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Nursing instructors give multiple-choice tests to prepare students for the N-CLEX RN. Multiple-choice tests may be a relatively new form of test taking for you. If you want to practice this type of testing, you may want to study this information.


Advice about test-taking is available from multiple sources. This advice will not be helpful unless you can diagnose your own style of test taking and follow only the advice that is best for you.

One method of classifying learning styles is based on the Myers-Briggs Type Indicator. In this tool there are two ways of taking in information: learning through the use of the five senses and learning through the use of an intuiting process.

The sensing learner likes, or prefers, to take in information through seeing, hearing, touch, taste or smell. This is a more hands-on approach and builds knowledge from learning facts and more facts until concepts or principles are formed. Approximately 70% of nursing students are sensing learners.

The intuitive learner likes to learn a principle or generality first and then seeks facts to support the generality or principle. Facts are not particularly meaningful or easily remembered unless they can be related to some previously learned idea. About 30% of nursing students are intuitive learners.

Both methods of learning have distinct advantages. Everyone uses both methods of learning, but has a preference for one over the other. Sensing learners approach tests differently than intuitive learners.

Sensing learners approach test questions systematically, analyzing each word or phrase. No detail is missed. In fact these learners may find gaps in the information provided and automatically mentally add information. Sometimes the added information leads them to select an incorrect response. Sensing test takers usually take the entire time allowed for the test because they carefully analyze each word in the questions. Sensing learners need to learn to "mentally step back" from the question and see the overall concept being tested in the question.

Intuitive learns approach test questions more globally, reading for the general idea and quickly selecting the first response that occurs to them. Intuitive test takers often finish a test quickly, using only part of the time. Unfortunately these test-takers often miss a fact or clue that would cause them to change their answer. Intuitive learners need to learn to slow down and read each question in its entirety to be sure a key fact has not been missed.


Difficulty taking tests in nursing school generally falls into one or more of three categories: anxiety, test-taking skills, or preparation.


Some anxiety can heighten mental acuity. A moderate level of anxiety has been found to be helpful in test taking by making you more mentally alert and in a state of readiness for the testing situation. More extreme levels of anxiety can be paralyzing. Knowing the source of your anxiety may help you conquer it.


Poor Test-Taking Skills

As noted earlier, nursing students can be divided into two groups of learners. Each style of learning leads to different mistakes in interpreting test questions.

The 70% of nursing students, who have a sensing preference, like to learn in a step-by-step manner. They do a good job of learning the facts from the textbook and classroom presentations. Multiple choice test items that test for application, analysis, or synthesis are asking the student to translate these facts into a slightly different cognitive situation. The sensing student often "knows" the information required to answer the question, but "reads additional information into" the question or misinterprets the information that is there.

The remaining nursing students have a preference for intuitive learning or learning that starts with a general principle and then attaches supporting information or facts to the principle. The facts are remembered because they relate to the principle. These students often miss test questions because they failed to learn all the facts related to the principle or overlooked a fact in a test item. The intuitive learner is more likely to miss an important fact or piece of information in the question that would change the answer. The techniques that you find helpful may depend on your style.

All of us are capable of using sensing and intuition and do so on a daily basis. We may have a preference for one over the other and therefore have developed the use of the style that we prefer. For that reason students may make a combination of mistakes in test taking. As you read the suggestions given below, choose to use only those that apply to you.


Nothing can substitute for adequate preparation. Schedule your study time well in advance of the test. Learning should take place before you sit down to study for the test. Studying for a test should be reviewing the material and formulating applications of the material to the clinical setting.

Form a study group. The study group will be most effective if it includes both learning styles. You can learn from each other. One style will insist on vigorous memory work exercises. Drill and practice routines will help the information to be readily available for recall during the exam. The second style will insist that the group understand the information and view it as part of a bigger picture; that is, there is a reason for knowing the information.

To have a successful study group both styles of learning need to respect the contribution of the other, so they can benefit by learning and applying the methods of the opposite style. It can be helpful but not necessary to know your learning style and that of the group members. When you are in a conflict over how to study, often it will be because of the conflict between styles. The thing to do is stop and make an agreement to spend some time with both styles of studying. (It will pay off.)



Immediately Before the Test

Sleep well. Get to bed at your usual time and get your usual amount of sleep. Your body and mind will function best when your circadian rhythms are synchronized with your need for activity.

Do not take mind-altering drugs. This is not the time to start a new antidepressant, borrow a Valium from your neighbor, or try a different antihistamine. Any of these drugs can make you drowsy or produce a feeling of jitteriness. Do not believe anyone who tells you that you can learn more by relaxing with any drug whether it be prescription or street drugs.

Eat well. You should not have a heavy meal right before the test, but you should eat a balanced meal that will maintain your energy level throughout the test. Some sources recommend a high-carbohydrate, low-fat meal.

Avoid negative people. If you have a friend who gets test anxiety, don't spend time with him or her right before the test. Anxiety can be caught. Have confidence that you have studied well and know the material, and the test can be fun. One test does not generally make or break the academic career of a student.


During the Test

Pace yourself. Teachers generally allow a minute to a minute and a half for a multiple-choice question. You can actually read and answer the question in about half that time. Plan to leave yourself some time at the end to review the questions where you were not certain of the answers.

Answer all of the questions. Teachers usually do not give a penalty for guessing as some standardized tests do. With four possible answers, you have a 25% chance of getting the right answer by random guessing. You can often increase that to 50% by intelligent guessing.

Read each question carefully.

Read it a second time.

Read all the options.

Read them a second time.


You want to be concentrating while you read. Don't let your mind jump ahead to the answers. Intuitive learners are less likely to read the questions carefully. They get an overview of it and make a leap to the answers, missing some detail that made a difference. When students leave the test 20-30 minutes into the examination period, they are usually intuitive learners. Just a little more care in reading can make a difference.

Do not "compulse." Do not "read into" (add information) questions. Avoid asking "what if?" The correct answer is based only on the information given not the client you had yesterday at the hospital, or the example given in class. Use only the information that is presented to you in the question. Usually the students who need this advice are sensing learners, and they are the last to leave the room. That's OK when they are using their time well.

Sensing learners also need some practice in using intuition on a test. If you don't find the answer, then mentally step back from the question and try to get an overall sense of the question. This exercise may help you see what principle is being tested.

Note key words. Two answers may be correct, but one is a better answer for some reason. The reason is often simpler than you think: logical, obvious, or even common sense.

Key words in the question may help you distinguish between two apparently correct answers.

"Most important"—This phrase is asking you to establish a priority of some kind. Often that priority is safety. For example, if the question asks which step of the procedure is most important, the answer is probably one that if you leave it out the situation is not safe for the client.

"Best"—You may be able to substitute another phrase for best. For example, if the question asks "Which is the best definition?" you might substitute "Which is the most complete definition?" or "Which reflects the philosophy of nursing?" "Best" might also be asking you to establish a priority for care.

"Except"; "Not true"—Many teachers try to avoid these kinds of questions, but you will probably find a few on any test. If more than one answer seems correct, go back and make sure you did not miss one of these words.

Be Sure You Realize What Is Being Asked Students sometimes make difficult questions out of easy ones. For example, if the question asks which is a preventive health measure, there may be four nursing measures that are correct for the situation, but only one is a preventive measure.

General Hints. Some questions are factual, with only one correct answer. It is easy to get overly involved with test-taking skills and try to make a "trick" question out of a straightforward question.

If you can narrow the options down to two, go with your "gut" response. You have a 50% chance of guessing the right answer at this point.

Sometimes you read the question and know the right answer. You read the answers, and the "right" answer is not there. Think about the question in a different way (called reframing) and choose the best response that is there.

Accept unanswered questions. Move on. Getting upset will cause you to lose your concentration. You can come back when you have finished the test, and the answer may seem obvious at that time.

Do not get angry at questions. There is a way to answer the question, based on the information given. Getting angry will not help you see the answer.

There are no questions designed to "trick" students. You will not believe that, but it is true. Nursing teachers are nice people who want you to be successful. The questions are designed to test your ability to think and apply the information.

Do not "yes, but" the questions. That's what I mean by reading into questions. Saying "yes, but if the client ... then.... " is a particular temptation for students who have really studied and know more than is on the test.

Sometimes a "true-false technique" will help. Treat each response as a true-false question. You can often eliminate some responses.

Establishing Priorities. Maslow's hierarchy of needs can be useful in establishing priorities. Physiological needs are the bottom line, followed by safety on the next level.

The ABC's of cardiopulmonary resuscitation prioritize the physiological needs. Airway, Breathing, Circulation. The function of the other vital organs would come next. Nutrition and gastrointestinal problems would be low on the list when it comes to sustaining life.

Ordering Activities. The steps of the nursing process are assess, plan, implement, and evaluate, in that order.



1. A young mother has come into an outpatient facility with her 10-year-old daughter, who is mildly retarded. The daughter has been complaining of a sore throat. As the nurse doing the initial assessment, you know that

A. you are responsible for asking all the questions.

B. the mother has a right to tell you what she wants done.

C. the daughter may be too immature to give you correct information.

D. you should foster joint problem solving among all participants.


Rationale. This question represents testing for a principle. B is a true statement, but D is a principle of patient education. In a collaborative relationship, the nurse and client (the family) jointly make health care decisions. This approach fosters the client's self-care responsibilities, even when the client's capacity for self-care is diminished.

This question requires the student to analyze the situation and the answers to find a principle to use in answering the question. The principle is not stated anywhere in the question.

2. A ten-year-old girl, was diagnosed as having a strep throat and given a prescription for an antibiotic. The mother asks if she should stay home from a Girl Scouts meeting 2 days from now. The girl says she does not want to miss Girl Scouts. Your response is based on the knowledge that after 2 days on an antibiotic the infection will not be easily transmitted and that

A. Anyone with an infection is sick and should not be active until he or she is well.

B. Her ability to carry out activities depends on how well she feels.

C. The family's attitudes will not make a difference in the way the girl feels.

D. Amy is too young to make any health-related decisions.


Rationale. The principle being tested is "Well-being is an individual's subjective perception of his or her current level of functioning and satisfaction with life." Nursing care should foster and sustain well-being in clients. The student must analyze the answers to find a nursing care principle that will guide action.

3. In helping a minimally retarded 12-year-old girl and her mother plan a schedule for taking prescribed antibiotics, school activities, and play activities, the nurse keeps in mind that

A. Self-control will help the girl make a transition to wellness.

B. The girl's minimal retardation prohibits participation in the decision-making.

C. The mother has to make the decisions to avoid further infection.

D. The girl must do what she is told, to ensure safe behavior.


Rationale: The principle being tested is "An individual's sense of mastery and control in large part determines the extent to which a person engages in wellness behavior." Only one answer suggests that the child participate in the decision-making. Additionally, you can decide that it is the right answer because it is different from the rest.

If you have children, you may have to put aside what you would do in the circumstances with your own children and think about what you have been taught about health behaviors and school-age children. The principles being tested in this question draw information from two units.

4. You are doing an admission assessment on a 50-year-old man who has stopped smoking and wants to start on an exercise program. In considering alterations in wellness behavior important for this situation, which of the following would not be significant?

A. Eating daily lunch at the sidewalk vendors by his office.

B. Spending most of the weekends watching sports on TV.

C. Yelling at the children for no apparent reason.

D. Saving up to buy a motorcycle.


Rationale: Eating poorly, lack of fitness, and feeling stressed are all dimensions of altered wellness. Saving for a "dream" (motorcycle) may be a sign of midlife crisis but won't affect his ability to start an exercise program. This again shows that you must pay attention to the information in the question. I hope you caught the NOT. When you are seeing more than one right answer go back and look for a "not", "all except" or similar modifier.

5. Late one Saturday night, a friend drove a male college student home because he was "stoned." His college house parent insisted that he see a counselor. As you do the intake assessment, you consider that for any health education to be of help,

  1. His parents must make him fearful enough to come to the center.
  2. He must receive reading material geared to his age.
  3. His girlfriend must threaten to leave him if he does not stop using drugs.
  4. He must recognize that smoking marijuana is detrimental to his personal goals.


Rationale: The best answer deals with the student and his attitude toward health. The principle is that health teaching is most effective when it is consistent with personal values. B is a correct answer but D is better.

6. You decide that you will begin working a male college student by talking about self-responsibility for health care. Which of the following would be the least appropriate topic to discuss with this student?

A. Testicular self-exam skills.

B. Sexually transmitted diseases.

C. General warning signs of serious illness.

D. Safe driving skills.


Rationale: To answer this question you need information about the major health problems in this age group. A, B, and D are major health problems of his age group. Serious physical illness is not a major health concern in that age group.

7. A fourteen-year-old girl had been complaining of vague stomach pains off and on for the past 4 days. Her parents became more concerned when she willingly stayed home from the homecoming game. As the admitting nurse, your primary initial concern is

A. Her comfort and safety during this experience.

B. Her medical diagnosis.

C. Her parents' concerns.

D. Her previous hospitalization experience.


Rationale: Primary initial concern is another way of saying priority. You would be concerned about all of these things. The first priority is always safety, psychological as well as physical.

8. The physician determines that and adolescent female has appendicitis. Her surgery will begin in 2 hours. She tells you that she is frightened of having pain. You tell her

A. Do not worry about that now; we can talk about it after the operation.

B. Young people generally do not have as much pain as adults.

C. The nurses can keep you busy with things to do so you won't even think about the pain.

D. You and I will work together to manage the pain through medication and relaxation techniques.


Rationale: This question pattern appears commonly. Answer A puts the patient off. Answer B denies the patient's concern. Answer C seems to deny the concern. Only answer D directly address the concern and suggests a collaborative relationship with the client.

9. An elderly client, who lives independently, is admitted to a semiprivate room following a sudden onset of shortness of breath. The physician has ordered a complex series of tests. Hospitalization is most likely to threaten her sense of well-being because it represents a

A. Loss of autonomy.

B. Loss of privacy.

C. Sensory overload.

D. Any of the above.


Rationale: You probably learned that hospitalization could be disorienting and stressful, particularly during the initial period of adaptation. Hospitalization affects an individual through loss of autonomy; loss of privacy; sensory overload; social isolation; exposure to risk and pain; threat to body image; and worry about the future. You probably began by trying to analyze the relative threat, but found nothing clear. You are right, the answer would be the same for most any client. (Hint: Any or All of the above is generally the right answer.)

10. You have a patient admitted with fever of unknown origin. Which of the following would be the initial focus of your nursing assessment?

A. The client's primary concern.

B. The medical diagnosis.

C. The nursing diagnosis.

D. The family's perception and concerns.


Rationale: A general principle of taking a health history is to focus on the client by beginning with the client's primary concern, the aspect of the health problem about which she is most concerned. Obviously there are situations where this principle is not applicable. However, in general, the type of client does not change your approach.