1. Basic Information on Test taking for Nursing Exams
First year

2. Do not approach exams believing the questions are “tricky.”
If you know the answer do not use test taking strategies.

3. The perfect world according to the textbook, not what you see everyday.

4. Look for the answer that will let the exam writers know the client is in safe hands.

5. Basic, common, and general knowledge, not critical care concepts.

6. There is one, and only one, correct answer.
If you find it, keep it, don’t convince yourself to choose another! Remember your first instinct is often the best.

7. Test Taking Strategies
Odd-Man out
Two opposites
Partially incorrect
Nursing process
ABC’s
Maslow’s Hierarchy of Needs
Global options
Similar distractions

8. Any time they give the AGE it is usually significant

9. Any time they give you TIME, it is usually significant.

10. A student who “thinks she is failing and doesn’t know what to do”.
The bookstore manager wants the book order for next semester ASAP.
School administrator with “impending crisis”.
Daughter could “use some cash”.
A Director of a nursing program returns to her office and has four phone calls. In which order should the Director prioritize return of phone calls?

11. Your friend has just completed a 2-hour exam in anatomy and is very cranky. She tells you that she woke up 30 minutes before the exam, got dressed in 10 minutes, and made it to the exam despite a 20-mile drive. Your first action should be:
Take her to Pizza Hut for pizza.
Tell her she probably flunked the exam.
Recommend that she fast to cleanse her system of toxins.
Suggest psychiatric help.

12. During the immediate postoperative period after a transurethral resection of the prostate (TURP), what common physical problem should the nurse observe for?
Sexual impotence.
Thrombophlebitis
Venous bleeding
Atelectasis

13. The client is responsible for making decisions about their healthcare.
The nurse is responsible for providing the client with information on which to base these decisions.

14. A client says to the nurse, “My doctor ordered Adefovir (Hesera) for me, so I guess I’ll be cured.” Which nursing response would be most therapeutic?
“Yes. Although it’s relatively new and its results remain tentative, it does seem so.”
“Yes, it will cure the disease but you will want to monitor for side effects and stop the medication immediately if any occur.”
“Although this medication cannot cure your disease, it will control it.”
“Yes, but just be certain to divide the dosage as the doctor has indicated in his instructions.”

15. A client with type I diabetes asks the nurse if it will be possible for her to breastfeed after the birth of the baby. The nurse’s best response would be:
“It is possible but it can be difficult because breastfeeding mothers have increased insulin requirements.”
“Certainly, we encourage you to breastfeed because it can be beneficial both physically and psychologically.”
“Yes, you may, and it is encouraged, but keep in mind that hyperglycemia can cause a decrease in milk production.”
“Generally, breastfeeding is contraindicated in women with diabetes because it places a greater physical strain on them.”

16. Answers should be supportive of culture

17. All correct answers, re-read the stem, what exactly is the question asking?

18. When asked “What will the nurse do first” think nursing assessment or
“What will keep the client safe?”

19. A confused elderly client has wet herself and is standing in the hospital corridor in a puddle of urine. She has trouble getting to the bathroom in time. She looks ashamed. She says to the nurse, “I want to go outside for a walk now.” Which of the following statements would be the most therapeutic response by the nurse?
“Before we go for a walk, perhaps we can make a list that will help you make your bathroom trips easier.”
“Right now, let me wipe up the urine on the floor, and let’s get a change of clothing for you. I am sure that this problem is upsetting for you.”’
“This has been a problem for you. Let’s see if we can find a solution together.”
“Wetting yourself is very upsetting. Yes, let’s take a walk.”

20. The nurse enters the room of a diabetic client, and finds the client difficult to arouse, with warm, flushed skin. The pulse and respiratory rate are elevated from the client’s baseline. Which of the following should the nurse plan to do first?
Prepare an insulin drip.
Give the client a glass of orange juice.
Administer a bolus of 50% dextrose.
Check the client’s capillary blood glucose.

21. The physician has prescribed Shersye 1.5 Gm daily for a post-op client. The client complains of nausea and vomiting after taking the drug. The nurse should recommend that he take the medication:
On an empty stomach.
With food or milk
At night before retiring.
In four divided doses.

22. 80% of drugs cause nausea and vomiting!

23. General tips about medications
Learn generic and trade names, they will usually be a part of any questions.
Don’t choose drug therapy as the first response unless there is not another choice that will solve the problem.
Avoid medicating clients as the first response.

24. If you have an opportunity to suction,
Remember ABC’s
Airway
Breathing
Circulation
If you have an opportunity to suction,
Suction!

25. Never heard of it,
It’s not the answer.

26. If it is in your pool of answers, you have access to it.

27. Remember Maslow:
The nurse is caring for a client admitted yesterday for an acute cerebral vascular accident. Which nursing diagnosis has the highest priority?
a. Anxiety
b. Knowledge deficit
c. Impaired swallowing.
d. Altered family processes

28. Reflection
Is frequently used with therapeutic communication and assessment of teaching needs.

29. A client says to the nurse, “Ever since my wife passed on, my life is empty and has no meaning.” Which of the following is the most appropriate nursing response?
“What would your children think if they knew how you felt?”
“Most people who lose a loved one feel empty.”
“Your life has no meaning?”
“Let’s talk about the positive things that you have in your life.”

30. A client with heart disease says to the nurse, “I guess I’ll never be able to eat ice cream again.” The nurse most appropriately responds with which of the following statements?
“There are lots of other foods you can eat.”
“Ice cream has too much fat content, so why would you even want to eat it.”
“You don’t think you will be able to eat ice cream at all?”
“Why do you say that?”

31. When you don’t know the answer, look again at what question is asking.
Underline it.
Look for patterns in the answers. Does three of the four answers address the questions in a similar fashion?

32. The physician has ordered digoxin (Lanoxin) 0. 25 mg PO daily
The physician has ordered digoxin (Lanoxin) 0.25 mg PO daily. Currently the client has a pulse rate of 96. In preparing the care plan, the nurse knows that Lanoxin will:
Not affect cardiac conduction.
Slow the cardiac rate.
Maintain a constant cardiac rate.
Increase the cardiac rate.

33. The nurse in the emergency room receives a telephone call from emergency medical services and is told that several victims who survived a plane crash will be transported to the hospital. Several victims are suffering from cold exposure because the plane plummeted and submerged into the local river. The initial nursing action of the emergency room nurse is which of the following?
Supply the triage rooms with bottles of sterile water and normal saline.
Call the laundry department and ask the department to send as many warm blankets as possible to the emergency room.
Call the nursing supervisor to activate the agency disaster plan.
Call the intensive care unit to request that nurses be sent to the emergency room.

34. All answers correct…Chose the answer with the “most stuff”, that is the most inclusive answer.

35. When two opposites are present, usually one is the answer.

36. A nurse develops a plan of care for a client newly diagnosed with Graves’ disease. The nurse includes which of the following in the plan?
Provide a diet low in calories and protein.
Keep the room temperature cool.
Encourage frequent ambulation and other physical activities.
Place extra blankets on the client’s bed.

37. Many times the answer to the question is in the stem.
Make sure you look to see if stem is negative or positive.

38. A 22-year old sustained fracture of the tibia and fibula while playing football. A long leg cast was applied, and the client was admitted to the orthopedic unit. Following four weeks of bed rest, the nurse notes decreased breath sounds in the lower lobes of both lungs. What is the best explanation for this change in breath sounds?
The client did not take deep breaths while the nurse examined his lower lobes.
Because of improper positioning, the client has developed pulmonary edema.
Atelectasis, caused by immobility, has resulted in the decreased breath sounds.
The client's resistance is down, and he has caught a cold from someone else.

39. The most common test taking strategy is probably ODD MAN OUT, that is one answer is very different from the other three.

40. A 56-year old male is admitted through the Emergency Department with crushing substernal chest pain. The admitting diagnosis is acute myocardial infarction. Immediate admission orders include oxygen by nasal cannula at 4L/minute, blood work, a chest radiograph, a 12-lead ECG and 2 mg of morphine sulfate given intravenously. The nurse should first:
Administer the morphine.
Obtain a 12-lead ECG
Obtain the blood work.
Order the chest radiograph.

41. Practice
Let’s Identify what test taking strategy we are using…

42. A patient is on a low-sodium diet
A patient is on a low-sodium diet. Before discharge the patient should be taught to avoid:
Stewed fruit.
Luncheon meats.
Whole grain cereal.
Green leafy vegetables.

43. A client is anxious about impending emergency abdominal surgery
A client is anxious about impending emergency abdominal surgery. The nurse’s statement that best addresses the client’s complaints of thirst and pain is:
“Seven-up would be better for your nausea, and I’ll give you a pain medication to reduce your anxiety.”
“Do these deep breathing and leg moving techniques to reduce your pain, and I’ll bring you some hot tea.”
“I can let you have an occasional ice chip to suck on, and I’ll see about applying a heating pad for the pain.”
“This IV that I’m starting will help decrease your thirst, and you’ll receive medication for pain just before surgery.”

44. A client has rib fractures and a resulting pneumothorax
A client has rib fractures and a resulting pneumothorax. The physician orders Morphine sulfate 1-2 mg/hour IV as needed for pain. The primary objective of this order is to obtain adequate pain control so the patient can breathe effectively. Which of the following outcomes would indicate successful achievement of this objective?
Pain rating of “no pain” by the client.
Decreased client anxiety.
Respirations 26/min.
PaO2 of greater than 70 mm Hg.

45. A nurse is caring for a client with chronic back pain who is taking high doses of opioids narcotics for pain. The nurse will teach the client or family about what common side effect of these medications?
Inability to change position.
Problems with communication.
Constipation.
Diarrhea.

46. A nursing assistant reports to the nurse that his client is having difficulty breathing. When the nurse enters the client’s room, the nurse’s first priority would be to:
Elevate the head of the bed .
Elevate the foot of the bed.
Assess the radial pulse.
Assess the blood pressure.

47. The nurse assesses the laboratory results of a client with pheochromocytomia. The magnesium level is 7 mEq/L. On the basis of this laboratory result, the nurse would monitor for:
Drowsiness.
Hypertension.
Hyperpnea.
Hyperactive reflexes.

48. The nurse is caring for a client who is scheduled for radiation therapy. The nurse prepares a nursing care plan for the client, and in the planning, the nurse expects that the most common response by the client would be:
“I’m certain that this will do the trick.”
“Will I be radioactive afterwards?”
“This is just one of several treatment options I have for treatment.”
“This treatment is great because it is invisible and very effective.”

49. A client tells the nurse “I increased my fiber, but I am very constipated.” What further information does the nurse need to tell the client?:
“Just give it a few more days and you should be fine.”
“Well that shouldn’t happen. Let me recommend a good laxative for you.”
“When you increase the fiber in your diet, you also need to increase liquids.”
“I will tell the doctor you are having problems, maybe he can help.”

50. A client is to have a nasogastric tube inserted because of an obstruction in his bowel. The nurse explains the procedure to him and is about to begin the insertion, when the client says, “No way! You are not putting that hose down my throat. Get away from me.” Which of the following statements is the best nursing response?
“You have the right to refuse treatment. Why don’t you talk to your doctor about it?”
“Something is upsetting you. Can you tell me what it is?”
“What do you feel about this hose?”
“I would just get it over with, because you won’t get better without this tube.”

51. New Format Questions
Approach “select all that apply” questions like you would true/false questions.

52. Which of the following interventions would be helpful for the student who is in a nursing program. Select all that apply.
Low-calorie diet with high fiber.
Add alcohol to daily routine.
Include daily exercise in routine.
Join a study group.
Obtain psychiatric help .

53. Which of the following assessment data for a hospitalized senior adult should alert the nurse to an increased risk for falls? Select all that apply.
Obesity
Visual impairment
Bright lighting in room
History of falls
Use of walker when ambulating
Lack of restraint use

54. Many times the “ideal” answer is not there. Re-read the stem.
Focus on the adjectives.
Don’t jump at expected words!
Look at answers for clues.

55. If two options say the same thing or include the same idea, then neither of these options can be correct.

56. A client arrives at the health care clinic after sustaining an eye injury in which paint thinner splashed into the eye. The nurse would initially ask the client which of the following questions?
“Did you bring the container of paint thinner with you?”
“What time did the injury occur?”
“Did you flush the eye after the injury?”
“What brand of paint thinner caused the injury?”

57. The wife of a victim who sustained an eye injury calls the emergency department and speaks to a nurse. The wife reports that her husband has hit in the eye area by a piece of board while building a shed in the backyard. The nurse advises the wife to immediately?
Apply ice to the affected eye.
Call an ambulance.
Irrigate the eye with cool water.
Bring the husband to the emergency department.

58. A client with an upper respiratory infection (common cold) tells the nurse, “I am so angry with the nurse practitioner because he would not give me any antibiotics.” What would be the most accurate response by the nurse?
a. “Antibiotics have no effect on viruses.”
b. “Why do you think you need an antibiotic?”
c. “Let me talk to him and see what we can do.”
“I agree with you. You do need an antibiotic.”

59. Which of the following routes of drug administration would be the most rapidly absorbed?
a. Oral tablet
b. Oral syrup solution
c. Sublingual tablet
d. Oral sustained-released capsule

60. Strategies That DON’T Work on most exams
When in doubt, choose C.
Selecting the answer that you don’t know.
Selecting the response that is a different length compared to other choices (the longest answer).

61. Testing Hints Look for the correct answer, not the best answer.
If all of the answers are true, re-read the question. What is it asking?
If all the answers are correct, choose the most inclusive answer.

62. Studying skills Don’t use only practice questions to study.
Write your own questions.
Re-write your notes if the concept isn’t clear.
Study with someone who is smarter than you!