need help with exams please!

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I just entered the junior year of my BSN program and I am passing but it seems like no matter how hard I study I cannot do well (B or higher for me) on the exams. The questions and answers are subjective and there's more than one right answer. This is driving my crazy. I miss the basic science classes where there was only one right answer. Can advice you guys can give would be greatly appreciated.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

the multiple choice questions on nursing tests are called application questions. they require you to use critical thinking and reasoning skills. just knowing the information isn't enough to answer correctly. see this thread and go to the weblinks listed on it:

with application type question you must pull your knowledge of a number of different subjects into answering correctly. what makes this complicated is that you are not told what subjects to consider in answering. that is part of your test. in general, you may need to consider:

  • the medical disease involved, it's normal pathophysiological progression and the signs and symptoms associated with the pathophysiological changes. learn the progression of symptoms as they go from mild to serious to fatal. this helps you determine priorities of care.
  • priorities of care determined by maslow's hierarch of needs: http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs
  • knowing the medical tests and treatments that the doctor is going to order. know which tests and treatments fit which each sign and symptom (again this helps determine priority if you get asked which to get done first). some of these tests and treatment will impact the nursing care you will give.
  • knowing the steps of the nursing process. there are five of them. know which order they come in and what goes on in each step: assessment, determining problems, planning care, implementation and evaluation. each step of the nursing process is a link in a chain; ask yourself if the question is placing you in one of the link of events on the chain of the steps of the nursing process and what would be logically happening on that step.
  • that there are many kinds of principles behind nursing actions (i.e., principles of asepsis, principles of osmosis, infection process, etc) that you need to know and sometimes pull into determining the answer to a question. this is where you sometimes cannot discount the science or math you learned before. something as simple as heat coagulates protein helps you to know that it is the underlying principle of steam sterilization in the killing of bacteria.
  • reading the root or stem of a multiple choice question very carefully. i've read some of the instructors manuals on how to write these questions. they deliberately give you answer choices designed to distract you from what was originally asked because it naturally draws your attention to it. a mediocre student or a student who isn't thinking will opt for these distractive answer choices. if you've done your reading and studying you should be putting two and two together. nursing involves a process of logical thinking, not guesswork. if you are narrowed down to two possible answers, try to figure out from the stem of the question if pulling in knowledge of the nursing process or the disease process is going to help you make your final decision.
  • thinking about previous test questions you missed and why you missed them. teachers use the same techniques that "gotcha" to answer incorrectly before over and over again which is why you should always review your tests when you get them back and correct your reasoning for picking wrong answer choices.
  • the bottom line. . .you always have to be thinking "why". why would this situation a question poses be happening to the patient? why would the doctor order some particular treatment? why would a nurse do what a question is asking? why? why? why? answer that, and you are closer to answering the question correctly.

here are some previous threads where application test questions and the rationales for their answers were discussed:

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I hesitate to post after Daytonite, because her answers are always so awesome, but here goes:

I always mark up my test when I'm taking it. Underline what they are actually asking for, and make sure if it's a "check all that apply", you give more than one answer. Done that. Boo. If it's a question about a certain problem, like alkalosis, write down all you know about alkalosis before you answer it. Then look at the answers.

Delete the two answers that are obviously wrong or of little importance.

Look at the two remaining and think, "Which is MOST important?" Always remember ABCs (airway, breathing, circulation). If one of the answers is about those, it's probably what you want.

Before you take any action (intervention) on a patient's condition, you will always ASSESS. So, even if one of the answers IS airway, and one is ASSESS, you may want to pick "assess" first.

Try to listen in class to the order the teachers use. Have them give you some sample questions to work from. Look in the back of the book or at the book's website for practice questions. I had one test that took at least five questions directly from the book. Wahoo!

And before you even look at the answers, think of the answer in your head as you read the question. If that one is one of your choices, you're probably right.

Don't read too much into the question, and don't spend too much time on it. Your first reaction is probably the right one.

Hope this helps.

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Thanks for the responses. I definately often second guess myself and change the answer, and usually my first guess was the correct one.

As far as viewing the tests, they are computerized. We can view what we missed immeditely after the test. Once we leave the computer lab, we can never see the questions again.

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A couple of questions that I can remember missing on today's exam...

A. Patient admits to the ER with hyperpyrexia. This is indicative of...

The only two possible correct answers to the question were fever and infection. Thinking it obvious that hyperpyrexia is a fever, I put "infection" as the answer, since a fever indicates infection. Nope. The correct answer was "fever."

B. A patient chooses to have an abortion, which one of the following is she likely to experience?

I narrowed it down to "regret and remorse" and "loss and sadness." I put "regret and remorse" and got it wrong.

Another question asked us to choose 4 answers from 6 on how to educate cross country runners on how to reduce their chances of heat exhaustion. We never received training on that. Some of these questions just make me :cry:

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To help with the problem of changing answers, our instructors handed out pencils with big goofy erasers so that you would think twice before using them. The only reason to change an answer is if something later in the test triggers a memory that makes your first answer definitely wrong. And if you can get away from that because on the NCLEX you cannot go back and change an answer.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

it is really important going into a test that you know the subjects that you are being tested over. the questions should be about those subjects. you said, "another question asked us to choose 4 answers from 6 on how to educate cross country runners on how to reduce their chances of heat exhaustion. we never received training on that." yet, there are 2 questions you have listed that are about body temperature. so, i'm wondering. . .was body temperature one of the subjects that was to be covered on this test? hyperpyrexia is a medical term connected with elevated temperature. heat exhaustion is a medical condition of elevated body temperature. it is appropriate that both would be tested over on a test about body temperature, especially if it was listed in the objectives covered for the test. did you completely study what was necessary about body temperature in order to take this test? you should have been provided the objectives for the test. it is important that you make an appointment to meet with one of the instructors asap to discuss the outcome of this exam immediately to help get yourself on the right track in order to prepare for subsequent exams.

a. patient admits to the er with hyperpyrexia. this is indicative of...

the only two possible correct answers to the question were fever and infection. thinking it obvious that hyperpyrexia is a fever, i put "infection" as the answer, since a fever indicates infection. nope. the correct answer was "fever."

hyperpyrexia
is an elevation of temperature over something like 106 degrees f. you would have to know the definition of this term to answer the question.
indicative
means
suggestive of
, or
represents
. hyperpyrexia is suggestive of a fever. this is a straight up medical terminology question. it is not asking you what the cause of the hyperpyrexia is. infection would be a cause of the fever occurring.

you're in a bsn program, right? they are heavy into words and the way questions are worded. english and the way it is used gets important in upper division nursing classes.

b. a patient chooses to have an abortion, which one of the following is she likely to experience?

i narrowed it down to "regret and remorse" and "loss and sadness." i put "regret and remorse" and got it wrong.

an abortion is the death of a fetus any way you look at it. that evokes the grief reaction which is the emotional response following a
loss
, which was a big clue, and has the following symptoms: shock, disbelief, anger, blame, acceptance, distress and despair. sadness is part of that.

another question asked us to choose 4 answers from 6 on how to educate cross country runners on how to reduce their chances of heat exhaustion.

heat exhaustion is a condition of exposure to high external temperature and can be complicated by failure to replenish lost water and electrolytes or a lack of sweating. that's pretty much dehydration as a complication. there should have been answer choices there about maintaining fluid intake, using cool liquids, avoiding caffeine and stimulants, electrolyte replenishment, wearing loose clothing, and conserving activity by allowing for rest periods.

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