Is the BEST answer on a nursing exam opinion or fact?

Altra, BSN, RN · Sep 30, 2004

Interestingly one of the books has a very long chapter on the famous psychologist Maslow. They go on and explain how Maslow's Hierarchy of Needs is the basis for any test question that asks for the best or most appropriate way to deal with a patient. It is interesting that if you use this theory and then do some nclex test questions you will start to see a pattern. Not perfect but food for thought.

You're right on the money, dave1117. Any question that deals with prioritizing care (for one or multiple patients) is always testing your ability to prioritize physiologic needs before psychological needs. Tip #2: if a question on prioritizing includes an answer re: airway/respiratory function, that is nearly ALWAYS the correct choice (remember A-B-C from BLS: airway, breathing, circulation).

blueeyedgurl · Sep 30, 2004

Roland, I would have answered the question the same as you. Our physical assessment teacher told us never to stare at the patient, eye contact is important but staring may cause them to become uncomfortable and try to hurry through the interview. We do have some questions that are tricky but nothing like that so far...and our grading scale is an 80 to pass.... :uhoh3:

natsfanrn · Sep 30, 2004

Reread the question...it says all of the following exhibit good listening EXCEPT.... So yes, staring down the patient IS always inappropriate, which makes it the best right (or in this case, wrong) answer.

(I missed that "except" the first time I read it, too, since it was off my 'puter screen)

Roland · Sep 30, 2004

Thanks, for the input. A few points to clarify my question:

1. Yes, the question was asking for the question which demonstrated improper listening skills. Both answers showed improper behavior (a. by only sitting three feet away and invading the clients personal space. (b.) by staring at the client).

2. I thought (a) was "more right" because the text mentioned this issue twice instead of once. I always try to pick the answer that I can best defend and in this case I knew I could quote two text citations instead of only one by choosing (a) as my choice.

3. My larger point is that if their grading scales are going to be so darn tough (78% to pass and 95% for an A, and as a general rule I would rather throw myself from a building than get less than an A) then the least they could do is write extra clear questions. They even made a point of saying that many students in the past had FAILED the course with 77.9% ect. If your willing to FAIL someone for being a tenth of a percent off, then you better be very sure that all of your questions are right on the money (at least if you want to be able to sleep at night).

4. I was "extra irritated" because I had taken the extra time required to memorize all of the various "interview/space distances". To any student (or instructor) that had not taken the time to memorize these items (or to read as closely) this would have been a simple question. Of COURSE stairing is the obvious "simple" answer. My point is that all of the students who had studied less than me, probably got this answer correct. Now that would be fine if I could apply it as some sort of "general rule". However, half the time getting the correct answer depends upon having a very close and exact, technical understanding of the text (thus picking the obvious answer would be incorrect). Thus, my deeper point goes to what exact "criteria" do nursing instructors employ when deciding upon the best answer. If it's not clearly, objective then it is an opinion rather than fact. Of course no one is perfect, and few (if any) test will ever be perfect. However, MOST courses (Biology, Chemistry ect) deal with this issue by having CURVES, and or more forgiving grading scales (and often being willing to credit answers as correct if the student can make a good argument). Nursing school (at least in my experience and that of my wife) does few or NONE of these things, and then goes the extra step of imposing HARSHER penalties for low test scores (which is to say being kicked out of the program rather than just having to retake the course as is the case in most majors).

twarlik · Sep 30, 2004

I probably would have chosen (B) since I hate it when people stare me down, so I would never do it to another person. Plus I seem to remember reading in my text that you shouldn't stare at people when asking them questions.

I think the REAL issue here is that it was a lame question. :rolleyes:

mauser · Sep 30, 2004

Carla,

LOL - I checked to see where you were from - I could have sworn you were in my class.

"...Besides that, I have found, as have many of my classmates, that as a group, our instructors are rather unorganized........they don't even know the syllabus as they were telling us that we had to pass in a certain assignment which is still not due (according to our syllabus) for another two weeks.....then they also contraindict each other with their answers to other specific questions.............it all seems like an exercise in futility..."

We are not even in the same state - but I would describe our class/instructors exactly the same!

Bing&Bat · Oct 1, 2004

Geez Louise!

I am experiencing similar issues at the school I attend. Our instructor generally creates her own tests. Half of the time I can't figure out what the question is asking. She keeps telling us that we have to be "critical thinkers" or pick the "beeeessst answer". It's driving me nuts! I can argue till I am blue in the face about how a particular question is worded or I can show her the page in the text book in black and white.......the CORRECT answer. To no avail. She will say the book is incorrect, yada, yada. BUT my big problem here is that the school I attend is basically all Philippino. The teachers and students. My daughter and myself are the only Caucasians. There is one gal from Burma. Initially I was naive enough to think that this was fine. What I am experiencing now are cultural and language barriers. The test questions reflect the teachers English as a second language. Our clinicals have thus far been in facilities that employ mostly Philippino's. So our instructor often slips into her native language when explaining treatments, meds....... Having been employed in the health field before, I am aware of her many lapses in basic medical instruction. I rarely see her wash her hands before or after entering a patients room (after doing a treatment!) The facility that we are supposed to be learning from ran out of gauze yesterday. Using other patients meds when they run out for another patient. Sharing all manner of prescription creams between patients. Some of these patients have MRSA. Not to mention they ran out of isolation gowns! Yesterday our instructor was showing us how to treat a stage 4 decubitis ulcer. The patient had a BM, which the instructor promptly cleaned up......never changed gloves (there was poop on those gloves) then preceded to stuff the gauze into the tunneling wound with her finger with those same gloves! :angryfire If I point out politely these situations, she gets flustered and angry. She tells me this is the way it is in the real world. Thank God I have been around and know this to be untrue. My fellow students really are great to be with ...I have very few complaints there. I know I sound like I am dissing Philippino's. Really I am such an unbiased person. And not all my encounters with nursing staff that are from the Philippine's have been negative. I was lucky enough to spend some time in another facility were I learned the right way from 2 Philippino R.N.'s that were awsome. But they tell me in the Phillipines it just is not done to question your superiors! Yes, yes I have talked to them about this. Well the sad fact is that I am half way thru this program. I have paid $10,000. each for myself and my daughter, with another $8000. each to go. To late to pull out now. But to sum it all up, I really think this system of testing and clinicals needs to change. When I graduate, I resolve to voice my opinions to the state of California. None of this, "that's they way it is". Thanks for letting me vent. Good luck to you. :rotfl: Bing&Bat

We just had an exam and one question I missed read something like this:
All of the following exhibit good listening behaviors while taking a health history except the following.
The two answers that I got it down to were:
a. Sitting three feet away from the client.
b. Stairing intently at the client while she is describing her health problems.
The correct answer was (b), but I chose (a). Here's why I chose (a).
Our text (Physical Examination and Health Assessment Jarvis 4th edition) in the relevent chapter said the following which made (a) seem correct:
1. p. 53 "Place the distance between you and the patient at 4 to 5 feet (twice arm's length). If you place the patient any closer, you may invade his or her private space and you may create anxiety.
2. p. 66 Table 4-3 Functional Use of Space 1.5 to 4 feet is the Personal Distance and is perceived as an extension of the self similar to a bubble.
Our text said the following to indicate that b stairing might be the correct answer:
1. p. 59 "You should aim to maintain eye contact, but do not "stare down" the person.
I picked (a) because I knew the book had referenced the issue of distance on two seperate occassions (although I couldn't remember the exact page numbers). When I brought it to the attention of the instructor via email, and then followed up during the test review session she indicated that not only was she not going to count my answer, but it was in fact a good question.
So here's my question. What objective criteria do instructors consider when they decide what in fact constitues the best answer? Personally, I don't think that she recalled the specific distances referenced in the text when she was writing the questions ( I say this because it has been my experience in previous classes that Prof's often don't re-read chapters before writing exams, and thus sometimes miss easy to forget details that a student who has been studying 24/7 has fresh in their mind). If I were at some hypothetical nursing school instructor "exam writing" seminar" what criteria would they tell me to implement when coming up with a "best" answer?
I think these are important questions because the grading scales are so strict (95% for an A and 78% just to pass) with absolutely NO curves, that even a few bad questions can adversely impact student grades (and potentially cause them to fail the course outright since there is NO leeway with regard to 78%). In my opinion by having such strict standards for grades they also impose an even higher standard upon themselves (even if they don't realize, acknowledge or admit to this fact) with regard to the necessity of writing accurate and objectively valid questions. However, my experience has been that many non-nursing courses such as Biology, Chemistry, Anatomy, ect. actually have better written questions despite having more forgiving grading scales AND curves. If by some miracle I actually manage to graduate nursing school any graduate program to which I apply will assume that I was tested and evaluated in a fair, accurate manner. Can someone explain the thought process behind what seems to be a contradiction? Why can't they use the comparitively excellent "peer reviewed" questions provided within the "test banks" of most good text books.

XIGRIS · Oct 1, 2004

Hmmmm!!!!!!

What a comment!

I am experiencing similar issues at the school I attend. Our instructor generally creates her own tests. Half of the time I can't figure out what the question is asking. She keeps telling us that we have to be "critical thinkers" or pick the "beeeessst answer". It's driving me nuts! I can argue till I am blue in the face about how a particular question is worded or I can show her the page in the text book in black and white.......the CORRECT answer. To no avail. She will say the book is incorrect, yada, yada. BUT my big problem here is that the school I attend is basically all Philippino. The teachers and students. My daughter and myself are the only Caucasians. There is one gal from Burma. Initially I was naive enough to think that this was fine. What I am experiencing now are cultural and language barriers. The test questions reflect the teachers English as a second language. Our clinicals have thus far been in facilities that employ mostly Philippino's. So our instructor often slips into her native language when explaining treatments, meds....... Having been employed in the health field before, I am aware of her many lapses in basic medical instruction. I rarely see her wash her hands before or after entering a patients room (after doing a treatment!) The facility that we are supposed to be learning from ran out of gauze yesterday. Using other patients meds when they run out for another patient. Sharing all manner of prescription creams between patients. Some of these patients have MRSA. Not to mention they ran out of isolation gowns! Yesterday our instructor was showing us how to treat a stage 4 decubitis ulcer. The patient had a BM, which the instructor promptly cleaned up......never changed gloves (there was poop on those gloves) then preceded to stuff the gauze into the tunneling wound with her finger with those same gloves! :angryfire If I point out politely these situations, she gets flustered and angry. She tells me this is the way it is in the real world. Thank God I have been around and know this to be untrue. My fellow students really are great to be with ...I have very few complaints there. I know I sound like I am dissing Philippino's. Really I am such an unbiased person. And not all my encounters with nursing staff that are from the Philippine's have been negative. I was lucky enough to spend some time in another facility were I learned the right way from 2 Philippino R.N.'s that were awsome. But they tell me in the Phillipines it just is not done to question your superiors! Yes, yes I have talked to them about this. Well the sad fact is that I am half way thru this program. I have paid $10,000. each for myself and my daughter, with another $8000. each to go. To late to pull out now. But to sum it all up, I really think this system of testing and clinicals needs to change. When I graduate, I resolve to voice my opinions to the state of California. None of this, "that's they way it is". Thanks for letting me vent. Good luck to you. :rotfl: Bing&Bat

Roland · Oct 1, 2004

XIGRIS, your objections seem to be more significant than mine! However, they emanate from the same "thematic" well. Where did this "attitude" in nursing instruction come from anyway? I really want to know. By "attitude" I mean the seemingly common notion that we should be held to extremely demanding grading scales, without benefit of "curves", and evaluated with tests that are often poorly worded/written with answers that seem to often lack objective validity (and then told that these questions/answers are not subject to debate even when they are clearly in error). It is certainly not an attitude that is very common in other disiplines. Indeed, I know several people who have gone to medical school, and they stated that the exams although quite difficult were also eminently fair. Indeed, I have a study guide for Physicians taking their boards for Internal Medicine (it was written to go with a previous edition of Harrison's Guide to Internal Medicine) and the questions while quite difficult (most are written in the context of real world clinical examples) all have answers which are clearly correct.

Furthermore, why do nursing schools seem to want to foster an attitude of submission? I would assert that such an attitude is not only bad for students, but also dangerous for patients. We want nurses who will not be afraid to stand up against authority be it the DON or a leading cardiac surgeon, if they determine it in the best interest of the patient. Consider, the case at Duke University last year (or was it this year) where that girl from Mexico was given the wrong blood/tissue type during a transplant procedure. I wonder if maybe a nurse might have been more inclined to notice (and or say something), but for the fact that they had been inculterated into an attitude of submission by an outdated educational system that stresses submission over logical analysis, and then defends the practice by calling it an exercise in critical thinking skills.

XIGRIS · Oct 1, 2004

XIGRIS, your objections seem to be more significant than
mine! However, they emanate from the same "thematic" well. Where did this "attitude" in nursing instruction come from anyway? I really want to know. By "attitude" I mean the seemingly common notion that we should be held to extremely demanding grading scales, without benefit of "curves", and evaluated with tests that are often poorly worded/written with answers that seem to often lack objective validity (and then told that these questions/answers are not subject to debate even when they are clearly in error). It is certainly not an attitude that is very common in other disiplines. Indeed, I know several people who have gone to medical school, and they stated that the exams although quite difficult were also eminently fair. Indeed, I have a study guide for Physicians taking their boards for Internal Medicine (it was written to go with a previous edition of Harrison's Guide to Internal Medicine) and the questions while quite difficult (most are written in the context of real world clinical examples) all have answers which are clearly correct.
Furthermore, why do nursing schools seem to want to foster an attitude of submission? I would assert that such an attitude is not only bad for students, but also dangerous for patients. We want nurses who will not be afraid to stand up against authority be it the DON or a leading cardiac surgeon, if they determine it in the best interest of the patient. Consider, the case at Duke University last year (or was it this year) where that girl from Mexico was given the wrong blood/tissue type during a transplant procedure. I wonder if maybe a nurse might have been more inclined to notice (and or say something), but for the fact that they had been inculterated into an attitude of submission by an outdated educational system that stresses submission over logical analysis, and then defends the practice by calling it an exercise in critical thinking skills.

Hi Roland nice seeing you again here in this Discussion borad.

I'm in a nurse-anesthesia right now and so far no grading curve. Either you make it or not.

Regarding whether an answer is subjective or not as question by the originator of this discussion, in my situation most if not all of the test questions in our tests, we had 3 major exams ( which I object becuase of the bulk of the areas covered ), are not the "regurgitation type" "objective type of exam". I agree on critical thinking because unfortunately, we have a few new grad who do not posses critical thinking or common sense. The board exam is a format where only one and only one best answer is the right answer. Can you appeal your grades? yes. can you changed it. NO!

Regarding Filipino nurses being a " yes and yes " nurse. I would like to say that the we are not submissive as what is mentioned earlier. We were raised to respect others but by saying yes does not mean we are not aggressive. If you havent noticed yet that majority of the ICU nurses dealing with critical care nursing in major hospitals are Filipinoes ( California is an example). We would not be able to manage a unit like that if we are not aggressive. Thus, the " hhhhmmmm! what a comment " heading comes from.

And by the way, I used to teach BSN in UT and I can read, write and speak the English language without any problem.