Test Taking Skills Rita Carey-Nita

Avoid asking What If?Focus on the information in the

questionDo not add information or read

into the questionRule out definite incorrect options

firstThen re-read the question and

make choice based on remaining options

Trust yourself

Example of What If ?A nurse is changing the tapes on a

tracheostomy tube. The client cough, and the tube is dislodge. The initial nursing action is to:

1. Call the physician to reinsert the tube.2. Ventilate the client using a manual

resuscitation bag and face mask.3. Cover the tracheostomy site with a

sterile dressing to prevent infection4. Call the respiratory therapy department

to reinsert the tracheostomy tube.

What IfA nurse is changing the tapes on a

tracheostomy tube. The client cough, and the tube is dislodge. The initial nursing action is to:

1. Call the physician to reinsert the tube.2. Ventilate the client using a manual

resuscitation bag and face mask.3. Cover the tracheostomy site with a

sterile dressing to prevent infection4. Call the respiratory therapy department

to reinsert the tracheostomy tube.

Strategic WordsMakes difference with regard to

what question is askingHelps to focus your attention on

a critical point to consider when answering the question

All options may be correct but one is priority or most essential

Strategic Words◦Best ◦First◦Immediately◦Initial◦Most likely ◦Least likely◦Most appropriate◦Least appropriate◦Early ◦Late

Example of Strategic Word ? A client with a diagnosis of heart

failure reports the occurrence of sudden shortness of breath and dyspnea. The nurse takes which immediate action:

1. Calls the physician2. Administers oxygen3. Elevates the head of the bed4. Prepares to administer

furosemide (Lasix)

Answer for Strategic Word ?A client with a diagnosis of heart

failure reports the occurrence of sudden shortness of breath and dyspnea. The nurse takes which immediate action:

1. Calls the physician2. Administers oxygen3. Elevates the head of the bed4. Prepares to administer

furosemide (Lasix)

Prioritizing QuestionsWhat is the first priority in

regards to scenario?◦Think about the question◦Apply nursing knowledge◦Apply clinical experience

For listing answers according to priority you must list what is first then next & so on…

Prioritizing Strategic WordsBestEssentialFirstHighest priorityImmediateInitialMost importantPrimaryVitalNext

Prioritization QuestionThe nurse is assigned to care for

four clients. When planning client rounds, which client should the nurse check first ?

1. A client on a ventilator2. A client in skeletal traction3. A postoperative client preparing

for discharge4. A client admitted on the previous

shift who has a diagnosis of gastroenteritis

Prioritization QuestionThe nurse is assigned to care for

four clients. When planning client rounds, which client should the nurse check first ?

1. A client on a ventilator2. A client in skeletal traction3. A postoperative client preparing

for discharge4. A client admitted on the previous

shift who has a diagnosis of gastroenteritis

Ingredients of Question See Box 5.3

Subject of QuestionWhat is the subject or focus of

the question?Focus on the subject to help

eliminate incorrect optionsIf the option does not fit the

subject, you know to rule it out.

Example of Subject of the QuestionThe nurse is planning to teach a

client in skeletal leg traction about measures to increase bed mobility. Which item would be most helpful for this client?

1. Television2. Fracture bedpan3. Overhead trapeze 4. Prepares to administer

furosemide (Lasix)

Subject of Question The nurse is planning to teach a

client in skeletal leg traction about measures to increase bed mobility. Which item would be most helpful for this client?

1. Television2. Fracture bedpan3. Overhead trapeze4. Prepares to administer

furosemide (Lasix)

Positive Versus Negative QueryPay attention….Is the question asking

you for a positive or a negative answer

Example of Positive Query◦The patient shows an understanding of the

goal of treatment when….. Looking for a positive response by patient

Example of Negative Query◦The patient requires further patient

teaching when stating…. Looking for an incorrect response by the patient

Positive QueryThe nurse has provided discharge instructions regarding

nitroglycerin therapy to the client with angina. Which statement by the client indicates an understanding of the home use of the nitroglycerin?

1. “If I use the nitroglycerin and the pain does not subside in 15 minutes, I should go to the hospital.”

2. “When I have pain, I should lie down and place a tablet under my tongue. If unrelieved in 5 minutes, I should take another tablet.”

3. “When I have pain, I should put a tablet under my tongue. If I have a burning sensation, I should call the doctor immediately.”

4. When I experience chest pain, I can continue what I’m doing. If it doesn’t go away in 10 minutes, I should use a nitroglycerin tablet.”

Positive QueryThe nurse has provided discharge instructions regarding

nitroglycerin therapy to the client with angina. Which statement by the client indicates an understanding of the home use of the nitroglycerin?

1. “If I use the nitroglycerin and the pain does not subside in 15 minutes, I should go to the hospital.”

2. “When I have pain, I should lie down and place a tablet under my tongue. If unrelieved in 5 minutes, I should take another tablet.”

3. “When I have pain, I should put a tablet under my tongue. If I have a burning sensation, I should call the doctor immediately.”

4. When I experience chest pain, I can continue what I’m doing. If it doesn’t go away in 10 minutes, I should use a nitroglycerin tablet.”

Negative QueryA nurse has provided medication instructions

to a client who will be taking warfarin sodium (Coumadin) indefinitely. Which statement by the client indicates a need for further teaching?

1. “I need to use a soft toothbrush.”2. “I need to use a straight razor for shaving.” 3. “I need to avoid drinking alcohol while

taking this medication.”4. “I need to carry identification about the

medication being taken.”

Negative QueryA nurse has provided medication instructions

to a client who will be taking warfarin sodium (Coumadin) indefinitely. Which statement by the client indicates a need for further teaching?

1. “I need to use a soft toothbrush.”2. “I need to use a straight razor for shaving.” 3. “I need to avoid drinking alcohol while

taking this medication.”4. “I need to carry identification about the

medication being taken.”

Focus on ABC’s Think ABC’s

1. Airway2. Breathing 3. Circulation

If you don’t have an airway…you have nothing

With physiological questions focus on first airway, then breathing & move on to circulation

ABC QuestionA client with a compound (open) fracture of the

radius has a cast applied in the emergency department. The nurse provides home-care instructions and tells the client to seek medical attention if which of the following occurs?

1. Numbness and tingling are felt in the fingers2. The cast feels heavy and damp 24 hours after

application3. The entire cast feels warm during the first 24

hours after application4. Bloody drainage is noted is noted on the cast

during the first 6 hours after application.

ABC QuestionA client with a compound (open) fracture of the

radius has a cast applied in the emergency department. The nurse provides home-care instructions and tells the client to seek medical attention if which of the following occurs?

1. Numbness and tingling are felt in the fingers2. The cast feels heavy and damp 24 hours after

application3. The entire cast feels warm during the first 24

hours after application4. Bloody drainage is noted is noted on the cast

during the first 6 hours after application.

Maslow’s HierarchyPhysiological are first priority

1. Airway~Respirations~Heart Rate~Nutrition~Elimination

Safety & Security2. Protection from injury~sense of security

Love & Belonging3. Having support system~not isolated

Self-Esteem4. control~competence~positive

regard~acceptance~worthiness Self-Actualization

5. hope~spiritual well-being~enhanced growth

Maslow HierarchyA nurse is assigned to care for a client

experiencing difficult labor. When assisting with planning care, the nurse would consider the highest priority to be frequent:

1. Position changes and providing comfort measures

2. Explanations to family members about what is happening to the client

3. Monitoring for changes in the physical condition of the mother and fetus

4. Reinforcement of breathing techniques learned in childbirth preparatory classes

Maslow’s HierarchyA nurse is assigned to care for a client

experiencing difficult labor. When assisting with planning care, the nurse would consider the highest priority to be frequent:

1. Position changes and providing comfort measures

2. Explanations to family members about what is happening to the client

3. Monitoring for changes in the physical condition of the mother and fetus

4. Reinforcement of breathing techniques learned in childbirth preparatory classes

Question focusing on the Nursing ProcessThink about the steps of the nursing

process◦Data Collection (Assess)◦Diagnose◦Plan◦ Implement◦Evaluate

If it is a question involving the nursing process determine which step the question is focused on

Then choose the option that addresses that step

Nursing ProcessIf it is a data collection (AKA: Assessment)

step look for options that have terms such as:◦ Check◦ Collect◦ Determine◦ Find out◦ Gather◦ Identify◦ Monitor◦ Observe◦ Obtain information◦ Recognize

Nursing ProcessPlanning phase:

◦The planning of care◦Focuses on setting goals◦Organizing or managing care

Implementation phase:◦The action of providing care◦Managing care◦Providing care◦Communicating ◦Documenting

Nursing ProcessEvaluation phase

◦Evaluates the success or failure of the plan of care

◦Focus on comparing the actual outcome with the planned or expected outcome

◦Focus on possible factors the cause interference of accomplishment of goals

◦May use a negative query for this type of question

Nursing Process QuestionThe nurse develops a plan of care for an older

client with diabetes mellitus. The nurse plans to first:

1. Structure menus for the diet2. Teach about insulin administration using videotapes 3. Encourage dependence on others to

prepare the client for this chronic disease

4. Determine the clients ability to read label markings on syringes and blood

glucose monitoring equipment

Nursing Process Question: AssessmentThe nurse develops a plan of care for an older

client with diabetes mellitus. The nurse first must:

1. Structure menus for the diet (plan)2. Teach about insulin administration using videotapes (implementation)3. Encourage dependence on others to

prepare the client for this chronic disease (implementation)

4. Determine the clients ability to read label markings on syringes and blood

glucose monitoring equipment(assessment)

Client NeedsRemember the importance of safety

measures◦Call bell~side rails~bed in low

position~handwashingPsychosocial Integrity

◦Questions regarding emotional, mental & social well-being

◦Use of therapeutic communication as correct option

◦Select options that focus on the feeling of patient, caregiver, significant others.

Client NeedsHealth Promotion

◦Questions focus on promotion of patient health or maintenance of health

◦May focus on normal growth and development

◦Early detection or screening for illness

◦May focus on patients willingness & readiness to change health habits

◦These questions are often set up as negative query

Certain options to watch forEliminate comparable or alike options

◦ If only one answer is correct, you know these can be eliminated narrowing your choices

Eliminate options with close-ended words◦Options with the following words are usually

wrong; too extreme All~Always~Every~Must~None~Never~Only

Look for umbrella options◦This option contains the concepts of the other

options as well◦This is usual a correct option

Comparable or Alike QuestionA nurse instructs an adolescent

with iron-deficiency anemia about the administration of oral iron preparations. The nurse tell the adolescent that it is best to take iron with:

1. Cola2. Soda3. Ginger ale4. Tomato juice

Comparable or Alike QuestionA nurse instructs an adolescent with

iron-deficiency anemia about the administration of oral iron preparations. The nurse tell the adolescent that it is best to take iron with:

1. Cola2. Soda3. Ginger ale4. Tomato juice

Delegating There may be question regarding

delegationKey Principles:

◦Know your scope of practice as well as the CNA & RN

◦Which tasks can be delegated to the CNA?◦What are the skill and duties you can perform?◦What is strictly the role of the RN?

Keep in mind..Depending on the setting…you may be the one delegating or in charge.

Delegating QuestionA nurse is planning the client assignment

for the day and most appropriately assigns which client to the nursing assistant?

1. A client on strict bedrest2. A client with dyspnea who is receiving

oxygen therapy3. A client scheduled for transfer to the

hospital for surgery4. A client with a gastrostomy tube who

requires feedings every 4 hours

Delegation QuestionA nurse is planning the client assignment

for the day and most appropriately assigns which client to the nursing assistant?

1. A client on strict bedrest2. A client with dyspnea who is receiving

oxygen therapy3. A client scheduled for transfer to the

hospital for surgery4. A client with a gastrostomy tube who

requires feedings every 4 hours

Pharmacology QuestionsIf familiar with medication, use your

nursing knowledgeWill include generic and trade nameBreak down the medication

◦What class is it?◦ Is there a specific disease process it is used

for?◦What are some common side-effects?◦Think about the common endings to

medications olol-beta-blocker

Pyramid PointsNo antacid with medsDon’t not crush enteric coated &

sustained release tablets or open capsules

Patients should never adjust doses or abruptly stop medications

Use caution with over the counter and herbal supplements

Use caution with alcohol and smokingNever administer a medication that is

questionable or illegible

Calculations Calculations If there is a question requiring

calculations always recheck your math

Review and understand your formulas for dosage calculations or for IV therapy

Unfortunately this is a point of memorizing the formula

Need to know it to apply it

Some key study skillsBe sure not to cramFind a study method that works best for youDetermine best time for you to study Know what type of learner you are and

utilize methods that work best for youSometimes study groups are good and

sometimes bad◦ You need to know material before you can work

in group setting◦ Choose study partner carefully ◦ Don’t take someone’s word for it ◦ Be sure they know what they are talking about

Wrap UpSome general principles for test

day:◦BREATHE◦RELAX◦Dress comfortable◦Give yourself enough time to arrive

for test◦On the day of a test just have

confidence that you know the material

◦Trust yourself