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.....

[dudette10, MSN, RN]

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

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)

These are the ones I missed for the reasons you did. On 3, I focused on "induce sleep" in the question. That is a valid test-taking strategy (what is the question asking), and the answer marked "correct" was not a strategy to induce sleep. It was a physiological basis for why sleep is more difficult for older clients, and the question did not mention the age of the patient.

For 5, it's one of those stupid questions. Who cares what classification of behavior the nurse is demonstrating. The point is her behavior sucks! In addition, a test-taking strategy that I've read about involves selecting the most general answer that covers all components of the question. So, I too picked b.

For the other questions, I do think you were over-thinking them, but then again, I picked the same answers you did on 3 and 5. :)

[ashleyisawesome, BSN, RN]

i went through and answered all the questions without reading the answers first and got them all correct... but i can see where you are coming from, i think you might be thinking too much into it. after reading your explanations of why you chose other answers, i too began questioning my answers for some of them.. but, dont feel alone, my tests have stupid questions like that too. sometimes the answer is blatantly wrong, and the teachers even admit that it is horribly worded, but alas, they never change our grades.

[Streamline2010]

I am an engineer and not in nursing classes yet. I answered 1-4 correctly, by reasoning what seems like the most correct. Someone posted on here that the NCLEX questions frequently are staged with answers as follows:

red

dark red

light red

blue

meaning that there is usually one blatantly wrong answer and three that are correct to some degree, but you pick the most obviously correct one.

Question 5 was the only one that even generated a "whattheheck" response from me, lol. Neither of those answers.

It's the nurse's job to take assessments and check the IV. It's the patient's and visitor's job to ask the status.

Maybe it's me, but I don't think that with today's high patient loads, any nurse should be expected to hello/goodbye/yesmaam/nomaam/chitchat/howzaweather everyone and his/her distant relatives who is visiting a patient. So, I strongly feel that no ack of the wife or other visitors was in order, except a smile, unless they were being disruptive. Nurse *could* have said "Everything looks normal" as she finished and walked out, but nurses are very busy people, and as a patient or as a visitor, I don't expect it's the staff's job to tell me every play-by-play, especially when nothing is going wrong with the patient. (Notify me if/when something goes wrong, please.)

Personally, I would not be counting IV drips and yakking at the same time; I'd be concentrating and deliberately staying out of their chitchat to concentrate, and I'd probably not join the conversation unless I was asked to. I am the hired help, with a specific job to do. What the hospitals need to do is start developing MORE REASONABLE expectations in their customers of what they are or are not entitled to. A Four-Star HotelResort, this aint. It is a hospital, and has more than one patient in it at any given time.

[Tarabara]

I am an engineer and not in nursing classes yet. I answered 1-4 correctly, by reasoning what seems like the most correct. Someone posted on here that the NCLEX questions frequently are staged with answers as follows:

red

dark red

light red

blue

meaning that there is usually one blatantly wrong answer and three that are correct to some degree, but you pick the most obviously correct one.

Question 5 was the only one that even generated a "whattheheck" response from me, lol. Neither of those answers.

It's the nurse's job to take assessments and check the IV. It's the patient's and visitor's job to ask the status.

Maybe it's me, but I don't think that with today's high patient loads, any nurse should be expected to hello/goodbye/yesmaam/nomaam/chitchat/howzaweather everyone and his/her distant relatives who is visiting a patient. So, I strongly feel that no ack of the wife or other visitors was in order, except a smile, unless they were being disruptive. Nurse *could* have said "Everything looks normal" as she finished and walked out, but nurses are very busy people, and as a patient or as a visitor, I don't expect it's the staff's job to tell me every play-by-play, especially when nothing is going wrong with the patient. (Notify me if/when something goes wrong, please.)

Personally, I would not be counting IV drips and yakking at the same time; I'd be concentrating and deliberately staying out of their chitchat to concentrate, and I'd probably not join the conversation unless I was asked to. I am the hired help, with a specific job to do. What the hospitals need to do is start developing MORE REASONABLE expectations in their customers of what they are or are not entitled to. A Four-Star HotelResort, this aint. It is a hospital, and has more than one patient in it at any given time.

While I agree with some of what you said, I do want to add that we are suppose to tell pts their vitals when we take them because its important that our pts are active participants in knowing about their health. If this is a new pt to you and you take their BP as 90/60 and the pt says yes they always have a low BP or "what? my BP is always 120/80" that info could be very helpful. Also, nurses should be telling pts what they're doing as they're doing it, even just a simple statement that you're going to adjust or set their IV is helpful to them just so they know whats going on. I'm not saying to explain all the details like number of drops you're counting or whatever, but just general info.

[Streamline2010]

Okay, noted, lol. But that question made it sound like the nurse was deficient for not initiating a whole long conversation. If I had a busy nurse, I'd not be demanding much of him/her if I could figure out what was going on myself, lol.

[hiddencatRN, BSN, RN]

Okay, noted, lol. But that question made it sound like the nurse was deficient for not initiating a whole long conversation. If I had a busy nurse, I'd not be demanding much of him/her if I could figure out what was going on myself, lol.

It would be really odd to go in to a patient's room and say nothing to him/her. Part of being a patient advocate is explaining what you're doing as part of the patient's care so that they know what's going on. Have you had any experience as a patient in a hospital before?

[DolceVita, ADN, BSN, RN]

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 ass 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.

i could read all of the other responses but this one pretty much says it all. just remember that you need to choose the "best" answer which is not always 100% correct -- very frustrating i know. you test is just like the ones i had in 1st semester. great instructor but daft tests.

[kenpochic]

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

that is what referred pain is. it starts one place and moves to another or the problem may be in a certain area but you feel it in another.

[~Mi Vida Loca~RN, ASN, RN]

It's the nurse's job to take assessments and check the IV. It's the patient's and visitor's job to ask the status.

Maybe it's me, but I don't think that with today's high patient loads, any nurse should be expected to hello/goodbye/yesmaam/nomaam/chitchat/howzaweather everyone and his/her distant relatives who is visiting a patient. So, I strongly feel that no ack of the wife or other visitors was in order, except a smile, unless they were being disruptive. Nurse *could* have said "Everything looks normal" as she finished and walked out, but nurses are very busy people, and as a patient or as a visitor, I don't expect it's the staff's job to tell me every play-by-play, especially when nothing is going wrong with the patient. (Notify me if/when something goes wrong, please.)

Personally, I would not be counting IV drips and yakking at the same time; I'd be concentrating and deliberately staying out of their chitchat to concentrate, and I'd probably not join the conversation unless I was asked to. I am the hired help, with a specific job to do. What the hospitals need to do is start developing MORE REASONABLE expectations in their customers of what they are or are not entitled to. A Four-Star HotelResort, this aint. It is a hospital, and has more than one patient in it at any given time.

Actually educating is a huge role of the nurse, so is communication. A nurse should not be going into the patients room and hanging out for 15 mins without saying a word to the patient. It's perfectly reasonable to expect the nurse to talk to the patient or the patients spouse, they could utilize that time to gain more information about the patient, to open the doors to communication, to assess the patient. It doesn't have to be how is the weather, it could be "are you feeling off at all from the medications? how are you feeling? etc.)

It never said you were counting drips. It said you were monitoring vitals and IV medication. You can do both of these things while engaging in conversation with your patient.

Patients need to feel that trust, they are in a very vulnerable high stress and high anxiety situation. To have someone come in for 15 mins and "work on them" and not say a word, adds to that anxiety and stress and vulnerability.

[NSALVADORE]

But it didn't say the pain was moving, it said the pain was in another location.

Agree.. And lets just say none of the other answers work so process of elimination.. The only other "possible" would be radiating but that would have to clearly had stated it traveled down the leg or down the arm ect..

The key to tests when you don't like a question or the answers are look at why the other answers don't work!!!! That is key! And you can't read too much into it, take it for face value what's there in the question!

[NSALVADORE]

Actually educating is a huge role of the nurse, so is communication. A nurse should not be going into the patients room and hanging out for 15 mins without saying a word to the patient. It's perfectly reasonable to expect the nurse to talk to the patient or the patients spouse, they could utilize that time to gain more information about the patient, to open the doors to communication, to assess the patient. It doesn't have to be how is the weather, it could be "are you feeling off at all from the medications? how are you feeling? etc.)

It never said you were counting drips. It said you were monitoring vitals and IV medication. You can do both of these things while engaging in conversation with your patient.

Patients need to feel that trust, they are in a very vulnerable high stress and high anxiety situation. To have someone come in for 15 mins and "work on them" and not say a word, adds to that anxiety and stress and vulnerability.

AMEN!!!!!! The only way to be efficient and be thorough is to be able to talk to your patients while you're doing tasks!!

[healthstar, BSN, RN]

I wish I had these test questions :)

our test questions are horrible even our instructor has to think twice before answering them.