CRUISING THROUGH EXAMS AND DEALING WITH TEST ANXIETY

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CRUISING THROUGH EXAMSAND DEALING WITH TEST
ANXIETY

• Linda Anne Silvestri MSN, RN
• Nursing Instructor Salve Regina University
• Author
• Saunders Pyramid to Success for the NCLEX Exam
• Elsevier Health Sciences
• President
• Nursing Reviews, Inc.
• Professional Nursing Seminars, Inc.

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• PART 1
• BEFORE
• THE
• EXAM

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• TEST PREPARATION

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DONT MAKE EXAM-TAKING HARD ON YOURSELF!PREPARA
TION IS THE KEY!
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HOW TO NAVIGATETHROUGHTEST PREPARATIONSIX
TOOLS
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TEST PREP TOOL 1
CLASS ATTENDANCE

• Attend all classes
• Actively participate
• Take notes
• Ask questions
• Review

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TEST PREP TOOL 2

• READ ASSIGNED READINGS

• Read before class
• Take notes
• Make a list of questions and unclear material
• Ask questions

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TEST PREP TOOL 3

• REVIEW CLASS NOTES DAILY

Frequent, short study periods and review sessions
will help you retain information and prevent the
need to cram.
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FIND YOUR SPECIAL STUDY PLACE
TEST PREP TOOL 4

• It should be comfortable,
• quiet, free of distractions,
• and suitable for you!

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TEST PREP TOOL 5

• STUDY GROUPS

Be sure that study groups are helpful to you!
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TEST PREP TOOL 6

• FLASH CARDS

• Can include that difficult to remember
  information
• Are convenient, portable, and can be used to
  study anywhere
• Are helpful for studying alone or with a group

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PART 2 DURING THE EXAMTWO TOOLS
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TOOL 1

• USE BREATHING EXERCISES

Breathe in through the nose and breathe out
slowly through the mouth
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TOOL 2

• IDENTIFY THE INGREDIENTS
• OF A
• QUESTION

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WHY INGREDIENTS OF A QUESTION ARE
IMPORTANT?HELPS AVOID READING INTO A QUESTION
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INGREDIENTS OF A QUESTION

• Include
• Client or Clinical Event
• Question Query
• Options

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CLIENT OR CLINICAL EVENT

• Provides information
• about a client or event
• Provides the information you need in answering
  the question

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CLIENT OR CLINICAL EVENT

• EXAMPLE
• A clients abdominal dressing becomes wet while
  giving a bed bath.
• THE CLIENT OR CLINICAL EVENT TELLS YOU ABOUT THE
  PROBLEM
  
  
  
  

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QUESTION QUERY

• Usually comes after the client or clinical event
  and asks you something about it
• Read carefully and identify exactly what the
  question is asking

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QUESTION QUERY

• A clients abdominal dressing becomes wet while
  giving a bed bath.
• QUERY
• The nurse should
• THE QUERY ASKS YOU WHAT THE NURSE SHOULD DO

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OPTIONS

• There are four options in multiple choice
  questions
• There are more than four options in a multiple
  response question

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EVENT, QUERY, AND OPTIONS

• EVENT A clients abdominal dressing becomes wet
  while giving a bed bath.
• QUERY The nurse should
• OPTIONS
• 1. Call the physician
• 2. Change the dressing
• 3. Let the dressing air dry
• 4. Leave the dressing alone
• Answer 2

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• STRATEGIES
• AND
• SAILING THROUGH THE EXAM
• TWO TOOLS

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TOOL 1HOW TO AVOID READING INTO QUESTIONS
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HOW TO AVOID READING INTO QUESTIONS

• Read every word in the client or clinical event,
  question query, and options
• Visualize the client or clinical event and think
  about what the nurse should do
• Think about what the question is asking
• Look for strategic words
• Avoid the What If? syndrome

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HOW TO AVOID READING INTO QUESTIONS

• Think about the answer to the question before
  reading the options
• Use the process of elimination when reading the
  options
• Then, reread the event and query before selecting
  the answer

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TOOL 2ELIMINATING INCORRECT OPTIONS
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ELIMINATING INCORRECT OPTIONS

• Read every option and eliminate incorrect options
• When you have eliminated 2 options, reread the
  client or clinical event and determine what the
  question is asking
• Then, read the remaining options again

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• TOP
• TEN
• TEST-TAKING
• STRATEGIES

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1. STRATEGIC WORDS and PRIORITIZING

• Important words or phrases in a question
• Focus your attention to crucial ideas in the
  client or clinical event, query, and in the
  options
• Certain strategic words will indicate the need to
  prioritize

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1. BE ON THE LOOKOUT FOR STRATEGIC WORDS

• Early or Late
• Immediately, initial, first
• Most Likely or Least Likely
• Most Appropriate
• On The Day Of
• After Several Days

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1. STRATEGIC WORDS

• EXAMPLE
• A nurse is monitoring a postoperative client for
  signs of infection. Which of the following is an
  early sign of infection?
• 
  1. A
  low blood pressure
• 2. A low respiratory rate
• 3. An elevated temperature
• 4. Separation of the incisional
• wound edges and a pus-like drainage
• Answer 3

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2. USE THE ABCS

• AIRWAY
• BREATHING
• CIRCULATION

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2. USE THE ABCS

• EXAMPLE
• A nurse is caring for a client with pneumonia who
  suddenly experiences respiratory difficulty. The
  nurse should first
• 1. Call the physician
• 2. Document the clients problem
• 3. Check the clients oxygen level by pulse
  oximetry
• 4. Cover the client with a blanket and check the
  clients temperature
• Answer 3

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2. USE THE ABCS

• EXAMPLE
• A nurse is assigned to care for four clients. In
  planning client rounds, which client should the
  nurse assess first?
• 1. A client scheduled for a chest x-ray
• 2. A client requiring daily dressing changes
• 3. A postoperative client preparing for
  discharge
• 4. A client receiving oxygen via nasal cannula
  who had difficulty breathing during the previous
  shift
• Answer 4

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3. THE SUBJECT OF THE QUESTION

• A disease, treatment, diagnostic test
• A complication or effect of a treatment
• A specific nursing action
• An action of a medication
• A side effect, intended effect, or adverse or
  toxic effect of a medication

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3. THE SUBJECT OF THE QUESTION

• EXAMPLE
• The nurse administers morphine sulfate to a
  postoperative client. The nurse monitors for
  which intended effect of the medication?
  
  
• 1. Sleepiness
  
• 2. Decreased pain
  
• 3. Increased alertness
• 4. Lowered blood pressure
• Answer 2

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4. NEGATIVE EVENT QUERIES

• Be on the Lookout for questions that contain
  negative event queries
• These questions use strategic words that ask you
  to select an option that is an incorrect item or
  statement
• Avoid
• Unsafe
• Incorrect
• Least likely
• Lowest priority
• Need for further instructions

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4. NEGATIVE EVENT QUERY

• EXAMPLE
• The nurse teaches a client with heart disease
  about the foods that are high in cholesterol.
  The nurse determines that the client needs
  further instructions if the client states that
  which food item is acceptable to consume?
  
  1. Broccoli
• 2. Cantaloupe
• 3. Broiled steak
• 4. Baked chicken
• Answer 3

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5. CLOSE-ENDED WORDS

• Options that contain close-ended words are
  usually incorrect
• All
• None
• Must
• Only
• Every
• Never
• Always

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5. CLOSE-ENDED WORDS

• EXAMPLE
• The family of a client with Parkinsons disease
  tells the nurse that the client is having
  difficulty adjusting to the disorder and that
  they do not know what to do to help. The nurse
  suggests which therapeutic measure to assist the
  client to cope with the disease?
• 1. Plan only a few activities for the client
  during the day
• 2. Assist the client with all activities of daily
  living (ADLs)
• 3. Cluster all activities at the end of the day
  when the client is restless and bored
• 4. Encourage and praise client efforts to
  exercise and perform activities of daily living
  (ADLs)
• Answer 4

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6. COMPARABLE OR ALIKE OPTIONS

• Be on the Lookout for comparable or alike
  options
• If two options include a similar concept or
  nursing action, then NEITHER OF THESE OPTIONS
  can be the answer

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6. COMPARABLE OR ALIKE OPTIONS

• EXAMPLE
• A clients abdominal dressing becomes wet while
  giving a bed bath. The nurse should
• 1. Call the physician
• 2. Change the dressing
• 3. Let the dressing air dry
• 4. Leave the dressing alone
• Answer 2

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7. THE UMBRELLA OPTION

• A broad or universal statement and may include
  the ideas of other options within it

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7. THE UMBRELLA OPTION

• EXAMPLE
• The nurse teaches a client taking colestipol
  hydrochloride (Colestid) about the need to take
  which of the following to counteract unintended
  medication effects?
• 1. Vitamin C
• 2. Vitamin B
• 3. B-complex vitamins
• 4. Fat-soluble vitamins
• Answer 4

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8. THE NURSING PROCESS

• Assessment
• Analysis
• Planning
• Implementation
• Evaluation

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8. THE NURSING PROCESS

• ASSESSMENT is the first step
• When you are asked a question regarding your
  immediate, initial, or first nursing action,
  select the option that addresses an assessment
  action
• If an assessment action is not addressed in one
  of the options, follow the steps of the nursing
  process
• EXCEPTION Emergency Situation the nurse may
  need to implement an action

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8. THE NURSING PROCESS

• EXAMPLE
• A nurse enters a clients room and finds the
  client slumped down in the chair. Breathing is
  shallow and a pulse is present. Based on this
  data, the nurse determines that the priority
  should be to
• 1. Call the doctor immediately
• 2. Have the unit clerk call a Code Blue
• 3. Ask the unit clerk to call the family
  immediately
• 4. Check the blood pressure and level of
  consciousness
• Answer 4

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9. MASLOWS HIERARCHY OF NEEDS THEORY

• Use MASLOW'S HIERARCHY OF NEEDS THEORY to
  prioritize
• Physiological needs come FIRST and select an
  option that addresses a physiological need
• When a physiological need is not addressed in the
  question or options, think about the hierarchy
  safety needs receive priority next
• Remember, address
• physiological needs first!

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9. MASLOWS HIERARCHY OF NEEDS THEORY

• EXAMPLE
• The nurse is developing a plan of care for a
  client with sickle cell anemia. Which nursing
  diagnosis if stated on the plan of care would the
  nurse select as receiving the highest priority?
  
  1. Anxiety
  2.
  Ineffective coping
• 3. Deficient fluid volume
• 4. Disturbed body image
• Answer 3

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10. FOCUS ON CLIENTS FEELINGS

• When presented with a communication question, use
  of therapeutic communication techniques in an
  option indicates a CORRECT option
• Use of nontherapeutic communication techniques in
  an option indicates an INCORRECT option
• Always focus on the client's feelings, concerns,
  anxieties, and fears FIRST!
• If an option reflects the client's feelings,
  concerns, anxieties, or fears select that option
  as the answer to the question!

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10. FOCUS ON CLIENTS FEELINGS

• EXAMPLE
• The nurse is having a conversation with a client
  who is upset and is having difficulty verbalizing
  his thoughts and feelings. The appropriate
  nursing response to the client is which of the
  following?
  1. Dont worry so
  much.
  2. Everything is going to be all right.
  3. I can see that
  you are upset. Lets talk about your thoughts and
  feelings?
  4. Why are you having so much trouble
  verbalizing your thoughts and feelings?
• Answer 3

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PART 3 -- AFTER THE EXAM
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AFTER THE EXAM

• At the exam review, determine the rationale for
  any incorrect questions
• Continue to review content from the exam in
  preparation for the final exam and for the NCLEX
  exam

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AFTER THE EXAM

• Relax and reward yourself for doing the very best!

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Thank You and I Wish You Success!