1. Nataliya Lishchenko TSMU School of Nursing
Test Taking Skills
Nataliya Lishchenko
TSMU School of Nursing

2. What is NCLEX
In April 1994 nurse licensure candidates began taking the National Council Licensure Examination (NCLEX®) on a computer at test centers located across the United States and its territories.
National Council of State Boards of Nursing (NCSBN).
The NCLEX examinations are only provided in a computerized adaptive testing format.

3. Pass rates?

5. For more information http://www.ncsbn.org

6. Factors that negatively affect NCLEX scores:
1. English as a second language
2. Working more than 20 hours per week
3. Family responsibilities
4. A delay of five months or more between graduation and taking the NCLEX examination

7. Factors that positively affect NCLEX scores:
1. Taking the NCLEX examination within three months of graduation
2. Familiarity with computer test-taking
3. Strong English skills

8. Test Taking Strategies

9. Anatomy of a Test
The STEM is the initial part of the question and can:
Be a complete or incomplete sentence.
Have positive or negative polarity.

10. If it is a complete sentence:
STEM can stand alone.
Poses a question.
Example:
What should be the first action of the nurse when a fire alarm rings in a health care facility?
a) Close all the doors on the unit.
b) Take an extinguisher to the fire scene.
c) Check the code chart to locate the fire.
d) Move patients laterally toward the stairs.

11. If it is an incomplete sentence:
STEM is a group of words that forms the beginning of a sentence.
Becomes complete when combined with one of the answer options.
Example:
People should be encouraged not to smoke in bed because it could…
a) Result in a fire.
b) Upset a family member.
c) Trigger a smoke alarm.
d) Precipitate lung cancer.

12. If the STEM has positive polarity:
It is concerned with the truth.
Asks “What would you do?”
Example:
Which intervention most accurately supports the concept of informed consent?
a) Obtaining the patient’s signature.
b) Explaining what is being done and why.
c) Involving the family in the teaching plan.
d) Teaching preoperative deep breathing and coughing.

13. If the STEM has negative polarity:
It asks a question with a negative statement
Asks “What would you NOT do?”
Example:
What position would be contraindicated for the patient who has dyspnea?
a) Contour
b) Fowler’s
c) Prone
d) Supine

14. Anatomy of a Test
OPTIONS are the possible responses offered by the test item and can:
Be a sentence.
Complete a sentence begun in the stem.
Be an incomplete sentence.
Be a single word.

15. One OPTION is the correct answer to the test item.
Remaining OPTIONS are incorrect.
Incorrect OPTIONS are called DISTRACTORS.
DISTRACTORS are designed to distract you from the correct answer to the test item.

16. Three practice test items follow. For each item:
Identify the parts of the test items.
What is the issue?
Who is the client?
Are there key words in the test question?
Determine what type of stems are used.
Negative / Positive polarity
Incomplete / Complete sentence
Identify options & distractors in each test item.

17. Before performing a procedure, what should the nurse do first?
Raise the patient’s bed to its highest position.
Collect equipment necessary for the procedure.
Position the patient for the procedure.
Explain the procedure to the patient.
STEM: “What should the nurse do first?” (complete sentence)
OPTIONS: a – d (complete sentences)
KEY WORDS – FIRST
DISTRACTORS: options a, b, c
BEST ANSWER: option d

18. Which intervention is the most effective way to prevent the spread of microorganisms?
Donning a mask.
Wearing a gown.
Washing the hands.
Keeping visitors out.
STEM: entire question (complete sentence)
OPTIONS: a – d (incomplete sentences)
KEY WORDS – MOST EFFECTIVE
DISTRACTORS: options a, b, d
BEST ANSWER: option c

19. The nursing process is a method nurses use for: assessing the client
interviewing the client
writing the care plan
organizing and delivering nursing care
STEM: entire question (incomplete sentence)
OPTIONS: a – d (incomplete sentences)
KEY WORDS – METHOD
DISTRACTORS: options a, b, c (individual steps)
BEST ANSWER: option d

20. SCENARIOS require you to picture yourself in the situation
SCENARIOS require you to picture yourself in the situation. Think about the role of the nurse as it relates to the information given in the test item. Consider each option, then choose the BEST response for the nurse in that situation.

21. Scenario example 1.
Mr. Sherwood is a 58 year old accountant diagnosed with cancer of the colon. He was treated surgically with a colostomy. While checking Mr. Sherwood’s blood pressure, the nurse asks, “How are you feeling?”. He replies, “That feels tight on my arm.” This feedback tells the nurse:
a) Mr. Sherwood has a language barrier.
b) The meaning of her message was not received.
c) Her facial expression conveyed a different message.
d) Mr. Sherwood is disoriented.

22. Identify the main focus of the situation: communication
Consider each option:
No indication of this is given in the scenario.
Best answer.
No information given about facial expression.
Not enough data to determine this.

23. Scenario example 2.
The client, Mrs. Smith, is on strict bed rest after a right total hip replacement. Musculoskeletal abnormalities that can be identified during nursing assessment of Mrs. Smith include all of the following but:
a) decreased muscle tone.
b) contractures.
c) loss of muscle mass.
d) capillary refill.

24. Identify the main focus of the situation: musculoskeletal abnormalities
Note: this is a negative question that asks you to identify the option that is NOT musculoskeletal.
Consider each option:
a, b, c = musculoskeletal
d = cardiovascular (best option)

25. Rules for Successful Test-Taking:
Start preparing for the test the first day the topic is discussed.
Pay attention to content that is emphasized or repeated.
Know the parts of a test question.
Read the test questions carefully.
Identify key words.
Watch out for “except”; “first”; “best”; “always”; “never”; “must”.

26. Rules for Successful Test-Taking:
Identify the theme of the item – do not assume information that is not given.
Don’t add information.
Try to answer the question before reading the options.
Eliminate obviously incorrect options first.
Separate what the item is telling you from what it is asking you.
Select options that are therapeutic, show respect, and communicate acceptance.

27. Rules for Successful Test-Taking:
Know the basic principles that guide nursing.
Assess before acting.
Differentiate the need for nursing judgment from physician judgment.
Attend test reviews and assess your errors carefully.
Did you miss content?
Missed a key word?
Added information?
Manage time effectively – note number of questions and time allowed.
Leave enough time to check your answers.
Skip questions you cannot answer and come back to them.

28. Rules for Successful Test-Taking:
Look for grammar clues – singular subjects require singular verbs; plural subjects require plural verbs.
Master the math – you will see it on EVERY test.
DO NOT get into the habit of changing an answer – you cannot make changes on the NCLEX. If you feel you must change an answer, only do so if you are ABSOLUTELY sure your new answer is correct.
Choose the BEST answer – more than one may be correct, but only one is the BEST answer.

29. Reducing Test Anxiety
Be well-prepared and affirm your ability to do well.
Get a good night’s sleep.
Avoid caffeine.
Eat breakfast.
Leave home a little earlier than usual.
Anticipate the unexpected.

30. Be A “Test Manager”
Arrive on time, bring the right “tools” (pencils, erasers, calculators, etc.)
Sit in a quiet place – do not try to learn new material.
Check for all pages of the test and make sure you understand the directions.
Budget your time – do not leave the test early (review your answers).
Maintain a positive attitude.

31. Making Educated Guesses
Do not leave any answers blank, unless there is a penalty for guessing.
Choose the most general answer when other choices are specific.
Choose the longest answer when others are much shorter.
Choose the answer with the middle value when others are high or low.
Choose neither of two similar answers.
Choose one of two opposite answers.
Choose among familiar answers.
Choose logical answers
Avoid answers with absolutes (always, never, none, all) in them.

32. After the Test Review your score. Look for patterns in your errors.
Ask for extra help as soon as you know you need it.
Start reviewing for the next test!

33. Top 10 tips for answering questions on NCLEX
10. PRIORITIZE!! Remember to look for words that establish priority (most, first, best, & initial). These words will help you weed out info that you really don’t need!! Keep in mind Maslow’s hierarachy of needs, the nursing process, and patient safety. “Which patient should you see first?” is a popular question….understand the rules of management.

34. Top 10 tips for answering questions on NCLEX
9. Know your NORMALS!! Normal lab and test values are good to know.They will help you decide when there is a problem or if it has already been fixed!

35. Top 10 tips for answering questions on NCLEX
8. Stay CALM!! You will get questions that you will have little confidence on how to answer, but staying calm and using key words to pick the best answer will never lead you wrong.
7. Always ASSESS before you IMPLEMENT. It is easy to get tripped up by
implementing a nursing action before they assess the patient.

36. Top 10 tips for answering questions on NCLEX
6. Assume you have an MD ORDER. There are no trick questions out there and the NCLEX wants to know if you know what to do as a nurse….not what the doc knows! So, your first response is probably not going to be “calling the doc”.
5. Think PATIENT SAFETY at all times. Start remembering this mantra now because you will hear it over and over in practice.

37. Top 10 tips for answering questions on NCLEX
4. The REAL WORLD is a different place from the NCLEX WORLD. Answer the
questions by what you know from a textbook…..not what you remember
about taking care of Mrs. X in your clinical rotation.
3. Remember the FIVE RIGHTS of MEDICATION administration. Know these
frontwards, backwards, and sideways….you will use this on NCLEX and
daily in the real world!

38. Top 10 tips for answering questions on NCLEX
2. CONSIDER “THERAPEUTIC COMMUNICATION” WITH THE PATIENT. The wrong answers usually are ones that include you being a drill sergeant, asking closed-ended questions, or “why do you feel this way?” questions. Also be wary of any answers to patient questions that involve “don’t worry” or “that happened to me once”.

39. Top 10 tips for answering questions on NCLEX
1. REVIEW, STUDY, REVIEW, STUDY, REVIEW, STUDY!!!!!! Do not take the NCLEX until you have taken time to review what you learned in nursing school. Use the ATI system to assess your knowledge, review, and re-test, until you are confident in your knowledge. BUT DON’T WAIT TOO LONG TO TAKE NCLEX! You will do better if the information is “fresh” in your mind.