Test Taking Skills  Apply Critical Thinking to Multiple-choice Questions. –Although we want you to know as much as possible, there is no way you can know or experience everything. –You can learn how to critically approach exam questions to maximize your test-taking success. –Knowledge+Understanding+Ability to Approach Questions

Strategy #1 Examine, reframe, critique and evaluate the stem of each question.  Question: –Leg exercises after surgery are encouraged primarily to:  First, examine, critique, evaluate the stem: –What are the key words in the question? –What do you need to know to answer this question?  Second, construct the correct answer before looking at the options. –What are the possibilities for correct answer?

Leg exercises after surgery are encouraged primarily to:  1. Promote venous return  2. Limit joint contractures  3. Prevent muscle atrophy  4. Increase muscle strength

The correct answer is: 1. promote venous return

Strategy #2: Pay careful attention to the context or focus of the question.  Question 1: Which is associated with a physiological need of a patient with a colostomy? –1. Disturbance in body image –2. Inadequate nutrition –3. Lack of knowledge –4. Skin breakdown  Question #2: Which is associated with a psychological need of a patient with a colostomy? –1. Disturbance in body image –2. Inadequate nutrition –3. Lack of knowledge –4. Skin breakdown

Answer to Question #1 is: 2. Skin breakdown. Answer to Question #2 is: 1. Disturbance in body image.

Strategy #3: Avoid reading into the question. (This is also known as: “Don’t make the patient any sicker!)  You can avoid reading into the question by: –Underline or note the important words in the question. –Do not add information from your mind. –Do not read between the lines about the information presented.  Read all the options before choosing the correct answer. –Do not add information to an option. –Do not focus only on your experiences (they my be too narrow for a point of reference. –Pretend you are are in the perfect, NCLEX hospital

Strategy #3 question: A bronchoscopy was performed on a client at 7 AM. He returns to his room and the nurse plans to assist the client with his AM care. What is the best nursing action?  1. Encourage the client to take a shower  2. Perform all his AM care  3. Postpone the AM care until the client is more comfortable and can participate  4. Cancel all of the AM care since it is not necessary to perform after a bronchoscopy

The correct answer is: 3. Postpone the AM care until the client is more comfortable and can participate.

Strategy #4: Identify key words in the question that set a priority.  “most important”  “first”  “best”  “safest”  “most’  “priority”  This type of question is asking you to put a value on each option and then place them in rank order.  Rank the options in your mind from 1-most desirable option to 4-least desirable option. The correct answer will be the option you ranked as 1.

Strategy #4 Question: A patient adaptation that may first indicate internal abdominal bleeding postoperatively would be:  1. Pain in the area of bleeding and a decreased heart rate.  2. Cool, clammy skin and a decreased heart rate.  3. Restlessness and an increased heart rate.  4. Apathy and a decreased heart rate.

The correct answer is: #3 Restlessness and an increased heart rate.

Strategy #4 continued:  If you are having trouble doing this, eliminate the option you believe to be most wrong.  Reread the question to identify a key word(s).

Strategy #4 Question:  A patient has significant short-term memory loss and does not remember the primary nurse from day to day. When the patient asks, “Who are you?” what would be the most appropriate response? –1. “You know me, I take care of you every day.” –2. “Don’t worry. I’m the same nurse you had yesterday.” –3. “My name is Sue Clark. I am the nurse caring for you. “ –4. Say nothing, because it would probably upset the patient.

The correct answer is: 3. “My name is Sue Clark. I am the nurse caring for you.”

Strategy #4…a second question.  A patient has just returned from surgery with an IV and does not have a gag reflex. Which planned intervention takes priority? –1. Ensure adequacy of air exchange –2. Observe the dressing for drainage –3. Check for IV infiltration –4. Monitor vital signs

The correct answer is; 1. Ensure adequacy of air exchange.

Strategy #4 continued:  Other tips for prioritization questions: –Think ABC’s: airway comes before breathing which comes before circulation. –Think of Maslow’s hierarchy of needs: physiologic comes before psychological. –Think of the nursing process: assessment comes before diagnosis, planning, intervention and evaluation. Look before you touch. –Think of safety issues: a first issue often is meeting basic needs of survival—oxygen, nutrition, elimination, environmental hazards. –Hand washing is nearly always the correct option.

Strategy #5: Select the most comprehensive answer.  All options may be correct but one option includes the other three or needs to be considered first. –The nurse is planning to teach a diabetic client about his condition. Prior to the teaching, what is important for the nurse to evaluate? 1. Required dietary modifications 2. Understanding of the exchange list 3. Ability to administer insulin 4. Present understanding of diabetes

The correct answer is: 4. Present understanding of diabetes.

Strategy #6: Read the stem slowly and carefully to identify words that indicate negative polarity. The question being asked is probably concerned with what is false.  Except  Never  Not  Further teaching is needed when  Violate  Avoid  Contraindicated  Which intervention is unrelated to the prevention of postoperative thrombophlebitis? –1. Massaging the legs –2. Ambulating regularly –3. Increasing fluid intake –4. Applying antiembolism stockings

The correct answer is #1 Massaging the legs.