Nursing exam questions are terrible (according to science)

jadelpn, LPN, EMT-B · Dec 11, 2013

Do not overthink the questions, do not change your answers. Focus on specifically what the question is asking you, no "what if's " allowed!! Remember your ABC's. That takes priority, once an answer is "maintain airway" in nature--yup, that's the one.....

This style of testing is not great. And yes, it does stink when there are "2 right answers, one is just more right".

Now that you have taken many practice test, see if there is a common thread of answers you are not getting. This would be where I would focus some studying. Also, review your math calculations--especially drip rates....which in this day and age of the IV pump is rather silly, but you never know when you won't have a pump and have to calculate....so they ask those questions. Also where the decimal point goes....if you are calculating a dose--Finally, look over your major meds...the ones that perhaps you saw a great deal of in clinicals. I remember I got some nutty med question, drew a blank on what it even WAS, and then my Mom saying after the fact, JADE it is ON TV!! Oh, yeah.

Best of luck to you!

ArtClassRN, ADN, RN · Dec 11, 2013

Writing good exam questions is a skill most instructors do not possess. Further, when they write a crappy question and get called on it, they tend to dig their heels in. My program had its share of poor questions, but there was enough straightforward material and decent questions that if you studied and knew your stuff, you would certainly pass. Getting an A was very, very difficult, but Bs were well within reach. (I strongly suspect that was the purpose of the "bad" questions).

The students that failed blamed the poor questions, but they generally did poorly on the straightforward questions too.

I was an engineer before nursing school and had similar feelings to yours in the beginning. Fortunately, my program focused heavily on NCLEX preparation in our exams and provided HESI evaluations throughout the program. When I started, I was doing well on class exams but horrible on HESI tests.

So I threw a few tantrums, but then I put my big girl underwear on and learned how to take those stupid tests.

bear14 · Dec 11, 2013

A good amount of time their questions come from the text book test bank too. Then it's hard to argue those because they did not write the questions themselves so we're stuck. Especially if it contradicts what is taught in class.

HouTx, BSN, MSN, EdD · Dec 11, 2013

. . . I myself struggled severely in nursing school even though I came through the prerequisite classes with all A's. Before nursing I was a physics major and did fairly well, I've always been good at academia, and so it was very bruising to my ego to struggle so much.
I remember one of my teachers early on talking about how nursing wasn't like engineering or math because you had to think critically. Now, I call bull. In fact, I think that bad questions are actually a symptom of a bigger problem in nursing education as a whole. I think the field lacks a comprehensive and rational approach to its subject and so it takes on a vague and indirect quality. Hell, every nurse I've ever met has stated that nursing school doesn't have much to do with being an actual nurse.
Sorry for the long first post but I'm a little irked and stressed right now. So what do ya'll think? Also, wish me luck on the NCLEX, I think I might need it.

Well, I am a nurse - and I think that nursing education/school HAS EVERYTHING to do with nursing practice. New grads are generally overwhelmed for a bit... trying to learn all the 'tasks' so they are not in a good place to provide an objective viewpoint. To them, it does seem like a disconnect - "school did not prepare me for this". After a while, it evens out and they begin to appreciate the whole picture.

In my grad & post-grad work, I completed a few courses in psychometrics - I believe it is an essential skill set for any professional educator. So I do understand your frustration with "bad questions". Unfortunately, nursing instructors (like all other higher ed instructors) are only required to have a background in their area of specialization - not in the discipline of education. Not an excuse, just an explanation.

In order to minimize their own liability, most colleges & universities do have policies that outline the requirements for test creation, including reliability and validity of test items. Some schools do a great job of teaching their faculty how to develop tests - some don't.

In general, faculty development is most extensive for tenured positions.... less so for non-tenured, still less for adjunct ... all the way to non-existent for instructors at commercial schools who are basically academic 'temps' who just do what they are told for a specific class. Keep this in mind when you are evaluating the skill level of your faculty.

Rest assured that NCLEX - and all other nationally recognized licensure/certification exams - has been exhaustively researched and each item has been subjected to rigorous evaluation before you log on to take that exam.

Philly_LPN_Girl, LPN · Dec 11, 2013

Hi all. This is my first post. I recently graduated from an RN program and will be taking the NCLEX soon. I've been doing practice tests a lot and am getting a little frustrated. In short the questions are stupid and I hate them on a personal level which I have to work at what with them being inanimate and all. Fortunately science says I'm right.
http://www.ncbi.nlm.nih.gov/pubmed/17014932
http://www.nursingcenter.com/lnc/CEArticle?an=01709760-201303000-00002&Journal_ID=54029&Issue_ID=1526614
If you don't feel like reading these studies basically state that many nursing exam questions are poorly constructed. The second study actually finds that bad question writing could result in 10%-15% of students failing a test they should have passed. I have witnessed this in my own education as many very bright people simply couldn't do well on nursing tests. I myself struggled severely in nursing school even though I came through the prerequisite classes with all A's. Before nursing I was a physics major and did fairly well, I've always been good at academia, and so it was very bruising to my ego to struggle so much.
I remember one of my teachers early on talking about how nursing wasn't like engineering or math because you had to think critically. Now, I call bull. In fact, I think that bad questions are actually a symptom of a bigger problem in nursing education as a whole. I think the field lacks a comprehensive and rational approach to its subject and so it takes on a vague and indirect quality. Hell, every nurse I've ever met has stated that nursing school doesn't have much to do with being an actual nurse.
Sorry for the long first post but I'm a little irked and stressed right now. So what do ya'll think? Also, wish me luck on the NCLEX, I think I might need it.

wow I thought that it was just me who thought that a lot of nursing qurstions are poorly written. There were times when I was practicing nursing questions for my nclex and I didnt understand the question and had I did I would have gotten the question right.

Using the test banks that go with the text books are the worst. I also believe that knowing how to do nclex styled questions has helped me out a lot with my frame of thinking.

ericthered · Dec 11, 2013

Hello HouTx. Sorry if my comment offended you. I'm not saying that nursing school doesn't do anything to prepare one to be a nurse an perhaps my original writing was too strongly worded. However, I do still contend that nursing education is deeply flawed and needs a very critical examination, only part of which concerns exam questions. As for your statement that the NCLEX is well vetted I just don't buy it. Questions drawn from test banks seem to be poorly made and are designed to be as close to the NCLEX as possible. Also, my school contracted with a company to provide a review course for the NCLEX at the end of our classes. The instructor of that course stated that if you wait past 6 months from the end of classes to take the NCLEX your chances of passing the first time drop by 70%. That means someone who had a 90% chance of passing would only have a 30% chance if they wait to long. If the test is that variable over such a short period time that can't speak well of it's reliability or validity.

ericthered · Dec 11, 2013

Doing some more thinking about this and I have a few more examples of nursing education shortfalls. This one bugged me all through school, Maslow's. Our instructors kept talking about evidence based practice and then throw this antiquated and unsupported stuff out there and pretend it is valid (A causal correlational test of the need hierarchy concept). The thing that bothers me is that Maslow's hierarchy was so critical to our patient ranking structure yet there is in fact no real separation of the higher order needs into distinct ordered groups. The paper I linked too isn't the only one to reach this conclusion either, just Google it and see. I also can't stand the nursing diagnosis stuff. Why can't we just call a disease by its name a do a detailed pathology. I feel like nursing is trying really hard to pretend it is somehow not medicine and that leads to graduates unprepared to work in the medical field. I would really like to see nursing become a more scientific and rigorous field. Also, I think some sort of residency like they have with MD programs would be very helpful.

Here is an excellent article on current nursing that I find interesting, though I disagree with the author on a few things. Worth a look.

http://www.medscape.com/viewarticle/736236_1

liketheairport · Dec 11, 2013

Doing some more thinking about this and I have a few more examples of nursing education shortfalls. This one bugged me all through school, Maslow's. Our instructors kept talking about evidence based practice and then throw this antiquated and unsupported stuff out there and pretend it is valid (A causal correlational test of the need hierarchy concept). The thing that bothers me is that Maslow's hierarchy was so critical to our patient ranking structure yet there is in fact no real separation of the higher order needs into distinct ordered groups. The paper I linked too isn't the only one to reach this conclusion either, just Google it and see. I also can't stand the nursing diagnosis stuff. Why can't we just call a disease by its name a do a detailed pathology. I feel like nursing is trying really hard to pretend it is somehow not medicine and that leads to graduates unprepared to work in the medical field. I would really like to see nursing become a more scientific and rigorous field. Also, I think some sort of residency like they have with MD programs would be very helpful.
Here is an excellent article on current nursing that I find interesting, though I disagree with the author on a few things. Worth a look.
http://www.medscape.com/viewarticle/736236_1

Always remember, correlation DOES NOT equal causation. (Sorry, that's a big pet peeve of mine.)

ArtClassRN, ADN, RN · Dec 11, 2013

Doing some more thinking about this and I have a few more examples of nursing education shortfalls. This one bugged me all through school, Maslow's. Our instructors kept talking about evidence based practice and then throw this antiquated and unsupported stuff out there and pretend it is valid (A causal correlational test of the need hierarchy concept). The thing that bothers me is that Maslow's hierarchy was so critical to our patient ranking structure yet there is in fact no real separation of the higher order needs into distinct ordered groups. The paper I linked too isn't the only one to reach this conclusion either, just Google it and see. I also can't stand the nursing diagnosis stuff. Why can't we just call a disease by its name a do a detailed pathology. I feel like nursing is trying really hard to pretend it is somehow not medicine and that leads to graduates unprepared to work in the medical field. I would really like to see nursing become a more scientific and rigorous field. Also, I think some sort of residency like they have with MD programs would be very helpful.
Here is an excellent article on current nursing that I find interesting, though I disagree with the author on a few things. Worth a look.
http://www.medscape.com/viewarticle/736236_1

Maslow doesn't bother me; it is just a way of approaching patient issues and yes, it is arbitrary.

But I do share your frustration with nursing pushing utterly mindless garbage like therapeutic touch and Roger's unitary "science" of human beings. The other "theories" (Roy, Orem, King, Neuman) which like Maslow are actually viewpoints or paradigms or models - NOT scientific Theories - are simply varying ways on putting fancy labels on observations of human behavior. Even Henderson is just a restatement of Nightingale. The majority of that stuff is just nursing academia having a huge inferiority complex and can go.

The nursing diagnosis/care plan stuff is just a way of showing you can document a patient's needs and interventions. It's arbitrary if it didn't exist as it is, some other BS method would exist.

But, "This is the life we have chosen..."

llg, PhD, RN · Dec 11, 2013

But I do share your frustration with nursing pushing utterly mindless garbage like therapeutic touch and Roger's unitary "science" of human beings. The other "theories" (Roy, Orem, King, Neuman) which like Maslow are actually viewpoints or paradigms or models - NOT scientific Theories - are simply varying ways on putting fancy labels on observations of human behavior. Even Henderson is just a restatement of Nightingale. The majority of that stuff is just nursing academia having a huge inferiority complex and can go.
The nursing diagnosis/care plan stuff is just a way of showing you can document a patient's needs and interventions. It's arbitrary if it didn't exist as it is, some other BS method would exist.
QUOTE]
While I agree that there is a lot wrong with nursing education, I don't agree with many of your perspectives on the situation. Henderson's work was NOT just a re-statement of Nightingales's work. The other theories you mention ARE scientific or at least a combination of science and philosophy -- BOTH of which are important to nursing (though I admit, we need to move on and let them and nursing scholarship in general evolve).
Maybe you are going to a bad school ... or maybe you are just not attracted to the scholarly side of nursing. But I am sure there are a lot of things that you like that other nurses would hate, too. That doesn't make everything you like "bad".

kbrn2002, ADN, RN · Dec 11, 2013

Rest assured that NCLEX - and all other nationally recognized licensure/certification exams - has been exhaustively researched and each item has been subjected to rigorous evaluation before you log on to take that exam.

Absolutely! The number of very qualified individuals that have input on every question before it even sees the light of day on an exam is quite large, and current exam questions are continually reviewed. I can speak from experience as I am on the NCLEX panel and am one of professionals participating in this process, so I do take exception with OP's statements that the NCLEX is full of "bad" questions.