Testing Success

Fall 2016
Most Common Testing
Mistakes
Prepare Superficially
Not preparing for class
Dont do reading in text
Not part of study group
Cram night before exam
Depend on memorizing
Rely on what you think you know
Common Mistakes
Read questions on exam incorrectly
Dont grasp what question is really asking
Misread due to hurrying
Miss key words in question
Dont read all possible responses before
forming opinion
Select wrong answer by accident
Change answer
Dont listen to inner voice / instinct
4 Levels of Thinking
Simple to Complex
Knowledge

Comprehension

Application

Analysis
Study Techniques to Increase
Knowledge
Repeatedly study content
Recite out loud
Flash cards
Write it down
Alphabet cues (3 Ps of diabetes = polyuria, polydipsia,
polyphagia)
Acronyms word formed from first letters of facts
ADLs=Activities of Daily Living
ADPIE=Assessment, Diagnosis, Planning, Interventions, Evaluation
Acrostics - phrase, motto, or verse with first letters
Fat Soluble Vitamins = A, D, E, K (All Dieters Eat
Kilocalories)
Mnemonics variation of acrostic, not every word related to
content
There are 15 grains of sugar in 1 graham cracker (15 grains
= 1 gram)
EXAMPLE OF:
KNOWLEDGE TYPE QUESTIONS
Hospice care lies in which
level of prevention?
A. Secondary
prevention
B. Morbidity
prevention
C. Tertiary prevention
D. Primary
prevention
Study Techniques to Increase
Comprehension
Explore whys and hows
Why or how is this information important?
Immobility causes pressure ulcers why
Soap helps clean the skin how
Study in small groups
Sharing promotes comprehension
Listen to impressions and opinions of others
Learn new information you may have missed
Reinforce your learning by teaching others
Lets try a Comprehension-Type Question
The nurse administers a cathartic to a patient. To
evaluate the therapeutic effect of the cathartic, the
nurse should assess the patient for:
1. Increased urinary
output
2. A decrease in
anxiety
3. A bowel
movement
4. Pain relief
Study Techniques to Increase
Application
Apply concepts to what you already know
Gravity = force that draws all mass toward the
center of the earth
How does this apply to nursing
Hang urinary catheter bag below bladder
Hang IV bag above patient
Raise head of bed for patient with dyspnea
Elevate legs of patient with edema
Lets try an Application-Type Question
When lifting a heavy patient higher in bed,
the nurse can prevent self-injury by:
1. Keeping the knees
and ankles straight
2. Straightening the
knees while bending
at the waist.
3. Placing the feet
together and keeping
the knees bent.
4. Positioning the feet
apart with one foot
placed forward.
Study Techniques to Increase
Analysis
Analysis requires you to critically think
Interpret a variety of data
Recognize commonalities, differences, and relationships
Identify differences
Causes of elevated blood pressure
Many causes, each for different reason
Fluid retention, anxiety, infection
Practice test taking
Review rationales for right and wrong answers
Increase stamina
Control physical and emotional responses
Manage time
Practice test taking techniques
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 sodium and
high in fat.
B. Low in sodium and
low in calories
C. High in sodium
and high in protein
D. High in sodium
and low in
carbohydrates
PRACTICE TEST TAKING
Taking practice tests is an excellent way to improve the
effectiveness of your learning
Reviewing the rationales for the right and wrong answers
serves as an effective study technique
Practicing NCLEX-style Qs will:
Increase your knowledge

Become more emotionally and physically comfortable

in test taking
Better at selecting the correct option
Test Taking Techniques
Most items have 4 options for responses
Chance of picking correct answer is 25%
Eliminate 1 distracter and choice of picking
correct answer is 33%
Eliminate 2 distracters and have 50/50
chance of picking correct answer

Lets look at increasing your odds

TEST EXAMPLE
What should the nurse do immediately before
performing any procedure? (STEM)
1.Shut the door (Distractor)

2.Wash the hands (Correct Answer)

3.Close the curtain (Distractor)

4.Drape the patient (Distractor)

Step 1

Break question down into its components

Stem
What is the question asking?
READ SLOWLY AND CAREFULLY
Paraphrase into your own words before looking at options
Try to answer in your own words before looking at options
Options
Dont pick one too quickly
It may contain correct information but not answer the
question asked in stem
Eliminate obviously incorrect options

Most students can reduce down to 2 possible answers

If you have no idea which one to pick. THEN WHAT?
STEP 1 QUESTION
What is the most common reason why older
adults become incontinent of urine?

Determine what the stem of the question is

asking.
What are the key words?

Put it into your own words

STEP 1 QUESTION, cont.
What is the most common reason why older
adults become incontinent of urine?
1.The muscles that control urination become weak

2.They tend to drink less fluid than younger

patients
3.Their increase in weight places pressure on the
bladder
4.They use incontinence to manipulate and control
others
Step 2
Identify key words in stem that indicate
negative polarity
Not, except, never, contraindicated,

unacceptable, avoid, least, violate

This question is concerned with what is false

If all options appear correct re-read the stem

because you may have missed a key negative

word.
Lets try a negative polarity type question:
A patient is receiving a low-sodium diet. What
food should the nurse teach the patient to avoid
because it is high in sodium?
A. Stewed fruit
B. Luncheon meats
C. Whole grain cereal
D. Green leafy
vegetables
Step 3
Identify key words in stem that set a priority
First, initially, best, priority, safest, most

Requires you to rank all options in order of

importance
If having trouble ranking
Eliminate option you think is most wrong then
next most wrong, etc.

See next slide for strategies for prioritizing

Strategies for Prioritizing
ABCs (airway, breathing, circulation)
Maslows Hierarchy of Needs
Physiological always a priority

Nursing Process (ADPIE)

Assessment must be completed before other steps

Safety of patient is going to be a priority

Rarely is call the physician a priority
Stay with your patient
Treat patient first before equipment

Lets try a Prioritizing-Type Question:

STEM
The nurse is assigned to care for a patient
who is incontinent of urine and feces. What
should the nurse use to best protect this
patients skin?

What are Key words?

Rephrase in your own words
The nurse is assigned to care for a patient who is
incontinent of urine and feces. What should the
nurse use to best protect this patients skin?
A. Incontinence pad
B. Talcum powder
C. Petroleum jelly
D. Lamb skin
 Step 4
Identify key words/clues in stem that direct
attention to content
Takes a broad concept and focuses to a more
specific aspect of the concept

Lets try a question:

STEM
To meet patients basic physiological needs
according to Maslow, what should the nurse do?
To meet patients basic physiological needs
according to Maslow, what should the
nurse do?
A. Assist patient with
meals / fluid intake
B. Pull curtain when
patient is on
bedpan
C. Respond to call
light immediately
D. Raise both side
rails on the bed
Step 4
Word / phrase in the stem is significant
because it is similar to or a paraphrase of
a word or phrase in correct answer

Lets try a question:

STEM
What should the nurse do to help meet the
patients self-esteem needs?

Key words?

Rephrase
 What should the nurse do to help
meet the patients self-esteem
needs?
1. Encourage patient
to perform self care
2. Ask family to visit
more often
3. Anticipate patient
needs
4. Help patient with
bathing
Step 4
Clang Association
Word / phrase in stem is identical to word / phrase
in correct answer

Lets try a question:

STEM
What should the nurse do to meet patients
basic physical needs.

Key words?

Rephrase
What should the nurse do to meet patients
basic physical needs.
1. Pull curtain when
providing care
2. Answer call bell
immediately
3. Administer
physical hygiene
4. Obtain vital signs
Step 5
Identify patient centered options
Explore patient feelings, preferences, afford
patient choices, and empower the patient
Use therapeutic communication skills to
validate the patients feelings, fears, and
concerns
The patient is the priority

Lets try a couple Priority-Type questions:

STEM
When assisting a patient who recently had
an above the knee amputation to transfer
into a chair, the patient starts crying and
says, I am useless with only one leg.
What is the nurses best response?

Key words?
Rephrase
When assisting a patient who recently had an above the
knee amputation to transfer into a chair, the patient starts
crying and says, I am useless with only one leg. What is
the nurses best response?

A. Losing a leg can

be very difficult
B. You still have use
of one good leg
C. A prosthesis will
make a big
difference
D. Youll feel better
when you can use
crutches
An oriented patient states, I always forget the questions I
want to ask when my heath-care provider visits me. What
is the nurses best response?

A. Offer to stay when

health care provider
visits
B. Remind patient of
health care providers
next visit
C. Give patient pen and
paper to write
questions
D. Suggest family
member be present to
ask questions
Step 6
Identify specific determiners in options
A word/statement that conveys a thought or

concept that has no exceptions

Always, never, all, every, none, and only are absolutes
These statements with these words are
generally false
There are few absolutes in nursing so

examine carefully as there are some

All patients should be treated with respect
Step 6 question
A nurse should exercise caution in interviewing
patients who have an alcohol/dependence
problem because
1. These patients always exaggerate
2. These patients are never consistent
Step 7
Identify opposites in options

When options are opposites, more often than

not, one is the correct answer.
Lets try a couple of questions using
Opposites in options
STEM
A nurse understands that the progress of
growth and development in all older adults:

Key words?

Rephrase
A nurse understands that the progress of
growth and development in all older
adults:
A. Slips backwards
B. Moves forward
C. Becomes slower
D. Remains stagnent
STEM
A health care provider orders anti-embolism
stockings for a patient. When should the
nurse apply these stockings?

Key words?

Rephrase
A health care provider orders anti-embolism
stockings for a patient. When should the nurse
apply these stockings?

A. While the patient is

still in bed.
B. When patient
reports leg pain
C. When patients feet
become edematous
D. When patient gets
out of bed in the
morning.
Step 8
Identify equally plausible or unique options
2 or more options are similar/comparable,
one is no better than the other
So use If Then technique
If I perform this intervention in the option then
what will be the outcome?
Usually equally plausible options are
distracters and can be eliminated
If you find 3 equally plausible options then the
4th option will probably appear unique
Ask yourself Which of these is different?
STEM
Whatis the main reason passive range-of-
motion exercises are performed?

Key words?

Rephrase
What is the main reason for passive range
of motion exercises are performed?
A. Increase
endurance
B. Prevent loss of
mobility
C. Strengthen muscle
tone
D. Maximize muscle
atrophy
STEM
What should the nurse do immediately before
performing any patient procedure?

Key words?

Rephrase
What should the nurse do immediately
before performing any patient
procedure?
A. Shut the door
B. Wash hands
C. Close curtain
D. Drape patient
Step 9
Identify Global Options
Which option is more comprehensive than
the others

Usually a broad, general statement whereas

the distracters are more specific

Pick out the option that is different

STEM
The most effective way for the nurse to prevent
the spread of infection in the hospital is by:

Key Words?

Rephrase
Step 9 question
The most effective way for the nurse to prevent
the spread of infection in the hospital is by:
1. Administering antibiotics to sick patients

2. Limiting the spread of microorganisms

3. Isolating patients who are sick

4. Keeping all unit doors closed

STEM
When the nurse is repositioning a patient
what is the most important principle of body
mechanics?

Key words?

Rephrase
When the nurse is repositioning a patient what is
the most important principle of body
mechanics?
A. Elevating the arms
on pillows
B. Maintaining
functional alignment
C. Preventing external
rotation of the hips
D. Placing a small
pillow under the
lumbar curvature.
Step 10
Identify duplicate facts among the options

When each option contains 2 or more facts

Identify
1 fact as incorrect and can eliminate
whole option

Increases your chances of selecting correct

answers
STEM
A health care provider orders a 2-gram
sodium diet. Which group of nutrients are
most appropriate for this diet?

Key Words?

Rephrase
A health care provider orders a 2-gram sodium
diet. Which group of nutrients are most
appropriate for this diet?
A. Fruit, vegetables,
bread
B. Hot dogs,
mustard, roll
C. Hamburger,
onions, ketchup
D. Luncheon meats,
rolls, vegetables.
Step 11
Identify options that deny patient feelings,
concerns, and needs
Avoid Pollyanna syndrome not everything is
ok (nor does it have to be)
Dont diminish patient concerns, provide false
reassurances, or cut off patient
communication
Options that imply everything will be alright
deny the patients feelings, change the
subject, encourage the patient to be cheerful,
or transfer nursing responsibility to others are
usually distracters and can be eliminated
STEM
The day before surgery for a hysterectomy a
patient says to the nurse, I am worried that I
might die tomorrow. What is the nurses
best response?

Key Words?

Rephrase
The day before surgery for a hysterectomy a patient says to
the nurse, I am worried that I might die tomorrow.
What is the nurses best response?

1. It is really routine
surgery
2. The thought of
dying can be
frightening
3. You need to tell
your surgeon about
this
4. Most people who
have this surgery
survive
STEP 12
USE OF THE NURSING PROCESS

Assessment-Obtain patient information

Examples: VSs. PA, Specimens
Identify patient adaptations that are obj or subj, verbal or nonverbal,
expected (normal), unexpected (abnormal)
Use various data collection methods
Identify sources of data
Verify critical findings
Identify commonalities and differences in response to illness
Communicate info about assessment to appropriate members of
health care team
STEP 12-ASSESSMENT
Words indicating the item is looking for an
assessment:
inspect, verify, observe, determine, notify,
check, inform, question, communicate,
verbal and nonverbal S/S, stressors,
adaptations, sources, perceptions, and
assess
Lets try an Assessment-type question:
STEM
While making rounds, the nurse finds a
patient on the floor in the hall. What should
be the nurses initial response?

Key words?

Rephrase
While making rounds, the nurse finds a patient on
the floor in the hall. What should be the nurses
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
STEP 12
USE OF THE NURSING PROCESS
Analysis/Nursing Diagnosis

Validate interrelationship data

cluster data
identify clustered data as meaningful
interpret validated and clustered data
identify when additional data are needed to further
validate clustered data
identify nursing diagnoses
communicate nursing diagnoses to others.
STEP 12-NURSING DIAGNOSIS
The critical words within a test item that
indicate that the Q is focused on
analysis/nursing diagnoses include these:
valid, organize, categorize, cluster, reexamine,
pattern, formulate, nursing diagnosis, reflect,
relate, problem, interpret, contribute, relevant,
decision, significant, deduction, statement, and
analysis
STEM
The nurse understands that pressure ulcers
are most often associated with patients who:

Key words?

Rephrase
The nurse understands that pressure
ulcers are most often associated with
patients who:
A. Are immobilized
B. Have psychiatric
diagnoses
C. Experience
respiratory distress
D. Need close
supervision for
safety.
STEM
A patient who is debilitated and unsteady
when standing insists on walking to the
bathroom without calling for assistance.
This behavior best reflects a need to be:

Key words?

Rephrase
A patient who is debilitated and unsteady when standing
insists on walking to the bathroom without calling for
assistance. This behavior best reflects a need to be:

A. Alone
B. Accepted
C. Independent
D. Manipulative
STEM
The nurse assesses that a postoperative patient
has a decreased blood pressure and weak,
thready pulse and concludes that the patient
may be hemorrhaging. The nurse should
reassess the patient for the additional sign of:

Key words?
Rephrase
The nurse assesses that a postoperative patient has a
decreased blood pressure and weak, thready pulse and
concludes that the patient may be hemorrhaging. The nurse
should reassess the patient for the additional signs of:

A. Pain
B. Jaundice
C. Tachycardia
D. Hyperthermia
STEP 12-
USE OF THE NURSING PROCESS:
PLANNING

Involve the patient in the planning process

Set goals

Establish expected outcomes

Plan appropriate interventions based on their effects

Establish priorities

Anticipate patient needs

Recognize the need to collaborate with others, coordinate planned

care with other disciplines, plans must be flexible

STEP 12-PLANNING
The critical words within a test indicating an
item is focused on planning include:
Achieve, desired, plan, effective, desired
result, goal, priority, develop, formulate,
establish, design, prevent, strategy, select,
determine, anticipate, modify, collaborate,
arrange, coordinate, expect, and outcome.
STEM
The nurse is caring for a patient with a new
temporary colostomy. Which is a realistic
short-term goal for this patient?

Key words?

Rephrase
The nurse is caring for a patient with a new
temporary colostomy. Which is a realistic short-
term goal for this patient?
1. The patients bowel
will function within 2
days.
2. The patient will have
regular bowel
elimination.
3. The patient will be at
risk for impaired skin
integrity.
4. The patient will be at
risk for impaired skin
integrity.
STEM
A patient has just returned from surgery with
an IV and does not have a gag reflex.
Which planned intervention takes priority?

Key words?

Rephrase
A patient has just returned from surgery with an IV
and does not have a gag reflex. Which planned
intervention takes priority?
A. Observe the
dressing for
drainage
B. Ensure adequacy
of air exchange
C. Check for an
infiltration
D. Monitor VSs
STEP 12
USE OF THE NURSING PROCESS:
IMPLEMENTATION

Recognize steps in the implementation process

Implement a procedure or treatment

respond to life-threatening or adverse events

prepare a patient for a procedure, treatment, or surgery.

Identify safe or unsafe practice

rationalize a step in a procedure

Identify or apply concepts associated with teaching, counseling,

motivation, therapeutic communication

Identify the nurses responsibility associated with supervising and

evaluating care delivered by those to whom interventions have been

delegated.
STEP 12-IMPLEMENTATION
The critical words that indicate an item is
focused on implementation include:
Dependent, independent, interdependent,
change, assist, counsel, teach, give,
supervise, perform, method, procedure,
treatment, instruct, strategy, facilitate,
provide, inform, refer, technique, motivate,
delegate, and implement
STEM
The nurse understands that the underlying
rationale for turning a patient every 2 hours
is to:

Key Words?

Rephrase
The nurse understands that the underlying
rationale for turning a patient every 2 hours
is to:
A. Relieve pressure
B. Assess skin
condition
C. Ensure that skin is
dry
D. Provide massage
to bony
prominences
STEM
The Registered Nurse (RN) delegates the
implementation of a nasogastric tube
feeding to a Licensed Practical Nurse (LPN).
Which statement is accurate in terms of the
responsibility of the RN?

Key Words?
Rephrase
The Registered Nurse (RN) delegates the implementation of
a nasogastric tube feeding to a Licensed Practical Nurse
(LPN). Which statement is accurate in terms of the
responsibility of the RN?

A. The RN should
implement the
planned care and not
delegate
B. The LPN should
respectfully refuse to
implement this care.
C. The LPN is
accountable for his or
her own actions.
D. The RN is responsible
for delegated care.
STEP 12
USE OF THE NURSING PROCESS:
EVALUATION

Identify the steps in the evaluation process,

whether an outcome is met or not, progress or

lack of toward a goal, need to modify plan of
care in response to a change in patient status
Understand that the process of evaluation is

continuous, dynamic, and cyclical

STEP 12-EVALUATION
The critical words within a test item that
indicate that the item is focused on
evaluation, include:
Expected, met, desired, compared,
succeeded, failed, achieved, modified,
reassess, ineffective, effective, response, and
evaluate.
STEM
A patient on a bland diet complains about a
reduced appetite. What is the MOST
effective way for the nurse to determine
whether the patients nutritional needs have
been met?

Key Words?
Rephrase
A patient on a bland diet complains about a reduced
appetite. What is the MOST effective way for the nurse to
determine whether the patients nutritional needs have been
met?

1. Institute a three day

food intake study
2. Weigh the patient at
the end of the week
3. Request an order
for a dietary
assessment
4. Compare a current
weight with the
weight history.
STEM
A patient returns to the clinic after taking a
7-day course of antibiotic therapy and is still
experiencing signs of a urinary tract
infection. What should be the nurses initial
action?

Key Words?
Rephrase
A patient returns to the clinic after taking a 7-day course of
antibiotic therapy and is still experiencing signs of a urinary
tract infection. What should be the nurses initial action?
1. Arrange for the
physician to order a
different antibiotic
2. Obtain another urine
specimen for a culture
and sensitivity.
3. Determine if the patient
took the medication as
prescribed.
4. Make an appointment
for the patient to be
seen by the physician.
Summary
Break down into components
Negative polarity
Priority key words
Key words/clues directing to content
Patient centered options
Specific determiners for no exceptions
Opposite options
Equally plausible or unique options
Global options
Duplicate facts in options
Deny feelings, concerns, or needs
Best Nursing Practices Keep Patients Safe

Optimizing Every Great Decision Delivered

DONT FORGET THE NURSING PROCESS!!

General Test Taking Strategies
Follow your regular routine night before test
Go to bed usual time
Sleep deprivation decreases reactions time and
cognitive skills
Eatnormally
Relax
General Test Taking Strategies
Arrive Early for exam
Use the rest room

Relax

Meditate

Collect thoughts

Avoid comparing notes with other students

Anxiety is contagious avoid anxious

classmates
General Test Taking Strategies
Mange your time during the exam
Know how much time you have for each
question
Stay on target

Use all the time allotted

Read each item slowly

General Test Taking Strategies

Avoid reading into question

Answer question based on information given / stated
in stem
When reading stem underline important words
Dont add information from your own mind
Dont make assumptions about information given
Read all options before selecting one
Refer back only to words underline as important in stem
Dont add information to an option
Option may contain correct information but have nothing to
do with what the question is asking
General Test Taking Strategies
Make educated guesses
Reduce the number of options and guess

Trust your instincts

Do not change your answer

General Test Taking Strategies
Maintain a positive mental attitude
Too much anxiety interferes with your attention,
concentration, and problem solving ability
Feel in control by answering difficult questions
Enhance relaxation by practicing deep breathing
Tell self I am prepared to do well I studied
hard I will be successful
Go to your special place of relaxation