NCLEX: Test Questions and Strategies for Answering Them

The test questions used on the NCLEX-RN exam are written to test the knowledge, skills, and abilities essential to provide safe client care. Understanding the types of questions, the cognitive level of the questions, as well as the thinking processes used to answer the questions is essential for test success. This chapter provides information about the test items used on the NCLEX-RN exam and offers strategies for answering questions for various types of test items and levels of the cognitive domain.

Test Questions and Strategies for Answering Them: Types of Test Items

Focus topic: Test Questions and Strategies for Answering Them

The NCLEX-RN examination uses eight types, or formats, of test items.1 These include multiple-choice items and seven alternate item formats: multiple response, fill-in-the-blank (calculation), hot-spot, chart/exhibit, drag-and-drop/ordered-response, graphic options, and audio. Video inclusion items are being evaluated for use by the National Council of State Boards of Nursing2 and are included on the CD that accompanies this book as an additional way for you to develop your critical thinking and test taking skills.

Although each type of item tests your understanding of nursing content and is developed using the same test development process, each type of test item requires you to respond in a different way. Because alternate item formats test knowledge, skills, and abilities in a variety of ways, there are increased opportunities for you to demonstrate your competence.

All eight types of test items and video inclusion test questions are used in this review book and CD-ROM to give you the opportunity to learn how to answer each type of question. You can also find examples of these types of questions on the NCSBN web site (www.ncsbn.org), in the candidate tutorial that precedes each licensing exam at the PearsonVue web site (www.pearsonvue.com/nclex), and in the candidates’ bulletin that you will receive prior to taking the licensing exam.

Test Questions and Strategies for Answering Them: Multiple-Choice Item

Focus topic: Test Questions and Strategies for Answering Them

Multiple-choice items include a scenario/situation, a question, and four answers, only one of which is correct. The scenario provides information about the client or care management situation. The question (stem) poses the problem to solve. The question may be written as a direct question, such as “What should the nurse do first?” or as an incomplete sentence, such as “The nurse should…” The answers (options) are possible responses to the stem. Each stem has one correct option and three incorrect options. The options may be written as complete sentences or may complete the sentence stem stated in the question. Multiple choice items are the most common type of test item used on the licensing exam.

Test Questions and Strategies for Answering Them: Strategies for Answering Multiple Choice Questions

Focus topic: Test Questions and Strategies for Answering Them

■ Read the scenario and relate the question and answers to the data provided in the scenario. Pay particular attention to information about the client’s age, family status, health status, ethnicity, or point in the care plan (e.g., early admission versus preparation for discharge).
■ Answer the question before looking at the possible answers.
■ Choose the answer that best matches the answer you first thought was correct.
■ Recognize that only ONE answer is correct.
■ Double check your answer to be sure you have responded to the question; note particularly key words such as first, except, not, most, last; be sure that you are basing your answer on best nursing practice, not experience with one client or in a particular clinical agency.

Test Questions and Strategies for Answering Them: Multiple-Response Item

Focus topic: Test Questions and Strategies for Answering Them

Multiple-response items are similar to multiple choice items, except that they include four or more answers and have one or more correct answer(s). These questions will ask you to identify all of the answers that are correct (“Select all that apply.”). At least one of the answers will be incorrect, and thus you will not ever check all of the answers to a multiple-response question. Multiple response questions will be scored as being either correct or incorrect; no partial credit is given for selecting some of the correct responses.

When using the text pages in this book to answer the multiple-response questions, you can make check marks in the boxes located in front of the answers. When using the CD that accompanies this textbook and on the actual NCLEX-RN exam you will place your cursor on the box in front of the answer you wish to select and click on the box; a check mark will appear indicating that you wish to select that answer. To change an answer you can use the mouse to remove the check mark from that box.

Test Questions and Strategies for Answering Them: Strategies for Answering Multiple-Response Questions

Focus topic: Test Questions and Strategies for Answering Them

■ Read the question carefully and determine what it is you are to select, for example all possible side effects of a particular drug; all intended outcomes of a particular nursing intervention; all of the elements of a teaching plan for a client with a particular health problem; all instructions a nurse should give to a client who is being discharged.
■ Consider how the answers are “clustered” and how the correct answers are related.
■ Be sure you have selected ALL of the possible correct answers.
■ Double check your answer by reviewing the answers you did NOT check and be sure they are incorrect and should not be included in the answer.

Test Questions and Strategies for Answering Them: Hot-Spot Item

Focus topic: Test Questions and Strategies for Answering Them

Hot-spot items involve identifying the location of a specific item, such as an appropriate injection site, assessment area, or correct part of a waveform. The question will be phrased, “Identify the location.….” or “Select the area,,,,,,.”

When answering hot-spot questions in the book, you should place an X on the illustration provided to identify the proper area and then refer to the answer section for that chapter to confirm your response. On the actual NCLEX-RN and on the CD-ROM accompanying this book, you will use the mouse to move your cursor over the area you want to select and then left-click the area. A red “X” will appear over the area you have selected. If you make an error, you can move the cursor to the part of the figure that is the answer you wish to enter.

Test Questions and Strategies for Answering Them: Strategies for Answering Hot-Spot Questions

Focus topic: Test Questions and Strategies for Answering Them

■ Read the question carefully, and answer the question first by visualizing an answer; then look at the figure to mark your answer.
■ Double check your answer to make sure you have selected the correct “spot” based on evidence for best nursing practice.

Test Questions and Strategies for Answering Them: Fill-in-the-Blank (Calculation) Item

Fill-in-the-blank items involve calculations, such as determining a drug dose, calculating an I.V. drip rate, or totaling intake-output records. These items can be answered with a number. On the NCLEX exam, if you do not enter a number, you will receive an error message that will prompt you to “enter a numeric answer.” When an answer includes a measurement amount such as milliliters (ml), grams (g), or inches, the measurement unit will be stated in the stem of the question and supplied in the answer box, thus you will not include the unit of measure as part of your answer. The question will indicate if you are to round your answer and, if so, to how many decimal places.

When answering fill-in-the-blank questions on the text pages of this book you can use paper and pencil, a handheld device with a calculator, or a calculator to determine your answers. However, in the CD that accompanies this book and on the actual NCLEX-RN exam, a drop-down calculator will be available for you to use to calculate your answers. The division sign used is similar to the one used on the Microsoft Calculator (/); be sure to familiarize yourself with the mathematical function keys. To practice calculations required for fill-in-the-blank questions, use the calculator on your computer.

Test Questions and Strategies for Answering Them: Strategies for Answering Fill-in-the Blank Questions

Focus topic: Test Questions and Strategies for Answering Them

■ Determine what calculation the question is asking you to perform (add, subtract, use a formula).
■ Use the erasable note board provided at the testing station, the drop-down calculator, or another type of calculator or paper and pencil to perform the appropriate mathematical function.
■ To avoid calculation errors, be sure that you do not enter numbers rapidly when you are using the calculator.
■ Round the numbers, as directed, to one or two decimal points; round the number after completing the calculation. If rounded numbers are required to answer the question, the decimal point must be included in the answer.
■ Place your answer in the appropriate line.
■ Double check your answer using a logic test—is this answer plausible? Did I perform the correct mathematical function? Is the answer appropriate for the unit of measure required in the question?

Test Questions and Strategies for Answering Them: Chart/Exhibit Item

Focus topic: Test Questions and Strategies for Answering Them

Chart/exhibit items present data from a chart, graph, or table. Data from a client’s chart will be presented from one or more chart “tabs” such as: prescriptions/orders, history and physical, laboratory results, miscellaneous reports, imaging results, flow sheets, intake and output, medication administration record, progress notes, and vital signs. On the actual NCLEX-RN exam, you will be prompted to “Click on the exhibit button below for additional client information.” You will then use the data presented in the scenario and on the chart or exhibit to make a nursing decision. For example, you will click on up to three tabs to locate data and then you will interpret the data, validate if the data are correct or sufficient, and then be asked to respond to a question based on the data.

In this book and on the accompanying CD-ROM, chart/exhibit questions show data on 1 or 2 “tabs” and then ask you to use the data to respond to the question. When these types of questions are administered by the computer (as in the NCLEX-RN exam), you may be asked to determine which “tab” to use to locate the information that is required to answer the question and you will click on the tab to open the tab(s) and a “pop-up” window will appear on the computer screen.

Strategies for Answering Chart/Exhibit Questions

Focus topic: Test Questions and Strategies for Answering Them

■ Read the scenario and question carefully to understand the context for the data to be provided in the chart or exhibit. For example, are you looking for vital signs? Would an elevated pulse or drop in blood pressure be consistent with the context of the question and provide data for making a nursing decision?
■ Read the information provided on the chart or exhibit and identify the information that is essential to answer the question.
■ Review the chart or exhibit “pop-up box” as many times as needed.
■ If necessary, take notes on a scratch pad (one will be provided at the testing center).
■ Answer the question only from data provided in the chart or exhibit and from the data presented in the scenario.
■ Double check your answer by being sure you have obtained all of the data necessary to answer the question and that the answer is complete and plausible.

Test Questions and Strategies for Answering Them: Drag-and-Drop/Ordered-Response Item

Focus topic: Test Questions and Strategies for Answering Them

Drag-and-drop/ordered-response items require you to place information in a specified order. For example, the question might ask you to put steps of a procedure in order, or provide information about several clients, and ask you to determine the order of priority in which each client should receive nursing care. Or the question may ask you the order in which to teach a client about a procedure or self-care process. There may be up to 6 options to arrange in a specific order. The questions will be scored as correct or incorrect; there is no “partial credit” for having part of the answer in the correct order.

When answering drag-and-drop/ordered response items in the text of this book, you will simply write the answer options in their correct order in the blank spaces provided in the answer column. On the actual licensing exam, you will drag each response from the left-hand column and drop it into the correct order on the right-hand column. You can move the items around until you have them in the correct order and then click “submit” to enter your answer. If you need to change your answer, you can drag the response to another position and reorder the responses. The CD-ROM that accompanies this book functions in much the same way, except that you will click on “Next” to proceed to the next question.

Test Questions and Strategies for Answering Them: Strategies for Answering Drag/Drop Ordered Response Questions

Focus topic: Test Questions and Strategies for Answering Them

■ Read the key words in the stem of the question that indicate the order in which you are to place the answers (usually from first to last).
■ Test the logic of your answer.
■ Be sure all items have been placed.
■ Double check your answer by reviewing the correct order for the answers and that you have placed your answers in the order in which you intend to answer the question. One answer out of order will cause the question to be counted as incorrect.

Test Questions and Strategies for Answering Them: Graphic Option Item

Focus topic: Test Questions and Strategies for Answering Them

In the text of this book, you can use your pencil to mark the correct answer to a graphic option question. On the CD that accompanies this book and on the actual NCLEX-RN exam you will click on the circle in front of the graphic that represents your answer. To change your answer, click on another circle.

Strategies for Answering Graphic Option Questions

Focus topic: Test Questions and Strategies for Answering Them

■ Read the question carefully and visualize the answer before looking at the options presented with the test item.
■ Look carefully at each graphic option and be certain you understand the differences among the options.
■ Select the option that best answers the question.
■ Double check your answer by reviewing the question, answering the question based on best nursing practice, and matching the answer to the graphic option.

Test Questions and Strategies for Answering Them: Audio Item

Focus topic: Test Questions and Strategies for Answering Them

Audio items include a short audio clip with data that are essential to answer the question. For example, you could be asked to listen to breath sounds, heart sounds, bowel sounds, or verbal interactions. The question will indicate that you should click on the play button to listen to the audio clip. You will be able to play the audio clip as many times as needed to answer the question. The question may ask you to identify the sound on the audio clip, for example type of breath sound, or you may be asked to make a nursing judgment and/or select a nursing action based on your interpretation of the sound.

In this review book, the audio questions are presented on the CD that accompanies this textbook. You will be able to listen to the sounds and choose the correct answer. When taking audio test questions on the actual NCLEX-RN exam you will have headsets to use and you will be able to adjust the volume.

Test Questions and Strategies for Answering Them: Strategies for Answering Audio Questions

Focus topic: Test Questions and Strategies for Answering Them

■ Read the test item carefully to understand the clinical context in which the scenario occurs.
■ Listen to the audio clip before answering the question; listen to the audio clip as many times as needed to answer the question.
■ Relate the sounds in the audio clip to the scenario in the test item; if the question asks you to make a nursing decision or select a nursing action, base your answer on your interpretation of the sound and best nursing practices.
■ Double check your answer by reviewing the question and answering the question based on best nursing practice.

Test Questions and Strategies for Answering Them: Video Item

Focus topic: Test Questions and Strategies for Answering Them

Video items use video clips to present a clinical situation or to demonstrate a procedure. The question will be based on information you have viewed in the video clip. Video items in this book are only found on the CD.

Test Questions and Strategies for Answering Them: Strategies for Answering Video Items

Focus topic: Test Questions and Strategies for Answering Them

■ Read the question carefully to understand the clinical context of the question.
■ Anticipate what the video clip will show, what you should pay particular attention to when you are watching the clip, and how the question relates to what is being shown in the video clip.
■ Play the video clip as often as you need to view the action; look for actions that are correct or not correct.
■ Double check your answer by comparing the video clip and the answer options and selecting the option that represents best nursing practices.

Test Questions and Strategies for Answering Them: Cognitive Levels of Test Items

Focus topic: Test Questions and Strategies for Answering Them

The cognitive level of questions refers to the type of mental activity such as critical thinking, and clinical reasoning required to answer the question. The cognitive levels used to write test items for the NCLEX-RN are derived from the original Bloom’s taxonomy and the Bloom’s revised taxonomy of the cognitive domain. The next level of the cognitive domain, comprehension (or understand) requires you to interpret, explain, or understand the knowledge. The application (or apply) level involves using information that you remember and understand and can apply in new situations. Analysis (or analyze) requires recognizing and differentiating relationships between parts and using clinical reasoning and critical thinking skills.

Synthesis (or synthesize) refers to the ability to take several pieces of information or clinical data and use them to make a nursing care judgment or decision. The next level of the cognitive domain is evaluation (or evaluate). Here you must check data, critique information, or judge the outcome of nursing care. The final level of the cognitive domain is creation (or create). At this level, you must be able to generate new approaches to nursing care or develop a unique nursing care plan based on available information.

Test items can be written to test at all levels of the cognitive domain, but questions that are written for the NCLEX-RN exam are generally written at application levels and above because nursing requires the ability to apply knowledge to clinical situations, analyze data, think critically, prioritize information, make clinical decisions for client care, evaluate outcomes of nursing interventions or health care treatments, and create care plans based on specific client needs. This book presents questions at the application level and higher.

Clinical reasoning refers to the higher order mental activities and critical thinking skills used to solve a problem or make a decision. Nurses use clinical reasoning, critical thinking, critical synthesis, clinical decision making, and make clinical judgments to provide safe client care. Understanding the types of test items written at various levels of the cognitive domain and strategies to answer them is key ( ) to success on the licensing exam. Examples of questions at higher levels of the cognitive domain are provided here to assist you in further understanding the types of questions used on the licensing exam and the strategies you can use to answer them.

Test Questions and Strategies for Answering Them: Application Level Item

Focus topic: Test Questions and Strategies for Answering Them

Application level items test your ability to apply knowledge to a specific scenario. These questions draw on your ability to know and understand nursing content, and to then apply this information to a specific scenario or situation.

Test Questions and Strategies for Answering Them: Strategies for Answering Application Level Questions

Focus topic: Test Questions and Strategies for Answering Them

■ Read the question and consider what information you already know and how that information should be used to answer this particular question.
■ Consider how information you can recall should be applied to nursing care for the client that is described in the scenario for the question.
■ Apply known formulas (divided dose/drip rate calculation), frameworks (for example Maslow’s hierarchy, developmental stages, stages of moral development), and procedural steps (how to administer a particular medication) to answer the question posed in the new clinical situation (scenario).
■ Double check your answer by recognizing what information you are applying to answer the question.

Test Questions and Strategies for Answering Them: Analysis Level Items

Focus topic: Test Questions and Strategies for Answering Them

Questions at this level ask you to analyze data, clusters of symptoms, implementation plans, and then make nursing diagnoses and clinical decisions. These questions can also ask about what additional information should be obtained to make a clinical decision, plan care, or make a nursing diagnosis.

Strategies for Answering Analysis Level Questions

Focus topic: Test Questions and Strategies for Answering Them

■ Identify the data presented in the scenario that lead you to draw a conclusion or make a nursing diagnosis.
■ Identify how the parts are related and how the nurse should assemble them to make a complete care plan.
■ Determine if you have sufficient information to make a decision.
■ Review data from all sources possible (client’s vital signs, client’s responses to medication and treatments, chart information, client assignment list, etc.)
■ Double check your answer by determining that you have understand all of the components of care and have made the correct nursing decision based on those components.

Test Questions and Strategies for Answering Them: Synthesis Level Items

Focus topic: Test Questions and Strategies for Answering Them

Synthesis level test items ask you to use several pieces of information to make a clinical decision.

The focus here is on obtaining sufficient information to make a clinical decision, rather than analyzing data already available. The information may come from the client/family or members of the health care team. In synthesis level items, you must determine accuracy and usefulness of information for the particular situation, sort relevant data from irrelevant data, and use it to plan or give nursing care.

Test Questions and Strategies for Answering Them: Strategies for Answering Synthesis Level Questions

Focus topic: Test Questions and Strategies for Answering Them

■ Read the question to determine what information is necessary to provide safe client care.
■ Determine if you have sufficient and accurate information.
■ Interpret all data obtained in context of the question and the client’s needs.
■ Make a clinical decision about the relevant nursing action.
■ Double check your answer by being sure that the information you have directs you to the correct answer.

Test Questions and Strategies for Answering Them: Evaluation Level Items

Focus topic: Test Questions and Strategies for Answering Them

Evaluation level items ask you to make judgments about care, determine the effectiveness of nursing care, or evaluate the extent to which an intended outcome has been achieved. Evaluation level test items can also ask you to determine if the care given by others (client/family, health care team, health care provider) is appropriate.

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Test Questions and Strategies for Answering Them: Strategies for Answering Evaluation Level Questions

Focus topic: Test Questions and Strategies for Answering Them

■ Review the question to determine what is to be evaluated.
■ Before looking at possible answers, consider what is the accepted standard of care, ideal level of care, or intended outcome.
■ Match the answers with your understanding of the standard of care.
■ Double check your answer with the scenario and expected standard of care in that scenario.

Test Questions and Strategies for Answering Them: Creation Level Items

Focus topic: Test Questions and Strategies for Answering Them

Creation level test items require you to use information obtained from a client, family, or clinical situation and develop a new or unique approach to solving the clinical problem. For example, the test items may ask you to develop a plan of care, a discharge plan, or an action plan to manage quality improvement.

Test Questions and Strategies for Answering Them: Strategies for Answering Creation Level Test Questions

Focus topic: Test Questions and Strategies for Answering Them

■ Read the question to determine what is to be developed or created.
■ Consider all of the elements necessary to have a complete plan of care, discharge plan, etc.
■ Understand what is and is not appropriate to include in the plan being created and rule out inappropriate aspects of care for the client or situation presented in the scenario.
■ Double check your answer by reviewing the appropriateness of each of the elements in the plan you have developed.

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