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 Key Words
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 key word 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 key words: 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:
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
2. High fat, low protein
3. Low fat, high calorie
4. Low fat, high protein
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
2. Board of nursing
3. State nurses’ association
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
2. Compensatory
3. Psychophysiologic
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
2. Speaking loudly
3. Find out if he has a hearing aid
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
2. Energy carbohydrates
3. Water and electrolytes
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
2. Nausea
3. Belching
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%.
Reference: Elsevier, Inc, 2005
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