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Bombed first Fundementals Exam

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Hi everyone! I'm pretty new to the forum and the website but am familiar with it enough to know that if I need help, this is one of the places I need to go.

This past Tuesday, I just had my first Fundamentals exam. Grades came back and I got a D. Normally when I every receive a pretty bad grade, I deserved it -- I procrastinated, I didn't study enough or long enough, etc. This was NOT the case. I knew the materials inside and out. I studied for two solids weeks. I highlighted the text, wrote my own notes, scribbled on my PowerPoint slides, took tests in the back of the text... everything I could think of. And sure enough, I got my first D. Ever. And it's mortifying knowing that I gave it 110%, and this was the grade I received. Another horrible thing is that I've always been told "you can't be taught to critically think."

Maybe not. But something's got to give at this point.

Any help, advice, and new study methods would be greatly appreciated!

Bri_guy_bri

Specializes in ED, CEN, TCRN. Has 3 years experience.

Hey,

I'm truly sorry to hear you failed your first exam. As a student myself, I know how frustrating it is to do poorly on something you studied so hard for.

As a new student, you are just being exposed to the NCLEX style questions, which do require you to think critically, you haven't mastered that yet, but you will. The problem with nursing is that most of the time all the answers are correct, but it's knowing which answer is the most correct. It may take some time to get this skill down, but you can help yourself by doing practice NCLEX style questions that give you the rationales for why each answer is wrong or right. Nursing isn't just knowing the facts, it's about being able to analyze the situation at hand to combine facts with priority interventions to solve the problem.

-Don't over think, but don't under think the questions.

-Use the data you have in each question, don't assume anything else about the pt or situation.

-put yourself in the room with the patient in the question and imagine what you would do.

-try different study methods, group study is one of my personal favorites.

For example:

You enter a patient's room to find them restless and agitated. What is your priority intervention?

A- Elevate the head of bed.

B- Measure the patients O2 sat.

C- Ensure their nasal cannula is set to 2L

D- Call the primary care physician.

In this case the answer is B.

B- we know that restlessness is common in someone who is de-satting. However, we can't just assume that's why they are restless, you need data to support this.

A- while raising the HOB can helpful in increasing lung expansion and o2 intake, we need to know first whether or not low oxygen us even the problem.

C- again, you need to know if they even have low oxygen first. You'll be wasting your time of slow O2 wasn't even the problem.

D- the doctor should be informed if the patient has a change in mental status, but they want data first. They will ask you for vitals, including O2 sats.

Edited by Bri_guy_bri

jaycam, RN

Has 2 years experience.

I scribble all over my tests. I don't just mark the ones I know are wrong, but scribble a note as to why. I underline important phrase to help me focus details. If a question is about ranges, I write the ranges next to the answer. I don't know, it helps me.

My classmates all seem to love our fundamentals success book. It has lots of questions with reasonings behind each answer.

These kind of tests really throw me for a loop though. I have to work so much harder just to scrap by.

All of my Fundamentals exams are computerized, so there's no scribbling or marking out for me. I'm currently working with the B&S Fundamentals of Nursing 9th ed. I love the text. It makes it as plain as day, but doesn't provide much practice with NCLEX questions. I've just started going through NCLEX practice exams and am going through to try to improve my prioritization skills.

thank you!!!

I can relate mnw9412, in almost all of my pre-req's totally a A-B student. I've just taken my 1st Pharm exam after studying my butt off and failed. The grading scale has changed to where a C is now an F - I CRIED! After review the test and my answers, I realized I was over thinking it AND rushing. Break down the stem (what's being asked) and then eliminate the wrong answers, then based on what's being asked - decide and don't change it!

Good luck!

Bri_guy_bri

Specializes in ED, CEN, TCRN. Has 3 years experience.

All of my Fundamentals exams are computerized, so there's no scribbling or marking out for me. I'm currently working with the B&S Fundamentals of Nursing 9th ed. I love the text. It makes it as plain as day, but doesn't provide much practice with NCLEX questions. I've just started going through NCLEX practice exams and am going through to try to improve my prioritization skills.

thank you!!!

Do you guys have access to any programs such as HESI or ATI? These programs have tons of practice tests that give correct answer rationales and wrong answer rationales. I'm sure if you just google around a bit you'll be able to find some free practice tests in whatever topic you are doing.

Also BSN_VIP couldn't be more right. SLOW DOWN, DON'T CHANGE ANSWERS, DO PROCESS OF ELIMINATION.

Could you meet with your instructor to go over your exam? A lot of times it helps just getting the rationale from instructors for why an answer was correct or incorrect. Your instructors want to see you succeed! :yes:

During my fundamentals course I had failed 2/5 exams. The first exam I figured was a fluke - I didn't study nearly as hard as I should have and focused on the wrong aspects. After my second failed exam I knew I needed to do something so I set up an appointment with my instructor. She let me go over the exam and explained the rationales behind the answers I got incorrect. It also helped her to see why I thought the way I did. She also loaned me this book - Test Success: Test-Taking Techniques for Beginning Nursing Students: 9780803628182: Medicine & Health Science Books @ Amazon.com which gave a lot of great strategies for answering questions. I did much better on my next exam. There are also a lot of great YouTube videos that offer tips on taking nursing exams and learning how to answer NCLEX style questions.

Good luck on your next exam!

Edited by brit.pz
formatting

Do you guys have access to any programs such as HESI or ATI? These programs have tons of practice tests that give correct answer rationales and wrong answer rationales. I'm sure if you just google around a bit you'll be able to find some free practice tests in whatever topic you are doing.

Also BSN_VIP couldn't be more right. SLOW DOWN, DON'T CHANGE ANSWERS, DO PROCESS OF ELIMINATION.

We have HESI through Evolve. It provides practice questions relevant to our textbooks. Our instructors even snag questions from that particular site. Our textbooks provide rationales for certain things, but nothing like the test. One question said which would you asses first, and it gave us an option of a UAP reporting a patient crying in the bathroom, a patient complaining of pain, and a patient needing to be discharged. Pain is a priority, but crying on the bathroom floor was very vague, but alarming. Like, are they crying from pity or are they suicidal?... that definitely stumped me.

And I guess that it didn't help matters any that I rushed the tail end of the exam because I had to go to the bathroom so bad... :(

I'm going to give you my standard instructions on answering NCLEX tests, because they apply here and give you a reason (also known as a rationale). (not a rational, that's different)

Whatever resource you use to help you study, make sure it gives you the rationales for why the wrong choices are wrong as well as the right ones, right. If you are learning out of texts or other resources, for every fact you read, you should be able to close the book and say out loud why it's important and why we care. This is where most people fall down in tests-- they pick an answer that is factually true but is not the best answer for the situation as it would be assessed by a good RN. They try to memorize facts but forget critical thinking skills that are, well, critical in all nursing judgment. If you know the WHY of something, it makes it a great deal easier to reason your way through a problem, both in practice and in a test.

NCLEX items (and your school tests are fashioned after them, so this advice still applies to you) are developed in part from knowing what errors new grads make and how. They tend to be of two kinds: inadequate information, and lack of knowledge (these are not the same thing). The goal of NCLEX is to pass candidates who will be acceptably SAFE in practice as NURSES. So-- they want to know what the prudent NURSE will do.

1) When confronted c 4 answers, you can usually discard 2 out of hand. Of the remaining two,

-- always choose the answer that (in priority order) makes the patient safer OR gets you more information. "Can you tell me more about that?" "What do you know about your medication?" "What was the patient's lab result?" "Why are you crying?"

-- NEVER choose the answer that has you turf the situation to another discipline-- chaplain, dietary, MD, social work, etc. It's often tempting, but they want to know about what the NURSE would do. See "always..." above.

2) "Safer" might mean airway, breathing, circulation; it might mean pull the bed out of the room and away from the fire; it might mean pressure ulcer prevention; or improving nutrition; or teaching about loose scatter rugs ... Keep your mind open. It might also mean "Headed down a better pathway to health." For example, while telling a battered woman who has chosen not to leave her partner that "studies show that he will do it again" is factually true (and that's why this wrong answer is often chosen), the better answer is to acknowledge that you hear her choice to stay and say "now let's think of a plan to keep you safe." This doesn't turn her off from listening to you, so she will trust you, acknowledges her right to choose, and helps her along a path to better safety.

3) Read carefully. If they ask you for a nursing intervention answer, they aren't asking for an associated task or action which requires a physician plan of care. So in a scenario involving a medication, the answer would NOT be to hang the IV, regulate it, or chart it; it would not be to observe for complications. It WOULD be to assess pt knowledge of the med/tx plan and derive an appropriate patient teaching plan. Only that last one is nursing-independent and a nursing intervention.

Again, they want NURSING here.

4) The day before a test, do not study. Research shows that your brain does not retain crap you stuff into it at the last minute-- musicians learning a new piece play the first part on Monday, the second part on Tuesday, and the third part on Weds. Then they do something else entirely on Thursday; meanwhile, behind the scenes, the brain is organizing the new info into familiar cubbyholes already stuffed with music, putting it ready for easy access. On Friday, the whole piece works much better.

What this translates for in test-taking land is this: The day before the test, you go to a museum or a concert, go take a hike, read a trashy novel, make a ragout, do something else entirely. Take a small glass of wine, soak in a nice hot bath in a darkened tub with a few candles on the sink, get a nice night's sleep.

5) On your way out the door in the morning, open the refrigerator door and read the mayonnaise jar label. Do what it says: Keep cool, do not freeze. Then go take your test!

Shjnsn

Has 15 years experience.

Make an appointment to meet with your instructor to go over your exam if you haven't already. This is the best way to know what you got wrong and why, this also gives you a chance to know what you did right! Good luck!! The fact that you are seeking help is fantastic!

I know the feeling. My first quarter in nursing (I go to a quarterly program rather than semesters) I was barely passing the class all the way up until I took the final, which was when I finally received a grade that reflected how hard I studied. Nursing tests are so much more different than tests taken in the prerequisite classes. Practice is what worked for me. I got the Saunders Comprehensive Review for the NCLEX-RN, 6th ed. and it has practice questions after each section. Additionally, it comes with online practice questions, HUNDREDS of them. I do the study questions before every single exam. Also, at the beginning of the book it has a chapter about test-taking strategies, which I am sure that one of the nursing books you have has a chapter covering this same thing, but I found that to be helpful too. When I was reading it at first I was thinking to myself "This is dumb, I already know what the stem of the question is" and all that stuff, but I continued to read it anyways because that's what my professor suggested I do. I took my test the next day and got a 94%. I'm not sure if it's because I knew the material really well or if it's because of reading the test-taking strategy section of the book, but now I do it the night before every test and I have been very satisfied with my grades.

I disagree with the statement that you can't be taught to think critically. I was horrible at critical thinking before I entered the nursing program, but I must have learned throughout the program because I graduate soon. You can't let yourself get discourage by one test because you will get a grade lower than you expected again at some point throughout the program. You just need to get back up and keep trying until you figure out what works for you.

I hope this is of some help! Just remember don't give up!

All of you are such wonderful people! Thank you so much for your kind words of encouragement! My next exam is the 25th of this month! I'm so ready to kick its butt because of you all. :)

Something that helped me a lot is the Saunders nclex-rn examination book. Mostly the online program. You can purchase just the online part for like $25 and it has at least a thousand practice questions and rationales for them. You study by the section so it's awesome to use throughout the entire nursing program. It has made me learn how to get used to the format of questions, how to eliminate answers and prioritize. You can get the book and online part which the book has reviews for each section and a few questions at the end of the chapter.

I second GrnTea's excellent post.

Here are a few resources if you are able to use them:

Fundamentals Success: A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&a Success): 9780803627796: Medicine & Health Science Books @ Amazon.com

Test Success: Test-Taking Techniques for Beginning Nursing Students: 9780803628182: Medicine & Health Science Books @ Amazon.com

Saunders Comprehensive Review for the NCLEX-RN® Examination, 6e (Saunders Comprehensive Review for Nclex-Rn): 9781455727551: Medicine & Health Science Books @ Amazon.com

I bombed my first Fundamentals test, too. I ended up graduating and passing the NCLEX on the first attempt. I had to forget every test-taking strategy I had learned in my previous thirty years of schooling and relearn how to take a test from the ground up.

These books are what I used to "get it." It took until the end of Fundamentals and I barely passed with a C, but it got better from there.

Good luck to you!!

LadyFree28, BSN, RN

Specializes in Pediatrics, Rehab, Trauma. Has 10 years experience.

GrnTea and canigraduate's posts all.day.long.

I second other people's posts as well; excellent advice.

Become familiar with strategies and NCLEX-style questions.

I'm also going to suggest when note taking to try to note take in the way of the nursing process; try to understand what is a part of the assessment, what would be the various diagnoses would be for what you are studying, and what would be the appropriate interventions and how to evaluate; my books had a great way to do this from fundamentals to acute care nursing.

I know books are not created equal, but you at least can organize your studies into "thinking like a nurse" NOW, before you get into the increasingly complex information that is going to come.

Best wishes.

MurseJJ

Specializes in Neurosurgery, Neurology.

I think you've gotten some great advice in this thread! As others have mentioned, the book Fundamentals Success is highly recommended. The key to doing well in clinical nursing courses (like Fundamentals) is doing a lot of questions so that you are familiar with what they are asking and how to *think* like a nurse. Whenever you do a question, even if you get it correct, read the rationales.

Fundamentals Success: A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&a Success): 9780803627796: Medicine & Health Science Books @ Amazon.com

UPDATE: Everyone, I am so very pleased to say that this past Wednesday, I had my second exam in fundamentals and passed with an 86!!!! I cried all day after the exam because even though I studied to my wit's end, it was still very difficult and mentally crippling. But as it turns out, I made a solid B!!! So happy I could cry even more. And even though I know you're not really supposed to compare yourself to other students, but my study partner/good friend made an 89, and she is beyond brilliant. She forever studies and I never feel like I'm anywhere close to her grades, and this time, I was merely three points away. Not putting her down by ANY means, but it does make me feel good knowing that I can hang with her in this hard class. I studied the material for nine days and spent about two days doing NLEC style questions from online and through my textbook.

Yall have been fabulous. I really can't believe I scored 12 points higher on this exam, but I am ecstatic with this B (probably the only time I'm thrilled about a B).

Thank you again for helping me! You all had better still be here in six months when I struggle with med surg (yikes..) :):):)