1. Test Taking Strategies
Katie Detrick, RN, BSN, CCRN

2. Format of the Exam Multiple choice questions Completion time CCRN: 150
PCCN: 125
Completion time
CCRN: 3 hours
PCCN: 2 ½ hours

3. Format of the Exam Computerized Able to change answers Pass/fail
Requires only two keystrokes
Able to change answers
First answer usually the best
Pass/fail
You will be told at the end of the exam that you passed or failed
Both include percentages for each section of exam

4. Components of Exam Cardiovascular 18% Pulmonary 17% GI Endocrine
CCRN
Cardiovascular %
Pulmonary % GI
Endocrine
Hematology
Renal, Integumentary
Neurology, Psychosocial
Musculoskeletal
Multisystem %
Professional Caring and %
Ethical Practices (Synergy)
Combined 20%
Combined 13%

5. Components of Exam Cardiovascular 27% Pulmonary 17% GI Endocrine
PCCN
Cardiovascular %
Pulmonary % GI
Endocrine
Hematology
Renal
Neurology
Multisystem
Behavioral
Professional Caring and %
Ethical Practices (Synergy)
Combined 18%
Combined 15%

6. Professional Caring and Ethical Practice
CCRN PCCN
Caring Practices % %
Collaboration % %
Facilitator of Learning % %
Advocacy/Moral Agency % %
Systems Thinking % %
Response to Diversity % %
Clinical Inquiry % %

7. What’s the Best Way to Prepare?
Taking a class
Studying from AACN self-assessment exams
Studying from a book
Studying from audio/CD’s
Study groups

8. Getting Ready Don’t drink alcohol Don’t stay up late studying
Preparation the night before
Don’t drink alcohol
Don’t stay up late studying
Don’t drink caffeine
Lay out clothes

9. Getting Ready Preparation the day of Do not attempt a major review
Don’t drink caffeine
Eat breakfast
Wear comfortable clothing
Layered clothing
Arrive minutes early

10. Taking the Exam Wear a watch
Check that you have answered at least 50 questions in the first hour
Don’t spend more than 2 minutes on a question

11. Taking the Exam No penalty for guessing Read question carefully
Don’t “read into” a question
May be able to eliminate two choices
Don’t think of atypical patients

12. Analyzing Questions Look for the answer that has a broader focus
Look for qualifying words
Look for negative words
Avoid questions with absolute words

13. Example of a Broad Answer
Billy Black is diagnosed with WPW syndrome. When evaluating his EKG, the nurse should note which of the following characteristics of this condition?

14. Example of a Broad Answer
A. PR interval < 0.12 second and wide QRS complex B. PR interval > 0.12 second and normal QRS complex C. Delta wave present in a positively deflected QRS complex in lead V1 and PR interval < 0.12 second D. Delta wave present in a positively deflected QRS complex in lead V6 and PR interval > 0.20 second

15. Qualifying Words
FIRST
BEST
MOST
INITIAL
BETTER
HIGHEST PRIORITY

16. Example of Qualifying Words
Mr. Redman is admitted to the ED complaining of chest pain, despite receiving sublingual NTG. He is beginning to have PVCs and short runs of VT. What is the most appropriate nursing intervention?

17. Example of Qualifying Words
A. Administer another dose of NTG B. Administer an IV bolus of amiodarone and start an amiodarone infusion C. Evaluate the patient’s mental and circulatory status D. Notify the ED doctor

18. Negative Words Not used in the exam
Poor test construction
Not, least, except, inconsistent, all but, atypical, incorrect, false, unlikely, inappropriate, unrealistic, contraindicated
May see in the form of a physician order you would question

19. Example of Negative Words
Mr. Redman is admitted to the ICU. He is still experiencing mild chest pain. Which of the following medications ordered by the physician would you question? A. Diltiazem (Cardizem) B. Propranolol (Inderal) C. Digoxin (Lanoxin) D. Morphine 1

20. Absolute Words
ALWAYS
EVERY
ONLY
ALL
NEVER
NONE

21. Example of Absolute Words
Which of the following is an accurate statement about cardiac chest pain?

22. Example of Absolute Words
A. This pain always is caused by constriction or blockage of the coronary arteries by fatty plaques or blood clots B. True cardiac pain is never relieved without treatment C. This type of pain is relieved only by nitroglycerin D. Patients generally attribute the pain to indigestion

23. ???What To Do??? When You Haven’t a Clue
Avoid selecting an answer that you also don’t understand!
Remember that nursing care is similar in many situations
Select the answer that seems most logical

24. Example of Clueless
George Green, age 33, is diagnosed as having a pheochromocytoma. Appropriate initial nursing care would involve: A. Administering large doses of xylometazoline to help control the symptoms of the disease

25. Example of Clueless
B. Closely monitoring Mr. Green’s vital signs, particularly his blood pressure C. Preparing Mr. Green and his family for imminent death D. Having the family discuss the condition with the doctor before informing Mr. Green about the disease because of the protracted recovery period after treatment

26. Example of Clueless
For several years, Karen Cooper has been treated for severe chronic emphysema with bronchodilating agents and relatively high doses of prednisone (Deltasone). Which activity poses the least risk for triggering an adverse effect of prednisone therapy in this patient?

27. Example of Clueless
A. Shopping at the mall on a Saturday afternoon B. Cleaning her two-story house C. Attending Sunday morning church services D. Serving refreshments at her 6 year-old son’s school play

28. Levels of Testing Exam tests at different cognitive levels
Level % of exam
Knowledge and comprehension
Level % of exam
Analysis and application
Level % of exam
Synthesis and evaluation

29. Example of Level 1
William Carlton is admitted to the PCU with acute exacerbation of COPD Which of the following is the normal range for the PaO2 value? A. 10 to 30 mmHg B. 35 to 45 mmHg C. 10 to 20 cm H2O D. 80 to 100 mmHg

30. Example of Level 2
William Carlton is becoming progressively short of breath. His ABG results are: pH 7.31 PaO2, 62 mmHg PaCO2, 53 mmHg HCO3-, 26 mEq/L Which problem do these values indicate?

31. Example of Level 2
A. Uncompensated metabolic acidosis with moderate hypoxia B. Respiratory alkalosis with hypoxia C. Uncompensated respiratory acidosis with moderate hypoxia D. Compensated respiratory acidosis with normal oxygen

32. Example of Level 3
William Carlton has become cyanotic and is experiencing Cheyne-Stokes respirations. What is the best action for the nurse to take at this time?

33. Example of Level 3
A. Call a code blue and begin CPR B. Call Mr. Carlton’s doctor and report the condition C. Ensure that Mr. Carlton’s airway is open and begin supplemental oxygen D. Immediately administer the ordered dose of 200 mg aminophylline IVP

34. Nursing Process Assessment 32% Planning 15% Implementation 40%
Evaluation % ).

35. Example of Assessment
William Carlton’s respiratory status continues to worsen. Which of the following signs and symptoms would best indicate deterioration of his respiratory status?

36. Example of Assessment
A. Increased restlessness and changes in level of consciousness B. Bradycardia and increased blood pressure C. Complaints of chest pain and shortness of breath D. Rapidly dropping PaCO2 and pH values

37. Example of Planning
William Carlton is diagnosed with acute respiratory failure and placed on mechanical ventilation with PEEP set at 10 cm H2O. Which of the following nursing diagnoses would have the highest priority for this patient?

38. Example of Planning
A. Impaired skin integrity related to immobility B. Decreased cardiac output related to changes in intrathoracic pressure C. Ineffective individual coping related to anxiety D. Impaired gas exchange related to decreased lung compliance

39. Example of Intervention
William Carlton has been on the ventilator for 3 days. He suddenly becomes extremely restless, and the pressure alarm sounds with each ventilator initiated inspiration. Which of the following would be an appropriate initial nursing action?

40. Example of Intervention
A. Disconnect the ventilator and call a code B. Disconnect the ventilator and manually oxygenate the patient for a few minutes with a handheld ventilator C. Increase the ventilator pressure limit to 50 mmHg D. Remove the endotracheal tube and reintubate the patient with a tube one size larger

41. Example of Evaluation
William Carlton’s condition has improved and he is preparing for discharge. He needs to take oral theophylline at home for his lung disease. Which response indicates he has understood the nurse’s instructions?

42. EXAMPLE: EVALUATION
A. “I can stop taking this medication when I feel better.” B. “If I have difficulty swallowing the time- release capsules, I can crush or chew them.” C. “If I become very sleepy when I take this medication, I need to cut back on the dosage.” D. “I need to avoid drinking coffee and caffeinated soft drinks while I’m taking this medication.”

43. Let me hear from you!