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.....

[HealthShepherd]

I can't remember where in nursing school I learned this, but for those of you debating question 3, the answer is c, that the quality of rem sleep decreases as you age. This is pretty standard knowledge, which can be found in many nursing related and adult psych texts.

Yes, but the question was about teaching the patient how to get better sleep, and since age isn't a modifiable factor, it's not relevant. Nursing "teachers" go on and on about reading the question carefully to see what is really being asked, but if you take that advice, you're "overthinking".

The more I think about that word "overthinking" the more irritated I am. If a test question doesn't stand up to careful thought, then the question is the problem, not the thought.

[GM2RN]

The more I think about that word "overthinking" the more irritated I am. If a test question doesn't stand up to careful thought, then the question is the problem, not the thought.

I agree with your statement, but it doesn't help because instructors aren't going to change their questions. One needs to be able to get past being irritated that the they are given bad questions and learn to pick the answers the instructors want. It can be done.

[joanna73, BSN, RN]

Yes that's true. But you need to be able to get past the wording of those bad questions and still pick the answer they want. The other choices given don't really apply. "C" is nursing knowledge. And you may be irritated, but the NCLEX and CRNE are worded this way. You get used to it.

[jjjoy, LPN]

The more I think about that word "overthinking" the more irritated I am. If a test question doesn't stand up to careful thought, then the question is the problem, not the thought.

I very much agree! Of course, one still must work with the testing materials and learn how to best navigate them, but I see no reason to defend poorly written questions as honing critical thinking skills, teaching how to think like a nurse, etc.

Learning how to choose best answers for this type of question is a skill unto itself; I don't believe it reflects much about one's nursing knowledge or critical thinking skills at all.

In fact, I tended to do better on questions where I wasn't very familiar with the content and when I concsciously avoided thinking critically about the question and answers, otherwise, I'd end up 'overthinking' it!

[joanna73, BSN, RN]

Learning how to answer the questions just takes practise, don't worry :). Always ask yourself "what answer do they want? What is the best NURSING" answer? Works well 99 percent of the time. Oh, and eliminate the garbage answers first off. Get rid of ones you know are wrong.

[rndenise1959]

I think you are overthinking the questions. You need to start picking the most right answers. I know that sounds stupid this early in your nursing education but that is how I remember the "Boards" to be when I took them. On my tests in school, a lot of the times we had 2 answers that may have been right but we had to pick the "most" right answer. I did like one of the other people said and answered the questions without looking at the answers. We all had to adjust to the way the nursing tests were worded but I am so glad my instructors did our tests that way because we were ready, for the most part, to take the NCLEX when we finished school.

Good Luck. Don't over think the questions and go with your first instinct (for the most part).

[johnsonny2fl]

How come I can answer these questions but cant get into nursing school!!!! Really irks me!! Maybe I have test anxiety! I don't know.

I just tell myself one day i'll make it and keep trying and never give up!

Words of encouragement..(and alittle prayer to myself)

[joanna73, BSN, RN]

Try to think positively about what you know. If you can go into these tests and exams with a plan and the right frame of mind, this is more than half the battle towards success. Sure, some questions may seem unfair, but once you master test taking, even those ones you can reason out. One thing that helped a lot of us who were successful with the CRNE was to understand the rationales for the questions in the study guide. You need to understand where your instructors are coming from. And it gets easier with practice.

[kgh31386, BSN, MSN, RN]

Everyone seems to dwell on question 3. The thing is when you are teaching a patient about stuff, you mus include potential obstacles or reasons that things may or may not work.

[jjjoy, LPN]

Everyone seems to dwell on question 3. The thing is when you are teaching a patient about stuff, you mus include potential obstacles or reasons that things may or may not work.

That's true. But here's some advice direct from a "How to Induce Sleep Naturally" guide:

"Exercise regularly. Exercise in the late afternoon or early evening but not within two hours of bedtime."

[neuroms]

Haha. Nursing test questions are a dense, hazy mixture of teacher's homebrewed opinion and half-remembered textbook winding through a twisty maze of syntax-as-a-second-language with only the one true path, and you have no say in what that is. Learn to like it or you'll throw yourself from the train.

Your teacher sounds exceptionally dim though.

[Meriwhen, ASN, BSN, MSN, RN]

I think all of the questions are valid...the wording on some of them could have been better though.

It's important for you to not read too much into the questions (i.e., your overthinking), because many of the answers may be correct things to do, but you need to choose which answer is the best. For example, ideally, fecal occults should be done over three BMs. The response "I must do the test over a three day period" may seem correct...unless you remember that not everyone has 1 BM a day. Normal for that patient may be 2 BM a day to 2 BM a week. So in that case, while you don't always need to use 1-2 inches of formed poop for the test, of the four answers given that is the best one.

I'm sorry you had a rough test...if you just started NS, these are the types of questions you have to get used to. And yes, they can suck big-time. Train yourself not to say, "but what if..." when reading the question, because then you will start reading too much into the question and head for trouble. Just look at the facts presented in the question and pick which answer is the best.