Let’s review the learning objectives for this program.
These outcomes are what I hope that you will achieve on completion of this program.
Let’s review the parts of a multiple-choice question.
I will be referring to these terms as I go through the presentation.
Let’s discuss Test-Taking Technique #1: Identify if the question is asking what the nurse should do or should not do.
Let’s review what a stem with positive polarity is asking you to do.
A stem with positive polarity asks what response is acceptable, what action should be done, and what statement is true.
The next slide will present an example of a question with a stem that has positive polarity.
The correct answer is what the nurse should do.
See if you can identify what the nurse should do.
The words when should indicate positive polarity.
Option 1 is the correct answer.
Rationales:
This allows family members time to make a last visit before the body is prepared for transfer to the morgue.
Postmortem care at this time is premature if it interferes with the family’s right to visit the remains. Also, it may take hours before the primary health-care provider can be located.
Postmortem care at this time is premature if it denies the family an opportunity to visit the remains.
Postmortem care at this time is premature if it negates the family’s right to visit the remains.
The next slide introduces information about stems with negative polarity.
Let’s review what a stem with negative polarity is asking you to do.
Here are additional words used in a stem that indicate negative polarity.
Reread the stem carefully when you see one of these words in a stem. The question is asking, What should the nurse not do or what is unacceptable or unexpected.
The next slide will present an example of a stem that has negative polarity.
The question is asking what the nurse should not do.
Can you identify the word in the stem that indicates negative polarity?
The word violates in the stem indicates negative polarity.
The question is asking, Which action does not support a patient’s right to confidentiality and privacy?
Let’s look at the options.
See if you can identify the option that is the correct answer.
If two or three options appear to be things the nurse should do then reread the stem because you may have missed the word that indicates negative polarity.
Option 1 is the correct answer. It is a nursing intervention that does not support a patient’s right to confidentiality and privacy.
Now let’s review the rationale for each option.
Rationales:
Interviewing a patient in the presence of others violates confidentiality; others may overhear information that should be kept confidential.
2 Documenting statements in the patient’s clinical record is an acceptable practice.
3 A team conference enables professionals to share important information about patients and is an acceptable practice.
4 Sharing information at change of shift report notifies nursing team members of the patient’s changing status and is an appropriate practice.
Lets examine Test-Taking Technique #2: Identify the key word in the stem that sets a priority.
Let’s look at examples of words that set a priority.
Questions with these words are asking, What option is most important?
Can you identify the word in the stem that sets a priority?
Now let’s look at the rest of the question.
The word best in the stem sets a priority.
Can you identify the option that is the correct answer?
If you are unable to identify the correct answer, eliminate the least desirable option first.
Repeat eliminating the least desirable option until you are left with a final option.
Option 2 is the correct answer. It is most important to offer the patient choices about care.
Let’s review the rationale for each option.
Rationales:
1 All behavior has meaning and requires recognition.
2 Making decisions places the patient in control and supports feelings of independence.
3 Setting firm limits may make the patient more angry because it is a controlling intervention.
4 Pointing out limitations only intensifies the patient’s feelings of dependence.
The concepts associated with Maslow’s Hierarchy of Needs can be used to help identify the priority.
First let’s review the levels in Maslow’s Hierarchy of Needs.
Remember that lower level needs (starting at the first level) must be met before higher level needs (ending with the fifth level).
Can you identify the word in the stem that sets a priority?
Here is a question that you can use Maslow’s Hierarchy of Needs to analyze the options.
Can you identify the option that is the correct answer while referring to the levels indicated in Maslow’s Hierarchy of Needs?
The word most in the stem sets a priority.
What most concerns postoperative patients?
Option 1 is the correct answer.
Food intake is essential for life and is a physiological need. It has the highest priority of the options offered according to Maslow.
Showering refers to microbiological safety, which is a second-level need according to Maslow.
Having visitors and going home refer to love and belonging which is a third-level need according to Maslow.
Let’s review the rationale for each option.
Rationales:
Eating is a basic human need identified by Maslow and is considered very important by most postoperative patients.
Although knowing when one can shower may be important to some patients, it is not the most basic, common concern of the majority of patients.
3 Although wanting to known when one can go home may be important to some patients, it is not the most basic, common concern of the majority of patients.
Although having visitors may be important to some patients, it is not the most basic, common concern of the majority of patients.
Let’s look at another question in which you can use Maslow’s Hierarchy of Needs to select the correct answer.
Can you identify the word in the stem that sets a priority?
Can you identify the correct option using the principles associated with Maslow’s Hierarchy of Needs?
The word primary in the stem is the word that sets a priority.
Option 4 is the correct answer.
Learning how to use the call bell when assistance is necessary, is a safety issue.
Safety takes priority over the other options, which are psychosocial in nature according to Maslow’s Hierarchy of Needs.
Let’s look at the rationale for each option.
Rationales:
1 Although the patient should be told the name of the nurse in charge of the unit, this is not the priority intervention.
2 Identifying the potential date of discharge is the primary health-care provider’s, not the nurse’s, responsibility.
3 Although it is important to know the routine on the unit, it is more important to know how to use the call bell because it is a safety concern.
4 Explaining the use of the call bell meets basic safety and security needs; the patient must know how to signal for help.
You can use the concept of ABCs when attempting to identify priorities among options in a test question.
We will review airway, breathing, and circulation separately.
Options that involve airway patency should always be considered first.
Maintaining a patent airway is always the priority because death will occur without effective gas exchange.
Let’s review the content in this slide.
Let’s now explore the concept of Breathing.
Options that involve breathing are the focus only after it is determined that no options address airway patency.
The rate, depth, characteristics, and rhythm of breathing will reflect the status of the patient.
Let’s review the content in this slide.
Let’s now discuss Circulation.
Options that involve circulation are the focus only after determining that no options address airway patency or breathing.
Let’s review the content in this slide.
Now let’s look at a question in which the ABCs can be used to identify a priority intervention.
Can you identify the word in the stem that sets a priority?
Can you select the correct answer using the ABCs to identify the intervention that is the priority?
The word initial is the word in the stem that sets a priority.
Option 3 is the correct answer. It is an intervention that will help to maintain a patent airway. In addition, this is a first-level need according to Maslow’s Hierarchy of Needs.
You have just used the test-taking techniques of using the ABCs and Maslow’s Hierarchy of Needs to identify the correct answer.
Let’s review the rationale for each option.
Rationales:
Providing choices concerning the plan of care supports self-esteem and the need to feel more empowered over one’s situation. According to Maslow, this is a higher-level need that is met after physiological needs, which should be met first.
Exploring the need to modify the home environment to prevent falls addresses safety, which is not as great a priority as physiological needs according to Maslow’s Hierarchy of Needs.
Meeting a patient’s physiological need to ingest adequate nutrition takes priority over higher-level needs according to Maslow. Preventing aspiration is associated with maintaining a patent airway.
Encouraging a patient to ventilate negative feelings supports self-esteem and the need to feel more empowered over one’s situation. According to Maslow, this is a higher-level need that is met after physiological needs, which are the priority.
Let’s review Test-Taking Technique #3: Identify the clang association in options.
Let’s examine each statement in this slide.
Can you find the words in the stem and in an option that are the same?
Remember, words that are the same or similar in the stem and an option is a clang association.
The words gown and linens are the same in the stem and in option 4.
More often than not an option that contains a clang association is the correct answer.
Can you identify the option that is the correct answer?
Option 4 is the correct answer.
Identifying the clang association in option 4 should have helped you identify the correct answer.
Let’s review the rationale for each option.
Rationales:
The response in option 1 cuts off communication and puts the focus on the nurse rather than on the patient.
The response in option 2 focuses on the nurse, generalizes rather than individualizes care, and minimizes the patient’s concern, all of which may cut off communication.
3 The response in option 3 generalizes rather than individualizes care. Also, it minimizes the patient’s concern and may cut off communication.
The response in option 4 meets the patient’s right to know who is providing care and what is to be done. This is a nonjudgmental, respectful response that reduces fears of the unknown. Although this response does not address the patient’s feelings, it is the best response of the options offered.
Let’s look at another question that has a clang association that is less obvious.
Can you identify the obscure clang in the stem?
An obscure clang is not just the repetition of the words in the stem and in an option. The connection between the two is less obvious.
Obscure clangs manipulate the word or they paraphrase the content in the stem. The connection between the two is less obvious.
The words disoriented and confused in the stem and the words inability to understand in option 4 is an obscure clang association.
The clang is not the same exact words in the stem and option. The clang is less obvious.
Can you identify the option that is the correct answer?
Option 4 is the correct answer.
You just used the test-taking technique, Identify the clang association in options, to answer this questions correctly.
More often than not an option with a clang association is the correct answer.
Let’s review the rationale for each option.
Rationales:
Confused, disoriented patients who are restrained may become agitated and respond in a reflex-like way; attempts to gain control require problem solving, which confused, disoriented patients usually are unable to perform.
A restraint should not cause discomfort if it is applied correctly and checked frequently.
3 A patient usually struggles against a restraint to get free, not to manipulate staff.
4 Disoriented and confused patients do not always have the cognitive ability to understand what is happening to them and often struggle against restraints.
Here is another question with an obscure clang.
Can you find the obscure clang association in the stem and in an option?
The words respiratory in the stem and chest in option 3 is an obscure clang association.
Respiratory refers to lungs and the lungs are located in the chest.
Now see if you can identify the option that is the correct answer.
Option 3 is the correct answer.
The word respiratory in the stem is a very important word. If the word respiratory is replaced with the word urinary the correct answer is different. Always read the stem carefully.
The clang association in this stem and option 3 is obscure.
If you have no idea which option is the correct answer go with the option that has a clang association.
More often than not an option with a clang is the correct answer.
Let’s review the rationale for each option.
Rationales:
A urinary catheter contributes to the risk for a urinary, not respiratory, tract infection.
The hospital environment contains many pathogens; however, a person has to be susceptible to contract an infection.
3 Coughing and deep breathing are often avoided by people with painful chest injuries in an effort to self-splint and minimize pain; this allows pooling of respiratory secretions, which supports the growth of microorganisms in the respiratory tract.
4 A nasogastric tube decompressing the stomach removes fluid from the body, which does not increase the risk for a respiratory tract infection. A nasogastric tube used as a feeding tube may place the patient at risk for aspiration pneumonia.
Here is another example of a question with an obscure clang association.
See if you can identify the words in the stem and an option that reflect a less obvious clang association.
The words diarrhea and loose, watery bowel movement in the stem are obscure clangs with the words similar stool in option 4.
Can you identify the option that is the correct answer?
Option 4 is the correct answer.
You have just used the test-taking technique, Identify the clang association in options, to select the correct answer.
Let’s review the rationale for each option.
Rationales:
Although the answer to the question in option 1 may help determine if food influenced the patient’s intestinal elimination, it does not further assess the presence of diarrhea.
Asking about cramping is not specific to diarrhea; it also is associated with constipation and intestinal obstruction.
3 Asking about excessive fluid intake is unrelated to diarrhea. Excessive fluid intake is excreted through the kidneys, not the intestinal tract.
4 Diarrhea is the defecation of liquid feces and increased frequency of defecation. The patient’s recent pattern of bowel elimination needs to be determined.
Let’s examine Test-Taking Technique #4: Identify the central person in the question.
Most questions focus on the patient.
However, some questions focus on someone other than the patient, such as a child, parent, or spouse.
You need to ask the questions:
“Who is the central person in the question?”
“Which person in the question is to receive
nursing care?”
Can you identify who the central person is in this question?
Once you identify the central person in this question then the answer becomes obvious.
The patient is the central person in this question, not the abusive nurse.
Option 4 is unique because it is the only option that addresses the needs of the patient.
Options 1, 2, and 3 all address the nurse. These options are distractors.
Option 4 is patient-centered.
Let’s now review the rationale for each option.
Rationales:
1 Telling the nurse in charge about the behavior should be done later; reassuring and calming the patient is the priority.
2 Being a role model will be done later after calming the patient.
3 Talking with the nurse about the event may be done later but it is not the priority at this time.
4 The patient is the priority at this point in time; after the patient is protected and safe, the actions of the abusive nurse must be addressed.
Not every question focuses on the needs of a patient.
To answer a question you need to identify who the central person is in relation to the question being asked.
Let’s look at a question where the focus is not on a patient.
Here is a question that focuses on someone other than a patient.
Who is the central person in this question?
One of the nursing assistants is the central person in this question.
Identify those options that do not include the nursing assistant and eliminate them from further consideration.
Options 1 and 3 do not include an intervention that addresses the behavior of the nursing assistant who is taking extensive lunch breaks.
Delete options 1 and 3 from consideration.
Examine options 2 and 4 closely.
Can you identify the correct answer?
The correct answer is option 2.
Let’s review the rationale for each option.
Rationales:
The nurse manager does not need to talk with the nursing assistants who are fulfilling their job responsibilities.
Once unacceptable behavior is identified and acknowledged then the reasons for the problem can be explored, solutions suggested, and expectations reinforced. The nurse manager must intervene directly with the nursing assistant who is not meeting job responsibilities.
3 It is not the responsibility of people other than the nurse manager to confront the nursing assistant. The nurse manager is the superior person in the chain of command of the organization. Also, counseling sessions with employees should be confidential and conducted in private.
4 This is premature. The nurse manager first should meet with the nursing assistant and conduct a counseling session.
Test-Taking Technique #5 is: Identify patient-centered options.
Let’s review the content in this slide.
Here is a question that requires you to select the answer that is patient-centered.
Can you identify the correct answer?
Option 4 is patient-centered.
Even though the patient is mentioned in options 1, 2, and 3, the nursing care does not address reducing the patient’s agitation or feelings of being upset.
Let’s review the rationale for each option.
Rationales:
Pointing out the behavior to the patient is confrontational and may precipitate a defensive response by the patient.
Keeping the patient as active as possible may increase the agitation, particularly if the cause of the agitation is ignored.
3 Agitated patients may not be able to lie still. They need some outlet for energy expenditure.
4 Agitation is a response to anxiety; the patient’s feelings and concerns must be addressed to help relieve the anxiety and agitation.
Let’s discuss Test-Taking Technique #6: Identify options that deny patients’ feelings, concerns, or needs.
If you can identify options that deny patients’ feelings, concerns, or needs, you can eliminate these options from consideration and increase your chances of selecting the correct answer.
Options that deny patients’ feelings, concerns, or needs are wrong answers.
See if you can identify the three options that deny the patient’s feelings, concerns, or needs.
Options 1, 3, and 4 deny the patient’s fearful feelings.
If you are able to identify one or two options that deny the patient’s feelings, concerns, or needs and eliminate them from consideration you will increase your chances of selecting the correct answer.
Which option is the correct answer?
Option 2 is the correct answer. It is the patient-centered option.
Generally, when the correct answer is patient-centered the three options that are distractors deny patient’s feelings, concerns, or needs in some way.
Let’s review the rationale for each option.
Rationales:
Continuing with the transfer denies the patient’s fears and can intensify the anxiety.
Lowering the patient onto the bed recognizes the cause of the anxiety and responds to the source.
3 Continuing with the transfer ignores the patient’s concern. Telling a person to relax will not necessarily precipitate a relaxation response.
Leaving the patient up in the air can intensify the anxiety.
Let’s look at another question that has options that deny patient’s feelings, concerns or needs.
Here is another example of a question in which you can use the test-taking technique, Identify options that deny patients’ feelings, concerns, or needs.
See if you can identify the three options that can be eliminated using this test-taking technique.
Options 2, 3 and 4 deny the patient’s feelings.
Option 1 is the correct answer. It is patient-centered.
Let’s review the rationales for each option.
Rationales:
1 The statement in option 1 provides information and an explanation; this generally reduces fear and increases understanding and compliance. Oxygen therapy generally helps patients breathe more easily, and therefore the statement is not false reassurance.
2 The statement in option 2 is false reassurance and minimizes the patient’s concerns.
3 The statement in option 3 may intensify fear if the oxygen is not discontinued; also, it does not provide an explanation.
4 The statement in option 4 does not address the fact that patients have a right to know what is being done and why.
Let’s discuss Test-Taking Technique #7: Identify words that are absolutes in options.
Let’s review the content in this slide.
Let’s review the content in this slide.
Here are words that are considered absolutes or specific determiners.
These terms have no exceptions.
When absolutes are used in an option, more often than not, the option is a distractor and can be eliminated.
Rarely are things in life absolute. However, there are some absolutes such as taxes, death, providing for a patent airway, and hand hygiene.
Here is question where you can use the test-taking technique, Identify words that are absolutes in options.
See if you can identify two options that include words that are absolutes.
The word always in option 2 and the word only in option 4 are words that are absolutes.
Generally, options with absolute words are distractors and can be eliminated.
Eliminate options 2 and 4. You have just increased your chances of selecting the correct answer to 50%.
Can you identify the correct answer?
Option 1 is the correct answer.
You just used the technique, Identify specific determiners in options, to eliminate two distractors. This increased your chance of selecting the correct answer to 50%.
Let’s now review the rationale for each option.
Rationales:
Using a new area of the washcloth for each stroke is a basic principle of medical asepsis. This should be done so that contaminated material will not be carried by the washcloth to another area of the perineum.
Cleaning from the pubis toward the rectum, not from the rectum toward the pubis, minimizes contaminating the urinary meatus and vagina with fecal material.
3 The cleanest area should be cleaned first. The area closest to the urinary meatus and vagina is cleaned first because it is considered the cleanest area of the perineum.
4 Soap can be used on the perineal area.
Let’s look at another question.
Here is another question to practice the test-taking technique, Identify absolutes in options.
Can you identify the options with words that are absolutes?
The word all in option 1 is an absolute.
Eliminate option 1.
You have now increased your chances of selecting the correct answer from 25% to 33% .
Can you identify the correct answer?
Option 2 is the correct answer.
Let’s review the rationale for each option.
Rationales:
1 People from different cultures and people in subgroups within the same culture place different values on words.
Touch is a form of nonverbal communication that sends a variety of messages depending on the person’s culture, sex, age, past experiences, and present situation; touch also invades a person’s personal space.
Words, whether they are spoken or written, are considered verbal communication.
4 Patients with expressive aphasia often can communicate using nonverbal behaviors, a picture board, or written messages.
Let’s review this slide.
Here is an example of a stem that includes the word never.
It indicates negative polarity.
What should the nurse never do?
Option 1 is an example of an absolute used in a stem with an option that is a correct answer to the question.
Massaging over ischemic tissue should never be done because massage may further injure the tissue.
The nurse should massage outside the perimeter of, not directly over, ischemic tissue.
Massaging outside the perimeter of ischemic tissue facilitates vasodilation bringing oxygen to the area, promoting healing.
Now we are going to move on to another test-taking technique.
Let’s discuss Test-Taking Technique #8: Identify opposites in options.
Let’s review the content in this slide.
What are opposites?
Here is a question that has options that are opposites.
Can you identify the two options that are opposites?
Options 3 and 4 are opposites.
More often than not the correct answer is one of the opposite options.
Select the correct answer between options 3 and 4.
The correct answer is option 3.
Let’s review the rationale for each option.
Rationales:
Suspecting that the patient is feeling withdrawn is an assumption based on insufficient data.
Waiting is unsafe.
More information must be collected to make a complete assessment and reach an accurate conclusion.
Waiting is unsafe.
Here is another question that has opposites in the options.
See if you can identify the two options that are opposites.
Options 1 and 3 are opposites.
More often than not the correct answer is one of the opposite options.
Option 1 is the correct answer.
Let’s review the rationales for each option.
Rationales:
1 The equipment should be discarded because a small vessel was pierced and the fluid and needle are contaminated. A new sterile syringe and medication should be prepared.
Removing the syringe and attaching a new needle is unsafe; the fluid in the syringe is contaminated.
Withdrawing the needle slightly and injecting the solution is unsafe; the fluid in the syringe is contaminated.
4 It is unnecessary to notify the health-care provider.
Sometimes opposites are obvious, such as hyperglycemia versus hypoglycemia, and sometimes opposites are not as obvious.
Here is a question where the opposites are not as obvious.
Can you identify the options that are opposites?
Options 1 and 3 are obscure opposites.
In option 1 anabolism (a building up) exceeds catabolism (a breaking down) of substances.
In option 3 an increase in metabolic demands associated with cancer (hyper-metabolic state) causes a loss of mean body mass (catabolism) as the body attempts to meet energy demands.
The concepts associated with anabolism are opposite to those associated with catabolism.
Look at options 1 and 3 carefully. Often one of the opposites is the correct answer.
Option 3 is the correct answer.
Let’s review the rationales for each option.
Rationales:
1 Catabolism exceeds anabolism with cancer.
The ability to utilize nutrients is not impaired with cancer.
The energy required to support the rapid growth of cancerous cells increases the metabolic demands 1.5 to 2 times the resting energy expenditure.
4 The by-products of cell breakdown cause a negative nitrogen balance.
Here is another question that contains obscure opposites.
Can you identify the options that are opposites?
Options 1 and 3 are obscure opposites.
A resting arterial pressure occurs when the left ventricle is at rest (diastolic pressure), not when contracting (systolic pressure).
Consider options 1 and 3 carefully.
Can you identify the correct answer?
The correct answer is 3.
Let’s review the rationale for each option.
Rationales:
Contraction of the left ventricle is reflected by the systolic pressure.
The volume of cardiac output is computed by multiplying the stroke volume by the number of heart beats per minute.
3 Diastole is the period when the ventricles are relaxed and reflects the pressure in the arteries when the heart is at rest.
4 Pulse pressure is the difference between the systolic and diastolic pressures.
Let’s review the content in this slide.
The next slide presents a question that has options that are equally plausible.
See if you can identify the options that are equally plausible.
Which option is no better than another option?
Options 1 and 3 are equally plausible. Both are concerned with a drug reaction.
Option 1 is no better than option 3.
Both option 1 and 3 can be eliminated from consideration. They are distractors.
Now can you select the correct answer?
Option 4 is the correct answer.
Options 1 and 3 are equally plausible and can be eliminated .
Let’s review the rationale for each option.
Rationales:
The word teratogenic, when used in the context of medication, refers to a drug that can cause adverse effects in a fetus or an embryo.
The statement in option 2 is unrelated to the concept of teratogenic. Allergies are unpredictable hypersensitive reactions to allergens such as drugs.
The statement in option 3 is unrelated to the concept of teratogenic. Drug addiction refers to an uncontrollable craving for a chemical substance because of a physical or psychological dependence.
The statement in option 4 is unrelated to the concept of teratogenic. An anaphylactic reaction is a severe, systemic hypersensitivity to a drug, food, or chemical.
Here is another question that allows you to use the test-taking technique, Identify equally plausible options.
Can you identify two options where one is no better than the other?
Options 2 and 4 are equally plausible.
They both relate to problems with fluid balance.
One of these options is no better than the other.
They are both distractors that can be eliminated. You have increased your chance of selecting the correct answer to 50%.
See if you can identify the correct answer between options 1 and 3.
Option 3 is the correct answer.
Let’s review the rationale for each option.
Rationales:
1 Pain at the incisional site is common to postoperative patients and is not specific to a postoperative patient with a history of heart disease.
2 Although changes in fluid balance is an important assessment, an alteration in fluid balance is not immediately life threatening.
3 An irregular pulse rhythm may indicate a life-threatening dysrhythmia.
4 Although assessment of dependent edema is important, it is not as critical as another assessment.
Let’s discuss Test-Taking Technique #10: Identify the unique option.
Let’s review this slide.
Can you identify the three options that are equally plausible or that are similar?
Options 1, 3, and 4 are similar because they all are concerned with how to send information to the patient. They are equally plausible. They can be eliminated.
Once you identify three similar options you will be able to identify the remaining option that is unique.
Option 2 is the correct answer.
Options 1, 3, and 4 are similar and can be eliminated because they are distractors.
Option 2 is unique and different than the other three options. It is the only option that seeks feedback from the patient.
Let’s review the rationale for each option.
Rationales:
Using simple vocabulary helps to send a clearer message, but it does not inform the sender whether the receiver understands the message.
Seeking feedback enables the caregiver to know whether the message is understood as intended.
Speaking distinctly when giving directions helps to send a clearer message, but it does not inform the sender whether the receiver understands the message.
Speaking slowly helps to send a clearer message, but it does not inform the sender whether the receiver understands the message.
Here is another question to practice identifying the unique option.
Can you identify the three options that are similar and the one option that is unique?
Options 1, 2, and 3 are similar.
Micturition, concentrated urine, and functional incontinence are all associated with urine.
Option 3 is unique and different.
Option 3 is the only option that does not include something that includes “urine.”
Can you identify the correct answer?
Option 3 is the correct answer.
You just identified the three options that are similar and the one option that is unique.
Let’s review the rationale for each option.
Rationales:
Painful urination (dysuria) generally is caused by infection, inflammation, or injury, not urinary retention.
2 Concentrated urine is caused by inadequate fluid intake and indicates dehydration, not urinary retention.
Abdominal distension occurs as a result of a distended bladder. Outlet obstruction, decreased bladder tone, neurological dysfunction, opioids, and trauma can precipitate urinary retention.
Functional incontinence is unrelated to urinary retention. Functional incontinence occurs when a person who is aware of the need to void is unable to reach the toilet in time to void.
Let’s discuss Test-Taking Technique #11: Identify the global option.
Let’s review the content in this slide.
Here is a question that contains a global option
Can you identify the option that is a broad general statement?
Option 1 is the global option because it is a broad general statement.
Options 2, 3, and 4 are more specific.
Option 1 inherently includes the interventions identified in options 2, 3, and 4.
You have just used the test-taking technique, Identify the global option, to arrive at the correct answer.
Let’s review the rationale for each option.
Rationales:
The statement maintaining quality of life is broad in scope and addresses improvement in all aspects of the life of an older adult.
Supporting rehabilitation needs is only one part of caring for an older adult.
Helping with bureaucratic paperwork is only one part of caring for an older adult.
4 Encouraging interaction with the family is only one part of caring for an older adult.
Here is another question that contains a global option.
See if you can identify the global option.
Which option is more general than the other options?
Option 4, Promoting comfort, is the most general intervention. It is the global option.
Option 4 is the most global of all the options because it does not present a specific intervention to facilitate sleep.
Decreasing environmental noise, exploring emotional concerns and regulating room temperature may all promote comfort.
Let’s review the rationale for each option.
Rationales:
Although environmental noise can interfere with sleep, it is not the factor that has been proved most often to interfere with sleep.
Emotional concerns have not been proved to be the factor that most often interferes with sleep.
Room temperature has not been proved to be the factor that most often interferes with sleep.
Research supports the fact that the inability to find a position of comfort is the main reason why patients have difficulty sleeping in the hospital.
Let’s discuss the last test-taking technique, Technique #12: Identify duplicate facts among options.
Let’s review the content in this slide.
Duplicate fact options work to your advantage.
You are able to have a 50% chance of selecting the correct answer knowing only one fact.
Here is a question that contains duplicate facts among options.
Stay with me as I move through the options identifying duplicate facts.
Options 1 and 3 include lower legs.
Options 1 and 2 include around the mouth.
Options 2 and 4 include fingernail beds.
Options 3 and 4 include conjunctiva of the eyes.
If you know one correct fact, such as the fingernail beds are an appropriate site to assess for cyanosis, you can eliminate options 1 and 3.
You are now left with options 2 and 4. You have increased your chance of selecting the correct answer to 50%.
Questions with duplicate facts in options work to your advantage because as long as you know just one piece of information you can eliminate two options from consideration.
If you know one wrong fact, such as the lower legs are not the best sites to assess for cyanosis, you can delete options 1 and 3.
You are now left with options 2 and 4. You have increased your chance of selecting the correct answer to 50%.
Questions with duplicate facts in options work to your advantage because as long as you know just one piece of information you can eliminate two options from consideration.
We have only reviewed two facts for examples. You may know other information as it relates to one of the facts in the options which will either help you identify the correct answer or eliminate two additional distractors.
Can you identify the correct answer?
Option 2 is the correct answer. By knowing one fact you can eliminate two options.
Let’s review the rationale for each option.
Rationales:
1 Although the lips and mucous membranes of the mouth are a primary site to assess for early signs of oxygen deprivation, the lower legs are not the first sites to assess for cyanosis.
2 Nail beds, lips, and mucous membranes of the mouth are the primary sites to assess for cyanosis.
3 Pallor of the conjunctiva of the eyes may reflect reduced oxyhemoglobin. However, the lower legs are not the first sites to assess for cyanosis.
4 Although the nail beds are a primary site to assess for signs of cyanosis, pallor of the conjunctiva of the eyes reflects reduced oxyhemoglobin, not cyanosis.
Here is another example in which you can practice the test-taking technique, Identify duplicate facts among options.
Again, follow along with me as we move through the options identifying the duplicate facts.
Options 1 and 3 include osmotic diuresis.
Options 1 and 2 include hypoglycemia.
Options 2 and 4 include dumping syndrome.
Options 3 and 4 include electrolyte imbalance.
Four different responses to an excessive rate of total parenteral nutrition (TPN) solution are presented:
Osmotic diuresis
Hypoglycemia
Dumping syndrome
Electrolyte imbalance
If you are able to identify one response that is unrelated to an increased TPN rate, you can eliminate two distractors.
For example, if you know that hyperglycemia, not hypoglycemia, may result if a TPN solution is administered faster than the rate that was ordered, you can eliminate options 1 and 2.
Let’s look at the next slide.
We just eliminated options 1 and 2 because we know that hyperglycemia, not hypoglycemia, can occur when a TPN solution is administered faster than the rate that was ordered.
You are now left with options 3 and 4.
You now have a 50% chance of selecting the correct answer.
If you know one accurate fact about the response to an excessive amount of TPN you can eliminate two options from consideration.
For example, if you know that excessive TPN solution can cause osmotic diuresis, then you can eliminate options 2 and 4.
Let’s look at the next slide.
By eliminating options 2 and 4 you have increased your chance of selecting the correct answer to 50%.
Can you identify the correct answer?
Option 3 is the correct answer.
You can eliminate options based on what you know to be either true or false and even arrive at the correct answer without knowing all the information that supports the correct answer.
Duplicate facts work to your advantage.
Let’s review the rationale for each option.
Rationales:
Although osmotic diuresis does occur, hyperglycemia, not hypoglycemia, may result.
Hyperglycemia, not hypoglycemia, may result. Dumping syndrome, the rapid entry of food from the stomach into the jejunum, can occur with an intermittent tube feeding, not TPN.
The hypertonic TPN solution pulls intracellular and interstitial fluid into the intravascular compartment; the increased blood volume increases circulation to the kidneys, raising urinary output (osmotic diuresis). Potassium and sodium imbalances are common among patients receiving TPN. Therefore, TPN rates must be carefully controlled.
Potassium and sodium imbalances are common among patients receiving TPN. However, dumping syndrome can occur with an intermittent tube feeding, not TPN.
The use of multiple test-taking techniques will make you a wise test taker.
Let’s review this slide.
Let’s look at a question were you can use multiple test-taking techniques to arrive at the correct answer.
Break up into groups of three or four and see if you can identify test-taking tips that apply to this question.
See if your group can identify the correct answer.
Option 3 is the correct answer. Let’s review how you can arrive at this answer using test-taking techniques.
Refer to the list of the 12 Test-Taking Techniques.
Technique #1: Identify if the question is asking what the nurse should do or should not do.
The words, Which question asked by the nurse in the stem indicates positive polarity; what the nurse should do.
Technique #3: Identify the clang association in options.
The word diabetes appears in the stem and option 3; this repetition is a clang association. Consider this option carefully because more often than not an option with a clang association is the correct answer.
Technique #9: Identify equally plausible options.
Options 1, 2, and 4 are equally plausible because they all are concerned with a psychomotor skill. Delete options 1, 2, and 4.
Technique #10: Identify the unique option.
Option 3 is unique. It is the only option that is concerned with what is rather than how to.
You just used four test-taking techniques to eliminate distractors and focus on the potential correct answer.
Test-taking techniques facilitated your analysis of this item. They improved your chance of selecting the correct answer.
Let’s now review the rationale for each option.
Rationales:
Inspecting the skin is a skill that relates to the psychomotor domain, not the cognitive domain.
Measuring a serum glucose level is a skill that relates to the psychomotor domain, not the cognitive domain.
3 Knowing information about diabetes mellitus is related to the cognitive domain because it is concerned with the comprehension of information.
Performing a subcutaneous injection is a skill that relates to the psychomotor domain, not the cognitive domain.
See if you can identify several test-taking techniques that apply to this question.
Can you identify the correct answer?
Option 1 is the correct answer. Let’s review how you can arrive at this answer using test-taking techniques.
Refer to the list of the 12 Test-Taking Techniques.
Technique #1: Identify if the question is asking what the nurse should do or should not do.
The sentence Which is the nurse’s best response? in the stem indicates positive polarity; what the nurse should do.
Technique #2: Identify the word in the stem that sets a priority.
The word best in the stem sets a priority.
Technique #3: Identify the clang association in options.
The words nobody cares appear in the stem and option 1; this repetition is a clang association. Consider this option carefully because more often than not an option with a clang association is the correct answer.
Technique #4: Identify the central person in the question.
The patient is the central person in the question.
Technique #5: Identify patient-centered options.
Options 1 and 2 are patient-centered. Consider these options carefully.
Technique #6: Identify options that deny a patient’s feelings, concerns, or needs.
Options 2, 3, and 4 deny the patient’s feelings. Options that deny a patient’s feelings are never the correct answer. Eliminate options 2, 3, and 4.
Technique #7: Identify words that are absolutes in options.
In option 2 the word all is an absolute. Rarely are options with an absolute term are the correct answer. Eliminate option 2.
Technique #8: Identify opposites in options.
Options 1 and 2 are opposites. Consider these options seriously. More often than not one of these opposites is the correct answer.
WOW! You just used eight test-taking techniques to eliminate distractors and focus on the potential correct answer.
By using these techniques you are empowered when reviewing the stem and options of a test item.
Let’s now review the rationale for each option.
Rationales:
Repeating the patient’s statement allows the patient to focus on what was said, validates what was said, and encourages communication.
This statement may or may not be true and does not encourage verbalization of feelings.
This patient’s statement reflects feelings of sadness and isolation, not anger. Also, it denies the patient’s feelings.
This statement may or may not be true and does not encourage verbalization of feelings.
We just reviewed 12 test-taking techniques that will help you analyze a stem and options and arrive at the correct answer.
It is important to remember:
Always over prepare for your examinations and spend time studying. These are the best ways to be prepared
Take practice tests and study the rationales for the right and wrong answers.
If you are going to use test-taking techniques during an examination you must first practice using them. You can easily lose speed and become bogged down and frustrated without practice. Practice puts you in control and supports your sense of empowerment.
You do not have to apply these techniques to every question. Use these techniques when you are not sure of the correct answer.
The techniques may help you to better understand what the question is asking and they may help you to eliminate distractors.
When you eliminate distractors you increase your chances of identifying the correct answer.
Luck has nothing to do with scoring well on an examination. You must study content and practice test taking!
