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
• 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
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:
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
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:
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