1. Test-Taking Tactics
Tactics were adapted from Nugent, Vitale. Test Success: Test-Taking Techniques for Beginning Nursing Students, 6th edition. Silvestri. Comprehensive Review for the NCLEX-RN® Examination, 6th Edition.

2. “Knowing is not enough; we must apply.” -- Goethe
You’ve no doubt heard the saying, “It’s not what you know, it’s who you know.” Well, probably not the best advice for nursing school. Better: It’s not just what you know, it’s how you apply what you know.”

3. Anatomy of a multiple-choice question
Scenario: Background information, objective data or subjective data
Stem: The statement that asks the question
The correct answer
Those pesky incorrect answers
Anatomy of a test question, to help you understand what you’re looking at. Step one: identify and read the stem. This will tell you what the question is asking. For example, aliens crashed in UFOs in downtown Los Angeles and backed traffic up for miles. A nurse is stuck in traffic and late for work. What should the nurse do? The UFOs, however intriguing, constitutes background information. Don’t read into the question: Yes, some aliens may have gotten hurt, but this is not what it says. The stem (that nurse who’s stuck in traffic and late for work) combines with the question about what to do. Step two: try to answer the question in your own words before looking at all the options. Step three: eliminate obviously incorrect answers (you should be able to get rid of one or two this way, in most cases).

4. Try not to read into the question
Avoid getting into “what if…” territory
Pay attention to only the information in the question
Pay special attention to words that clue you into what the question is asking
This reading-into-the-question territory can also be avoided by not comparing the scenario with what happens at work, what you’ve heard somewhere, or picked up on the Internet. Is this hard to do? Oh, yeah. Instead, focus only on information in the question. Read every word. Decide what the question is asking.

5. Test-taking ideas Decide what the stem asking
Try to answer it in your own words before checking the options
Eliminate the options that don’t answer what the stem is specifically asking
Usually you can reduce plausible answers to just two

6. Do not use!
Fight the urge to go back and change answers. Sure, you can probably think of a time where this strategy worked, but the majority of the time you’ll be changing to a wrong answer.

7. Frameworks, such as Maslow’s Hierarchy of Needs, can help you organize data in questions and establish priorities. Circulation, Airway, and Breathing (CAB), the priorities of CPR, is another. Thinking within a framework helps you conclude what things you should do first, what is most important, or what is more significant. When reading a test question, use a framework whenever possible. E.g., is it a priority to help a homeless person improve relationships with his family? Answer: not before finding him a place to live.
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8. Assessment Diagnosis Planning Implementation Evaluation
The nursing process is a problem-solving sequence for organizing what nurses do with clients. When reading a test question, if you can recognize where it fits in the nursing process, it will help you identify what the question is asking. Certain words will clue you into what part of the nursing process the question is focusing on.

9. Assessment
Words suggesting the question is asking you to focus on assessment: assess, inspect, identify, verify, observe, question, check, determine, notify, inform, stressors, responses, signs and symptoms, verbal and nonverbal, clinical findings, sources, perceptions
Assessment questions will ask you to identify clinical findings (normal or abnormal, subjective or objective) or verify critical findings, perform a physical assessment, collect specimens, identify a patient’s verbal or nonverbal communication, identify how a patient responds to illness, obtain important information, different ways of collecting data. Bottom line: if the question is asking for assessment data, then the answer will not be “ambulate the patient,” which is an intervention.

10. Diagnosis
Words suggesting the question is asking you to focus on diagnosis: nursing diagnosis, organize, categorize, cluster, reexamine, reflect, interpret, formulate, pattern, problem, significant, statement, contribute, relevant, valid, decision, analyze
Relates to frameworks such as Maslow’s hierarchy
Diagnosis questions will ask about nursing diagnoses, but they might also ask about what you’re going to do with data, what you’re going to do with what you know. You may be asked to cluster data, group data to how they are related, or identify when more data are needed, or which data are meaningful. Clustering data relates to frameworks, such as Maslow’s Hierarchy, Kubler-Ross’s theory of grieving (look up these references if you don’t already understand them).

11. Planning
Words suggesting the question is focused on planning: achieve, desired, plan, effective, desired result, determine, goal, priority, develop, formulate, establish, design, prevent, strategy, select, anticipate, modify, collaborate, arrange, coordinate, expect, outcome
Planning-type questions will ask you about identifying goals or outcomes, setting priorities, anticipating patient needs, identifying interventions, collaborating with other healthcare team members. Test-taking errors: Not including the patient or family (if available) in the planning, setting inappropriate or unrealistic goals, not collaborating with other members of the team. Goals should be patient-centered, measurable, realistic, and achievable within a particular timeframe.

12. Implementation
Words suggesting the question is focused on implementation: dependent, independent, change, assist, counsel, teach, instruct, implement, give, supervise, perform, procedure, treatment, strategy, facilitate, provide, inform, refer, technique, delegate
Implementation is the part where nursing interventions are started or completed. This is the doing part. Test-taking errors: picking nursing interventions outside the scope of practice, not responding to an adverse situation or reaction, not seeing when additional assistance is needed, not being knowledgeable about an intervention, not safely performing an intervention, or not supervising or evaluating those tasks delegated to others.

13. Evaluation
Words suggesting the question is focused on evaluation: evaluate, expected, met, desired, compared, succeeded, achieved, failed, modified, reassess, ineffective, response.
Evaluation refers to identifying patients’ responses to care, the actual outcomes, and figuring out why the outcomes were met or not met. Test-taking errors: Failure to reassess the patient after care, failure to look at new data, or failure to compare expected outcomes with actual outcomes (the patient’s actual responses to your care).

14. Pick out negatives or absolutes
Negatives: not, except, never, violate, needs further education, needs more teaching, contraindicated, unacceptable, avoid, unrelated
Or absolutes: just, always, never, all, every, none, only, must
Beware of these negative words. Usually, the question is concerned with a false answer. It might be something like, “What statement, made by the client, suggests she needs more teaching?” If all the options appear correct, reread them and the stem. You may have missed a negative word. Absolute words usually indicate broad generalizations that tend to be false. There are, however, exceptions: all patients should be treated with dignity.

15. Find words that set a priority
These are words that modify what’s being asked:
First, initial, best, priority, safest, most, most important, most likely, lost appropriate, immediate, essential, nest, least appropriate, least likely
Priority words should make you weigh or rank the options. They may all be good options, but one is slightly better. Rely on your nursing knowledge, theories, concepts, principles, and standards of practice. Basic guiding theories: Maslow’s Hierarchy, the nursing process, Kubler-Ross’s theory of death and dying, therapeutic communication, teaching theory, and the CAB of CPR (circulation, airway, breathing).

16. Clues Opposites Plausible options Facts in series
Denying or minimizing patients’ feelings or concerns or needs
Often, there will be two options that are opposite of each other. Recognize when such opposites occur: One of them will likely be the correct answer, or both of them will likely be incorrect options. Occasionally, questions will contain two options that are similar, equally plausible. If this happens, use the if…then technique: If you preform an action (plug in each of the options), then what will be the outcome? If the outcomes are similar, then the plausible options are not correct – usually. At times, questions have options that contain a series of facts; e.g., BP, pulse, respirations, temp. Usually similar facts appear in at least two options. If you find one fact that’s incorrect in the series, then you can eliminate the entire option as an answer. Consider this: How would you know a client is stable? Answer: BP, pulse, respirations, feelings of self-worth. Sounds good, right? But BP, pulse, respirations, temp is ever-so better. The correct option will not have a stray or incorrect fact. Options that suggest that the nurse tell a patient that everything will be all right or change the subject that the patient is talking about denies that patient’s feelings and should not be chosen.

17. Who’s the central person?
The central person is the one receiving the care
Other folks in the stem may be there to distract you
To answer, focus on the patient
Your focus should be on the patient or client. Usually, the patient or client is the priority. Questions of this type will ask you to put emphasis on the one receiving the care.

18. Critical thinking Identify the key concept
Try not to read into the question
Study the rationales
The whole point about NCLEX-style questions is to stimulate, develop, and validate your critical thinking. A nurse who thinks critically is valuable and can reason in a clinical setting, the sort of person Patricia Benner says recognizes the salience in any given situation. When reading a stem, don’t add information from your experience and don’t read between the lines. At first blush, this might seem like critical thinking, but it’s more along the lines of biased thinking, which clouds any budding salience. Don’t add information to the options, either. Relate an option to what is being asked in the stem. In other words, an option may have correct information, but does it relate to the stem and what is being asked? Study the rationales in textbooks or other tools (such as NCLEX study guides) to understand the critical thinking underlying the correct response, and the incorrect responses. Read all four options. Remarkably, studies show that when “d” is the correct answer, fewer students pick it. More students pick “a” because, it seems, they want an A on the test and not a D.

19. “Having a sense of salience – being able to recognize what is more or less important in a clinical situation – is the beginning point for clinical reasoning within a situation.”
-- Patricia Benner
Or it’s the ability to use knowledge.

20. As Goethe said… “Knowing is not enough; we must apply.”
Doing better on tests will make you happier, your friends and family happier, your patients happier, and your professors happier, which, in the long haul, makes the world a far more peaceful place.