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Introduction To Testing Styles in Nursing
Entry Into Professional Nursing NRS 101
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How To Read and Interpret A Test Question
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Think Like an Item Writer
First, perform a content analysis Review the information being tested What do you know about it? Second, perform a construct analysis Look at the format of the question Let’s see what that means!
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Types of Questions Assessment Planning
Knowledge about brain tumors, radiation treatment, significant others, or general neurologic function Analysis questions about psychosocial implications of treatment, diagnosis of cancer, and loss Planning Safety measures for the client, for the nurse, for others in contact with the client
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Types of Questions (continued)
Implementation Basic care needs Problems associated with implants Radioactivity issues Evaluation Level of client’s understanding of treatment Family’s understanding of radiation precautions Effectiveness of specific interventions
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Sharpen Discrimination Skills
Look for key words in questions Most correct Most likely Do first Highest priority
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Timing IS Everything Keep your analysis time to 1 minute per item
This takes practice! Take practice tests using a timer Using practice tests in a timed environment helps reduce anxiety when it’s time for the real thing
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Construct Analysis What is being tested? Let’s try an example
Client safety? Physiologic issue? Psychosocial issue? Health promotion issue? Let’s try an example
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Scenario A client is admitted to the unit for treatment of a malignant glioma. He is transferred to a medical floor with a cranial radium implant (seeding). The implant will remain in place in his head for the next several days. Now…list five principles/concepts that could be tested within this single situation.
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Do You Suffer From Anxiety???
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Low Levels of Anxiety Are GOOD!
Heighten senses Dilate pupils Increase awareness of surroundings Sharpens responses during testing
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High Anxiety is BAD Senses narrow “Tunnel vision” develops
Testing ability declines Focus is on feelings of stress
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Identify Stress Signals
Identify four symptoms you have experienced related to stress 1. 2. 3. 4.
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Common Symptoms of Anxiety
Higher Anxiety Parasympathetic nervous system responses Tachycardia Shortness of breath Tunnel vision Dry mouth Muscle tension GI disturbances Mild Anxiety Slight irritability Impatience Sharpened perceptual field
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Handling Your Anxiety
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Think S-T-O-P Picture a stop sign Deep breath
Shape Color Word Deep breath Spell S-T-O-P to yourself 3 or 4 times while breathing deeply
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Practice STOPPING Practice the S-T-O-P exercise several times a day
Use it while practice-testing Practice makes perfect!
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Understanding NCLEX -Type Questions
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The Situation Sets the stage for the question
Usually describes a client or family with a particular problem or set of problems Contains very little or no non-pertinent information
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Question Stem Central focus of the item
Presented as a question or incomplete item May require information from the situation in order to answer
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The Correct Answer May be four options of similar length
May be two short and two long options There is NO PATTERN to the answers
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Distracters Incorrect answer choices
Must be plausible, but not correct Must be similar in length and design as the correct answer
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Types of Testing Errors
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Type-One Error Misperceiving information Words are read incorrectly
Information is overlooked
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Read these Options PARIS BIRD IN THE IN THE ONCE THE SPRING IN A
THE HAND ONCE IN A A LIFETIME
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What Did You See? Did you see “Paris in the Spring”, “Once in a Lifetime” and “Bird in the Hand”? Look again at the next slide
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Each option has repeated words
PARIS IN THE THE SPRING BIRD IN THE THE HAND ONCE IN A A LIFETIME
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Type-Two Error Misprocessing information
Not recognizing an indicator word Example – dysphagia may be misread as dysplasia Focusing on the wrong indicator word in a distracter
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Avoiding Type-Two Errors
Read all the answer options Identify those that truly pertain to the question stem Stick with your selection
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Type-Three Error Misapplying the response
Result when knowledge cannot be applied to the question Graduates have a great deal of knowledge, but may have difficulty narrowing it to a particular answer
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Let’s Try It!
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Step 1 Separate what the scenario tells you from what the stem is asking
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Parts of a Question Case scenario: statement giving information about a clinical problem Stem: specifically asks you something Options: choices to answer the stem
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Example During shift change, a client calls for a nurse. Upon entering the room, the nurse notes the client has a generalized rash that wasn’t apparent one hour ago. Which initial action by the nurse is appropriate?
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The Case Scenario During shift change, a client calls for a nurse. Upon entering the room, the nurse notes the client has a generalized rash that wasn’t apparent one hour ago. Which initial action by the nurse is appropriate?
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The Stem During shift change, a client calls for a nurse. Upon entering the room, the nurse notes the client has a generalized rash that wasn’t apparent one hour ago. Which initial action by the nurse is appropriate?
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Identifying Critical Elements
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Four Critical Elements
The ISSUE The CLIENT The KEY WORDS The TYPE OF STEM
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The Issue Primary problem or the subject of the question
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The Client The person who is the focus of the stem of the question
May be the ill person, family members or significant others
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The Key Words During shift change, a client calls for a nurse. Upon entering the room, the nurse notes the client has a generalized rash that wasn’t apparent one hour ago. Which initial action by the nurse is appropriate?
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Type of Stem True response stem - asks for a true statement
False response stem - asks for the incorrect answer
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Some Helpful Hints Separate what question is telling from what it is asking Always identify the client, issue, key words and type of stem Eliminate options offering new information Nurse is always therapeutic and time is available
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Eliminating Incorrect Options
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Options One option is the answer Three others are called distracters
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Rule Out Distracters If the stem is a true response stem, r/o distracters that are not true statements If the stem is a false response stem, r/o distracters that are true
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More Helpful Hints Next to each option note if it’s a true statement (+), a false statement (-) or a not sure (?) If there are 2 matching options left, select the more familiar If there is 1 matching and 1 not sure, pick the matching one GO WITH YOUR GUT
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Absolutes NEVER ALWAYS Antihypertensives always make you dizzy
Patients should never self-medicate Doubtless the nurse is correct The patient was completely satisfied with treatment NEVER ALWAYS DOUBTLESS COMPLETELY
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Qualifiers The medication is probably the cause of the problem
Patients usually walk after surgery Aspirin is the best medication No one ever documents that way Probably Usually Best Ever
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Item Length The longest answer contains the most information
Don’t assume the information in the longest answer is correct
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Option Position No one position is favored
Item writers know the same myth Read all options! When in doubt…pick “C” – Ancient Student Myth
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Umbrella Option Contains other options within it
Present when there is more than one right answer found
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Priority Option ABCs Maslow Patient first Safe care
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Negatives NOT EXCEPT Changes direction of the question
Looks for the WRONG answer NOT IM NON EXCEPT
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Patterns X Don’t look for shapes, letters, sequences, etc.
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Best Understood Option
Sounds familiar Subconscious at work
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Don’t “Read Into” Options
Take question at face value If it walks like a duck…
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Go with Your Gut Intuition Instinct Trigger memory
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No Penalty for Guessing
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Read ALL Options A B C D
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Tips for Avoiding Errors
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Strategy 1 Read the client description and question carefully
Take time to read each word in the situation Read the question stem – be sure you understand what it is asking
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Strategy 2 The information provided is the only information to use
Avoid adding information to the situation Don’t assume information that is not there Don’t refer to personal experience
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Strategy 3 Go with your gut
If you have strong feelings about an answer, stick with that answer Don’t assume an answer is wrong because it is easy to answer – that just means you know it! Form an answer in your mind, then select the option closest to your answer
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Strategy 4 Identify the step of the nursing process being tested
If an assessment question is asked, answers should involve collecting more data You need to become sensitive to words that indicate the phase of the nursing process being tested
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Nursing Process Vocabulary
Assessment Words Observe Assess Identify Gather Recognize Display Collect Detect Indicate Differentiate Distinguish Describe
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Vocabulary (continued)
Analysis Words Diagnose Contrast Compare Analyze Order Prioritize Define Classify Categorize Synthesize Sort Arrange
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Vocabulary (continued)
Planning Words Rearrange Formulate Plan Reconstruct Include Generate Determine Expected Short-term goals Outcomes Designate Criteria
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Vocabulary (continued)
Implementation Words Document Explain Give Inform Include Teach Offer Administer Implement Encourage Advise Provide
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Vocabulary (continued)
Evaluation Words Monitor Demonstrate Evaluate Synthesize Expand Consider Question Determine Outcomes Conclude Repeat Reestablish
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Strategy 5 Concentrate on the question at hand
Each question demands your undivided attention Once a question is answered, it’s done…. forget it!
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Strategy 6 Every question has the same point value
No question carries more weight on the test than another If you don’t know an answer, make an educated guess and move forward
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Strategy 7 Don’t test angry Avoid personalizing a question
Some topics, such as abortion, abuse, or rape trigger personal emotions Answer according to what you have learned, not according to what you believe
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Strategy 8 Avoid answers containing qualifying words
Always Never All None Nothing is always, never, all or none
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Strategy 9 Look for answers that are somehow different
If three options give a specific age, but the fourth option generalizes (i.e.. adult), the general option is usually the correct one
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Strategy 10 Prioritize care Airway Breathing Circulation Safety
ABCS method Airway Breathing Circulation Safety Categories of care method Safe, effective care environment Physiologic integrity Psychosocial integrity Health promotion/maintenance
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Strategy 11 Look for answers that facilitate something Client teaching
Assisting the client toward independence Look for key words
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Facilitative Words Assist Aid Support Encourage Facilitate Help
Reinforce Foster Nurture Endorse
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Strategy 12 Look for relationships between answers
Item writers usually write the question first, the right answer next, then the distracters Usually the correct answer has a connection with the other options Incorrect answers don’t have a relationship with each of the other answers
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Strategy 13 Select the answer that is most inclusive
If more than one answer looks to be correct, see if one of the answers contains the other The more comprehensive an answer is, the more likely it is the correct one
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Strategy 14 When given the option to medicate or use a non-pharmacologic treatment, select the non-pharmacologic treatment Alternative methods of treating a problem should be attempted before administering medications
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Remember…If you think you will succeed, you will
Remember…If you think you will succeed, you will! Good luck in your journey toward becoming a Registered Nurse!
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