My advice would be. Read the chapters before lectures and hitting the key points which can be found at the end of the chapter. When taking notes, don't write word for word what the instructor has on their powerpoint. Reason being, is because not all of the information on the power point will be on the exams. Pay attention to the key information that instructor might often say in repetition or when they say "You need to know..." because that might be on the exam. When studying for exams, actually do the study guides. I've never done study guides until I got to my LVN program and I spent hours reading and completing those study guides because they will help and you could see information the exam that you actually wrote in your notes. Form study groups because they will help you and you can bounce information off of each other. Utilize your instructors, when they have office hours or announce they are available for help take advantage. Another thing I would like to add is when you're reading or doing exams and you get rationales to why you get it wrong take time to read those because you will want to understand why the answer is wrong and not memorize it because each instructor will say, "Don't memorize, instead understand the information" because without a good understanding of the material you're in for a tough time.