3Think Like an Item Writer First, perform a content analysisReview the information being testedWhat do you know about it?Second, perform a construct analysisLook at the format of the questionLet’s see what that means!
4Types of Questions Assessment Planning Knowledge about brain tumors, radiation treatment, significant others, or general neurologic functionAnalysis questions about psychosocial implications of treatment, diagnosis of cancer, and lossPlanningSafety measures for the client, for the nurse, for others in contact with the client
5Types of Questions (continued) ImplementationBasic care needsProblems associated with implantsRadioactivity issuesEvaluationLevel of client’s understanding of treatmentFamily’s understanding of radiation precautionsEffectiveness of specific interventions
6Sharpen Discrimination Skills Look for key words in questionsMost correctMost likelyDo firstHighest priority
7Timing IS Everything Keep your analysis time to 1 minute per item This takes practice!Take practice tests using a timerUsing practice tests in a timed environment helps reduce anxiety when it’s time for the real thing
8Construct Analysis What is being tested? Let’s try an example Client safety?Physiologic issue?Psychosocial issue?Health promotion issue?Let’s try an example
9ScenarioA 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.
11Low Levels of Anxiety Are GOOD! Heighten sensesDilate pupilsIncrease awareness of surroundingsSharpens responses during testing
12High Anxiety is BAD Senses narrow “Tunnel vision” develops Testing ability declinesFocus is on feelings of stress
13Identify Stress Signals Identify four symptoms you have experienced related to stress220.127.116.11.
14Common Symptoms of Anxiety Higher AnxietyParasympathetic nervous system responsesTachycardiaShortness of breathTunnel visionDry mouthMuscle tensionGI disturbancesMild AnxietySlight irritabilityImpatienceSharpened perceptual field
32Step 1Separate what the scenario tells you from what the stem is asking
33Parts of a QuestionCase scenario: statement giving information about a clinical problemStem: specifically asks you somethingOptions: choices to answer the stem
34ExampleDuring 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?
35The Case ScenarioDuring 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?
36The StemDuring 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?
38Four Critical Elements The ISSUEThe CLIENTThe KEY WORDSThe TYPE OF STEM
39The IssuePrimary problem or the subject of the question
40The Client The person who is the focus of the stem of the question May be the ill person, family members or significant others
41The Key WordsDuring 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?
42Type of Stem True response stem - asks for a true statement False response stem - asks for the incorrect answer
43Some Helpful HintsSeparate what question is telling from what it is askingAlways identify the client, issue, key words and type of stemEliminate options offering new informationNurse is always therapeutic and time is available
45OptionsOne option is the answerThree others are called distracters
46Rule Out DistractersIf the stem is a true response stem, r/o distracters that are not true statementsIf the stem is a false response stem, r/o distracters that are true
47More Helpful HintsNext 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 familiarIf there is 1 matching and 1 not sure, pick the matching oneGO WITH YOUR GUT
48Absolutes NEVER ALWAYS Antihypertensives always make you dizzy Patients should never self-medicateDoubtless the nurse is correctThe patient was completely satisfied with treatmentNEVERALWAYSDOUBTLESSCOMPLETELY
49Qualifiers The medication is probably the cause of the problem Patients usually walk after surgeryAspirin is the best medicationNo one ever documents that wayProbablyUsuallyBestEver
50Item Length The longest answer contains the most information Don’t assume the information in the longest answer is correct
51Option Position No one position is favored Item writers know the same mythRead all options!When in doubt…pick “C” – Ancient Student Myth
52Umbrella Option Contains other options within it Present when there is more than one right answer found
62Strategy 1 Read the client description and question carefully Take time to read each word in the situationRead the question stem – be sure you understand what it is asking
63Strategy 2 The information provided is the only information to use Avoid adding information to the situationDon’t assume information that is not thereDon’t refer to personal experience
64Strategy 3 Go with your gut If you have strong feelings about an answer, stick with that answerDon’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
65Strategy 4 Identify the step of the nursing process being tested If an assessment question is asked, answers should involve collecting more dataYou need to become sensitive to words that indicate the phase of the nursing process being tested
66Nursing Process Vocabulary Assessment WordsObserveAssessIdentifyGatherRecognizeDisplayCollectDetectIndicateDifferentiateDistinguishDescribe
71Strategy 5 Concentrate on the question at hand Each question demands your undivided attentionOnce a question is answered, it’s done…. forget it!
72Strategy 6 Every question has the same point value No question carries more weight on the test than anotherIf you don’t know an answer, make an educated guess and move forward
73Strategy 7 Don’t test angry Avoid personalizing a question Some topics, such as abortion, abuse, or rape trigger personal emotionsAnswer according to what you have learned, not according to what you believe
74Strategy 8 Avoid answers containing qualifying words AlwaysNeverAllNoneNothing is always, never, all or none
75Strategy 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
76Strategy 10 Prioritize care Airway Breathing Circulation Safety ABCS methodAirwayBreathingCirculationSafetyCategories of care methodSafe, effective care environmentPhysiologic integrityPsychosocial integrityHealth promotion/maintenance
77Strategy 11 Look for answers that facilitate something Client teaching Assisting the client toward independenceLook for key words
78Facilitative Words Assist Aid Support Encourage Facilitate Help ReinforceFosterNurtureEndorse
79Strategy 12 Look for relationships between answers Item writers usually write the question first, the right answer next, then the distractersUsually the correct answer has a connection with the other optionsIncorrect answers don’t have a relationship with each of the other answers
80Strategy 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 otherThe more comprehensive an answer is, the more likely it is the correct one
81Strategy 14When given the option to medicate or use a non-pharmacologic treatment, select the non-pharmacologic treatmentAlternative methods of treating a problem should be attempted before administering medications
82Remember…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!