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Can anyone explain the logic behind nursing exam questions?

Posted

It's been established that we get questions that are tricky, contradictory, wrong etc etc... But how do you answer them correctly regadless of their flaws?

Could you answer this, for instance -- which one has a priority? - potassium imbalance, calcium imbalance, sodium imbalance, acidocis or alkalosis? Please. I don''t know the answer.

Please share your secret (we all use fake names here) - do you pick the longest answer, the shortest or answer C?

What do you do when you know the material well, give the most correct answer, and then find out that your answer is wrong? And the correct answer is some insignificant piece of information that you found lurking somewhere in the text, and you wouldn't choose it in a million years? Does it mean that the nursing logic is beyond you? What does it mean when you study hard for the exam, know and understand it well, and get a much lower grade than you received for the exam you hadn't studied for at all?

Please help :confused::uhoh3::uhoh3:

The answer is SIMPLE. potassium imbalances the most important of the choices.

potassium imbalances = cardiac irregularities,

chuckz, BSN, RN

Specializes in CVICU/ER. Has 10 years experience.

K+ would be my answer, but it also has to be given how much out of balance in relation to the condition of the patient and the other electrolytes. The tests are trying to get you to think in terms of a whole as well as foster critical thinking. It's easy to regurgitate information, I used to do it all the time in school, but the ability to think things through and to notice subtleties is something that I think every nurse needs. Is it fair? Probably not. Does it make you think on your feet and try and look at the big picture with these questions? Probably so. It's that or they just don't like us very much.

opensesame

Specializes in acute/critical care. Has 11 years experience.

That question is NOT simple, and IMO very, very stupid. I hope that isn't for real.

What do they mean by "imbalance" -- hypo, or hyper? Yes, hyperkalemia can be deadly -- but so can hypo/hypernatremia (cerebral edema, coma), and severe acidosis of any type (metabolic, respiratory) is a recipe for a code. To answer this question they would need to give you lab values and have you choose which one is the furthest out of range.

I haven't been in a basic nursing program for awhile but I can tell you that some schools have gone to asking NCLEX-style questions on exams. It is to get you thinking about priority setting and what your first plan of action would be according to the nursing process (think ADPIE).

Babyheart, BSN

Specializes in ICU. Has 7 years experience.

I could use help with this also. Waiting on midterm grade & hoping I passed the exam. I know the material & my lab values inside out, but I have no idea how well (or badly :scrying:) I may have done.

I find the questions are written oddly, and designed to make you choose the wrong answer. I read each question very carefully, and read it 3 times before choosing my answer. Even then I find them still tricky, 1 word may be the difference between a right & wrong answer. I do practice NCLEX questions every day & find them very straight forward compared to our school exams.

Fingers crossed!

decembergrad2011, BSN, RN

Specializes in Oncology. Has 12 years experience.

Sometimes I think the questions simply aren't fair, and some instructors are better than others about writing questions that don't require their specific frame of reference to figure out the correct response. I have also experience the feeling of doing poorly on an exam that I studied much more for than previous exams, and sometimes I think all of the excess knowledge plays against me because it makes me look for answers based on recognition of terms and procedures rather than using my critical thinking skills.

Practice, practice, practice. It gets better with time, seriously.

Babyheart, BSN

Specializes in ICU. Has 7 years experience.

Got 60% and this one counts for 30% of my grade. Not sure what to do at this point.

decembergrad2011, BSN, RN

Specializes in Oncology. Has 12 years experience.

Make a meeting with your instructor for a time to go over your answers with her personally. Schedule a 30-45 minute session so that you have time to actually go through each question you missed and find out the rationale behind why the right answer was correct.

That question is NOT simple, and IMO very, very stupid. I hope that isn't for real.

What do they mean by "imbalance" -- hypo, or hyper? Yes, hyperkalemia can be deadly -- but so can hypo/hypernatremia (cerebral edema, coma), and severe acidosis of any type (metabolic, respiratory) is a recipe for a code. To answer this question they would need to give you lab values and have you choose which one is the furthest out of range.

so right in this. any one of the conditions could have been lethal or debilitating, depending upon degree. if no degree is specified the question is invalid. sure, K is the easiest scale to fall off of and into death, but the question still stinks.

KeeperMom

Specializes in ED. Has 10 years experience.

I am not a straight A student but I have learned a LOT about how to answer HESI / NCLEX-style questions.

First of all, you have to know the patho of diseases and you have to know about electrolytes and how they affect the body if it is hypo or hyper.

Secondly, I think you need to learn HOW to read and answer questions. I have a Kaplan book that is a test taking how-to book. One thing that really helped me is to look at how the question is asked and WHAT the question is asking. Is it a nursing intervention question or an assessment question? It is very easy to misread a question and answer it incorrectly. It is also pretty easy to read too much into a question. I was guilty of that a few times.

Make sure you are meeting with instructors after tests so you know what questions you are missing and why. That helped me soooo much and it really made me a better test taker.

good luck!

m

Babyheart, BSN

Specializes in ICU. Has 7 years experience.

Thanks! I did meet with my instructor after our 1st test, and knew that I was making the error of not reading the questions and all of the options carefully enough. I thought I had done just that but obviously not! Am meeting with my prof tomorrow to see where I went so wrong. Also scheduled some private tutor sessions which will hopefully help.

nurse2033, MSN, RN

Specializes in ER, ICU.

The question does not have enough information to be answered consistently. Meaning each student will interpret the question differently and many will get is wrong because they did not "see" the question the way the author intended. Let's say the ph was 6.3 and the K 5.7. Acidosis would be the priority. Does the question mean, if one of these was out of the norm, which would have priority? Or, if they all were out of norm, which would have priority. Obviously severe alterations of any of the choices could kill you. I realize I'm just venting on the poor quality of test questions...

itsmejuli

Specializes in Home Care.

Read the question through once and look at the answers. Then read the question again and underline the key words and what the question is asking. Then eliminate the obviously wrong 2 answers. Read your underlined words/phrase again and look at the 2 remaining answers and select the right one.

Here's a really good example from the Saunders cd:

A nurse monitors the respiratory status of the client being treated for acute exacerbation of chronic COPD. Which of the following assessment findings would indicate a deterioration in ventilation?

a. cyanosis

b. rapid, shallow respirations

c. hyperventilated chest

d. coarse crackles auscultated bilaterally

Hyperventilated chest and cyanosis are common in people with chronic COPD so eliminate those right away.

If you read through the question quickly you'd be tempted to select D. You need to read the question again, its asking about "deterioration in ventilation" so the answer is B.

Do not sit there and keep looking at the question and answers and telling yourself that all of the symptoms apply to COPD. Concentrate only on what the question is specifically asking, don't try to justify anything.

This is how I do exams and it works well for me.

Babyheart, BSN

Specializes in ICU. Has 7 years experience.

Thank you - that post was really helpful. I am very frustrated by the lack of assistance from my school. I am an night student, and feel we get the short end of the stick. My professor is only available 4 hours a week in the early afternoon (difficult to arrange to get there to meet her - this is why I'm in night school after all!), so she really didn't want to see the 4 of us who showed up to go over the test.

Going over it, I got the ones I did not read carefully enough wrong. I read them too quickly, said "I know the answer" and missed a keyword in either the question or the correct option. It really is frustrating trying to learn how to take NCLEX style questions. I have every book out there and do questions every day. I find them very straight forward, but in our exams I find that the questions are very 'wordy' and have a lot of extra unnecessary information. I found a question in the Davies NCLEX book that was very similiar to one from our test, but ours had a lot more information added to the options.

I also find the time tight, we have an hour to do 50 questions. Guess I'd better do a lot more practice questions to improve my grades to have a hope of passing.

Thank you - that post was really helpful. I am very frustrated by the lack of assistance from my school. I am an night student, and feel we get the short end of the stick.

I was in a full-time 'regular' day program and our instructors were not very open to reviewing test questions either. It may just be a general nursing school thing as opposed to being a night student or not. It's hard to tell what the "usual" experience is since most of us have really only been exposed to one program!

That question is NOT simple, and IMO very, very stupid. I hope that isn't for real.

What do they mean by "imbalance" -- hypo, or hyper? Yes, hyperkalemia can be deadly -- but so can hypo/hypernatremia (cerebral edema, coma), and severe acidosis of any type (metabolic, respiratory) is a recipe for a code. To answer this question they would need to give you lab values and have you choose which one is the furthest out of range.

I haven't been in a basic nursing program for awhile but I can tell you that some schools have gone to asking NCLEX-style questions on exams. It is to get you thinking about priority setting and what your first plan of action would be according to the nursing process (think ADPIE).

That's a real question because it was on our Fundamentals exam number II.

2ndyearstudent, CNA

Specializes in CNA.

Thanks! I did meet with my instructor after our 1st test, and knew that I was making the error of not reading the questions and all of the options carefully enough. I thought I had done just that but obviously not! Am meeting with my prof tomorrow to see where I went so wrong. Also scheduled some private tutor sessions which will hopefully help.

As others have suggested - you absolutely need to get a Kaplan or Saunders book that has NCLEX strategies. It helps a lot.

thank you all for your replies. as it happens, i actually did figure out the logic behind nursing exams.

people! why are you kidding yourself - or more accurately - why are you misleading good students -- about critical thinking? critical thinking has nothing to do with this. nurses are discouraged from using any thinking, they just have to do exactly as they're told. those struggling students -- don't try to apply your real critical thinking -- it is suitable for doctors. no thinking or deep knowledge is required from you when you have to write "altered urinary elimination related to bacteria in urine" instead of "uti"....

another thing i'm tired of hearing is "oh you have to find what the stem or key words of the question is" -- this is nonsense. in english language the subject and the predicate indicate the stem and the key words of a sentence, and word placement in the beg or end of a sentence. some exam questions don't follow these rules - their idea of a stem is arbitrary.

other "exam strategies" are also bs.

sometimes you can make a mistake by not paying 1000% attention to every word of the question and all of the choices. you feel like you're being tested on "find 10 differences between these two pictures" instead of on real knowledge and skills, and no "exam strategies" will help you with this. the point is - that the "big picture" is outside of the scope of nursing, while your instructors and textbooks try to give you a different impression - that's what you study and that's why you fail.

nursing exams test you on a very narrow and very specific knowledge that you need to have -- i.e. how to position a client for procedure, what the procedure is for, what will happen after procedure, what to watch for and what to do in emergency, - to sum it up. nursing has never been a profession designed for very smart people; if you've ever seen older nurses, those bleached blondes with husky voices, you know what i mean. provided, there are exceptions, and what's changing today is that a lot of really intelligent people are getting into nursing programs while teaching plans and exams hasn't changed to accommodate them. if you are smart, you will make a better nurse, i believe; but the thing is - you don't have to be smart to be a nurse. of course a smart person will eventually figure out one way or the other how to ace those exams, but i also think that a lot of people who could be great nurses are failing because they don't realize that the exams are indeed more stupid that they are. they think that there's something wrong with them, while the only thing that's wrong is that they haven't figured out what they have to study - or rather - that they don't have to study at all, but just look at very specific and very few points and memorize them -- to pass the exams...

people who've created these exams had to make sure that stupid people getting out of nursing schools know specifically what to do in each situation. if you look at the scope of a major nursing exam, you will realize that it's very narrow -- if our textbooks and lectures reflected the exact things we need to know -- they would be very brief and thin.

people who make these exams are trying to take something very simple and cloud the issue to make it look difficult and complex, and in the process they often make no sense. for instance, all you need to know about patients who are unconscious is to turn them sideways so they don't aspirate. that's so simple, but the required 100 pages of text won't mention it, or mention it without emphasis. then the exam question is asking what do you do in this situation, while trying to make sure that you don't guess the right answer by clouding the issue with other info. all this other stuff that you were reading about is not important, you turn an unconscious pt on their side - and that's all you need to know or pay attention to... you probably would have answered the question correctly if the question and the choices weren't worded like you're about to try to solve the theory of relativity problem, you assume that the answer is complex because of the way everything is worded, because of all the tons of stuff you had to learn and memorize...

why are they doing it? why are they trying to stuff your head with other information that is very dense? they're only testing very simple piece of knowledge that a retard would get if you just told him. that i haven't figured out yet, but here's my theory - they do it for precisely the same reasons as the military testing that eliminates people who are too smart. why? because when you're intelligent and a thinker, it is well known that when you have a certain protocol to follow, you might notice other details and use your thinking to decide that a different solution is better. you might be right, but if you're not, you and your hospital and the entire nursing field will be liable. so they want you to follow the exact steps, and maybe the less intelligent you are, the easier it is for you to isolate those steps in the text, i.e. you are more likely to memorize something so simple as turning the patient rather than something more complex. it's just a theory and maybe it's not crystallized yet, but i believe something to this effect is taking place...

my only word of advise to those intelligent students struggling with the exams - please understand, that unless you have an absolute photographic memory, -- don"t try to master nursing exams by reading and rereading all of your assigned chapters. you will not get an a or even b by doing that. also don't think that your test taking strategies are bad.

think of other solutions.....

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