Test Taking Skills LeeAnn Danner-Wilson Preparing the Night Before Good nights sleep Be confident (positive self talk) Eat Breakfast Set your alarm early Be prepared Avoid conversations Don t study the day of! Just a few facts.. MEMORY DUMP Nursing exams are difficult because the questions ask you to make judgments and apply information-not just recall facts. No matter how hard you study or how much you can recall, you will not pass unless you can apply your nursing knowledge and make good nursing judgments. First Things First Setting the Stage Glass House Theory your questions as if the situation were ideal, and you had ALL the resources and time needed. The only client you need to be concerned with is the one in the question Perfect Medical World Components of a Question Case Scenario or Introductory Statement: May give you information about a clinical problem, present data, or it may state a nursing topic, such as a nursing intervention or a disease. Stem: the Specific question. Asks you to solve a specific problem. Four s 1
Example A client is receiving care at the clinic. Her doctor has prescribed an iron supplement and an increased intake of Vitamin C in her diet. The nurse understands that the best rationale for increasing Vitamin C in the client s diet is to: My New Routine After reading the Question ask: What is the question telling me? What is the question asking me? Who is the patient in the question? Are there any key words? What is the issue? First Second What is the question telling me? What is the question asking me? Look at the stem!!!! The Client Who is the focus of the question? You must identify the client in the question because the answer MUST relate to the client. The client is NOT always the patient, it sometimes is a family member. Example Rationale A nurse will be going on vacation. To involve the patient in the excitement, what is the best thing the nurse should say? A. Let me tell you about the plans for my vacation. B. Tell me about some of your past vacations. C. I ll bring the brochures for you to see. D. What do you think about vacations. There are 2 people in the stem., the patient and the nurse. There are 2 clues in the stem. 1. involve the patient. To involve them the patient must be active. Eliminate 1 & 3 because they focus on the nurse. 2. Clue is the word best. Best means set a priority. Now between options 2 & 4, Option 2 requires more detailed response than option 4. 2
Third Last Key Words (Circle These) The important phrases or words in a question Early Late Immediately Most likely, least likely Initial After several days What is the issue in the question? The specific problem or subject which the question is ASKING Drug Problem Toxic Effect Behavior Disorder Procedure o o o o o After Reading the Question Cover up the answers Read each answer individually Write out beside why that question Mark out the ones that are for sure incorrect Question mark the maybes Pitfalls Reading into the question Asking well what if. Reading into the Question based on REALITY s A client is admitted to the hospital for an exploratory laparotomy. The client s daughter says to the nurse, I wish I could stay with my father, but I need to go home to see how my children are doing. I really hate to leave my father alone at this time. The best nursing response is: 1. Your father needs opportunities to be independent. This will help him become selfsufficient. 2. Your father is capable of taking care of himself. Try allowing him more independence. 3. Stress is not good for your father at this time. Perhaps you could call your children. 4. You are feeling concern for both your father and your children. Let me know when you are leaving, and I ll stay with him. 3
Eliminating Incorrect Options Distracters are incorrect options that are designed to resemble the correct answer. They are intended to DISTRACT you from answering correctly. Read your answers Cross out the no s Question mark the maybe s Misreading Test Questions Incorrectly analyze what is being asked Overlook key words Read into the question Incorrectly interpret a disorder Helpful Tips To avoid reading into the question Restate in your own words Eliminate options that includes new information Eliminate options that require you to make assumptions Problem omy problem is I get narrowed down to 2 answers and I always pick the wrong one! Guidelines If you are left with two questions marks and can t make a decision go with your gut instinct! Using a selection procedure allows you to make educated guesses. When you narrow to 2, you have a 50% chance of guessing correctly! How to Choose the between the best 2 options? Use testing strategies Global Response Similar Distracters Similar words or phrases 4
Remember Testing is like playing a game! When you want to win, you need to strategize. The following are some of your strategies! Global Response A global response is one that is a general statement and may include the ideas of other options within it. This option is often the correct answer when 2 or 3 more specific options appear equally correct. Practice Using Global Response A Client says, I am having a real problem getting pregnant. What could be wrong? Which idea should be incorporated into the nurse s response? A. Infertility is often caused by congenital anomalies of the reproductive organs. B. Infertility is sometimes precipitated by the use of over-thecounter drugs. C. Infertility is frequently caused by multiple factors rather than a single factor. D. Emotional problems, including stress, can cause a decrease in fertility. C- This is the correct answer option because it is the most global. The multiple factors may include congenital anomalies, over-the-counter drugs, and emotional difficulties. Similar Distracters Always remember there is only 1 correct answer. If 2 options say the same thing or include the same idea, they can t be correct. is the option that is different. Practice using Similar Distracters In providing care to a client with COPD, the primary nursing consideration is to: 5
s 1. Not overtire the client 2. Plan adequate rest periods throughout the day. 3. Give only low-flow oxygen. 4. Allow the client to set the pace with when walking. C- This is the correct answer when selecting an option that reflects a nursing PRIORITY. After reading all the options, you will find that this is the best one. Similar Words First use Global Response Second use Similar Distracters If still no hope, try similar words, phrases. If you find a word, feeling, or behavior used in the stem or the case scenario that is repeated in one of the options, that option MAY be the correct answer. Not the most reliable strategy Using Similar Words Four weeks after a fracture of the tibia and fibula, the nurse notes decreased breath sounds in the lower lobes of both the client s lungs. What is the nurse s best explanation of this change in breath sounds? s 1.The client did not take deep breaths while the nurse examined lower lobes. 2. Because of improper positioning, the client has developed pulmonary edema. 3. Atelectasis caused by immobility resulted in decreased breath sounds. 4. The client has lowered resistance and has caught a cold from someone else. 3- Immobility causes atelectasis, which results in decreased breath sounds. This is the most plausible reason for the decreased breath sounds. Note: Breath sounds 6
Knowledge Questions Knowledge questions require you to recall or remember information. To answer a question you need to commit facts to memory. Knowledge Question The first step of the procedure for making unoccupied bed is A. Pulling the curtain B. Washing your hands C. Collecting the linen D. Placing the bottom sheet B- because you need to know the sequence of steps in the procedure of making an unoccupied bed or the basic principles that your hands must be washed before ALL procedures. Comprehension Questions Require you to understand information. To answer a comprehension question, you must commit facts to memory as well as translate, interpret, and determine the implications of that information. Comprehension Question To evaluate the therapeutic effect of a cathartic, the nurse should asses the patient for: A. Increased urinary output B. A decrease un anxiety C. A bowel movement D. Pain Relief C- to answer this question you have to know not only that a cathartic is a potent laxative that stimulates the bowel but also that the increase in peristalsis will result in bowel movement. 7
Difference The difference between knowledge questions and comprehension questions is: to answer knowledge questions you must know facts. To answer comprehension questions you must understand the significance of the facts. Application Questions Application questions require the learner to show solve, modify, change, use, or manipulate information in a real situation or presented scenario. To answer, you must apply concept you learned previously to concrete situations. Application Question To prevent self injury when lifting a heavy patient higher in bed, the nurse should: A. Keep the knees and ankle straight B. Straighten the knees and bend at the waist. C. Place the feet together with the knees bent D. Position the feet apart with one placed forward D- To answer this question, you have to understand the principles of body mechanics. You also need to apply these principles in a particular patient care situation, moving a heavy patient higher in bed. Analysis Questions Require you to interpret a variety of data and recognize the commonalities, differences, and interrelationships among presented ideas. Make the assumption that you know, understand, and can apply information. Analysis Question A patient has dependent edema of the ankles and feet and is obese. Which diet should the nurse expect the physician to order? A. Low in salt and high in fat B. Low in salt and low in calories C. High in salt and high in protein D. High in salt and low in carbohydrates 8
B- you have to understand the relationships between salt in the diet and fluid retention, and between obesity and caloric intake. You must also understand the impact of carbohydrates, proteins, and fats in a diet for a patient with edema and obesity. You must understand and examine the information presented, identify the interrelationships among the elements, and arrive at a conclusion. Differences Analysis questions require an ability to examine information, which is a higher thought process than knowing, understanding, or applying information. Example Studying Blood Pressure First memorize the parameters of a normal blood pressure (Knowledge) Then develop an understanding of what factors influence and produce a normal blood pressure (Comprehension) Identify a particular patient situation that would necessitate obtaining a BP (Application) Differentiate among a variety of situations and determine which has the highest priority for assessing the BP (Analysis) Communication Questions Thought is If you cannot communicate therapeutically, it is difficult to practice safely. Identify the Client in the Question Identify the issue Use the Communication Tools and Blocks Tools (enhance) Blocks (interfere) Communication Tools Communication Blocks Being Silent Sitting quietly Offering Self Let me sit with you. Showing Empathy You are upset. Focusing You say that.. Restatement You feel anxious? Validation/clarification What you are saying is Giving information Your room is 423. Dealing with the here and now At this time, the problem is. Giving advice If I were you, I would Showing approval/disapproval You did the right thing Using clichés and false assurances Don t worry, it will be okay Requesting an explanation Why did you do that? Devaluing client feelings Don t be concerned.it s not a problem. Being Defensive Every nurse on this unit is exceptional. Focusing on Inappropriate issues or person Have I said something wrong Placing the client s issues on hold Talk to your doctor about that. 9
Cheating on Communication Questions NEVER answer I Always focus on feelings, thoughts, and behaviors. Usually the answer with you feel is correct. Always remember it is about the client Practice Communication techniques After one week of hospitalization, a chronic alcoholic s son visits and says to the nurse, I would do anything if my dad would only stop drinking. What would be the initial goal of the nurse s response? s 1. Have the son join a support group like Al-Anon. 2. Reinforce that the family is very supportive of his father. 3. Help the son understand that his father needs to take responsibility for his disease. 4. Help the son explain the problem as he sees it. 4. This response uses the tool of clarification. In order for the son to resolve his problem, the problem needs to be defined. This also reflects the first step of the nursing process! Priority Questions Guidelines to select priorities Maslow s hierarchy of needs Physiological needs 1st Nursing process Assessment 1st Communication theory Focus on feelings Teaching/Learning theory Focus on motivation 1 st. Assessment A client is returning from the recovery room to the surgical unit following abdominal surgery. Upon the client s arrival in the care unit, which parameter would be the initial focus of the nurse s assessment? A. Urine output B. Vital signs C. Pain in the incision D. Status of the dressing 10
B- this is the INITIAL focus of your assessment. At this time, the nurse needs to gather objective data about the client s condition. This is a critical situation in which it is necessary to implement the ABC guideline. Analysis/Diagnose The 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 most significant to include with this clustered data; s A. Expressive aphasia B. Difficulty swallowing C. Inability to perform ADL s D. Incontinence of urine and stool B- this item tests your ability to recognize a cluster of data that indicates that a patient is at risk for aspiration. Planning A nurse is caring for a patient experiencing loss of appetite (anorexia) and nausea. Which statement includes an expected outcome? s A. The patient will eat 50 percent of every meal during the next week. B. The patient has altered nutrition less than body requirements. C. The patient s privacy will be maintained when providing care. D. The patient s mouth will be cleaned every 4 hours. 11
A- In this question you have to recognize the differences among a goal, an expected outcome, a nursing diagnosis, and a nursing intervention. Implementation A post-operative client returned to the unit eight hours ago. Temperature is now 102.4F. The dressing is dry and intact. The client has not yet been out of bed, and she has complained of incisional pain and was medicated with Demorol about 30 minutes ago. What should the nurse do first? s A. Give the client Tylenol 650 mg PO immediately. B. Report the elevated temperature to the MD. C. Do a physical assessment of the client s chest. D. Send a urine specimen to the lab for culture. C- This action is the nursing priority. This question requires an analysis of the assessment data, and priority setting. Evaluation A client has been diagnosed with iron deficiency anemia. The nurse knows that the client has understood information about recommended diet for her anemia when she identifies which of the following food categories as good dietary sources of iron? s A. Fresh fruits B. Milk and cheese C. Organ meats D. Whole grain breads 12
C- A diet rich in organ meats provides iron, which is what the client needs to improve her anemia. This question focuses on evaluation of client teaching. Last minute Pointers Visualize the question Only be concerned with the client in the question Remember the Glass House Theory Pace yourself, concentrate, and focus When you get Frustrated! Stop Deep breath Positive self talk DO NOT SECOND GUESS YOURSELF!!!!!! DO NOT CHANGE ANSWERS!!!!!!!!!!! Practice Makes Perfect Remember these are test taking skills, like any skill you have to practice to get good at it! How to review for your Nursing Courses 1. Review your class notes: pay special attention to rationales for nursing interventions. If you the reason is unclear, look it up! 2. As you review, keep the nursing process in mind: 1. What should the nurse assess? 2. How should you analyze the data to come up with a nursing diagnosis? 3. How should you plan the care? 4. What should you keep in mind while implementing? 5. How should you monitor and evaluate the client s response to treatments? How to review for your Nursing Courses YOUR FOCUS in on understanding, so put everything into your own words! 4. Re-read any section of the textbook you find unclear. If you are still unclear, ask faculty! 5. Use your review materials! * Saunders NCLEX-RN review * Meds Publishing Exams 6. practice questions! 13
Meds Publishing Rule of Thumb Meds Publishing recommends you should plan to answer about 200 practice questions in preparation for a typical 50 question exam. Test Anxiety How do I deal? What is test anxiety? An uneasiness or apprehension experienced before, during, or after an examination because of concern, worry, or fear. Physical distress symptoms such as headaches, nausea, faintness, feeling too hot or too cold. Strong emotions such as wanting to cry or laugh too much, or feeling angry or helpless. The problem with The problem with test anxiety is usually its effect on thinking ability; it can cause you to blank out or have racing thoughts that are difficult to manage. What can you do to manage? Be well prepared Healthy lifestyle Think positive Thought stopping Good night s sleep Arrive on time Don t visit with others before exam What can you do to manage? Location Calm yourself Read instructions carefully Focus only on the exam Approach with confidence Eat breakfast Treat yourself! 14