1. Strategies for Effective Test-Taking Adelita G. Cantu, PhD, RN

2. Know the parts of a test question and how to read them Three main parts: Three main parts: Background statement (brief scenario that will provide useful info to answer question) Background statement (brief scenario that will provide useful info to answer question) Stem (this contains specific problem or intent of the item, presented as question or incomplete statement & formed by subject and verb) Stem (this contains specific problem or intent of the item, presented as question or incomplete statement & formed by subject and verb) List of options (list of possible answers) List of options (list of possible answers)

3. Examples Stem forms Stem forms A young woman arrived at the hospital in early labor A young woman arrived at the hospital in early labor Which of the following signs is the best indicator that labor is progressing? Which of the following signs is the best indicator that labor is progressing? The best indicator that labor is progressing is The best indicator that labor is progressing is Background statement Stem in question form Stem in incomplete statement

4. Examples A 41-year old, at term and a diabetic, arrived at the L&D suite in early labor. A 41-year old, at term and a diabetic, arrived at the L&D suite in early labor. Which of the following assessment data should the nurse obtain upon admission? Which of the following assessment data should the nurse obtain upon admission? The assessment data that the nurse should gather include The assessment data that the nurse should gather include Background statement Stem in question form Stem in incomplete form

5. Read the question carefully before looking at the options, identify key words in the stem Stem is heart of the item Stem is heart of the item Provides the focus, directs your thinking Provides the focus, directs your thinking Key words found in the stem Key words found in the stem first, primary, initial, early, most important, except first, primary, initial, early, most important, except

6. Example A 3-year-old child was admitted to the ER after being rescued from a fire in his home. He is having difficulty breathing. A 3-year-old child was admitted to the ER after being rescued from a fire in his home. He is having difficulty breathing. An early sign of respiratory distress that you might observe is An early sign of respiratory distress that you might observe is increased pulse rate increased pulse rate cyanosis cyanosis decreased pulse rate decreased pulse rate clammy skin clammy skin

7. Identify the theme of the item, base it on info found in the stem, don’t assume A husband was admitted to the ER in delirium tremens. This admission is his third visit in 2 weeks. While waiting to see her husband, the wife said to the nurse, “What in the world can I do to help my husband get over this drinking problem?” A husband was admitted to the ER in delirium tremens. This admission is his third visit in 2 weeks. While waiting to see her husband, the wife said to the nurse, “What in the world can I do to help my husband get over this drinking problem?” The best initial response for the nurse is The best initial response for the nurse is Don’t feel guilty; I know this must be difficult for you. Don’t feel guilty; I know this must be difficult for you. Let’s go into the lounge, so we can talk more about your concern. Let’s go into the lounge, so we can talk more about your concern. You need to convince him to seek professional help. You need to convince him to seek professional help. How long has your husband been drinking? How long has your husband been drinking?

8. Answer difficult questions by eliminating the obviously wrong first Eliminate Eliminate The reread stem The reread stem Identify rationales Identify rationales Select strongest option Select strongest option If cannot eliminate, take a wild guess and select any answer. Not penalized for guessing, 25% of getting it right If cannot eliminate, take a wild guess and select any answer. Not penalized for guessing, 25% of getting it right

9. Select responses that are therapeutic, show respect and communicate acceptance A patient is recovering from a colon resection for removal of a malignant mass in the large bowel. Following breakfast one morning she tells the nurse, “I’m tired of waiting, I want my bath now. You’re never here when I need you.” A patient is recovering from a colon resection for removal of a malignant mass in the large bowel. Following breakfast one morning she tells the nurse, “I’m tired of waiting, I want my bath now. You’re never here when I need you.” Which of the following responses by the nurse is the most appropriate? Which of the following responses by the nurse is the most appropriate? “What do you mean, I ‘m never here? I spent 3 hours with you yesterday.” “What do you mean, I ‘m never here? I spent 3 hours with you yesterday.” “I’m sorry you’ve been waiting. Let’s get you comfortable now, and I’ll be back in 20 minutes to give you a bath.” “I’m sorry you’ve been waiting. Let’s get you comfortable now, and I’ll be back in 20 minutes to give you a bath.” “I’m doing my best. You know I have three other patients to take care of today, besides you.” “I’m doing my best. You know I have three other patients to take care of today, besides you.” “I must see another patient right now. She’s really sick today. I’ll be back as soon as I can. “I must see another patient right now. She’s really sick today. I’ll be back as soon as I can.

10. Know the basic principles that guide the practice of nursing Know nursing and the nursing process Know nursing and the nursing process Focus on learning principles Focus on learning principles Broad concepts Broad concepts Recognize and learn common needs and aspects of care of high-volume patient populations Recognize and learn common needs and aspects of care of high-volume patient populations

11. A 48-year-old woman was brought to a nursing home in a debilitating state with Helsink’s disease. Her husband says that she has become very unstable on her feet; her motor skills have become very spastic. She is becoming increasingly irritable and is having difficulty eating by herself. The couple appears very depressed. A 48-year-old woman was brought to a nursing home in a debilitating state with Helsink’s disease. Her husband says that she has become very unstable on her feet; her motor skills have become very spastic. She is becoming increasingly irritable and is having difficulty eating by herself. The couple appears very depressed. Following the initial assessment, the best action for the nurse is Following the initial assessment, the best action for the nurse is Give them a few hours of privacy so they can gather their composure Give them a few hours of privacy so they can gather their composure Introduce them to other clients in the day room so they won’t feel so isolated Introduce them to other clients in the day room so they won’t feel so isolated Get her settled in her room; give them a basic orientation to their immediate surroundings Get her settled in her room; give them a basic orientation to their immediate surroundings Assist her to ambulate in the corridor to regain her strength Assist her to ambulate in the corridor to regain her strength

12. Activities that would be appropriate for her are those that would allow her to Activities that would be appropriate for her are those that would allow her to Compete with others Compete with others Succeed at a task Succeed at a task Engage in social interaction Engage in social interaction Tax her thinking skills Tax her thinking skills **When you confront strange or unfamiliar background statements or vignettes, don’t panic. Proceed with the question. Look for behavior patterns or clinical portraits that will provide clues for nursing action. **When you confront strange or unfamiliar background statements or vignettes, don’t panic. Proceed with the question. Look for behavior patterns or clinical portraits that will provide clues for nursing action.

13. Look for patterns in your performance and flaws in your thinking. Analyze your test-taking behaviors, then establish strategies to correct these problems. Look for patterns in your performance and flaws in your thinking. Analyze your test-taking behaviors, then establish strategies to correct these problems. Did not recognize or remember subject matter Did not recognize or remember subject matter Did not understand subject matter Did not understand subject matter Did not recognize item idea Did not recognize item idea Did not recognize principle or rationale for correct answer Did not recognize principle or rationale for correct answer Missed key words Missed key words Did not read all distracters carefully Did not read all distracters carefully Did not understand question Did not understand question Read into question Read into question Used incorrect rationale for selecting response Used incorrect rationale for selecting response Changed the answer Changed the answer

14. Choose options that are within the realm of nursing Test questions that are action-oriented are based on clinical judgment. Test questions that are action-oriented are based on clinical judgment. A 58-year-old is recovering from a suprapubic prostatectomy. His urinary output in the past 2 days has been satisfactory; however the nurse now notices that it is becoming increasingly bloody. A 58-year-old is recovering from a suprapubic prostatectomy. His urinary output in the past 2 days has been satisfactory; however the nurse now notices that it is becoming increasingly bloody. The initial action of the nurse should be to The initial action of the nurse should be to Irrigate the Foley catheter Irrigate the Foley catheter Notify the physician Notify the physician Take vital signs Take vital signs Empty the drainage bag Empty the drainage bag

15. A patient is receiving Dilantin to stabilize his seizure condition. One morning when he is taking a walk in the hall, you, his nurse, notice his gait is extremely ataxic and that he complains of dizziness. A patient is receiving Dilantin to stabilize his seizure condition. One morning when he is taking a walk in the hall, you, his nurse, notice his gait is extremely ataxic and that he complains of dizziness. Which of the following nurse’s notes indicates that appropriate nursing action was taken? Which of the following nurse’s notes indicates that appropriate nursing action was taken? Very unsteady gait, probably owing to Dilantin toxicity. Notify MD. Very unsteady gait, probably owing to Dilantin toxicity. Notify MD. Complaining of dizziness while walking. Gait unsteady, returned to bed, BP 110/70, pulse 112, respiration 32. MD called. Complaining of dizziness while walking. Gait unsteady, returned to bed, BP 110/70, pulse 112, respiration 32. MD called. Gait very unsteady. Returned to bed. MD notified. Gait very unsteady. Returned to bed. MD notified. Gait unsteady. AM dose of Dilantin withheld. BP 110/70, pulse 112, respiration 32. Gait unsteady. AM dose of Dilantin withheld. BP 110/70, pulse 112, respiration 32.