Need advice on how to study for RN school exams

[McNabK9, BSN, RN, APN]

I'm so glad this site is here! I'm a first semester RN student. I have taken two exams on theory (Perry and Potter Fundamentals of Nursing). Both exams I missed a B by less than 1%. Grades are only important because they keep you in the program or get you kicked out. I scored 100% on my math exam and excelled at my basic skills test, but I walked away from my test results Thursday stunned because I study all the time....I don't have any ideas on what to do differently. I want to succeed, I'm not a quitter, but I really don't know what to do to become more effective in answering the nclex type multiple choice questions used for our exams.

From searching on this site, I have purchased the "Saunders Comprehensive Review for the NCLEX" hoping that it would train me how to analyze and interpret the questions. From reading that book, the author recommend buying another book she has published called "Saunders Strategies for Success for the NCLEX-RN Examination" which she states is geared to RN students.

I have always done well in school, studied for my BA while supervising 18 people when I had a corporate career and got two B's and the rest A's. I have had my own business for the last 14 years, I've always worked hard to succeed. Now I'm really worried that carrying a C grade could make me lose this dream I've had if I score poorly on a future test. I study, attend study groups, I'm usually the one that is able to answer the critical thinking questions during theory class.

I think there is a methodolgy to being able to successfully analyze and answer these questions. Any suggestions?

[LovingLearning]

I've found reading the whole question to be really important...figuring out what's being asked for, instead of just going by gut response. For example, a question on my last test read:

"Jim has to get an insulin injection. 25 units, 70/30. What would be the regular unit dose and the NPH dose?"

At first glance, it looks like a straight math question. And you don't know this yet, but there's a way to mix regular and nph together. In this calculation, the quantity of NPH is 0.70/25, and regular is 0.30. Like I said, easy to answer, right?

Except...

The answers were given with both NPH and regular units first. Eg. 17.5u NPH and 7.5u regular, and then another one read 7.5 regular and 17.5 NPH. At first glance, they were identical numbers, except switched. That's when I suspected I needed to look back at the question and find out what they wanted.

What the instructor was looking for was the 7.5 regular first, because that's how you draw it into the syringe. Regular first than NPH. Despite the fraction being 70/30 and the natural inclination to answer it as a 70/30 set up, the question itself asks for 'regular...and NPH?' So the answer had to be exactly as the question asked it.

It's those little things which drop one's score if you have a core base of knowledge. A few of those on each test, and you'll end up with a C instead of a B, which is more reflective of your knowledge.

The critical thinking aspect also is important. If you think about things from 'what has to be tended to first', or 'what is the worst problem here', then you'll usually come near enough to the answer to figure it out from the answers given. Knowing the issues being discussed, pure knowledge, is vital here, but so is sorting out what's the issue itself.

An example of that was also on my last exam. "Jim has lab serum results of Na 149, glu 126, K+ 5.4, BUN 19.6. Which of these labs is most crucial to correct?"

Pure knowledge says that all his labs are a bit high. What's important to understand is which one will kill Jim faster...which is the K+. Because the potassium range is so much smaller than everything else on the list, it's proportionately more out of range than the others. But it doesn't even take that kind of figuring out to understand...if you remember that potassium has to be kept in a tight range (the given lab values), and know (from your reading) that K+ imbalances will kill faster than Na+ imbalances.

It's both knowledge and application. Always think "what's going to kill my patient faster", and make sure you really understand what the question is asking you to answer. Pay careful attention to how the wording asks the question, answer the question and do not add anything to it (a "favorite trick" of mine that I have to be very careful about), and then verify your answer by reading the question and seeing if the answer fits when you put it all together.

And don't get discouraged. It's hard to switch to application thinking from knowledge based thinking, but that's what you're learning to do. It takes a while, and yes, getting NCLEX books really do help. I happen to really, really like the whole "...Made Incredibly Easy" series...they've improved my scores a lot.

Best-

Lovin' Learning

[McNabK9, BSN, RN, APN]

Thanks for your reply and taking the time LovingLearning. My biggest fault is also "adding on" to the question. I tend to get the difficult questions correct and miss the giveaways because I felt they were too simple! Aghhhh! I think the Saunders review book will start to change my approach and that will be a big help. The content is not difficult, time is a big challenge in trying to get it all done, but the approach to the questions is the mystery. I also plan to change my study habits and concentrate on thoroughly reading the chapters instead of focusing more on the content outlines and lectures. Thanks again!

[lilo2010]

We used Potter & Perry for 1st semester also! It really helped me to do the questions @ end of each chapter & on the disc!

[McNabK9, BSN, RN, APN]

Hi...thanks for the reply. Want to clarify which questions you did at the end of the chapters....the NCLEX questions (which I figure is a given to do those) or the critical thinking exercises? The critical thinking exercises are to, of course, stimulate thinking but there is nothing to confirm if you are on the right track with your answer. Just going throught the exercise has got to be helpful though.....