Transcript Introduction To Testing Styles in Nursing

Introduction To Testing
Styles in Nursing
Entry Into Professional Nursing
Summer 2009
How To Read and
Interpret A Test Question
Think Like an Item Writer
• First, perform a content analysis
– Review the information being tested
– What do you know about it?
• Second, perform a construct analysis
– Look at the format of the question
– Let’s see what that means!
Types of Questions
• Assessment
– Knowledge about
brain tumors,
radiation treatment,
significant others, or
general neurologic
function
– Analysis questions
about psychosocial
implications of
treatment, diagnosis
of cancer, and loss
• Planning
– Safety measures for
the client, for the
nurse, for others in
contact with the
client
Types of Questions
(continued)
• Implementation
– Basic care needs
– Problems associated
with implants
– Radioactivity issues
• Evaluation
– Level of client’s
understanding of
treatment
– Family’s understanding
of radiation
precautions
– Effectiveness of
specific interventions
Sharpen Discrimination
Skills
• Look for key words in questions
– Most correct
– Most likely
– Do first
– Highest priority
Timing IS Everything
• Keep your analysis time to 1 minute per
item
• This takes practice!
• Take practice tests using a timer
• Using practice tests in a timed
environment helps reduce anxiety when
it’s time for the real thing
Construct Analysis
• What is being tested?
– Client safety?
– Physiologic issue?
– Psychosocial issue?
– Health promotion issue?
• Let’s try an example
Scenario
• A client is admitted to the unit for
treatment of a malignant glioma. He is
transferred to a medical floor with a
cranial radium implant (seeding). The
implant will remain in place in his head
for the next several days.
• Now…list five principles/concepts that
could be tested within this single
situation.
Do You Suffer From
Anxiety???
Low Levels of Anxiety Are
GOOD!
• Heighten senses
• Dilate pupils
• Increase awareness of surroundings
• Sharpens responses during testing
High Anxiety is BAD
• Senses narrow
• “Tunnel vision”
develops
• Testing ability declines
• Focus is on feelings of
stress
Identify Stress Signals
• Identify four symptoms you have
experienced related to stress
– 1.
– 2.
– 3.
– 4.
Common Symptoms of
Anxiety
• Mild Anxiety
– Slight irritability
– Impatience
– Sharpened
perceptual field
• Higher Anxiety
– Parasympathetic
nervous system
responses
•
•
•
•
•
•
Tachycardia
Shortness of breath
Tunnel vision
Dry mouth
Muscle tension
GI disturbances
Handling Your Anxiety
Think S-T-O-P
• Picture a stop sign
– Shape
– Color
– Word
• Deep breath
• Spell S-T-O-P to
yourself 3 or 4 times
while breathing
deeply
Practice STOPPING
• Practice the S-T-O-P exercise several
times a day
• Use it while practice-testing
• Practice makes perfect!
Understanding
NCLEX -Type Questions
The Situation
• Sets the stage for the question
• Usually describes a client or family with
a particular problem or set of problems
• Contains very little or no non-pertinent
information
Question Stem
• Central focus of the item
• Presented as a question or incomplete
item
• May require information from the
situation in order to answer
The Correct Answer
• May be four options of similar length
• May be two short and two long options
• There is NO PATTERN to the answers
Distracters
• Incorrect answer choices
• Must be plausible, but not correct
• Must be similar in length and design as
the correct answer
Types of Testing Errors
Type-One Error
• Misperceiving information
– Words are read incorrectly
– Information is overlooked
Read these Options
PARIS
IN THE
THE SPRING
ONCE
IN A
A LIFETIME
BIRD
IN THE
THE HAND
What Did You See?
• Did you see “Paris in the Spring”, “Once
in a Lifetime” and “Bird in the Hand”?
• Look again at the next slide
Each option has repeated
words
PARIS
IN THE
THE SPRING
ONCE
IN A
A LIFETIME
BIRD
IN THE
THE HAND
Type-Two Error
• Misprocessing information
– Not recognizing an indicator word
– Example – dysphagia may be misread as
dysplasia
– Focusing on the wrong indicator word in a
distracter
Avoiding Type-Two Errors
• Read all the answer options
• Identify those that truly pertain to the
question stem
• Stick with your selection
Type-Three Error
• Misapplying the response
– Result when knowledge cannot be applied
to the question
– Graduates have a great deal of knowledge,
but may have difficulty narrowing it to a
particular answer
Let’s Try It!
Step 1
• Separate what the scenario tells
you from what the stem is asking
Parts of a Question
• Case scenario: statement giving
information about a clinical problem
• Stem: specifically asks you something
• Options: choices to answer the stem
Example
• During shift change, a client calls for a
nurse. Upon entering the room, the
nurse notes the client has a generalized
rash that wasn’t apparent one hour
ago. Which initial action by the nurse is
appropriate?
The Case Scenario
• During shift change, a client calls for a
nurse. Upon entering the room, the
nurse notes the client has a generalized
rash that wasn’t apparent one hour
ago. Which initial action by the nurse is
appropriate?
The Stem
• During shift change, a client calls for a
nurse. Upon entering the room, the
nurse notes the client has a generalized
rash that wasn’t apparent one hour
ago. Which initial action by the nurse is
appropriate?
Identifying Critical
Elements
Four Critical Elements
• The ISSUE
• The KEY WORDS
• The CLIENT
• The TYPE OF STEM
The Issue
• Primary problem or the subject of
the question
The Client
• The person who is the focus of the
stem of the question
• May be the ill person, family
members or significant others
The Key Words
• During shift change, a client calls for a
nurse. Upon entering the room, the
nurse notes the client has a generalized
rash that wasn’t apparent one hour
ago. Which initial action by the nurse
is appropriate?
Type of Stem
• True response stem - asks for a true
statement
• False response stem - asks for the
incorrect answer
Some Helpful Hints
• Separate what question is telling from
what it is asking
• Always identify the client, issue, key
words and type of stem
• Eliminate options offering new
information
• Nurse is always therapeutic and time is
available
Eliminating Incorrect
Options
Options
• One option is the answer
• Three others are called distracters
Rule Out Distracters
• If the stem is a true response stem, r/o
distracters that are not true statements
• If the stem is a false response stem, r/o
distracters that are true
More Helpful Hints
• Next to each option note if it’s a true
statement (+), a false statement (-) or a
not sure (?)
• If there are 2 matching options left,
select the more familiar
• If there is 1 matching and 1 not sure,
pick the matching one
• GO WITH YOUR GUT
Absolutes
NEVER
ALWAYS
DOUBTLESS
COMPLETELY
• Antihypertensives
always make you dizzy
• Patients should never
self-medicate
• Doubtless the nurse is
correct
• The patient was
completely satisfied
with treatment
Qualifiers
Probably
Usually
Best
Ever
• The medication is
probably the cause
of the problem
• Patients usually walk
after surgery
• Aspirin is the best
medication
• No one ever
documents that way
Item Length
• The longest answer contains the most
information
• Don’t assume the information in the
longest answer is correct
Option Position
When in doubt…pick “C” –
Ancient Student Myth
• No one position is
favored
• Item writers know
the same myth
• Read all options!
Umbrella Option
• Contains other
options within it
• Present when there
is more than one
right answer found
Priority Option
•
•
•
•
ABCs
Maslow
Patient first
Safe care
Negatives
• Changes direction of
the question
• Looks for the
WRONG answer
NOT
IM
NON
EXCEPT
Patterns
• Don’t look for
shapes, letters,
sequences, etc.
X
X
X
X
X
X
X
X
X
X
Best Understood Option
• Sounds familiar
• Subconscious at
work
Don’t “Read Into” Options
• Take question at
face value
• If it walks like a
duck…
Go with Your Gut
• Intuition
• Instinct
• Trigger memory
No Penalty for Guessing
Read ALL Options
• A
• C
• B
• D
Tips for Avoiding Errors
Strategy 1
• Read the client description and question
carefully
– Take time to read each word in the
situation
– Read the question stem – be sure you
understand what it is asking
Strategy 2
• The information provided is the only
information to use
– Avoid adding information to the situation
– Don’t assume information that is not there
– Don’t refer to personal experience
Strategy 3
• Go with your gut
– If you have strong feelings about an
answer, stick with that answer
– Don’t assume an answer is wrong because
it is easy to answer – that just means you
know it!
– Form an answer in your mind, then select
the option closest to your answer
Strategy 4
• Identify the step of the nursing process
being tested
– If an assessment question is asked,
answers should involve collecting more
data
– You need to become sensitive to words
that indicate the phase of the nursing
process being tested
Nursing Process
Vocabulary
• Assessment Words
–
–
–
–
–
–
Observe
Assess
Identify
Gather
Recognize
Display
–
–
–
–
–
–
Collect
Detect
Indicate
Differentiate
Distinguish
Describe
Vocabulary (continued)
• Analysis Words
–
–
–
–
–
–
Diagnose
Contrast
Compare
Analyze
Order
Prioritize
–
–
–
–
–
–
Define
Classify
Categorize
Synthesize
Sort
Arrange
Vocabulary (continued)
• Planning Words
–
–
–
–
–
–
Rearrange
Formulate
Plan
Reconstruct
Include
Generate
–
–
–
–
–
–
Determine
Expected
Short-term goals
Outcomes
Designate
Criteria
Vocabulary (continued)
• Implementation Words
–
–
–
–
–
–
Document
Explain
Give
Inform
Include
Teach
–
–
–
–
–
–
Offer
Administer
Implement
Encourage
Advise
Provide
Vocabulary (continued)
• Evaluation Words
–
–
–
–
–
–
Monitor
Demonstrate
Evaluate
Synthesize
Expand
Consider
–
–
–
–
–
–
Question
Determine
Outcomes
Conclude
Repeat
Reestablish
Strategy 5
• Concentrate on the question at hand
– Each question demands your undivided
attention
– Once a question is answered, it’s done….
forget it!
Strategy 6
• Every question has the same point
value
– No question carries more weight on the
test than another
– If you don’t know an answer, make an
educated guess and move forward
Strategy 7
• Don’t test angry

– Avoid personalizing a question
– Some topics, such as abortion, abuse, or
rape trigger personal emotions
– Answer according to what you have
learned, not according to what you believe
Strategy 8
• Avoid answers containing qualifying
words
– Always
– Never
– All
– None
• Nothing is always, never, all or none
Strategy 9
• Look for answers that are somehow
different
– If three options give a specific age, but the
fourth option generalizes (i.e.. adult), the
general option is usually the correct one
Strategy 10
• Prioritize care
– ABCS method
• Airway
• Breathing
• Circulation
• Safety
– Categories of care method
• Safe, effective care
environment
• Physiologic integrity
• Psychosocial integrity
• Health
promotion/maintenance
Strategy 11
• Look for answers that facilitate
something
– Client teaching
– Assisting the client toward independence
– Look for key words
Facilitative Words
•
•
•
•
•
Assist
Aid
Support
Encourage
Facilitate
•
•
•
•
•
Help
Reinforce
Foster
Nurture
Endorse
Strategy 12
• Look for relationships between answers
– Item writers usually write the question
first, the right answer next, then the
distracters
– Usually the correct answer has a
connection with the other options
– Incorrect answers don’t have a relationship
with each of the other answers
Strategy 13
• Select the answer that is most inclusive
– If more than one answer looks to be
correct, see if one of the answers contains
the other
– The more comprehensive an answer is, the
more likely it is the correct one
Strategy 14
• When given the option to medicate or
use a non-pharmacologic treatment,
select the non-pharmacologic treatment
– Alternative methods of treating a problem
should be attempted before administering
medications
Remember…If you think
you will succeed, you will!
Good luck in your journey
toward becoming a
Registered Nurse!
