Well, it sounds like you are definitely studying enough. Sounds to me that you are interpreting the test questions wrong. Most people have a a hard switching to the critical thinking questions. Maybe you are having issues with the NCLEX style questions. It sounds like you are learning enough material. In nursing school, the material is only half way. You have to apply the material in a scenario or use it to weed out other answers.
Above all else, make sure you are reading and understanding what the question is asking. The scenario in a question might make you feel like you have to pick an answer that's best for a pt overall, but the the answer is the answer to the question, despite whatever the scenario is. For example, a question might say " A pt has a blood pressure of 91/52 and a HR of 61. Has history of cardiomyopathy. What med do you give to alleviate cardiomyopathy? A) ace inhibitor or B, C, D, etc. The answer is A. That's one of the treatments. Now, you might say...That's a trick question...you don't give an ace inhibitor because it's blood pressure medication, and if you give that, the blood pressure will drop and the pt will die. The 91/52 has absolutely nothing to do with the question. Nothing. It's irrelevant. The question is what med do you give to alleviate cardiomyopathy. Just answer the question. Nothing more, nothing less....unless it question asks for it. They will throw in irrelevant information, curveballs, etc. Now, if it mentions that the pt is unresponsive, cold, clammy, and the question is asking the priority, than the answer is different.
Take a step back and look at the question from a different angle. Ask yourself, is this a question about assessment, maybe intervention, maybe evaluation? Is this a question about safety? If it is an assessment question, then the evaluation answer is wrong....even if the evaluation would, in fact, be the right choice if you were evaluating it...but it's not an evaluation question.
Think of exams like trick questions. Let me give you an example that is way over the top.
You have 4 items...a car, a cell phone, a computer, and a chair. One of these items is the smallest of the 4. How many fingers are on your hand? See what I mean???? Is this a question about the smallest item or a question about fingers on your hand? Now, a cell phone is absolutely the smallest item, but that is not what the question is asking. The good thing is, that one answer that seems really weird or out of place, might be a clue to the right choice. If you saw the choices it would be a) car, b) cell phone, c) computer, d) 5. 5 doesn't fit the other, but maybe there's a reason it's there. If you go back and read the question, then it makes sense.
You can learn all the material you want, but you have to learn how strategically take exams and dissect the question. Hope this helps.