Test Taking Strategies

Joyce Stanley, MSN, RN Assistant Professor Department of Nursing The University of North Carolina at Pembroke

Reference

 Nugent, B.M., & Vitale, B.A. (2004). Test success: Test-taking techniques for beginning nursing students (4 th 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

Options  What should the nurse do immediately before performing any procedure? a) Shut the door b) c) d) Wash the hands Close the curtain Drape the patient Correct Item

Sample 2—You try

 When providing care to a patient with a nasogastric tube, the nurse recognizes that the tube goes into the: a) b) c) d) Stomach Bronchi Trachea 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) c) d) Explaining what is being done and why Involving the family in the teaching plan 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) c) d) Back Under the breasts Glans of the penis

You pick—Is this positive or negative?

 Range of motion (ROM) exercises should NOT be done: a) b) c) d) For comatose patients On limbs that are paralyzed Beyond the point of resistance For patients with chronic joint diseases

Positive or Negative

 What position would be contraindicated for the patient who has dyspnea: a) Supine b) c) d) Contour Fowler’s 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) b) c) d) Ambivalence Sadness Anger 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) b) c) d) Raise the patient’s bed to it highest position Collect the equipment for the procedure Position the client for the procedure Explain the procedure to the client

The “complete the sentence option.”

 The primary etiology of obesity is a: a) b) c) d) Lack of balance in the variety of nutrients Glandular disorder that prevents weight loss Caloric intake that exceeds metabolic needs 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) b) c) d) Donning a mask Wearing a gown Washing the hands 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) b) c) d) Hers Mine Theirs Nobody’s

THE NURSING PROCESS

Your blueprint for success

 Five steps: 1.

2.

3.

4.

5.

Assessment Diagnosis Planning Implementation 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) b) c) d) Inspect the patient for injury Transfer the patient back to bed Move the patient to the closest chair 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 clustered data?

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 a) Excessive aphasia b) c) d) Difficulty swallowing Inability to perform ADLs 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) b) c) d) Anger Denial Depression 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) b) The patient’s bowel will function within 2 days The patient will have regular bowel elimination c) d) The patient will be at risk for impaired skin integrity 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) b) c) d) Ensure adequacy of air exchange Observe the dressing for drainage Check for infiltration 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) b) c) d) Explain the procedure to the patient Gather all equipment at the bedside Check the physician’s order 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) c) d) Sugar Liquids Margarine Teaching = implementation

Sample--Intervention

 What is the underlying rationale for turning a patient every 2 hours?

a) b) c) d) To relieve pressure To assess skin condition To ensure the skin is clean and dry 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) c) d) Weigh the patient at the end of the week Request an order for a dietary assessment 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 not all.

some correct information but 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