NURSING EXAM TIPS & HINTS

Disclaimer

Views, observations and opinions expressed here have been developed over years of experience working with students and observing patterns during one on one tutor sessions and during mock examinations.  Nursing Education Academy offers these insights to assist student nurses pass exams and is not a replacement for study and appropriate learning methods.  We do not insure or guarantee the learner’s examination scores will improve but, if test taking tips is used in conjunction with other learning resources examination scores should improve.  This is for informational purposes only.  We make no guarantees

LET'S BEGIN

What’s different about nursing exams? 

In order to be proficient at passing nursing exams the learner must master critical thinking skills. A single response usually won’t be found on a single page of a text; you must understand the concepts, disease processes, health and wellness practices, etc. and apply them given the information provided in the examination question.   Simply put this means one cannot simply memorize data and expect to find the right answer.  Most all exam responses will be ‘right’ to some degree, the key is that the test taker is able to analyze, evaluate and asses which is the BEST response.

Know The Parts of a Question The question contains several parts:

• The case aka the scenario. This is the description of the client and what is happening to him/her
• The stem. This is the part of the question that asks the question
• The correct response
• The deadly distracters. 

Look for Key Words 

Read the question carefully and determine the key elements in each question. Each question has key words. Key words relate to the client, to the problem and to specific aspects of the problem. Words that describe and/or show action such as early, acute, age, thin, etc. can all help you arrive at the correct answer.

Look for clues in the stem. 

For example, pay attention to describers such as age, weight, appearance. Would the issue the question discusses be expected given the description of the patient?

Pay Attention to the Client 

Pay attention to factors such as age, sex, and marital status in the question. When a child’s age is given it often is very relevant to the answer. Vital signs vary with age. Preoperative teaching methods vary with age. Watch for appropriate toys and age specific activities. Always pay special attention to the age of a client when it is given. Know who the focus of the question is. The client may be the identified sick person, or it might be a relative of the identified sick person, or even a staff member.

Look for the Problem/Behavior in the Question

The problem may be a disease, a symptom or a behavior.

Does the question ask for a positive or a negative answer?

In other words, if the question asks what response from your patient would require further teaching?  Your patient’s response (the answer to the question) will be a negative one.  For example, if you patient with a history of DVT states, “I will massage my calf twice a day” That is a false statement aka a negative response and the correct answer.

Know the Details of the Problem

• Is the question asking for nursing actions or client symptoms or family responses?
• Does the question ask about a specific aspect of nursing care? Pay attention; if it asks about assessment, planning, implementation or evaluation then the correct answer will need to address this part of the question.
• Does the question ask details relevant to a specific symptom or behavior the client exhibits?
• Is there additional information about the client or the problem that is important?

Understand what the question is really asking

Reword the question in your mind as needed.  For example, you may memorize heart failure is a common complication in many circumstances but the exams rarely come right out and say heart failure. You will need to be able to identify heart failure by way of the symptoms presented. 

Prioritize-Use Maslow’s Hierarchy of Needs and remember ABC (airway, breath and circulate) If your patient’s respirations are compromised you can’t even consider anything else until this issue is resolved.

• “What action takes priority?”
• “What should the nurse do first?”
• “What should the nurse do initially?”
• “What is essential for the nurse to do?”

Physiologic needs are first, followed by safety needs, then love and belonging, self-esteem and self-actualization.

The first step of the nursing process is assessment! When the stem of a question asks for the initial nursing action always look to see if there is a relevant assessment answer. The nurse will take an action only when there is enough data to act. Call the physician only when there is not a nursing action that should be taken first. The stem of the question may ask for a nursing action and the correct answer may be to assess.

When the stem of the question asks what is essential for the nurse to do, think safety. Remember many of the test questions are safety questions.

What is the Time Frame? 

 Whenever a specific time frame is indicated in a question it is very important. Pay attention to it. Time related words may be like early or late in relation in symptoms, pre operative or post operative, care on the day of surgery or later postoperative care.

Repeated Words

Words from the question are repeated in the answer. Frequently the same word or a synonym will be in both the question and the answer.

Opposites 

When two answers are opposite such as high blood pressure and low blood pressure or increase the drip rate and stop the IV, or turn on the right side and turn on the left side, the answer is usually one of the two.

Same Answer

If two or three answers say the same thing in different words none can be correct. If the answers are too similar, then none of them can be correct.

Odd Answer Wins

The answer that is different from the others is apt to be the correct answer. It may be the longest or the shortest or simply very different in content or style.

Is there an Umbrella Answer?

One answer includes the others. There may be more than one correct answer. One answer is better than all the others because it includes them.

Avoid Absolutes

Answers containing universal or absolute words are very apt to be incorrect. Very little in life or nursing is always correct or incorrect. Answers stated in absolute terms should be looked at with great caution. Absolutes would include words such as never, always, only, none, all, etc.

Read the question and all responses carefully.

For example, is the question discussing an open cholecystectomy or laparoscopic? An abdominal or vaginal hysterectomy? 

Know when you must call the Dr. and when you can assess further before calling

For example, if your patient in the question has a BS of 475 and the possible answers include *assess neuro status and another option is *call the Dr. then pick asses since you will do this first before calling the Dr.

A risk for diagnosis may take priority over an actual diagnosis.

You must understand the entire question and situation. For example, test question is about a status post CVA patient with swallowing difficulty.  A nursing diagnosis of impaired physical mobility is noted and a nursing diagnosis of potential for aspiration.   The aspiration takes priority over the mobility.

When the question asks for a nursing action

Apply nursing actions/interventions appropriately.  Provide medications as ordered, complete an assessment and evaluate as needed.

Most nursing exams usually include a lot of dietary questions

Be able to identify the major food groups and be able to apply to specific disease processes.

Choosing between the two best options

If you find yourself having difficulty choosing between two seemingly correct responses, use the following strategies:

• Eliminate Similar Distracter - If two options are essentially saying the same thing or include the same idea, then neither of them can be the answer. The answer has to be the option that is different.
• Reread two seemingly correct options – If two options seem equally correct, reread them carefully; there must be some difference between them. Reread the stem; you may notice something you missed before.
• Look for a global response – A more general statement may also include correct ideas from other options.

Before the Exam

Practice, practice, practice: Complete practice exams every day

Understand your learning style

Guidelines to follow during the exam:

• Budget your time – Although you may not know exactly how many questions you’ll be asked to answer, you can estimate a little over 1 minute per question. Keep moving at a steady pace.
• Read each question thoroughly but quickly – In general, your first reaction to a question is the correct one. Remember that the examination is designed to determine if you’re minimally competent and safe.
• Concentrate on one item at a time. Don’t worry about how many questions you’ll have to answer.
• Answer questions as if the situation were ideal. Assume the nurse had all the time and resources needed. You’re only concerned about one patient, the one in the question.
• Focus on the key words in the stem.
• Identify whether the stem is seeking a true response or a false response. Those stems asking for false responses are easily misread.
• Reword a difficult stem.
• Try answering the question before you've read the options provided.
• Always read all options before selecting the best one.
• Relate each option to the stem.
• Use logic and common sense to figure out the correct response.
• Remember that the correct option will tend to have greater applicability and flexibility.
• Clueless? Look for clues in answer choices instead of in the stem of the question.
• Do Not change your answers unless you are 100% sure your response is wrong
• Do Not read into the questions
• Wear earplugs if you are easily distracted

10 Things to Remember on the day of the examination:

1. Get up early.
2. Wear comfortable clothes.
3. Check you have materials as needed. (sweater, pencils, pens, etc.)
4. Eat breakfast.
5. Leave early so you will arrive early.
6. Do NOT study while you wait for your examination.
7. Read, listen to music and above all, try to relax.
8. Leave notes and books at home.
9. Listen carefully to the instructions given by the test administrators.
10. Positive self talk 

During the Exam say to yourself, DID I CAREFULLY…

Read the stem? Read all of the options? Read the stem again? Look for key words? Eliminate obviously incorrect options?

This may sound silly but this tip has helped a lot of people in all types of exams.

If you tend to be a quick reader and test taker you may overlook some of the steps and key points above. An easy way to force your mind to slow down and pay attention to every element is use your finger, a pen, a pencil or the cursor and point to each word. As you use the pointer mouth the word to yourself. This seemingly silly practice has helped many who struggled during exams so give it a try.

Sources:

NCLEX Exam Tips

Nursing Education Academy