Enhancing Nurses’Test-Taking Skills

Prepared by Debi Boyle RN, MSN, AOCNS®, FAANOncology Clinical Nurse Specialist

University of California Irvine Health/Chao Family Comprehensive Cancer Center

Orange, California

Adapted from material found in: Dennison RD & Rollant PD (2002). Test Taking Techniques, ANCC:

Washington D.C.

The goal of this self-study module is to provide nursing staff with critical thinking skills related to the formulation of examination test questions.

Practical tips will be provided along with sample questions and the rationale for choosing the correct answer.

On the slides with sample questions, once you have made your choice, then click the ‘Enter’ button or ‘Advance’ arrow again, and the correct choice and it’s rationale will appear on the slide.

Why This Module?

General Thoughts for Test-Taking Preparedness

Remember, certification testing is designed to measure basic competency in the area being addressed.

Study groups may be helpful if your style of learning is enhanced by discussion & dialogue about answer choice.

Memory joggers may also be helpful aligned in a mnemonic (i.e., He always is prepped (to) voice opinion – hepatic artery in, portal vein out).

Taking practice tests help to identify your weak areas & hence target topics needing further study.

Understanding the Question

Mentally highlight key points as you read the question: Age & gender. Setting (i.e., acute care, home, office/ambulatory). Medical diagnosis & co-morbidities (other

concurrent illnesses).

Look for key words such as: ‘Except’, ‘least’ or ‘never’ ‘Indicated’ or ‘contraindicated’ ‘Always’ ‘First’ or ‘priority’ ‘Best’

Understanding the Question

Read the question thoroughly; immediately eliminate wrong answers; also cross off any two options that essentially say the same thing (two answers could not be correct).

Answer easy questions first; mark those you are unsure of & return to them later; however, try not to leave questions blank … you are not penalized for guessing … test scores are based on the # of correct answers.

Deciding On the Correct Answer

Follow these tips in your decision-making: ACTUAL problems always take precedence over potential problems.

PRIORITY problems are those most life threatening.

In the absence of an urgent physiologic need, pick the choice that addresses patient safety.

Check the patient first & the equipment second. Pulmonary & cardiovascular system implications

are always the priority in a life threatening situation.

Deciding On the Correct Answer

Know your pattern of errors (this is where taking practice tests help): If you tend to answer questions

inaccurately because you don’t read the question thoroughly, after re-reading the question & you change your mind, then change your answer.

If you tend to miss questions even though you have read them thoroughly, do not change your original answer.

Question #1

A nurse would expect a patient with recently resolved pneumonia to cough up sputum that is:

1. Red, pink and frothy.2. Clear or white and thin.3. Brown or grey and smoky-smelling.4. Yellow or green and thick.

The key phrase in this question is ‘pneumonia that has recently resolved’. The question is targeting the well patient even though they have had a diagnosis of pneumonia. Hence

the correct choice = #2.

Question #2

Which roommate would you choose for a child with leukemia?

1. A teenager with leukemia.2. A child with suspected tuberculosis.3. A toddler with intestinal inflammation.4. A child with influenza.

While the question seems to point you to a choice based on the developmental age of the potential roommate, your critical thinking is required here. Is the age or the clinical status most important in selecting a roommate? Knowing immuno-compromise is a corollary of leukemia, the best choice would be to avoid potential infectious exposure & hence choose a roommate without acknowledged infection (#1).

Another way to evaluate this question, is to recognize that only one answer does not have an infection affiliation. This leaves you with the one answer that remains different than the other three.

Question #3

The most important aspect to hand washing is which of the following?

1. Soap.2. Friction.3. Paper towels.4. Warm water.

Your immediate reaction to these answer options would most likely be that they are all necessary. These types of

questions, while seemingly simple to answer, are problematic in that ‘most important’ is what they are looking for. With another review of the options, you would note that three of the four options are all items you need to wash your hands, while the fourth is not. Hence, #2 is the correct answer.

Question #4

A patient is sent home on Coumadin. The nurse is at highest risk for negligence in which of the following circumstances?

1. The patient does not wear the medic alert band after discharge from the hospital.

2. The nurse failed to document patient education regarding anticoagulant therapy.

3. The patient did not show up for the 2nd follow-up visit.

4. The nurse did not call the physician’s office with the PT results the morning of the patient’s discharge.

The key word in the stem of this question is ‘nurse’. This recognition immediately eliminates #1 & #3. Although #4 is an option, #2 would be the better choice. #4 does not tell you if the results were abnormal. #2 addresses the critical role that nurses

play in educating patients about anticoagulant therapy & this education is a major factor in promoting patient safety.

Question #5

What of the following is the major problem that occurs with severe diarrhea?

1. Fluid & electrolyte imbalance.2. Spasmodic abdominal cramps.3. Anal skin irritation.4. Disruption of lifestyle & QOL.

All of the answers are correct. However the question’s stem asked for you to prioritize by it’s verbiage the ‘major problem’. Hence the correct

answer it #1.

Question #6

A patient is to be discharged receiving long-acting doses of oral morphine sulfate. The patient has been on this medication for 2 weeks while hospitalized. Which of these foods would be recommended to reduce the risk of a significant side effect of morphine?

1. Rice cereal with whole milk.2. Peanut butter sandwiches.3. Bran cereal with 2% milk.4. Cheese sandwiches.

This question addresses two areas of critical thinking. First, is to know prominent toxicities of narcotic analgesics, particularly

associated with long-term use (i.e., constipation). Second, using the cluster technique, three of the options can cause constipation (i.e., cheese, whole milk, peanut butter) rather than prevent it, which is

what the question targeted. #3 is the correct answer.

Question #7

Which is the most comprehensive definition of the nursing process?

1. It is a nursing approach to medical diagnoses.2. It is the method by which conceptual frameworks

for nursing are put into practice.3. It is a problem solving method which includes five

steps of assessing, diagnosing, planning, intervening and evaluating.

4. Assessment is the first step in the nursing process.

The only really wrong option is #1. Option #3 is the most comprehensive. It’s length

also makes it stand out as different than the others. #3 is correct.

Question #8

Which of the following aspects of the aging process increases the risk of injury that needs to be reinforced to the ancillary staff?

1. Decreased lung elasticity.2. Decreased visual acuity & altered proprioception.3. Decreased peristalsis.4. Decreased cardiac contractility.

There are two major foci in the stem of the question that need to be considered: ‘risk of injury’ & ‘ancillary staff’.

Injury is most likely associated with physical movement and mobility/activity is a frequent intervention by ancillary staff (either nursing aides, physical therapists). While you might

think that peristalsis is associated with problematic constipation (another foci for nursing aides) this option only implies this rather than stating it outright. Hence #2 is the

correct answer.

Question #9

A woman is in active labor on the way to the hospital. What should the nurse do first once the patient is placed in the bed?

1. Check the vital signs.2. Get a urine sample.3. Check the cervix.4. Evaluate the intensity of contractions.

The woman is in active labor, a key point in this scenario. Though all the options are appropriate,

checking the cervix (#3) is most important.

Question #10

Your patient is dying of cancer with metastases to the brain. He has asked you not to allow his sister to visit. Today he is unconscious. His sister calls the unit crying and requests that she be allowed to visit. What is the most appropriate response?

1. Gently explain that it was the patient’s wish for her not to visit.

2. Tell her that she will have to have the chaplain’s permission to visit since he was counseling the patient about his dying.

3. Let her visit for a few minutes only.4. Let her sit by the bedside for as long as she wants.

Regardless of the patient’s capacity to respond, if the patient relayed wishes to you about his care, you must still

honor these requests. Also note in these answers, that options #2, 3, 4, all have the potential to allow the sister to

visit. #1 is the correct response.

Question #11

The most important nurse responsibility to prevent complications during mannitol infusion is to:

1. Position patient in a prone position & administer drug via deep IM injection.

2. Include an in-line filter for the prevention of particulate matter infusion.

3. Monitor blood pressure every 15 minutes x 1 hour.

4. Evaluate urine output for response to mannitol.The most important clues in the question’s stem are the

words ‘during infusion’ and ‘prevent complications’. Option #1 would immediately be eliminated because the IM

administrative route is not intravenous. Options #3 & 4 do not describe behaviors that are preventive in nature. Hence,

#2 is the correct answer

Question #12

A patient is scheduled for a liver biopsy in two days. The pretest lab work has returned to the outpatient office. Which of these reports is a priority for the nurse to notify the physician about by the end of the day?

1. Hemoglobin of 10.5 grams/dl.2. Activated prothrombin time of 45 seconds.3. Elevated ALT & AST.4. Elevated ammonia level.

All of the answer options identify abnormal findings. Think about the significance of these to determine your priority in this patient’s case. Hemoglobin is low but not life threatening. With significant

liver compromise that may have prompted biopsy, ALT & AST increases could be expected. An ‘elevated ammonia level’ does not tell how bad it is. Due to the vascularity of the liver, a major

complication post-biopsy is bleeding, hence #2 is correct.

Test Taking Skill Enhancement

When you think a question is too difficult, take a minute and consider if you are reading too much into it.

Close your eyes, take a deep breath. Then open your eyes & reread the

question with a fresh perspective. Underline clues in the question

stem.

Final Thoughts

Negative test-taking results may not mean you have inadequate knowledge in the subject matter. It may correspond with a lack of skill in clearly considering the test question.

Considerations these issues specific to skill-building in test-taking will hopefully foster a positive outcome in your certification examination experience.

Disclaimer

Please Note: ONCC does not guarantee success on a certification examination with the use of these strategies.