Tuesday, March 15, 2011

Difficulty taking tests in nursing school generally falls into one or more of three categories: anxiety, test-taking skills, or preparation.


Some anxiety can heighten mental activity. A moderate level of anxiety has been found to be helpful in test taking by making you more mentally alert and in a state of readiness for the testing situation. More extreme levels of anxiety can be paralyzing. Knowing the source of your anxiety may help you conquer it.

Poor Test-Taking Skills

70% of nursing students like to learn in a step-by-step manner. They do a good job of learning the facts from the textbook and classroom presentations. Multiple choice test items that test for application, analysis, or synthesis are asking the student to translate these facts into a slightly different cognitive situation. The sensing student often "knows" the information required to answer the question, but "reads additional information into" the question or misinterprets the information that is there.
The remaining nursing students have a preference for intuitive learning or learning that starts with a general principle and then attaches supporting information or facts to the principle. The facts are remembered because they relate to the principle. These students often miss test questions because they failed to learn all the facts related to the principle or overlooked a fact in a test item. The intuitive learner is more likely to miss an important fact or piece of information in the question that would change the answer.
As you read the suggestions given below, choose to use only those that apply to you.

Nothing can substitute for adequate preparation. Schedule your study time well in advance of the test. Learning should take place before you sit down to study for the test. Studying for a test should be reviewing the material and formulating applications of the material to the clinical setting.



If you are feeling anxiety building, try one of the following stress buster exercises.

Stress Busters:

  • Engage in deep breathing for 2-5 minutes. Close your eyes and concentrate on the air going in and out of your lungs. Take long, deep breaths, fill your lungs and abdomen, hold your breath, and then exhale.
  • Tense and relax different muscle groups. For example, if your shoulders are tense pull them back and hold them for a few seconds, then relax. This will help you to be aware of the relaxation of muscles and help you to relax more.
  • Engage in guided imagery for a few minutes. Pick a scene that you find peaceful, beautiful, and natural. Think about what you see, what you hear, what you feel and what you smell while in this scene.
  • Try to describe the anxiety. Focus your attention on your anxiety and think about the feelings it causes: how large is it? Where is it located in your body? What is its color, its shape, and ifs texture? If you can completely experience a physical sensation it will often disappear.
  • Aerobic exercise will help you to release anxiety and excess energy and, as a result, reduce body tension.
  • Engage in positive self-talk. This involves: (a) thinking about rational responses to counter negative thoughts (e.g., instead of saying “I’m going to fail this test” say “I have the ability to do this, I just need to get some help.”); (b) thoughts that help you to cope with stress (e.g., “a little, anxiety is helpful will just try my best:”); and (c) thoughts that keep you on task (e.g., “I can write this paper if I break it into smaller steps.”)

  • Arrive early so you can sit where you are most comfortable, and avoid people who are anxious and might cause you to doubt your knowledge.
  • When you receive the test look it over, read the directions twice, and then organize you time efficiently.
  • Don’t rush through the test, but work at a comfortable, pace and don’t worry about how far along your classmates are on the test.

  • Use some of the Stress Buster exercises during the test, such as deep breathing and muscle relaxation. You may want to take a break for a few minutes during the test and try them.
  • Get a drink of water and try to clear your mind.
  • Move onto easier questions if you feel stumped by one; you can go back to it if you have time.
  • Eat something or chew gum as an anxiety distraction.
  • Ask the instructor a question if you are not clear about the wording of a question.
  • Think about post-exam rewards for a minute as a way to motivate yourself.
  • Utilize positive self talk. Come up with positive statements which help to keep you calm, such as “this is only one test,” “I am familiar with this material,” “This test doesn’t reflect on my intelligence,” etc.

Multiple Choice

Questions of this type consist of two parts: the stem (i.e., the “question” portion); and the answer choices (i.e., “a,” “b,” “c,” etc.). The correct answer choice is called the “key,” while the other incorrect choices are called “distractors.”

Although these questions are relatively simple in form since the correct answer is surely already provided, they can be quite deceptive. It is not uncommon to read an answer choice and feel that there is more than one correct answer in the provided choices.  Sometimes, none of the answer choices seem correct. What should you do? Nursing students need not worry, there are some tricks to increasing your chances of choosing the right answer.

1. If the answer choices are short (i.e., one word or a short phrase), then glance over each choice before reading the stem. This will help focus your mind on the relevant part of the question. Reading the choices before the stem will give you an idea of what answer the stem would be looking for.

2. You should read the stem very carefully. Not being able to identify the stem or losing concentration while reading it will cause you to misinterpret the question. Oftentimes, this can point you to an incorrect answer choice since distractors are often almost the right answer to the real question.

3. If you are not sure of the answer, eliminate choices you know are wrong. This may point you to the one correct answer. But even if it doesn’t, each answer choice you can eliminate greatly increases your chances of guessing right.

4. Watch out for words such as “except,” “only,” “always,” “not,” and “but.” These little words can completely change the meaning of the question or of the answer choices, making you choose an incorrect answer if you miss them.

5. If you read a question and you have absolutely no idea what the answers is and you cannot eliminate any of the answer choices, make an intelligent guess and move on. If you think you may be able to think of the correct answer if you take some time to think about it, circle it and come back to it after you finish answering the other questions. (Note, if you get to the end of the exam and you’re out of time, make sure to go back and choose an answer for the question you skipped—don’t leave it blank!)

6. If you are recording your answers on a separate answer sheet, make sure to mark the correct answer on the exam itself , that is if you’re allowed to write on separate papers other than your exam sheet. If you have enough time at the end, double check that your marked answers on the exam and the answers you put on the answer sheet match up. If not, fix the problem.

7.  Answer choices with words that generalize like “always”, “never”, “all”, and “none” tend to be wrong. Of course, that still depends on the question.

8. In nursing exams like the NCLEX, there are two obvious wrong answers. Identify those and eliminate them. Now, you have a 50% chance of getting the correct answer if you still don’t know what the answer is. Make an intelligent guess.

A reminder:  Test taking strategies are just guidelines to help you understand and analyze the questions given. Knowing the correct answer will still depend on your knowledge and how much you prepared for the exam. Study hard, review your lessons, go over your previous assignments, get proper rest and sleep. If you do all these, you will have a better chance of passing your exams and head on your way to being a professional nurse.


1. Identify what you know and what you don’t know
Remember that you were given a whole semester to learn the concepts that are to come out on the final exams, however, not everything that has been taught will be retained. To avoid wasting precious study time reading a whole textbook or studying something that you already know, try to recount what you remember on a certain concept and just browse a bit on that part. Use your in class tests and quizzes as a guide on the topics you know best and worst. Take special note, also, of any class topics and lectures you may have missed during the semester.

2. Study groups vs Studying solo
If you’re the kind of person who learns more through interaction, then join or form a study group. You should have an arbiter or someone who will make sure that the group stays on track and not end up talking about other things unrelated to studying for the finals. Here is an article on 6 tips to forming your nursing school study group. If you’re planning to study solo, make sure to pick a place where there are no distractions and keep away from things that can disrupt your study time.

3. Set a realistic study plan
Make a commitment to put in at least an hour a day to study. It’s a lot easier to study an hour everyday than to hold off until the weekend and plan to study the whole day. Don’t stress yourself about the upcoming exams. Mild anxiety is good and widens your perceptual field but more than that leads to mental block. Plan several study sessions. Cramming an entire semester into one study session does not work.

4. Select a study method that fits you best
Each student has a different learning style. If you’re a visual learner, go for flashcards and images. If you’re more on the auditory type, search for resources that provide short but loaded information, like podcasts or recorded lectures.

5. Take Breaks
While studying, don’t forget to take occasional breaks. Most experts agree that we learn best in shorter bursts. Aim for studying for 40 – 50 minutes and then take a break for 10 to 15 minutes. Get up and walk around, get something to drink or a snack, check out or update your Facebook status, text a friend to see how their studying is going.

6. Be well rested for the exam day
Getting enough rest by adequate sleep and maintaining a balanced diet keeps your mind sharp and alert. Nothing beats being physically ready for an exam. Like I’ve said earlier, cramming doesn’t work and studying and staying up all night before the exams will do more harm than good.


The following video clips demonstrate ways to break down multiple choice questions through critical thinking.  They are divided into five key strategies.  View them as often as you like until you get each idea so that you can apply them to your own thinking when taking tests.

Avoid Reading Into Questions

Key Concepts:
  • Read the question carefully
  • Identify key words
  • Focus on the issue

Look for Key Words

Use Guidelines for Prioritizing

Identify True or False Response Questions

Answering Communication Questions

Professor Nightengale's Test Taking Strategies