Test Taking Skills Nataliya Lishchenko TSMU School of Nursing

Test Taking SkillsTest Taking Skills

Nataliya LishchenkoNataliya Lishchenko

TSMU School of NursingTSMU School of Nursing

What is NCLEXWhat is NCLEX

In April 1994 nurse licensureIn April 1994 nurse licensure candidates began candidates began taking thetaking the National Council LicensureNational Council Licensure Examination (NCLEX®) on aExamination (NCLEX®) on a computer at test computer at test centerscenters located across the Unitedlocated across the United States and States and its territories. its territories.

National CouncilNational Council of State Boards of Nursingof State Boards of Nursing (NCSBN).(NCSBN).

The NCLEX examinationsThe NCLEX examinations are only provided inare only provided in a computerized adaptivea computerized adaptive testing format.testing format.

Pass rates?Pass rates?

For more informationFor more information

http://www.ncsbn.orghttp://www.ncsbn.org http://www.pearsonvue.com/nclex/#tutorihttp://www.pearsonvue.com/nclex/#tutori

alal

Factors that negatively affect NCLEX scores:

1. English as a second language 2. Working more than 20 hours per week 3. Family responsibilities 4. A delay of five months or more

between graduation and taking the NCLEX examination

Factors that positively affect NCLEX scores:

1. Taking the NCLEX examination within three months of graduation

2. Familiarity with computer test-taking 3. Strong English skills

Anatomy of a TestAnatomy of a TestThe The STEMSTEM is the initial part of the question is the initial part of the question

and can:and can:

Be a complete or incomplete sentence.Be a complete or incomplete sentence.

Have positive or negative polarity.Have positive or negative polarity.

If it is a complete sentence:If it is a complete sentence: STEM can stand alone.STEM can stand alone. Poses a question.Poses a question.

Example:Example:

What should be the first action of the nurse when a What should be the first action of the nurse when a fire alarm rings in a health care facility?fire alarm rings in a health care facility?a) Close all the doors on the unit.a) Close all the doors on the unit.b) Take an extinguisher to the fire scene.b) Take an extinguisher to the fire scene.c) Check the code chart to locate the fire.c) Check the code chart to locate the fire.d) Move patients laterally toward the stairs.d) Move patients laterally toward the stairs.

If it is an incomplete If it is an incomplete sentence:sentence:

STEM is a group of words that forms the STEM is a group of words that forms the beginning of a sentence.beginning of a sentence.

Becomes complete when combined with one of Becomes complete when combined with one of the answer options.the answer options.

Example:Example:People should be encouraged not to smoke in bed People should be encouraged not to smoke in bed

because it could…because it could…a) Result in a fire.a) Result in a fire.b) Upset a family member.b) Upset a family member.c) Trigger a smoke alarm.c) Trigger a smoke alarm.d) Precipitate lung cancer.d) Precipitate lung cancer.

If the STEM has positive If the STEM has positive polarity:polarity:

It is concerned with the truth.It is concerned with the truth. Asks “What would you do?”Asks “What would you do?”Example:Example:Which intervention most accurately supports the Which intervention most accurately supports the

concept of informed consent?concept of informed consent?a) Obtaining the patient’s signature.a) Obtaining the patient’s signature.b) Explaining what is being done and why.b) Explaining what is being done and why.c) Involving the family in the teaching plan.c) Involving the family in the teaching plan.d) Teaching preoperative deep breathing and d) Teaching preoperative deep breathing and coughing.coughing.

If the STEM has negative If the STEM has negative polarity:polarity:

It asks a question with a negative statementIt asks a question with a negative statement Asks “What would you NOT do?”Asks “What would you NOT do?”Example:Example:What position would be contraindicated for the What position would be contraindicated for the

patient who has dyspnea?patient who has dyspnea?a) Contoura) Contourb) Fowler’sb) Fowler’sc) Pronec) Proned) Supined) Supine

Anatomy of a TestAnatomy of a Test

OPTIONSOPTIONS are the possible responses are the possible responses offered by the test item and can:offered by the test item and can:

Be a sentence.Be a sentence. Complete a sentence begun in the stem.Complete a sentence begun in the stem. Be an incomplete sentence.Be an incomplete sentence. Be a single word.Be a single word.

OneOne OPTIONOPTION is the correct answer to the is the correct answer to the test item.test item.

Remaining OPTIONS are incorrect.Remaining OPTIONS are incorrect.

Incorrect OPTIONS are called Incorrect OPTIONS are called DISTRACTORSDISTRACTORS..

DISTRACTORSDISTRACTORS are designed to are designed to distractdistract youyou from the correct answer to the test from the correct answer to the test item.item.

Three practice test items follow. Three practice test items follow. For each item:For each item:

Identify the parts of the test items.Identify the parts of the test items. What is the issue?What is the issue? Who is the client?Who is the client? Are there key words in the test question?Are there key words in the test question?

Determine what type of stems are used.Determine what type of stems are used. Negative / Positive polarityNegative / Positive polarity Incomplete / Complete sentenceIncomplete / Complete sentence

Identify options & distractors in each test Identify options & distractors in each test item. item.

1. Before performing a procedure, what should the nurse do first?

a) Raise the patient’s bed to its highest position.

b) Collect equipment necessary for the procedure.

c) Position the patient for the procedure.

d) Explain the procedure to the patient.

STEM: “What should the nurse do first?” (complete sentence)

OPTIONS: a – d (complete sentences)

KEY WORDS – FIRST

DISTRACTORS: options a, b, c

BEST ANSWER: option d

2. Which intervention is the most effective way to prevent the spread of microorganisms?

a) Donning a mask.

b) Wearing a gown.

c) Washing the hands.

d) Keeping visitors out.

STEM: entire question (complete sentence)

OPTIONS: a – d (incomplete sentences)

KEY WORDS – MOST EFFECTIVE

DISTRACTORS: options a, b, d

BEST ANSWER: option c

3. The nursing process is a method nurses use for:

a) assessing the client

b) interviewing the client

c) writing the care plan

d) organizing and delivering nursing care

STEM: entire question (incomplete sentence)

OPTIONS: a – d (incomplete sentences)

KEY WORDS – METHOD

DISTRACTORS: options a, b, c (individual steps)

BEST ANSWER: option d

SCENARIOS require you to picture yourself in the situation.

Think about the role of the nurse as it relates to the

information given in the test item. Consider each option,

then choose the BEST response for the nurse in that

situation.

Scenario example 1.

Mr. Sherwood is a 58 year old accountant diagnosed with cancer of the colon. He was treated surgically with a colostomy. While checking Mr. Sherwood’s blood pressure, the nurse asks, “How are you feeling?”. He replies, “That feels tight on my arm.” This feedback tells the nurse:

a) Mr. Sherwood has a language barrier.

b) The meaning of her message was not received.

c) Her facial expression conveyed a different message.

d) Mr. Sherwood is disoriented.

Identify the main focus of the Identify the main focus of the situation:situation:communication communication

Consider each option:

a)No indication of this is given in the scenario.

b)Best answer.

c)No information given about facial expression.

d)Not enough data to determine this.

Scenario example 2.The client, Mrs. Smith, is on strict bed rest after a right total hip replacement. Musculoskeletal abnormalities that can be identified during nursing assessment of Mrs. Smith include all of the following but:

a) decreased muscle tone.b) contractures.c) loss of muscle mass.d) capillary refill.

Identify the main focus of the situation:musculoskeletal abnormalities

Note: this is a negative question that asks you to identify the

option that is NOT musculoskeletal.

Consider each option:

a, b, c = musculoskeletal

d = cardiovascular (best option)

Rules for Successful Test-Rules for Successful Test-Taking:Taking:

Start preparing for the test the first day the Start preparing for the test the first day the topic is discussed.topic is discussed.

Pay attention to content that is Pay attention to content that is emphasized or repeated.emphasized or repeated.

Know the parts of a test question.Know the parts of a test question. Read the test questions carefully.Read the test questions carefully.

Identify key words.Identify key words. Watch out for “except”; “first”; “best”; “always”; Watch out for “except”; “first”; “best”; “always”;

“never”; “must”.“never”; “must”.


Identify the theme of the item – do not assume Identify the theme of the item – do not assume information that is not given.information that is not given. Don’t add information.Don’t add information. Try to answer the question before reading the Try to answer the question before reading the

options.options. Eliminate obviously incorrect options first.Eliminate obviously incorrect options first. Separate what the item is telling you from what Separate what the item is telling you from what

it is asking you.it is asking you. Select options that are therapeutic, show Select options that are therapeutic, show

respect, and communicate acceptance.respect, and communicate acceptance.

Rules for Successful Test-Rules for Successful Test-Taking:Taking: Know the basic principles that guide nursing.Know the basic principles that guide nursing. Assess before acting.Assess before acting. Differentiate the need for nursing judgment from Differentiate the need for nursing judgment from

physician judgment.physician judgment. Attend test reviews and assess your errors carefully.Attend test reviews and assess your errors carefully.

Did you miss content?Did you miss content? Missed a key word?Missed a key word? Added information?Added information?

Manage time effectively – note number of questions Manage time effectively – note number of questions and time allowed.and time allowed. Leave enough time to check your answers.Leave enough time to check your answers. Skip questions you cannot answer and come back Skip questions you cannot answer and come back

to them.to them.


Look for grammar clues – singular subjects require Look for grammar clues – singular subjects require singular verbs; plural subjects require plural verbs.singular verbs; plural subjects require plural verbs.

Master the math – you will see it on EVERY test.Master the math – you will see it on EVERY test.

DO NOT get into the habit of changing an answer – DO NOT get into the habit of changing an answer – you cannot make changes on the NCLEX. If you feel you cannot make changes on the NCLEX. If you feel you must change an answer, only do so if you are you must change an answer, only do so if you are ABSOLUTELY sure your new answer is correct.ABSOLUTELY sure your new answer is correct.

Choose the BEST answer – more than one may be Choose the BEST answer – more than one may be correct, but only one is the BEST answer.correct, but only one is the BEST answer.

Reducing Test AnxietyReducing Test Anxiety

Be well-prepared and affirm your ability Be well-prepared and affirm your ability to do well.to do well.

Get a good night’s sleep.Get a good night’s sleep. Avoid caffeine.Avoid caffeine. Eat breakfast.Eat breakfast. Leave home a little earlier than usual.Leave home a little earlier than usual. Anticipate the unexpected.Anticipate the unexpected.

Be A “Test Manager”Be A “Test Manager”

Arrive on time, bring the right “tools” Arrive on time, bring the right “tools” (pencils, erasers, calculators, etc.)(pencils, erasers, calculators, etc.)

Sit in a quiet place – do not try to learn Sit in a quiet place – do not try to learn new material.new material.

Check for all pages of the test and make Check for all pages of the test and make sure you understand the directions.sure you understand the directions.

Budget your time – do not leave the test Budget your time – do not leave the test early (review your answers).early (review your answers).

Maintain a positive attitude.Maintain a positive attitude.

Making Educated Making Educated GuessesGuesses

Do not leave any answers blank, unless there is a penalty for Do not leave any answers blank, unless there is a penalty for guessing.guessing.

Choose the most general answer when other choices are Choose the most general answer when other choices are specific.specific.

Choose the longest answer when others are much shorter.Choose the longest answer when others are much shorter. Choose the answer with the middle value when others are Choose the answer with the middle value when others are

high or low.high or low. Choose neither of two similar answers.Choose neither of two similar answers. Choose one of two opposite answers.Choose one of two opposite answers. Choose among familiar answers.Choose among familiar answers. Choose logical answersChoose logical answers Avoid answers with absolutes (always, never, none, all) in Avoid answers with absolutes (always, never, none, all) in

them.them.

After the TestAfter the Test

Review your score.Review your score. Look for patterns in your errors.Look for patterns in your errors. Ask for extra help as soon as you know Ask for extra help as soon as you know

you need it.you need it. Start reviewing for the next test!Start reviewing for the next test!

Top 10 tips for answering Top 10 tips for answering questions on NCLEXquestions on NCLEX

10. PRIORITIZE!! Remember to look for words that establish priority (most, first, best, & initial). These words will help you weed out info that you really don’t need!! Keep in mind Maslow’s hierarachy of needs, the nursing process, and patient safety. “Which patient should you see first?” is a popular question….understand the rules of management.


9. Know your NORMALS!! Normal lab and test values are good to know.They will help you decide when there is a problem or if it has already been fixed!


8. Stay CALM!! You will get questions that you will have little confidence on how to answer, but staying calm and using key words to pick the best answer will never lead you wrong.

7. Always ASSESS before you IMPLEMENT. It is easy to get tripped up by

implementing a nursing action before they assess the patient.


6. Assume you have an MD ORDER. There are no trick questions out there and the NCLEX wants to know if you know what to do as a nurse….not what the doc knows! So, your first response is probably not going to be “calling the doc”.

5. Think PATIENT SAFETY at all times. Start remembering this mantra now because you will hear it over and over in practice.


4. The REAL WORLD is a different place from the NCLEX WORLD. Answer the

questions by what you know from a textbook…..not what you remember

about taking care of Mrs. X in your clinical rotation. 3. Remember the FIVE RIGHTS of MEDICATION

administration. Know these frontwards, backwards, and sideways….you will

use this on NCLEX and daily in the real world!


2. CONSIDER “THERAPEUTIC COMMUNICATION” WITH THE PATIENT. The wrong answers usually are ones that include you being a drill sergeant, asking closed-ended questions, or “why do you feel this way?” questions. Also be wary of any answers to patient questions that involve “don’t worry” or “that happened to me once”.


1. REVIEW, STUDY, REVIEW, STUDY, REVIEW, STUDY!!!!!! Do not take the NCLEX until you have taken time to review what you learned in nursing school. Use the ATI system to assess your knowledge, review, and re-test, until you are confident in your knowledge. BUT DON’T WAIT TOO LONG TO TAKE NCLEX! You will do better if the information is “fresh” in your mind.

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Test Taking Skills Nataliya Lishchenko TSMU School of Nursing