3 Think 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!
4 Types 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
5 Types of Questions (continued) ImplementationBasic care needsProblems associated with implantsRadioactivity issuesEvaluationLevel of client’s understanding of treatmentFamily’s understanding of radiation precautionsEffectiveness of specific interventions
6 Sharpen Discrimination Skills Look for key words in questionsMost correctMost likelyDo firstHighest priority
7 Timing 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
8 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
9 ScenarioA 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.
11 Low Levels of Anxiety Are GOOD! Heighten sensesDilate pupilsIncrease awareness of surroundingsSharpens responses during testing
12 High Anxiety is BAD Senses narrow “Tunnel vision” develops Testing ability declinesFocus is on feelings of stress
13 Identify Stress Signals Identify four symptoms you have experienced related to stress184.108.40.206.
14 Common Symptoms of Anxiety Higher AnxietyParasympathetic nervous system responsesTachycardiaShortness of breathTunnel visionDry mouthMuscle tensionGI disturbancesMild AnxietySlight irritabilityImpatienceSharpened perceptual field
24 Type-One Error Misperceiving information Words are read incorrectly Information is overlooked
25 Read these Options PARIS BIRD IN THE IN THE ONCE THE SPRING IN A THE HANDONCEIN AA LIFETIME
26 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
27 Each option has repeated words PARISIN THETHE SPRINGBIRDIN THETHE HANDONCEIN AA LIFETIME
28 Type-Two Error Misprocessing information Not recognizing an indicator wordExample – dysphagia may be misread as dysplasiaFocusing on the wrong indicator word in a distracter
29 Avoiding Type-Two Errors Read all the answer optionsIdentify those that truly pertain to the question stemStick with your selection
30 Type-Three Error Misapplying the response Result when knowledge cannot be applied to the questionGraduates have a great deal of knowledge, but may have difficulty narrowing it to a particular answer
32 Step 1Separate what the scenario tells you from what the stem is asking
33 Parts of a QuestionCase scenario: statement giving information about a clinical problemStem: specifically asks you somethingOptions: choices to answer the stem
34 ExampleDuring 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?
35 The 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?
36 The 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?
38 Four Critical Elements The ISSUEThe CLIENTThe KEY WORDSThe TYPE OF STEM
39 The IssuePrimary problem or the subject of the question
40 The Client The person who is the focus of the stem of the question May be the ill person, family members or significant others
41 The 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?
42 Type of Stem True response stem - asks for a true statement False response stem - asks for the incorrect answer
43 Some 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
45 OptionsOne option is the answerThree others are called distracters
46 Rule 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
47 More 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
48 Absolutes NEVER ALWAYS Antihypertensives always make you dizzy Patients should never self-medicateDoubtless the nurse is correctThe patient was completely satisfied with treatmentNEVERALWAYSDOUBTLESSCOMPLETELY
49 Qualifiers The medication is probably the cause of the problem Patients usually walk after surgeryAspirin is the best medicationNo one ever documents that wayProbablyUsuallyBestEver
50 Item Length The longest answer contains the most information Don’t assume the information in the longest answer is correct
51 Option Position No one position is favored Item writers know the same mythRead all options!When in doubt…pick “C” – Ancient Student Myth
52 Umbrella Option Contains other options within it Present when there is more than one right answer found
53 Priority OptionABCsMaslowPatient firstSafe care
54 Negatives NOT EXCEPT Changes direction of the question Looks for the WRONG answerNOTIMNONEXCEPT
55 PatternsXDon’t look for shapes, letters, sequences, etc.
56 Best Understood Option Sounds familiarSubconscious at work
57 Don’t “Read Into” Options Take question at face valueIf it walks like a duck…
58 Go with Your GutIntuitionInstinctTrigger memory
62 Strategy 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
63 Strategy 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
64 Strategy 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
65 Strategy 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
66 Nursing Process Vocabulary Assessment WordsObserveAssessIdentifyGatherRecognizeDisplayCollectDetectIndicateDifferentiateDistinguishDescribe
71 Strategy 5 Concentrate on the question at hand Each question demands your undivided attentionOnce a question is answered, it’s done…. forget it!
72 Strategy 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
73 Strategy 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
74 Strategy 8 Avoid answers containing qualifying words AlwaysNeverAllNoneNothing is always, never, all or none
75 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
76 Strategy 10 Prioritize care Airway Breathing Circulation Safety ABCS methodAirwayBreathingCirculationSafetyCategories of care methodSafe, effective care environmentPhysiologic integrityPsychosocial integrityHealth promotion/maintenance
77 Strategy 11 Look for answers that facilitate something Client teaching Assisting the client toward independenceLook for key words
78 Facilitative Words Assist Aid Support Encourage Facilitate Help ReinforceFosterNurtureEndorse
79 Strategy 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
80 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 otherThe more comprehensive an answer is, the more likely it is the correct one
81 Strategy 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
82 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!