Introduction To Testing Styles in Nursing Entry Into Professional Nursing NRS 101

How To Read and Interpret A Test Question

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!

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

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

Sharpen Discrimination Skills Look for key words in questions Most correct Most likely Do first Highest priority

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

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

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.

Do You Suffer From Anxiety???

Low Levels of Anxiety Are GOOD! Heighten senses Dilate pupils Increase awareness of surroundings Sharpens responses during testing

High Anxiety is BAD Senses narrow “Tunnel vision” develops Testing ability declines Focus is on feelings of stress

Identify Stress Signals Identify four symptoms you have experienced related to stress 1. 2. 3. 4.

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

Handling Your Anxiety

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

Practice STOPPING Practice the S-T-O-P exercise several times a day Use it while practice-testing Practice makes perfect!

Understanding NCLEX -Type Questions

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

Question Stem Central focus of the item Presented as a question or incomplete item May require information from the situation in order to answer

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

Distracters Incorrect answer choices Must be plausible, but not correct Must be similar in length and design as the correct answer

Types of Testing Errors

Type-One Error Misperceiving information Words are read incorrectly Information is overlooked

Read these Options PARIS BIRD IN THE IN THE ONCE THE SPRING IN A THE HAND ONCE IN A A LIFETIME

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

Each option has repeated words PARIS IN THE THE SPRING BIRD IN THE THE HAND ONCE IN A A LIFETIME

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

Avoiding Type-Two Errors Read all the answer options Identify those that truly pertain to the question stem Stick with your selection

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

Let’s Try It!

Step 1 Separate what the scenario tells you from what the stem is asking

Parts of a Question Case scenario: statement giving information about a clinical problem Stem: specifically asks you something Options: choices to answer the stem

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?

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?

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?

Identifying Critical Elements

Four Critical Elements The ISSUE The CLIENT The KEY WORDS The TYPE OF STEM

The Issue Primary problem or the subject of the question

The Client The person who is the focus of the stem of the question May be the ill person, family members or significant others

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?

Type of Stem True response stem - asks for a true statement False response stem - asks for the incorrect answer

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

Eliminating Incorrect Options

Options One option is the answer Three others are called distracters

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

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

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

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

Item Length The longest answer contains the most information Don’t assume the information in the longest answer is correct

Option Position No one position is favored Item writers know the same myth Read all options! When in doubt…pick “C” – Ancient Student Myth

Umbrella Option Contains other options within it Present when there is more than one right answer found

Priority Option ABCs Maslow Patient first Safe care

Negatives NOT EXCEPT Changes direction of the question Looks for the WRONG answer NOT IM NON EXCEPT

Patterns X Don’t look for shapes, letters, sequences, etc.

Best Understood Option Sounds familiar Subconscious at work

Don’t “Read Into” Options Take question at face value If it walks like a duck…

Go with Your Gut Intuition Instinct Trigger memory

No Penalty for Guessing

Read ALL Options A B C D

Tips for Avoiding Errors

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

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

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

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

Nursing Process Vocabulary Assessment Words Observe Assess Identify Gather Recognize Display Collect Detect Indicate Differentiate Distinguish Describe

Vocabulary (continued) Analysis Words Diagnose Contrast Compare Analyze Order Prioritize Define Classify Categorize Synthesize Sort Arrange

Vocabulary (continued) Planning Words Rearrange Formulate Plan Reconstruct Include Generate Determine Expected Short-term goals Outcomes Designate Criteria

Vocabulary (continued) Implementation Words Document Explain Give Inform Include Teach Offer Administer Implement Encourage Advise Provide

Vocabulary (continued) Evaluation Words Monitor Demonstrate Evaluate Synthesize Expand Consider Question Determine Outcomes Conclude Repeat Reestablish

Strategy 5 Concentrate on the question at hand Each question demands your undivided attention Once a question is answered, it’s done…. forget it!

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

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

Strategy 8 Avoid answers containing qualifying words Always Never All None Nothing is always, never, all or none

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

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

Strategy 11 Look for answers that facilitate something Client teaching Assisting the client toward independence Look for key words

Facilitative Words Assist Aid Support Encourage Facilitate Help Reinforce Foster Nurture Endorse

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

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

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

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! 