Test takingtechniques

Patricia M. Nugent Barbara A. Vitale

Test Success, 7th Edition

Test Success: Test-Taking Techniques for Beginning Nursing Students, 7th Edition

Patricia M. NugentBarbara A. Vitale

F.A. Davis CompanyPublishers

Patricia M. Nugent, RN, MA, MS, EdD

Barbara A. Vitale, RN, MA

PURPOSE OF PROGRAM This program is designed for nurse

educators to help beginning nursing students improve their performance on nursing examinations.

PROGRAM LEARNING OBJECTIVES

At the completion of this program the student will: Identify and explain 12 test-taking techniques to use

when taking a multiple-choice examination. Have a beginning ability to analyze the stem of a multiple-

choice question. Have a beginning ability to use test-taking techniques to

eliminate distractors in a multiple-choice question. Have a beginning ability to use multiple test-taking

techniques to answer multiple-choice questions.

TEST-TAKING TECHNIQUES1. We will review 12 test-taking techniques to help

you identify key words in the stem and learn how to eliminate options that are distractors.

2. By eliminating distractors you will increase your chances of selecting the correct answer.

3. An example of each of these techniques will be presented during the program.

PARTS OF A MULTIPLE-CHOICE QUESTION

Stem: The statement that asks a question Distractors: Options that are wrong answers Correct answer: Option that answers

the question

Technique #1 Identify if the question is asking what the

nurse should do or should not do.

IDENTIFY THE WORD IN THE STEM THAT INDICATES POSITIVE POLARITY

A question with positive polarity is asking:What response is acceptable?What action should be done?What statement is true?

A patient dies and the hospital-based practitioner pronounces death. When should the nurse begin postmortem care?

1. After significant others have an opportunity to view the remains

2. When the primary health-care provider is notified3. Once the nursing supervisor is informed4. As soon as death is pronounced

A patient dies and the hospital-based practitioner pronounces death. When should the nurse begin postmortem care?

1. After significant others have an opportunity to view the remains

2. When the primary health-care provider is notified3. Once the nursing supervisor is informed4. As soon as death is pronounced

IDENTIFY THE WORD IN THE STEM THAT INDICATES NEGATIVE POLARITY A question with negative polarity is asking:What is unacceptable?What should not be done?What is the exception to a rule?What is false or contraindicated?

WORDS THAT INDICATE NEGATIVE POLARITY

Not Avoid Never Unrelated Contraindicated

Least Except Violate Incorrect Unacceptable

WHICH WORD IN THE STEM INDICATES NEGATIVE POLARITY?

Which action by the nurse violates patient confidentiality and privacy?

WHICH WORD IN THE STEM INDICATES NEGATIVE POLARITY?

1. Interviewing a patient in the presence of others

2. Writing patient statements in the progress notes

3. Presenting the patient’s problems at a team conference

4. Sharing data about a patient at a change of shift report

1. Interviewing a patient in the presence of others

2. Writing patient statements in the progress notes

3. Presenting the patient’s problems at a team conference

4. Sharing data about a patient at a change of shift report

Identify the word in the stem that sets a priority.

Technique #2

IDENTIFY THE WORD IN THE STEM THAT SETS A PRIORITY

A word in the stem that sets a priority is asking:

What should be done first? What action or response is most important?

WORDS THAT SET A PRIORITY

Best Most Main Priority

Initial Safest Primary Greatest

WHICH WORD SETS A PRIORITY?

A patient is angry about not being able to perform activities of daily living without help. What should the nurse do to best reduce the patient’s anger?

WHICH WORD SETS A PRIORITY?

1. Disregard the behavior.2. Offer choices about care.3. Set firm limits on the behavior.4. Encourage recognition of limitations.

USE MASLOW’S HIERARCHY OF NEEDS TO IDENTIFY THE PRIORITY

Self-actualization needs are fifth-level needs. Self-esteem needs are fourth-level needs. Love and belonging needs are third-level needs. Safety and security needs are second-level needs. Physiological needs are first-level needs.

Which concern, about what a postoperative patient will be able to do, is the most common concern that the nurse needs to consider when providing preoperative teaching?

1. Eat2. Shower3. Go home4. Have visitors

Which concern, about what a postoperative patient will be able to do, is the most common concern that the nurse needs to consider when providing preoperative teaching?

1. Eat2. Shower3. Go home4. Have visitors

A primary nurse is orienting a newly admitted patient to the hospital. Which is the primary information that the nurse should review with the patient?

1. Name of the nurse in charge2. Potential date of discharge3. Daily routine on the unit4. Use of the call bell

A primary nurse is orienting a newly admitted patient to the hospital. Which is the primary information that the nurse should review with the patient?

1. Name of the nurse in charge2. Potential date of discharge3. Daily routine on the unit4. Use of the call bell

USE THE ABCs (AIRWAY, BREATHING, CIRCULATION) TO

IDENTIFY THE PRIORITY

AIRWAY PATENCY Airway patency is always the first priority

because life depends on oxygenation.

AIRWAY PATENCY Identify an option that contains content such as: Airway assessmentAn intervention to maintain airway patencyEvaluation of outcomes to interventions that facilitate

airway patency

BREATHING Once the airway is maintained, breathing

becomes the next focus.

BREATHING Identify options that contain content, such as: Assessment of breathing Interventions that facilitate breathing Evaluation of outcomes to interventions that facilitate

breathing

CIRCULATION Once the airway is patent and the patient

is breathing, circulation becomes the next focus.

CIRCULATION Identify options that contain content, such as: Assessment of circulation Interventions that facilitate circulation Evaluation of outcomes to interventions that

facilitate circulation

A nurse is caring for a patient recently discharged from the hospital. Which should be the nurse’s initial intervention?1. Providing opportunities to make choices concerning the plan

of care2. Exploring the need to modify the home environment to

prevent falls3. Teaching a family member how to feed a patient who has a

decreased gag reflex4. Encouraging the patient to ventilate negative feelings about loss

of independence

A nurse is caring for a patient recently discharged from the hospital. Which should be the nurse’s initial intervention?1. Providing opportunities to make choices concerning the plan

of care2. Exploring the need to modify the home environment to

prevent falls3. Teaching a family member how to feed a patient who has a

decreased gag reflex4. Encouraging the patient to ventilate negative feelings about loss

of independence

Identify the clang association in options.

TECHNIQUE #3

IDENTIFY THE CLANG ASSOCIATION

A clang is a word or phrase in the stem that is the same or similar to a word or phrase in an option.

Like the sound of a ringing bell, the sound is repeated. Clangs can be obvious or obscure. More often than not, an option with a clang is the

correct answer.

A patient who is incontinent of urine becomes upset. What is the best response by the nurse while changing the patient’s gown and linens?

1. “I am a nurse. This is part of my job.”2. “This doesn’t bother me. It often happens.”3. “This occurs all the time. Try not to feel bad.”4. “I am your nurse. I will change your gown and linens.”

IDENTIFY THE OBSCURE CLANG ASSOCIATION

Disoriented, confused patients who are restrained often struggle against restraints. What does the nurse conclude as the reason for this behavior? 1.Attempt to gain control2.Response to discomfort3.Effort to manipulate the staff4.Inability to understand what is occurring

Disoriented, confused patients who are restrained often struggle against restraints. What does the nurse conclude as the reason for this behavior?

1. Attempt to gain control2. Response to discomfort3. Effort to manipulate the staff4. Inability to understand what is occurring

Disoriented, confused patients who are restrained often struggle against restraints. What does the nurse conclude as the reason for this behavior?

1. Attempt to gain control2. Response to discomfort3. Effort to manipulate the staff4. Inability to understand what is occurring

Which factor identified by the nurse creates the greatest risk for a patient developing a respiratory tract infection?

1. Urinary catheter2. Long hospital stay3. Painful chest injury4. Nasogastric tube to suction

A patient has a loose, watery bowel movement in the morning. What question should the nurse ask the patient to determine if the patient has diarrhea?

1. “What did you have for dinner last night?”2. “Are you experiencing abdominal cramping?”3. “Have you been drinking a lot of fluid lately?”4. “When was the last time you had a

similar stool?”

Identify the central person in the question.

TECHNIQUE #4

IDENTIFY THE CENTRAL PERSON IN THE QUESTION

Most questions focus on the patient. Some questions focus on someone other than

the patient, such as a child, parent, or spouse. Who is the person to receive the care?

IDENTIFY THE CENTRAL PERSON IN THIS QUESTION

A nurse observes another nurse treating a patient in an abusive manner. What should the nurse do first?1.Tell the nurse in charge and write a report.2.Become a role model for the other nurse.3.Talk with the nurse about the event.4.Reassure and calm the patient.

A nurse observes another nurse treating a patient in an abusive manner. What should the nurse do first?

1. Tell the nurse in charge and write a report.2. Become a role model for the other nurse.3. Talk with the nurse about the event.4. Reassure and calm the patient.

IDENTIFY THE CENTRAL PERSON IN THE QUESTION

The patient is not always the central person in a question.

Several nurses report to the nurse manager that one of the nursing assistants takes extensive lunch breaks. What should the nurse manager do?1. Convene a group meeting of all the nursing assistants to review their

responsibilities related to time management.

2. Talk with the nursing assistant to explore the reasons for the behavior and review expectations.

3. Arrange a meeting with the nurses so they can confront the nursing assistant as a group.

4. Document the nursing assistant’s behavior and place it in the nursing assistant’s personnel file.

TECHNIQUE #5 Identify patient-centered options.

PATIENT-CENTERED OPTIONS Explore patient feelings. Identify patient preferences. Empower the patient. Afford the patient choices. Place emphasis on the patient in some way.

IDENTIFY THE PATIENT-CENTERED OPTION

A newly admitted patient appears upset and agitated. What should the nurse do to best assist this patient?1.Point out the behavior to the patient.2.Keep the patient as active as possible.3.Secure a bed rest order for the patient.4.Encourage the patient to share feelings.

A newly admitted patient appears upset and agitated. What should the nurse do to best assist this patient?

1. Point out the behavior to the patient.2. Keep the patient as active as possible.3. Secure a bed rest order for the patient.4. Encourage the patient to share feelings.

TECHNIQUE #6 Identify options that deny patients’ feelings,

concerns, or needs.

IDENTIFY OPTIONS THAT DENY PATIENTS’ FEELINGS, CONCERNS, OR NEEDS

A nurse is transferring a patient from the bed to a chair using a mechanical lift. As the nurse begins to raise the lift off the bed, the patient begins to panic and scream. What should the nurse do?1.Quickly continue and say, “It’s almost over.”2.Immediately lower the patient back on the bed.3.Say “relax” and slowly continue with the transfer.4.Stop the lift from rising until the patient regains control.

A nurse is transferring a patient from the bed to a chair using a mechanical lift. As the nurse begins to raise the lift off the bed, the patient begins to panic and scream. What should the nurse do?1. Quickly continue and say, “It’s almost over.”2. Immediately lower the patient back on the bed.3. Say “relax” and slowly continue with the transfer.4. Stop the lift from rising until the patient regains control.

What should the nurse say to a patient to reduce anxiety related to the use of oxygen via a nasal cannula?1. “This is oxygen; it will help your breathing.”2. “Keep calm because everything will be fine.”3. “It will be discontinued as soon as possible.”4. “Your health-care provider ordered this because

it’s important.”

TECHNIQUE #7

Identify words that are absolutes in options.

IDENTIFY WORDS THAT ARE ABSOLUTES IN OPTIONS

An absolute is a word or statement that conveys a thought or concept that has no exceptions.

Another term for absolute is specific determiner.

Words that are “absolutes” place limits on a statement that generally is considered correct.

Examine options with absolute words carefully. Because there are few absolutes in the world,

generally options with these words can be eliminated.

KEY WORDS THAT ARE ABSOLUTES

Just Only None Never

All Every Always

A nurse is providing perineal care for a female patient. What should the nurse do during this procedure?1.Use a new area of the washcloth for each stroke.2.Always wash from the rectum toward the pubis.3.Clean the dirtiest area first.4.Use only warm tap water.

A nurse is providing perineal care for a female patient. What should the nurse do during this procedure?

1. Use a new area of the washcloth for each stroke.

2. Always wash from the rectum toward the pubis.3. Clean the dirtiest area first.4. Use only warm tap water.

A nurse is providing perineal care for a female patient. What should the nurse do during this procedure?

1. Use a new area of the washcloth for each stroke.

2. Always wash from the rectum toward the pubis.3. Clean the dirtiest area first.4. Use only warm tap water.

What concept is most important for the nurse to consider when interacting with others?

1. Words have the same meaning for all people.2. Touch has various meanings to different people.3. Progress notes are a form of nonverbal communication.4.Patients with expressive aphasia are unable to communicate.

1. Words have the same meaning for all people.2. Touch has various meanings to different people.3. Progress notes are a form of nonverbal communication.4. Patients with expressive aphasia are unable

to communicate.

WHEN AN ABSOLUTE IS USED IN A STEM

Don’t confuse the use of absolutes in the stem versus an option.

If an absolute is used in the stem, it is a very important word.

For example: If the word never is used in the stem, it usually indicates a question with negative polarity.

What should the nurse never do when providing a massage for a patient with a stage I pressure ulcer?

What should the nurse never do when providing a massage for a patient with a stage I pressure ulcer?1.Massage directly over ischemic tissue.

TECHNIQUE #8

Identify opposites in options.

WHAT ARE OPPOSITES? Single words or phrases that reflect extremes on

a continuum Options that are extremes of a concept, principle,

or action More often than not, the correct answer is one of

the opposite options

IDENTIFY OPPOSITES IN OPTIONS

When making rounds, the nurse finds a patient in bed with the eyes closed. What should the nurse do?1.Suspect that the patient is feeling withdrawn.2.Return in a half hour to check on the patient.3.Collect more information about the patient.4.Allow the patient to continue sleeping.

When making rounds, the nurse finds a patient in bed with the eyes closed. What should the nurse do?

1. Suspect that the patient is feeling withdrawn.2. Return in a half hour to check on the patient.3. Collect more information about the patient.4. Allow the patient to continue sleeping.

When making rounds, the nurse finds a patient in bed with the eyes closed. What should the nurse do?

1. Suspect that the patient is feeling withdrawn.2. Return in a half hour to check on the patient.3. Collect more information about the patient.4. Allow the patient to continue sleeping.

While the nurse is aspirating an intramuscular injection, blood appears in the syringe. What should the nurse do?

1. Discard the syringe and prepare a new injection.2. Remove the syringe and attach a new sterile needle.3. Withdraw the needle slightly and inject the solution.4. Interrupt the procedure and notify the

health-care provider.

IDENTIFY OBSCURE OPPOSITES

A patient with cancer is concerned about having had a rapid weight loss and asks why this occurred. Which information should the nurse use as a basis for a response when answering this patient's question?§Anabolism exceeds catabolism.§Nutrients are unable to be absorbed.§Cancer increases metabolic demands.§Cell division causes an altered nitrogen balance.

A patient with cancer is concerned about having had a rapid weight loss and asks why this occurred. Which information should the nurse use as a basis for a response when answering this patient's question?1. Anabolism exceeds catabolism.2. Nutrients are unable to be absorbed.3. Cancer increases metabolic demands.4. Cell division causes an altered nitrogen balance

A nurse is obtaining a patient’s blood pressure. Which physiological action is reflected by the diastolic blood pressure?1. Contraction of the left ventricle2. Volume of cardiac output3. Resting arterial pressure4. Pulse pressure

TECHNIQUE #9 Identify equally plausible options.

WHAT ARE EQUALLY PLAUSIBLE OPTIONS?

Two or more options that are similar One option is no better than the other in relation

to the statement in the stem. If one is no better than the other, both can be

eliminated.

IDENTIFY EQUALLY PLAUSIBLE OPTIONS

What question should the nurse ask the patient before administering a medication that is teratogenic?1.“Have you ever had an anaphylactic reaction?”2.“Were you ever addicted to drugs?”3.“Do you have any allergies?”4.“Are you pregnant?”

What question should the nurse ask the patient before administering a medication that is teratogenic?

1. “Have you ever had an anaphylactic reaction?”2. “Were you ever addicted to drugs?”3. “Do you have any allergies?”4. “Are you pregnant?”

What question should the nurse ask the patient before administering a medication that is teratogenic?

1. “Have you ever had an anaphylactic reaction?”2. “Were you ever addicted to drugs?”3. “Do you have any allergies?”4. “Are you pregnant?”

A postoperative patient has a history of heart disease. Which nursing assessment is most significant when monitoring this patient?1. Pain at the site of the incision2. Alterations in fluid balance3. Irregular pulse rhythm4. Dependent edema

TECHNIQUE #10 Identify the unique option.

IDENTIFY THE UNIQUE OPTION Identify the option that is unique or

different from the others. If three options are equally plausible, then

the fourth option is unique and probably the correct answer.

IDENTIFY THE UNIQUE OPTION (cont’d)

A nurse provides preoperative teaching for a patient scheduled for surgery. What should the nurse do to ensure that the patient understands the content of the teaching session?1.Use simple vocabulary.2.Ask the patient what was learned.3.Speak distinctly when giving directions.4.Speak slowly when talking with the patient.

A nurse provides preoperative teaching for a patient scheduled for surgery. What should the nurse do to ensure that the patient understands the content of the teaching session?

1. Use simple vocabulary.2. Ask the patient what was learned.3. Speak distinctly when giving directions.4. Speak slowly when talking with the patient.

A nurse provides preoperative teaching for a patient scheduled for surgery. What should the nurse do to ensure that the patient understands the content of the teaching session?

1. Use simple vocabulary.2. Ask the patient what was learned.3. Speak distinctly when giving directions.4. Speak slowly when talking with the patient.

A nurse makes the inference that the patient may be experiencing urinary retention. Which patient response supports this inference?1. Painful micturition2. Concentrated urine3. Abdominal distension4. Functional incontinence

TECHNIQUE #11 Identify the global option.

IDENTIFY THE GLOBAL OPTION A global option is a broad general

statement, whereas the other three options are specific.

The three options that are distractors inherently are included under the umbrella of the global option that is the correct answer.

IDENTIFY THE GLOBAL OPTION

Which is the priority when the nurse cares for an older adult in the community?1.Maintaining quality of life2.Supporting rehabilitation needs3.Helping with bureaucratic paperwork4.Encouraging interaction within the family

Which is the priority when the nurse cares for an older adult in the community?1. Maintaining quality of life2. Supporting rehabilitation needs3. Helping with bureaucratic paperwork4. Encouraging interaction within the family

A nurse is planning interventions to facilitate a patient’s ability to sleep. Which action best minimizes the most common cause of insomnia?

1.Decreasing environmental noise2.Exploring emotional concerns3.Regulating room temperature4.Promoting comfort

A nurse is planning interventions to facilitate a patient’s ability to sleep. Which action best minimizes the most common cause of insomnia?1. Decreasing environmental noise2. Exploring emotional concerns3. Regulating room temperature4. Promoting comfort

TECHNIQUE #12 Identify duplicate facts among options.

IDENTIFY DUPLICATE FACTS AMONG OPTIONS

If four facts are paired differently in four options, the following applies:

If you can identify one fact that is incorrect, you can eliminate two distractors.

If you can identify one fact that is correct, you can eliminate two distractors that do not contain this fact.

You now have a 50% chance of selecting the correct answer.

IDENTIFY DUPLICATE FACTS AMONG OPTIONS

A nurse is monitoring a patient with a respiratory problem for the presence of cyanosis. Which are the most appropriate sites to assess?1.Lower legs and around the mouth2.Around the mouth and fingernail beds3.Conjunctiva of the eyes and lower legs4.Fingernail beds and conjunctiva of the eyes

A nurse is monitoring a patient with a respiratory problem for the presence of cyanosis. Which are the most appropriate sites to assess?1. Lower legs and around the mouth2. Around the mouth and fingernail beds3. Conjunctiva of the eyes and lower legs4. Fingernail beds and conjunctiva of the eyes

A patient’s total parenteral nutrition solution was administered faster than the rate that was ordered. For what response should the nurse assess the patient?

1. Osmotic diuresis and hypoglycemia2. Hypoglycemia and dumping syndrome3. Electrolyte imbalance and osmotic diuresis4. Dumping syndrome and electrolyte imbalance

A patient’s total parenteral nutrition solution was administered faster than the rate that was ordered. For what response should the nurse assess the patient?1. Osmotic diuresis and hypoglycemia2. Hypoglycemia and dumping syndrome3. Electrolyte imbalance and osmotic diuresis4. Dumping syndrome and electrolyte imbalance

USE MULTIPLE TEST-TAKING TECHNIQUES

MULTIPLE TEST-TAKING TECHNIQUES

Use multiple test-taking techniques to: Understand the stem more clearly Maximize your ability to eliminate distractors Increase your ability to focus on the remaining

options to identify the correct answer

A nurse is collecting information to prepare a teaching plan for a patient with type 1 diabetes. Which question asked by the nurse is associated with collecting information in the cognitive domain of learning?1. “How do you inspect your feet each day?”2. “Can you measure a serum glucose level?”3. “What do you know about diabetes mellitus?”4. “Are you able to perform a subcutaneous injection?”

A patient is being discharged to a nursing home. While preparing the discharge summary, the patient says, “I feel that nobody cares about me.” Which is the nurse’s best response?

1. “You feel as if nobody cares.”2. “We all are concerned about you.”3. “It’s hard to be angry at your family.”4. “Your family doesn’t have the skills to care for you.”

A patient is being discharged to a nursing home. While preparing the discharge summary, the patient says, “I feel that nobody cares about me.” Which is the nurse’s best response?

1. “You feel as if nobody cares.”2. “We all are concerned about you.”3. “It’s hard to be angry at your family.”4. “Your family doesn’t have the skills to care for you.”

TEST-TAKING TECHNIQUES

Test takingtechniques

Healthcare

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