain related to pressure on the sternum c. Hyperthermia related to bacterial infection d. Ineffective airway clearance related to retained respiratory secretions 9. A 62-year-old client who has a history of coronary artery disease is brought into the emergency room

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(ER) complaining of chest pain. What action should the nurse take first? a. Give the client nitroglycerin gr 1/150 sublingual now. b. Call the clients cardiologist about his admission. c. Check his blood pressure and note the location and degree of chest pain. d. Place the client in an elevated Fowlers position after loosening his shirt collar. 10. A client diagnosed with sickle cell disease is admitted in acute crisis. Which action by the nurse has highest priority? a. Open the airway and begin high-flow oxygen therapy. b. Administer prescribed narcotic pain medications c. Establish a strong therapeutic relationship d. Begin prescribed rehydration with IV fluids STRATEGY 10. For delegation questions, match the activity with the person. Know the persons skill level and education. Know the job description. Evaluate the clients status (acute not appropriate vs. chronic OK to assign; unstable not appropriate vs. stable OK to assign. LPNs can do most skills but for the NCLEX: Cannot do admission assessments Cannot give IV push medications Cannot write nursing diagnoses Cannot do most teaching Cannot do complex skills Cannot take care of clients with acute conditions Cannot take care of unstable clients UAPs/CNAs/Aides on the NCLEX: Look for the lowest level of skill required for the task. Look for the most uncomplicated task. Look for the most stable client. Look for the client with the chronic illness. In the real world of health care, these individuals often perform functions beyond their legal scope of practice, but for the NCLEX, these are the general limitations. Sample questions for strategy 10: 11. Identify the task that the RN may delegate to an LPN if all of the clients are stable

a. Adding potassium (KCL) to a bag of D5W that is already hanging b. Developing a nursing diagnosis for a newly admitted client with diarrhea c. Teaching a newly diagnosed diabetic client how to self-administer insulin d. Turning a comatose client with a head injury side to side every 2 hours 12. Which client would be most appropriate for the charge RN to assign to an LPN? a. A ventilator-dependent client with COPD b. A client with dementia who is clutching her chest c. A client with a history of head trauma transferred from the ICU 1 hr ago d. A newly admitted client who is vomiting bright red blood 13. The medical unit is staffed today with three RNs and one LPN. To which client would it be appropriate to assign the LPN? a. A man with TB who is being discharged today b. A woman who fell and is now in skeletal traction c. A woman who is scheduled for an EGD d. A man newly diagnosed with gout 14. Select the task that is most appropriate for the RN to delegate to a CNA. a. Suction a client with a new tracheostomy b. Change a sterile dressing on a 60-year-old man with fresh skin grafts c. Complete the initial postoperative assessment on a client just returned from the RR. d. Obtain the temperature of a 29-year-old woman who is receiving the final 30 minutes of a whole blood transfusion. STRATEGY 11. Once you realize something is seriously wrong with the client, do NOT delay care! Serious conditions require immediate treatment. Delaying action only allows the client to die slowly rather than quickly. Sample question for strategy 11: 15. While the labor and delivery nurse is administering IV oxytocin (Pitocin) to augment labor, he or she notices that the fetal monitor is showing late decelerations and loss of beat-to-beat variability. What is the initial action the nurse should take? a. Re-assess the FHT in 15 min. b. Call the physician immediately. c. Increase the rate of the primary IV. d. Turn off the medication.