COMPETENCY APPRAISAL 1 1

Eugene Flor Lindawan Ulpindo, ECE, RN, MSN

Test Taking Strategies

REMEMBER: These are test taking strategies to help you choose the best answer but apply your concepts FIRST.
• The key to success is PREPARATION
– Create a quiet study environment
Read before class
• This will help you understand lecture
• This will save you time later
– Review notes daily after class
– Ask “why” something happens as you study
Understand Parts of a Multiple Choice Question
Case— (sometimes called scenario) —description of the patient and what is happening.
Stem---That part of the question that asks the question.
Distracters---Incorrect but feasible choices.
Correct response— The answer to the question.

Case Scenario: A patient who is visibly upset says to the nurse, “I want to talk with the head nurse, no, get me the
supervisor and the director of nursing and the owner of the hospital. I am mad.”
Stem: The best initial response for the nurse to make is:
Distractors: A. “Whom do you wish to see first?”
B. “Don’t be angry.”
C. “Why do you want to talk to them when I can help
Correct Answer D. “You seem upset.”
RATIONALE
A. Incorrect. Does not promote communication and does not allow exploration and understanding of the issue.
B. Incorrect. Discounts feelings and does not promote communication.
C. Incorrect. Places the patient on the defensive. Does not defuse the situation.
D. Correct. The nurse uses the technique of paraphrasing. Acknowledges the patient’s feelings. Promotes
Communication.
TEST TAKING STRATEGIES
1. Read the questions carefully from the first word to the last word.
 Remember not to miss out on key words that would lead you to what the question is really asking for.
(Encircle or underline keywords if possible)
2. Rephrase the question in your own words so that it can be answered with a “yes” or “no” or with a specific bit of
information.
 “What”, “When”, “Why”
Example:
The nurse should teach the patient who has cirrhosis of the liver to avoid which of the following food in
the diet?
A. Baked chicken C. Macaroni
B. Apple pie D. Spinach
REPHRASE:
What is the metabolic problem of a patient with liver cirrhosis?
Answer: He cannot digest fats.
What food is contraindicated for patients with liver cirrhosis?
Answer: Fatty food. Thus, among the choices, baked chicken should not be given.
3. Look for qualifiers.
 These are most often absolute terms or generalizations.
 Don’t choose these options.
o “Never” o “None”
o “Always” o “Only”
o “All”
4. Look for contrasting options.
 Usually contrasting options lead you to the correct answer. One of these is the right choice.
EXAMPLE:
Mr. Juan is suffering from gastric ulcer. As a nurse, you have to prevent dumping syndrome. Which of the
following preventive measures should not be taken?
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Eugene Flor Lindawan Ulpindo, ECE, RN, MSN

a. Allow him to lie down after eating. c. Allow him to walk after eating.
b. Avoid giving fluids after the meal. d. Serve dry meals only.
 Contrasting options are a and c, thus one of these may be the correct option, eliminating b and d.
the question may be rephrased to “what is the best position after meals to prevent dumping
syndrome?”
 ANSWER: Allow him to lie down after meals, but the question is asking for the measure that
should not be advised, thus the answer is C.
5. Prioritization.
 The board exam is testing your ability to decide your priorities in patient care.
 “First”  “Primary”  “Highest priority”
 “Immediate”  “Priority”
 “Initial”  “Most important”
 The most common basis of prioritization are:
a. Physiologic reaction/ Emergency cases
– CAB’s (Circulation, Airway and Breathing)
b. Safety and protection. Decide what will cause the least amount of HARM. Do no harm!
– Suicidal, homicidal, aggressive
c. Needs. Remember Maslow’s Hierarchy of Needs.
– Physiological needs come as priority
d. Nursing Interventions. Use the nursing process.
– Assessment comes before any intervention.
 “Assess”  “Inspect”  “Percuss”
 “Check”  “Palpate”  “Determine”
 “Monitor”  “Auscultate”
e. Rights of patients. Will of the patient is the basis of the action. We are safeguards or advocates of
the patient’s well-being.
f. The less invasive procedures first before the invasive ones.
g. Patient first before equipment
6. Umbrella.
 All three other options are directed to one option. One option encompasses, includes, or conceptualizes
all the other options.
 Previously known as “All of the above”
7. Keyword association.
EXAMPLE:
The keyword COGNITIVE is found in the stem of the question.
“COGNITIVE = THOUGHTS”
Then find THOUGHTS among the options given
8. Mirror options.
 Options with the same meaning or ideas are wrong so eliminate them
9. Explicitly wrong options.
 Eliminate obviously wrong options
10. Negative question – Negative option.
 “All but one”  “False”  “Needs further
 “Expect”  “Negative” discussion”
 “Least effective”  “Needs further  “Has not been
 “Least priority” teaching” understood”
 “Not included”  “Needs further  “Indicates inadequate
 “Incorrect” reinforcement” knowledge”
 “Unacceptable”  “Needs further  “Misunderstood”
 “Inappropriate” understanding”
 “Null”
11. Positive question – Positive option.
 “Understands”  “Effective teaching”  “Indicates adequate
 “Most effective”  “Demonstrates knowledge”
 “Included” understanding”  “Highest priority”
 “Understands teaching”  “Has been understood”  “Priority”
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Eugene Flor Lindawan Ulpindo, ECE, RN, MSN

 “Included”  “Most appropriate”  “Allowed”

 “True”  “Positive”  “Valid”
 “Correct”  “Encouraged”
 “Acceptable”  “Advised”
o If you find these keywords in the stem of the question, look for the correct entry or information.
12. Next question answer.
 Following question gives or contains the correct answer of the previous question
13. Options containing both correct and wrong items are incorrect.
 Choose options that include all or most correct items
EXAMPLE:
In the stem question, you find “foods contraindicated to MAOI’s”
a. Green leafy vegetables, cheese, carrots
b. Green leafy vegetables, carrots, tomatoes
o Option B is the correct answer because all of the items are not contraindicated and option A is incorrect
because it contains cheese which is contraindicated for MAOI though it contains correct items which is
green leafy vegetables and carrots
14. Normal.
 Decide if the assessment data being presented in the question is within normal range if the answer is yes,
you just look for the option that will not need further interventions. Only continue monitoring or
assessment. If the answer is otherwise, then go ahead and rephrase the question and follow the steps in
answering a question.
 Familiarizing yourself with the values will be much easier than memorizing. Post them on your walls where
you see them every day.
15. Always be therapeutic.
 Therapeutic simply means choosing the options that will solicit information from the patients and make
him/her express his/her feelings.
 The longest option may be the correct answer.
 Communication techniques should be “KISS” – Keep It Short and Simple.
 “Focus on the feelings”.
 Usually, we eliminate options that will:
a. Present an option or experience of the nurse
b. Present a generalization
c. Present false reassurance, like telling the patient “Everything will be alright”.
d. Present a suggestion from the nurse on what the patient should do.
e. Start with the word “WHY” – your patient will become defensive.
16. It is your business, not others.
 Eliminate choices that present what the doctors, midwives, or social workers will do. The board exam is
asking what you as a nurse will do given a situation. Thus, before you call the physician, make sure you
have done something first, as nurse. Never pass the responsibility.
17. Do everything by the book.
 Be careful in using your experiences. Remember everything is taken from books. The questions are often
presented not in the real world where there is lack of resources, time or personnel. Rather, everything is
based on ideal settings. Thus, it is best to ask “What do the books say about this?” and NOT “What did I do
about this?”
REMEMBER:
1. Eliminate only what you know is wrong. Once choice has been eliminated, PUT IT OUT OF YOUR MIND.
2. Stay focused on the REWORDED QUESTION. Not on the background information. Don’t fall for
distractions.
3. If your “IDEAL” answer choice is not there, well don’t sit and moan because it will get you NOWHERE.
Read the question again, rephrase, and select the best answer.
Additional:
What is the Time Frame?
Words like early or late in relation to symptoms are very important
 Preoperative
 Postoperative
 Care on the day of surgery
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Eugene Flor Lindawan Ulpindo, ECE, RN, MSN

Eliminating Answer Choices

 Take out the two answers that you know are not correct
 Anxiety decreases with a 50% chance of picking the right response
 Strategy for use in multiple choice questions
Predicting Answers
 Do not pick the answer that jumps out at you
 Make sure to carefully consider each answer choice
 Eliminate the wrong answers to derive the correct answer
Example:
When doing a physical assessment of a 17-year old primigravida who is at 30 weeks of gestation, a nurse should expect
which finding is related to mild preeclampsia?
A. Epigastric discomfort C. Dyspnea
B. Trace proteinuria D. Blood pressure of 150/100 mm hg
ADPIE
Utilize the nursing process
 Assessment
 Diagnosis
 Planning
 Implementation
 Evaluation
 Are they asking for an assessment, a diagnosis, a plan, how to implement an intervention, or how do we evaluate
or teach our patients?

Assess
 Always assess before you act
 Question regarding care that includes both assessments and implementations
 “Is there enough information given to take action?”
 If there is not, you must assess first
Example:
The night after an exploratory laparotomy, a patient who has a nasogastric tube attached to low suction reports nausea.
A nurse should take which of the following actions first?
A. Administer the prescribed antiemetic to the patient
B. Determine the patency of the patient’s nasogastric tube
C. Instruct the patient to take deep breaths
D. Assess the patient for pain
Assessment versus Implementation
 Eliminate the implementations first unless you are certain the question gives you enough information to take
action
 If the question does give you enough information to act, you must assess
 eliminate the answer choices involving unnecessary assessment
Example:
A nurse enters a client's room and finds that the wastebasket is on fire. The nurse immediately assists the client out of the
room. The next nursing action would be to:
A. Call for help C. Activate the fire alarm
B. Extinguish the fire D. Confine the fire by closing the room door
Activate the fire alarm
 The order of priority in the event of a fire is to rescue the clients who are in immediate danger
 The next step is to activate the fire alarm
 The fire is then confined by closing all doors
 Finally, the fire is extinguished
Select All That Apply
 Select all that apply questions on the NLE are increasing in numbers
 Treat each answer as a true or false response
Repeated Words
 Words from the question are often repeated in the answer
 Frequently the same word or a synonym will be in both the question and the answer
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Eugene Flor Lindawan Ulpindo, ECE, RN, MSN

THE 6 TECHNICAL TIPS FOR THE BOARD EXAMINATION

1. Accept the fact that you can never know everything. Therefore, once you see an unfamiliar question that was never
been taught, use your test taking strategies.
2. If you are in Test I, II, III, and IV and you are being asked to prioritize, Use ABC first and then Maslow's Hierarchy of
needs.
3. The use of your nursing process is heralded by the word: "The Nurse Would or The nurse's initial action"
Remember to Assess first before intervening. If the situation and the question already assessed the patient, then
proceed with the next step.
4. Encircle your modifiers. Some people make mistakes because of failure to see the word, "EXCEPT" or "NOT" or
"INAPPROPRIATE", etc. The magic words…
5. Use your questionnaires as your scrap. You can write anything on that paper. If you will skip a number, place an
asterisk or encircle the number.
6. DO NOT USE BLUNT PENCIL. Always use a sharp one and shade lightly. A sharpened pencil will give a very dark shade
even if you will shade it lightly. Use the sides of the pencil not the tip. Use MONGOL NUMBER 2 ONLY. Some brands
especially those made in china pencils are substandard. The machine will check the lead. If you are INCONSISTENT with
your shading like an altering dark and light shades, you will FAIL the boards because of technicalities.

Strategies for Difficult Questions

Improve your odds, think critically:
1. Cover options, read the stem & try to answer.
2. Select option that most closely matches your answer.
3. Read the stem with each option.
4. Treat each option as a true-false question, and choose the “most true.”
5. Eliminate options you know to be incorrect.
6. Question options that grammatically don’t fit with the stem.
7. Question options that are totally unfamiliar to you.
8. Question options that contain negative or absolute words. (Try subbing a qualified term for an absolute one ~
frequently for always or typical for every to see if you can eliminate it).
9. “All of the Above:” If two or more seem correct, “all of the above is a strong possibility.
10. Number answers: Toss out high and low and consider middle range numbers.
11. Look alike options: Probably one is correct, choose the best but eliminate choices that mean basically the same
thing thus cancel each other out.
12. Double negatives: Create the equivalent positive statement and consider.
13. Echo options: If two options are opposite of each other, chance are one of them is correct.
14. Favor options that contain qualifiers: The result is longer, more inclusive items that better fill the role of the
answer.
15. If two alternatives seem correct, compare them for differences, then refer to the stem to find your best answer.
16. Use hints from words you know in both stem and options.
17. Remember, you are looking for the BEST ANSWER.

ANXIETY REDUCTION
• Relaxation response: any technique or procedure that helps you become relaxed
• Effect of negative self-talk
• Emotional (somatic) test anxiety
• Deep breathing techniques
The Tensing and Differential Method
1.Put feet flat on the floor.
2.Grab underneath the chair with hands
3.Push down with feet and pull up on chair at the same time for about five seconds
4.Relax for five to ten seconds
5.Repeat the procedure two or three times
6.Relax all muscles except the ones that are actually used to take the test
The Palming Method
1.Close and cover eyes using palms of hands
2.Think of some real or imaginary relaxing scene
3.Visualize this relaxing scene for one to two minutes
4.Open eyes and repeat
5. Add sounds or smells to enhance the scene
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Eugene Flor Lindawan Ulpindo, ECE, RN, MSN

ADDITIONAL NOTES
PRINCIPLES OF TEST TAKING

I. PRINCIPLE OF CONTRADICTION
When two options contradict each other, there is a higher chance of one of them being the correct answer.

Example: Which physiologic effect should the nurse expect in a client addicted to hallucinogens?
A. Dilated pupils C. Bradycardia
B. Constricted pupils D. Bradypnea

II. PRINCIPLE OF COMMONALITY AND DIFFERENCE

Two or more options that has the same essential configuration and thought is unlikely the correct answer.

Example: When injecting subcutaneous injection in an obese patient, it should be angled at around:
A. 45° C. 180°
B. 90° D. Parallel to the skin

III. PRINCIPLE OF CENTRAL TENDENCY

Correct answers in an all numeric options is most likely located in between the extremes.

Example: What is the KVO rate of BT?

A. 5 gtts/min C. 15 gtts/min
B. 10 gtts/min D. 20 gtts/min

IV. PRINCIPLE OF POSITIVE AND NEGATIVE HARMONY

A positive question will always ask for a positive answer and so is a negative question.
FORMULA: [-] [-] = + Question
[+] [+] = + Question
[-] [+] = - Question

Example: All but one of the following is an Anxiolytic:

[+] [-]
A. Tranxene C. Atarax
B. Miltown D. Parlodel

V. PRINCIPLE OF IMPROBABLE EXTREMES

Extreme modifiers, such as always, all, never, or only make it more likely that the question is false. Here is a more complete
list of EXTREME modifiers.
All, every, nothing, none, best, absolutely, always, never, worst, absolutely not, only, nobody, everybody, certainly,
invariably, no one, everyone, certainly not.

Example: The most effective way in limiting the number of microorganism in the hospital is:
A. Using strict aseptic technique in all procedures
B. Wearing mask and gown in care of all patients with communicable diseases
C. Sterilization of all instruments
D. Handwashing

VI. PRINCIPLE OF INITIATIVE CRITICAL THINKING

1. Cover the options
2. Read the question carefully
3. Try answering the question without looking at the options
4. Select the option that most closely matches your answer

Example: The nurse knew that the normal color of Michiel’s stoma should be:
A. Brick Red C. Blue
B. Gray D. Pale Pink
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Eugene Flor Lindawan Ulpindo, ECE, RN, MSN

VII. PRINCIPLE OF GRAMMATICAL HARMONY

Options that do not coincide with the grammatical configuration of the stem is NOT the correct answer.
Choices that are grammatically incorrect or contain typographical errors are probably not the correct answer.

Example: When planning a care for a client who is pancytopenic, The major goal should be:
C.Prevent hemorrhage, infection and decrease oxygenation
B. Administering an oral iron preparation
C. Preventing Fatigue and fluid overload
D. Encouraging a consumption of a neutropenic diet

VIII. PRINCIPLE OF UMBRELLA EFFECT

A choice that is more inclusive is usually the correct answer.

Example: To view a person holistically, the nurse should think of him or her as:
A. Physical being who experiences pathology and sociological changes
B. Social being who needs the dynamics of group interaction
C. Psychological being whose mind influences his or her health status
D. Biopsychosocial being who is in constant interaction with the environment

IX. Principle of ABC, Maslow’s Hierarchy and Nursing Process

When questions require prioritization, these principles should apply. Keywords that indicate the need to prioritize include:
BEST VITAL
ESSENTIAL PRIMARY
FIRST HIGHEST PRIORITY
IMMEDIATE INITIAL
MOST IMPORTANT NEXT

Example: A nurse is reviewing the plan of care for a pregnant client with a diagnosis of sickle cell anemia. Which nursing
diagnosis, if stated on the plan of care, would the nurse select as receiving the highest priority?
A. Anxiety C. Disturbed body image
B. Ineffective coping D. Deficient fluid volume

Example: When caring for Aida after a chest surgery, your priority would be to maintain:
A. Supplementary oxygen C. Blood replacement
B. Chest tube drainage D. Ventilation exchange

X. Principle of “Tell Me More”

In Psychiatric Nursing, Remember to focus on the client’s feeling, concerns, anxieties and fears. This is best summarized by
a response that encourages the client’s verbalization of feelings.

Example: A mother says to the nurse, “I am afraid that my child might have another seizure” Which response by the nurse
is most therapeutic?
A. “Why worry about something you cannot control?”
B. “Most children will never experience a second seizure”
C. “Tell me what frightens you the most about seizures.”
D. “Tylenol can prevent another seizure from occurring”

XI. Principle of Reappearing Visage

A word or phrase that appears in the question and then reappears at one of the 4 choices is the most probable answer.

Example: A chronically ill school-age child is most vulnerable to which stressor?

A. Mutilation anxiety C. Anxiety over school absences
B. Anticipatory grief D. Fear of hospital procedures
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Eugene Flor Lindawan Ulpindo, ECE, RN, MSN

XII. The Drug Technique

Most drugs, especially psychotropic medications either act as a CNS Stimulant or a CNS depressant. The strategy revolves in
determining which are the Central nervous system excitations and which are the Central nervous system inhibitions. If 3 of
the options are all CNS up and 1 is CNS down, pick the CNS down. If 3 of the options are all CNS down and 1 is CNS up, pick
the CNS up.

Example: The nurse is assessing a client who has just been admitted to the emergency department. Which signs would
suggest an overdose of an antianxiety agent?
A. Combativeness, sweating, and confusion
B. Agitation, hyperactivity, and grandiose ideation
C. Suspiciousness, dilated pupils, and increased blood pressure
D. Emotionally blunt, lethargy and impaired memory

11 Test Taking Strategies

1. Read Questions Carefully

Scores on tests are greatly affected by reading ability. In answering a test item, you should begin by carefully reading the
stem and then asking yourself the following questions:
 What is the question really asking?
 Are there any key words?
 What information relevant to answering this question is included in the stem?
 How would I ask this question in my own words?
 How would I answer this question in my own words?
After you have answered these questions, carefully read the options and then ask yourself the following questions:
 Is there an option that is similar to my answer?
 Is this option the best, most complete answer to the question?
Deal with the question as it is stated, without reading anything into it, or making assumptions about it. Answer the
question asked, not the one you would like to answer. For simple recall items the self-questioning process usually will be
completed quickly. For more complex items the self-questioning process may take longer, but it should assist you in
clarifying the item and selecting the best response.
2. Identify Keywords
Certain key words in the stem, the options, or both should alert you to the need for caution in choosing your answer.
Because few things are absolute without exception, avoid selecting answers that include words such as always, never, all,
every, only, must, no, except, and none. Answers containing these keywords are rarely correct because they place special
limitations and qualifications on potentially correct answers. For example:

All of the following are services of the National Kidney Foundation except:
1. Public education programs
2. Research about kidney disease
3. Fund-raising affairs for research activities
4. Identification of potential transplant recipients

This stem contains two keywords: all and except. They limit the correct answer choice to the one option that does not
represent a service of the National Kidney Foundation. When except, not, or a phrase such as all but one of the following
appears in the stem, the inappropriate option is the correct answer—in this instance, option 4.
If the options in an item do not seem to make sense because more than one option is correct, reread the question; you
may have missed one of the key words in the stem. Also be on guard when you see one of the key words in an option; it
may limit the context in which such an option would be correct.
3. Pay Attention to Specific Details
The well-written multiple-choice question is precisely stated, providing you with only the information needed to make the
question or problem clear and specific. Careful reading of details in the stem can provide important clues to the correct
option. For example:

A male client is told that he will no longer be able to ingest alcohol if he wants to live. To effect a change in his behavior
while he is in the hospital, the nurse should attempt to:
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Eugene Flor Lindawan Ulpindo, ECE, RN, MSN

1. Help the client set short-term dietary goals

2. Discuss his hopes and dreams for the future
3. Discuss the pathophysiology of the liver with him
4. Withhold approval until he agrees to stop drinking

The specific clause to effect a change in his behavior while he is in the hospital is critical. Option 2 is not really related to his
alcoholism. Option 3 may be part of educating the alcoholic, but you would not expect a behavioral change observable in
the hospital to emerge from this discussion. Option 4 rejects the client as well as his behavior instead of only his behavior.
Option 1, the correct answer, could result in an observable behavioral change while the client is hospitalized; for example,
he could define ways to achieve short-term goals relating to diet and alcohol while in the hospital.
4. Eliminate Clearly Wrong or Incorrect Answers
Eliminate clearly incorrect, inappropriate, and unlikely answers to the question asked in the stem. By systematically
eliminating distractors that are unlikely in the context of a given question, you increase the probability of selecting the
correct answer. Eliminating. obvious distractors also allows you more time to focus on the options that appear to
be potentially sound answers to the question. For example:

The four levels of cognitive ability are:

1. Assessing, analyzing, applying, evaluating
2. Knowledge, analysis, assessing, comprehension
3. Knowledge, comprehension, application, analysis
4. Medical-surgical nursing, obstetric nursing, psychiatric nursing

Option 1 contains both cognitive levels and nursing behaviors, thus eliminating it from consideration. Option 4 is clearly
inappropriate since the choices are all clinical areas. Both options 2 and 3 contain levels of cognitive ability; however,
option 2 includes assessing, which is a nursing behavior. Therefore option 3 is correct. By reducing the plausible options,
you reduce the material to consider and increase the probability of selecting the correct option.
5. Identify Similar Options
When an item contains two or more options that are similar in meaning, the successful test taker knows that all are correct,
in which case it is a poor question, or that none is correct, which is more likely to be the case. The correct option usually
will either include all the similar options or exclude them entirely. For example:

When teaching newly diagnosed diabetic clients about their condition, it is important for the nurse to focus on:
1. Dietary modifications
2. Use of sugar substitutes
3. Their present understanding of diabetes
4. Use of diabetic nutritional exchange lists

Options 1, 2, and 4 deal only with the diabetic diet, involving no other aspect of diabetic teaching; it is impossible to select
the most correct option because each represents equally plausible, though limited, answers to the question. Option 3 is the
best choice because it is most complete and allows the other three options to be excluded. As another example:

A child’s intelligence is influenced by:

1. A variety of factors
2. Socioeconomic factors
3. Heredity and environment
4. Environment and experience

The most correct answer is option 1. It includes the material covered by the other options, eliminating the need for an
impossible choice, since each of the other options is only partially correct.
6. Identify Answer (Option) Components
When an answer contains two or more parts, you can reduce the number of potentially correct answers by identifying one
part as incorrect. For example:

After a cholecystectomy the postoperative diet is usually:

1. High fat, low calorie 3. Low fat, high calorie
2. High fat, low protein 4. Low fat, high protein
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If you know, for instance, that the diet after a cholecystectomy is usually low or moderate in fat, you can eliminate options
1 and 2 from consideration. If you know that the cholecystectomy client usually is overweight, you can eliminate option 3
from consideration. Therefore option 4 is correct.
7. Identify Specific Determiners
When the options of a test item contain words that are identical or similar to words in the stem, the alert test taker
recognizes the similarities as clues about the likely answer to the question. The stem word that clues you to a similar word
in the option or that limits potential options is known as a specific determiner. For example:

The government agency responsible for administering the nursing practice act in each state is the:
1. Board of regents 3. State nurses’ association
2. Board of nursing 4. State hospital association

Options 2 and 3 contain the closely related words nurse and nursing. The word nursing, used both in the stem and in option
2, is a clue to the correct answer.
8. Identify Words in the Options That Are Closely Associated With Words in the Stem
Be alert to words in the options that may be closely associated with but not identical to a word or words in the stem. For
example:

When a person develops symptoms of physical illness for which psychogenic factors act as causative agents, the
resulting illness is classified as:
1. Dissociative 3. Psychophysiologic
2. Compensatory 4. Reaction formation
Option 3 should strike you as a likely answer since it combines physical and psychologic factors, like those referred to in the
stem.
9. Watch for Grammatical Inconsistencies
If one or more of the options are not grammatically consistent with the stem, the alert test taker usually can eliminate
these distractors. The correct option must be consistent with the form of the question. If the question demands a response
in the singular, plural options usually can be safely eliminated. When the stem is in the form of an incomplete sentence,
each option should complete the sentence in a grammatically correct way. For example:
Communicating with a male client who is deaf will be facilitated by:
1. Use gestures 3. Find out if he has a hearing aid
2. Speaking loudly 4. Facing the client while speaking
Options 1 and 3 do not complete the sentence in a grammatically correct way and can therefore be eliminated. Option 2
would be of no assistance with a deaf client, so option 4 is the correct answer.
10. Be Alert to Relevant Information From Earlier Questions
Occasionally, remembering information from one question may provide you with a clue for answering a later question. For
example:
A client has an intestinal tube inserted for treatment of intestinal obstruction. Intestinal suction can result in excessive loss
of:
1. Protein enzymes 3. Water and electrolytes
2. Energy carbohydrates 4. Vitamins and minerals
If you determined that the correct answer to this question was option 3, it may help you to answer a later question. For
example:
Critical assessment of a client with intestinal suction should include observation for:
1. Edema 3. Belching
2. Nausea 4. Dehydration
The correct answer is option 4. If you knew that excessive loss of water and electrolytes may lead to dehydration, you could
have used the clue provided in the earlier question to assist you in answering the later question.
11. Make Educated Guesses
When you are unsure about the correct answer to a question, it is better to make an educated guess than not to answer
the question. You generally can eliminate one or more of the distractors by using partial knowledge and the methods just
listed. The elimination process increases your chances of selecting the correct option from those remaining. Elimination of
two distractors on a four-option multiple-choice item increases your probability of selecting the correct answer from 25%
to 50%.
 COMPETENCY APPRAISAL 1 11
Eugene Flor Lindawan Ulpindo, ECE, RN, MSN

Cognitive Levels of Learning

Remembering
– Requires committing facts to memory
• You are required to remember information that forms the foundation for nursing practice
• Knowledge is basic information you need to think critically and make decisions related to your client
Understanding
– Requires understanding information committed to memory
• You must also translate, interpret and determine implications of the information
• Recognizing the significance of the information is another step in critical thinking and being able to make decisions
related to your client
Applying
– Requires a higher level of understanding of information
• You need to know the information and understand its importance
• You must solve and modify, change, or use this information in real life situations or scenarios
• In order to provide competent and safe nursing care, you must be able to apply the information in a clinical
situation
Analyzing
– Requires an even higher understanding of the information
• You must know, understand and be able to apply information
• You must look at a variety of data and recognizing the commonalities, differences and inter-relationships.
– That is, You must identify, dissect, and evaluate the information presented
» You must sort through high volumes of data when caring for clients. You must be able to analyze the
data in order to understand what the problem is and how to intervene
Evaluating
– Requires an even higher understanding of the information
• You must know, understand, apply and be able to analyze the information.
• The learner makes decisions based on in-depth reflection, criticism and assessment.

How to Prepare for Exams Using the Cognitive Levels

Example: Studying Medications: Furosemide (Lasix)
• Remembering: Memorize the classification of Furosemide (Lasix).
• Understanding: Develop an understanding of the action of Furosemide (Lasix).
• Applying: Identify specific patient situations where Furosemide (Lasix) would be used; Identify specific patient
situations requiring the care of the patient receiving the medication.
• Analyzing: Differentiate among the side effects of Furosemide (Lasix) and other medications. Determine priorities
and explore relationships among data.
• Evaluating: Make decisions based on reflection; what is the expected outcome of Furosemide (Lasix).