Am I over-thinking, or are these just bad test questions?

[chicken1]

I'm a Freshman I student in an ADN program. I'm getting really frusterated with what I feel are some poorly written test questions. I get the idea that the test questions are supposed to mimic the NCLEX by having the 'critical thinking', judgement-based questions, but I think some of the questions that I've gotten wrong this semester have logical fallacies that make the question invalid. I want opinions from you guys: are these really bad questions, or am I just 'over-thinking' them, as my instructors tell me?

Question #1:

Your client tells you he is feeling pain in a location different from where it started. You know his type of pain is....

a. referred

b. viseral

c. radiating

d. cutaneous

I picked 'c', and was wrong. The answer given by the teacher is 'a', referred. My impression of referred pain is that pain is not felt at the site of tissue damage, but is felt in a different location....so 'referred' would be the correct answer if the question read ...'Your client tells you he is feeling pain in a location different from the site of tissue damage. But, the way the question is written, 'it' refers to pain, and it is true to say that radiating pain is pain that is felt in one location, and then is felt in a different location (as it radiates from one location to the next).

Question #2

What is the surgical classification for cataract removal?

a. major

b. urgent

c. restorative

d. cosmetic

I don't think any of these answers are correct, so the question is invalid. The instructor's answer was 'c', restorative. While cataract removal does result in restored vision, the definition for restorative surgery is that is 'restores function or appearance to traumatized or malfunctioning tissues'; cataract removal does not restore function to the damaged tissue, it removes the tissue and replaces it with an artifical lens. Therefore the classification pertaining to purpose should be 'ablative', or 'ablative and transplant'. I picked 'b', urgent, thinking it was the best answer out of those provided, even though I understand that cataract surgery is better classified as an elective surgery.

3. You are teaching a patient about ways to induce sleep. You will be sure to teach him that...

a. a cup of warm, regular tea before bed will help him sleep.

b. a glass of red wine promotes deep and REM sleep

c. as you age, the length and quality of REM and deep sleep decrease

d. physical activity prevents falling asleep

Again, I think there is not a fully correct answer. C is the only completely true statement, but I would NOT teach my client that if my purpose is to teach about ways to induce sleep because it is not fully relevant to the teaching topic and would obsure the main messages that the patient should learn. I picked 'd', figuring that although physical activity may help promote sleep if it is moderate and well bedfore bedtime, it can also prevent sleep if it is to the point of fatigue or too close to bedtime.

4. Which of the following statements, if stated by your client, would show understanding of the fecal occult test?

a. I must use a 1-2" piece of formed stool

b. I will complete the test over a three day period.

c. I will wait until my cycle starts to do the test.

d. I eat red meat on a daily basis.

The instructor gave the correct answer as 'a'. I had eliminated this choice because it is true to say "You do not have to use a 1-2" piece of formed stool for the fecal occult test, instead, you can use 15 mL of liquid stool. I picked 'b' instead, because the test can be completed over three days....like the Hemoccult test directions say to do. Instructor said it's better to do it over three consecutive stools, which may be true....but I think the question is invalid as written because of the logical error in using the word 'must' in choice 'a', rather than 'can'.

5. A nurse monitors a patient's vital signs and assesses his IV medications for 15 mintues. The nurse does not acknowledge or speak to the patient or the patient's spouse while she is in the room. Which behavior is the nurse best demonstrating?

a. discourtesy

b. unprofessionalism

(c and d were nonsense answers that I can't remember)

I picked 'b', unprofessionalism, while the instructor's correct answer is 'a', discourtesy. The book lists the 'elements of professional communication' as consisting of 'courtesy', 'use of names', 'trustworthiness', 'autonomy and responsibility', and 'assertiveness'. The instructor says discourtesy is the best answer because it it most specific. I think unprofessionalism is a better choice because the nurses behavior in this situation fails to be courteous, to use names, to build trust, and to promote patient autonomy; therefore, unprofessionalism encompasses all the failures in her communication which 'discourtesy' unneccessarily limits the boundaries of the behavior. In either case, I think this question is arbitrary and could have been made a valid question by simply asking 'Which behavior is the nurse most specifically demonstrating?'

Again, am I over-analyzing or do the questions have inherent flaws? Am I misunderstanding the material somehow? Any input is appreciated. As an 'A' is a 93, there is not much room for error on these tests....and I'm debating whether I should try to formally petition a few of these questions if I end up with a 91 or 92 in the class.....

[puravidaLV]

Yes and no. Sometimes I look at my answers am amazed that I got it wrong, yet when I get the rational from the teacher I am awestruck how I got my answer.

I think the more you think about the question the more the answer doesn't make sense. Some of the things I thought to be common sense now don't even make sense....so go figure.

[2ndyearstudent, CNA]

Question #1:

Your client tells you he is feeling pain in a location different from where it started. You know his type of pain is....

a. referred

b. viseral

c. radiating

d. cutaneous

Rotten question. Requires you to read the instructor's mind for context.

Question #2

What is the surgical classification for cataract removal?

a. major

b. urgent

c. restorative

d. cosmetic

The answer is clearly C. The vision is restored. Valid question.

3. You are teaching a patient about ways to induce sleep. You will be sure to teach him that...

a. a cup of warm, regular tea before bed will help him sleep.

b. a glass of red wine promotes deep and REM sleep

c. as you age, the length and quality of REM and deep sleep decrease

d. physical activity prevents falling asleep

C is clearly the correct answer. Valid question.

4. Which of the following statements, if stated by your client, would show understanding of the fecal occult test?

a. I must use a 1-2" piece of formed stool

b. I will complete the test over a three day period.

c. I will wait until my cycle starts to do the test.

d. I eat red meat on a daily basis.

A is the only sensible choice. You are correct that "must" is a trouble word, but the other three are obviously incorrect. Valid question.

5. A nurse monitors a patient's vital signs and assesses his IV medications for 15 mintues. The nurse does not acknowledge or speak to the patient or the patient's spouse while she is in the room. Which behavior is the nurse best demonstrating?

a. discourtesy

b. unprofessionalism

(c and d were nonsense answers that I can't remember)

This is just a stupid question.

As an 'A' is a 93, there is not much room for error on these tests....

Ah, here we are again. The reason for stupid questions like 1 and 5 are so they don't have too many people getting over 93. These subjective coinflip type test questions serve little to no purpose in teaching you about the nursing profession or helping you pass the NCLEX. They do, however, make the professor feel they designed a "good" test because very few people scored too high.

Questions 2, 3, and 4 are perfectly valid and as you suspect you are reading too much into them and asking "What if...?" Don't do that. The trick to getting an A on these tests is getting absolutely 100% on the 2, 3, and 4 types and rolling good dice on the 1 and 5 types.

I have a flaming jerk of a professor who loves asking questions like 1 and 5. He is a lazy *** who thinks if he writes a confusing question that half the class answers one way and the other half answers another, he wrote a good test question.

[sweet_b]

It's ok to feel like you don't know what you're doing with these questions. You've never expereinced them before. I too struggled my first semester with them, but you learn. I suggest getting Sunders Comprehensive Review for the NCLEX - RN examination, by Silvesteri. It really helped me figure out how to read and break up the questions. It will come, I promise. It's just not the test questions you are used to seeing while getting into the program. There are just my thoughts behind the questions you posted. Good luck!!

Question 1: a. your teacher is right. an example would be: People with gallbladder pain may have that pain referred to the shoulder.

Question 2: c. The cataracts surgery is "restoring" the pts eyesight.

Question 3: c. As a nurse you are always teaching. You need to let him know why he may be expereincing lack of sleep. You over thought the question....the key word was prevents sleep.

Question 4: hmmm this one stummped me as well. I need to look go back and look at some stuff. :)

Question 5:I think maybe she didn't choose unprofessionalism, because it may more refering she was doing the aspects of her job, checking vitals, IV meds and such, but she was being discourteous (rude) as she was not acknowledging the pt or the pts wife.

[llg, PhD, RN]

As in most cases, I think the "truth" lies somewhere in the middle. There are some weaknesses in some of the questions, but you are also over-thinking them.

1. Badly worded question. The example should have been more clear.

2. "restorative" is the best answer because it restores vision. It is not urgent in the usual sense of the word urgent in health care. You over-thought that one.

3. "C" was the best answer as it is true. You had to go through mental contortions to try to find a way to justify the d answer. There is no reason why you couldn't teach your patient the value of getting exercise -- you just have to teach him to do it at the proper time. There is no law that says that your intervention must be done within an hour of bedtime. You were just wrong on that one.

4. Bad question. I don't like any of the answers.

5. Bad question unless your class content included a discussion of the distinction between rudeness and professionalism. Did it? Most people would assume that being rude is unprofessional. So this question is not worth asking unless the distinction is part of the course content.

Just my $.02

[CrazierThanYou]

Yes and no. Sometimes I look at my answers am amazed that I got it wrong, yet when I get the rational from the teacher I am awestruck how I got my answer.

I think the more you think about the question the more the answer doesn't make sense. Some of the things I thought to be common sense now don't even make sense....so go figure.

I do the same thing. I suspect these questions came from the Potter and Perry test bank because I've had the exact same questions. But, I don't really think they were bad test questions.

Here is one we had on our last test:

Which of the following is a life style risk factor for disease:

A: Obesity

B: Sunbathing

C: Genetics

D: Can't remember this one.

In reading this question, I saw that BOTH A and B are lifestyle risk factors but I picked A. So did everyone else. Surprise! The instructor says the answer is B. In checking the textbook I found this exact sentence "Lifestyle factors can increase the risk of disease; for example obesity can increase the risk of heart disease, while sunbathing can increase the risk of skin cancer."

When we argued this answer, the very lame rationale is that obesity is a modifiable risk factor. First of all, the question says NOTHING about modifiable risk factors and second, sunbathing is ALSO a modifiable risk factor.

There were 3 other similar questions that were in the book, yet our answers were counted wrong.

If we don't get those points back, I don't know what I'm going to do but it won't be pretty.

[kgh31386, BSN, MSN, RN]

Question #1:

This one I can say I don't really like. I would agree if they said different location from where the "injury occurred". The only way I can see it being referred is if..site A was hurting, then site A no longer hurts, but site B hurts now. Say you had a pancreatic injury, so your abdomen hurt, but now your back is hurting because the pain is referred there. Radiating kind of has a flow to it...like a wave from your chest down your left arm sort of thing. But both sites will still have pain. Still not the WORST question because it did let you know the original site no longer hurt.

Question #2

How is this urgent? Very legit question, restorative is the way to go because it helps to..well restore your vision.

Question #3

C is a very good answer. Remember that when you teach, you also have to teach about potential obstacles. If you're teaching them about a night time routine or habits to help them sleep, their age may play a factor in the success of these interventions. The patient may do the exact same routine as someone half their age, but sleep a lot less because of their age.

Question 4.

Like they said, must is a bad choice of words..but you can easily eliminate C and D. I do agree with the OP on this one. It's a good idea to get 3 stool samples at least a day apart. You don't have to use formed stool. I can kind of see that A is specific to the occult blood and most important in the success of the test. You can be successful even if you don't get 3 stools a day apart, but if you don't use enough..well yeah.

Question 5.

I'm just thinking that B isn't really a behavior. But being discourteous is a behavior. A is the most specific answer to the description in the question. You don't know if the nurse had a full conversation with the patient and spouse prior to these 15 minutes. You don't know if the nurse was pleasant the night before or hour before. But based on what is simply given, they are being discourteous. Don't go into the what if, what if they aren't helping their rapport, autonomy, trust, comfort, this and that or the other. While you do like to shoot for the universal answers, this one described a specific behavior. Still not the best question

[kenpochic]

I'm sorry but i didnt find ANY of those questions hard. No offense but those arent tough nursing questions. its just a matter of training your brain. ok for example the first one the pain is in a different place right. well thats referred pain. you have problem in one area but another area hurts. so lets say the pain was in his chest at first now its in the arm thats a referred pain. You need to be able to apply the concept it seems like you are just looking at the memorize definition of the words and thats not gonna cut it. work on your application skills and get some strategy guides. perhaps your teacher can tell you some she recommends. I am a first year student so trust me I understand how it is to be new too lol

[kenpochic]

oh by the way nursing tests are all about picking out KEY words if you miss the key words its easy to get the answer wrong

[kgh31386, BSN, MSN, RN]

Here is one we had on our last test:

Which of the following is a life style risk factor for disease:

A: Obesity

B: Sunbathing

C: Genetics

D: Can't remember this one.

Hah, I never thought obesity was necessarily a "lifestyle". Things like being a Christian, being gay, being whatever... the things you DO in life are your lifestyles. Sunbathing is a lifestyle because it's something you do. But being obese, I guess it could be because you're "being obese".

[CrazierThanYou]

Hah, I never thought obesity was necessarily a "lifestyle". Things like being a Christian, being gay, being whatever... the things you DO in life are your lifestyles. Sunbathing is a lifestyle because it's something you do. But being obese, I guess it could be because you're "being obese".

I guess one's eating habits would be the lifestyle. But, either way, the book listed BOTH of them as lifestyle risk factors in the SAME sentence.

[2ndyearstudent, CNA]

its just a matter of training your brain. ok for example the first one the pain is in a different place right. well thats referred pain. you have problem in one area but another area hurts.

The question is bad because it could also be interpreted as the pain starting in one place then moving to another.