Is the BEST answer on a nursing exam opinion or fact?

stbernardclub · Sep 30, 2004

hahaha...your going to drive yourself nuts if you think you can understand all the theory behind those questions. But as for this one, even your book stated 4-5 feet away, and the question said 3 feet. Now get a yard stick and place it near a pillow on a bed, and then sit on the other end..its just too close. Would make the patient feel closed in. And you always want them to feel they have your undivided attention when giving a history.Remeber a few tips I figured out when taking those test...If two answers sound the same, its neither one. And when two answers are opposite, its one of them..:)

We just had an exam and one question I missed read something like this:
All of the following exhibit good listening behaviors while taking a health history except the following.
The two answers that I got it down to were:
a. Sitting three feet away from the client.
b. Stairing intently at the client while she is describing her health problems.
The correct answer was (b), but I chose (a). Here's why I chose (a).
Our text (Physical Examination and Health Assessment Jarvis 4th edition) in the relevent chapter said the following which made (a) seem correct:
1. p. 53 "Place the distance between you and the patient at 4 to 5 feet (twice arm's length). If you place the patient any closer, you may invade his or her private space and you may create anxiety.
2. p. 66 Table 4-3 Functional Use of Space 1.5 to 4 feet is the Personal Distance and is perceived as an extension of the self similar to a bubble.
Our text said the following to indicate that b stairing might be the correct answer:
1. p. 59 "You should aim to maintain eye contact, but do not "stare down" the person.
I picked (a) because I knew the book had referenced the issue of distance on two seperate occassions (although I couldn't remember the exact page numbers). When I brought it to the attention of the instructor via email, and then followed up during the test review session she indicated that not only was she not going to count my answer, but it was in fact a good question.
So here's my question. What objective criteria do instructors consider when they decide what in fact constitues the best answer? Personally, I don't think that she recalled the specific distances referenced in the text when she was writing the questions ( I say this because it has been my experience in previous classes that Prof's often don't re-read chapters before writing exams, and thus sometimes miss easy to forget details that a student who has been studying 24/7 has fresh in their mind). If I were at some hypothetical nursing school instructor "exam writing" seminar" what criteria would they tell me to implement when coming up with a "best" answer?
I think these are important questions because the grading scales are so strict (95% for an A and 78% just to pass) with absolutely NO curves, that even a few bad questions can adversely impact student grades (and potentially cause them to fail the course outright since there is NO leeway with regard to 78%). In my opinion by having such strict standards for grades they also impose an even higher standard upon themselves (even if they don't realize, acknowledge or admit to this fact) with regard to the necessity of writing accurate and objectively valid questions. However, my experience has been that many non-nursing courses such as Biology, Chemistry, Anatomy, ect. actually have better written questions despite having more forgiving grading scales AND curves. If by some miracle I actually manage to graduate nursing school any graduate program to which I apply will assume that I was tested and evaluated in a fair, accurate manner. Can someone explain the thought process behind what seems to be a contradiction? Why can't they use the comparitively excellent "peer reviewed" questions provided within the "test banks" of most good text books.

allnurses Guide · Sep 30, 2004

Yes, you'll drive yourself crazy if you ponder these questions.

I always picked the least stupid answer . .. . oh and wait for nclex! :uhoh3: :rolleyes: The answers make even less sense. I walked out of that test feeling very angry that I wasn't tested on my ability to be a nurse but to outfox a test.

Seriously though, you have a good point.

steph

talaxandra · Sep 30, 2004

If I were as diligent a student as you, and had actually remembered the distance the book said, I'd be royal p***ed, too! The key for me when I read your options was "staring intently" - never good practice. OTOH I know that primarily because I've been working for a while and so can see in my mind's eye how that would be uncomfortable. I've taken histories sitting next to the patient recumbent in bed (patient recumbent, my sitting on a chair! :chuckle ); distance is relative, but continuous eye contact is always bad.

Hoever, given that the book said so clearly what was required, I'd seriously consider following this up further if it makes a dent in your mark. What did others in your class think?

oldiebutgoodie, RN · Sep 30, 2004

At my school, most of the time, if you present your case to the prof, you might get a break. (sometimes--depending on the prof).

However, that was really a lame question. I had a Med-Surg class that had such obtuse questions, when I left the test, I never knew whether I got an A or an F.

Does kind of make you wonder why we have to spend so much energy learning how to take these tricky tests, as opposed to learning how to be a nurse.

oldiebutgoodie

chris_at_lucas_RN, RN · Sep 30, 2004

I think you answered your own question, hon.

You quoted your text as saying that personal space is an extension of the self, like an invisible bubble. Then you pick an answer where you are violating the person's personal space?

What's up with that?

It looks like an obvious answer to me. Listen intently to what they are saying. Nothing more, nothing less.

As for the NCLEX, I just took it about 2-1/2 weeks ago. It was pretty clear cut too.

Don't listen to people who tell you it is anything but that. The thing that will sink you on the NCLEX is the same thing that will sink you on your nursing exams: working so hard to remember (and defend!) little details that you miss the major concepts.

Take it easy. You're evidently doing fine.

LeesieBug · Sep 30, 2004

Unfortunately, I don't find the N-CLEX style questions clear cut at all (at least the way our instructors write them, as I have not taken the N-CLEX). Maybe it just depends on how your brain works.

I am one of those that believe nursing test questions are ridiculous. The thing they test most accurately is your ability to catch on to the test maker's way of thinking, and your ability to catch the little verbal nuances of the question. For example, in your question, ROLAND, the key word was "staring". So even though you would stand more than three feet away from someone, "staring" at them is MORE WRONG! :rolleyes: I mean, every test there are several questions our instructors wind up taking two answers to, because we point out how screwed up the question is. This past test, we had an insulin question that was plain wrong, I even varified the fact that it was wrong by asking my clinical instructor the question, looking in the book, at a hospital handout on the subject, and on the internet. However, they decided not to change that question (no explanation why, so I just went with it..not usually worth pressing the issue). It's a big game, and I have just learned to play the game and not worry about it too much.

Try not to stress too much over the questions you miss, if YOU know that you understand the nursing concepts behind the questions... all that matters is that you can pass the tests and come out of school a well educated, conscientious, GOOD nurse! THAT'S where your focus should be. And don't worry...you get better at figuring out how to answer those types of test questions as you continue to get more practice with them.

P.S. I also found it amusing that even some of us who are responding seem to have misunderstood the question. If you carefully re-read some of the discussion, you'll notice that. So take heart, the question must not be THAT clear cut...it's not just you! :chuckle

Euphrosyne7, MSN, RN · Sep 30, 2004

Hi Roland:

I can see where you are coming from..............I actually have the exact same book for one of my nursing classes and then another book for another class. These classes are supposed to be "working in conjunction with each other"; however, some things stated in one text actually contraindict things stated in the other one...........

Also we have 4 instructors, each one makes out one of our 4 quizzes for the semester.......thus far we have taken 3.........the first two weren't too bad even though we had one questions about "empathy".........the two answers that were left after eliminating the others were "showing warmth" or "placing yourself in the person's reality"................lol.........apparently showing warmth was the BEST answer........although it doesn't seem to be the actual definition of empathy.....our class argued it and they finally gave us the pt.

Also we had another crazy question on "open ended questions"........which if you look at page 55 of your text, you will find a definition of..........Well.....apparently there is also something called an "indirect statement"........which is nowhere to be found in the book but seems to be the same as defined in the book as an open ended question..........so that was another strange question................since the book calls both questions and statements to obtain more general information, open ended questions.............lol..........the best answer was indirect statement...........even though the book would have called it an open ended questions. I brought this up and was told that it depends on the type of interview!!!??? Then the two instructors that made up the quiz were supposed to get back to me.......but neither has as of yet.......and I was congratulated on my "good critical thinking skills"..and for bringing up "a stimulating class discussion".....lol............Our third exam was even worse with most of the class barely, if at all, passing because it was written by yet another instructor who had more "trick" questions on it than the previous two. I can only begin to venture what our fourth quiz will consist of....................

Besides that, I have found, as have many of my classmates, that as a group, our instructors are rather unorganized........they don't even know the syllabus as they were telling us that we had to pass in a certain assignment which is still not due (according to our syllabus) for another two weeks.....then they also contraindict each other with their answers to other specific questions.............it all seems like an exercise in futility.

In any event, our clinicals will be starting in about 2 weeks, and I hope that when our groups go off with just one instructor each, it will work out a little better. I did pass my med math exam with a 99, so at least that was a comfort to me since the way it has been going, I was sure they were going to include questions on it that we have not yet been told to cover according to our syllabus!

I am kind of looking at this semester as just get through the best I can so I can move on and am hoping for the best in the next semester which will include med-surg where I hope things will be more organized. Good luck to you and I would suggest that if you can show rationale of why your answer is the best, you might want to argue it.......some instructors will give the point, particularly if most of the class answered the same way.

Carla

hoolahan, ASN, RN · Sep 30, 2004

I probably wouldn't have chosen (a) myself because I know 3 ft is too close, and even though I think staring intently would creep me out, it would be a lesser of 2 evils in invading my space so to speak. I would think it was weird, but I would know I did have the person's complete attention, whereas being into my physical personal space would make me much more uncomfortable than the staring.

In some cultures, staring like that would be considered extremely rude, or inappropriate.

Maggie in NC · Sep 30, 2004

I would have picked (B) because the question askes "which of the following EXHIBITS..." which would mean gives the appearance of-it doesn't mean you're actually doing it LOL

I am really disappointed if that's the kind of questions you get in nursing class. That's like saying "look busy". Seems like the focus would be on more technical/clinical info. Maybe I am WAAYYY off...

Altra, BSN, RN · Sep 30, 2004

I guess I approach this differently from those of you who diligently seek out the answer by referencing textbook and/or page notes word for word. And I applaud your diligence, I think ...

I haven't gotten out my yardstick to measure how far away I am from someone when I'm talking with them. As a general rule, it's a little further away with someone who 1) I've never met before or 2) is giving off vibes of hostility/mistrust/distress/etc. and a little closer with 1) people who I have met before, even just once and 2) people who just give off that vibe that closeness is OK. My point is, I would have answered the question based on 37 years of being a human being, not trying to extrapolate the best answer from textbook pages.

Again, from 37 years of life experience - staring is just rude - it's different from looking interested - so I would have picked that answer. Have you ever experienced someone staring at you? Was it uncomfortable? There may very well be some culture in which staring is viewed differently, but since the intent of the question was on active listening skills and not multi-culturalism, I would have picked that one.

dave1117 · Sep 30, 2004

Is key to succes in every walk of life. I also would have chosen "B" not based on my nursing book but on my life experience. Perhaps them using the word staring was a bad choice, but lets face it, one of the keys to being a good listener is to make good eye contact. Now we could have a whole arguement over whether "eye contact" is technically "staring" or not. But eye contact shows you have an interest and a sick person who is divulging their life story to a complete stranger will definately feel more comfortable if they believe you are truly interested and not wandering out the window so as to not stare. Does staring equal good eye contact? Some famous writer said something like " a rose called by another name would smell just as sweet"...or something like that. And your other choice of 3 feet apart is clearing violating someones "space".

As a side bar, I have been reviewing several test for success books, nclex review books etc and most do say that you need to think outside of the box to get through nursing school. The exams are made to see if you can do that. After all nursing is not in a box, the same S & S today could mean something completely different tomorrow and I think some of the disputable test questions are trying to get you think in that way. What do they call it, Critical thinking?

Interestingly one of the books has a very long chapter on the famous psychologist Maslow. They go on and explain how Maslow's Hierarchy of Needs is the basis for any test question that asks for the best or most appropriate way to deal with a patient. It is interesting that if you use this theory and then do some nclex test questions you will start to see a pattern. Not perfect but food for thought.

Meanwhile, I am just a lowly 1st semester nursing student who "hasn't" taken his first exam yet. :chuckle But there coming...:uhoh21:

have a great day all, dave