How to Answer MCQs in a Nursing Examination

Every time nursing students receive the test booklet during examinations, you can see from their faces disgruntled appearance and pouting lips - displaying more frustrations rather than eagerness to go on with the examination. The main reason for the dissatisfied looks is the long test items on multiple-choice questions.

What are MCQs?

The test format on multiple-choice is not as easy as it may look like. It is more on the manner on how the questions were written that makes this test format more formidable to the test taker. To know (and defeat) the opponent, one must take a good look on its characteristics.

The multiple-choice question (MCQ) is made up of several parts:

1. The Test Item - This is the entire test question. Sometimes the test writer will provide a patient situation giving the examinee a clear picture of what's suppose to transpire in the following events.
2. The Stem of the Question - After you have read the test item (or situation), you will encounter the stem of the question or portions that ask a question or propose a problem. This is now the beginning of utilizing your critical thinking processes. You must read carefully through the stem since there are tricky words incorporated that you might just not read. For example, the words except, initial action, priority, most likely, least likely, not, best, and select all that apply, just simply disappeared from the examinee's perceptual field and would only be shocked that they have answered the wrong choice upon reviewing their corrected test papers.
3. The Options - Some would call it as choices or selections, but I am calling it the distractors. Basically, because they distract the examinee from arriving to the correct answer. If the test writer provided you with 4 distractors (A, B, C, and D), you have 25% chances that you will select the correct answer. Again, you will need your critical thinking skills in eliminating the three distractors and coming up with a 100% sure and correct answer.

Strategies in Selecting the Best Answer

I always tell my students that there is no sure-fire strategy in preparing and acing the examination compared to a good study habits and possessing adequate knowledge of the content or topics. Nevertheless, the following test-taking tips can somehow augment your chances in answering MCQs. But If you have thorough knowledge of the content, use good testing skills, and can apply your knowledge, you will pass the exam. Remember that testing skills, like any other skill, improve with practice.

Read the test question carefully. It is recommended that in a 100-item MCQ test, the examinee must read and understand fully a test item for 2-minutes. This will allow the examinee to read through the test question, the stem, and the distractors and be able to organize his/her thoughts and come up with a generalization on what is the test item all about. Be guided of the following questions while you are going through this phase:

• What is the question asking?
• Does the question include keywords?
• Is there relevant information in the stem?
• How would I ask this question (in my own words)?
• How would I answer this question (in my own words)?

Find Keywords. Alright, reading through the whole test item will sometimes give you a headache. One strategy that eliminates this problem is looking for keywords that will lessen the burden on reading the lengthy manuscript. As you read along, try to locate for these words because they make a difference with regard to what the question is asking about.

• COMMON STRATEGIC WORDS: best, early or late, first, immediately, initial, most appropriate or less appropriate, most likely or least likely.
• COMMON STRATEGIC WORDS THAT INDICATE THE NEED TO PRIORITIZE: best, essential, first, highest priority, immediate, initial, most appropriate or less appropriate, most likely or least likely, most important, next, primary, vital.

Adopt the Process of Elimination. As mentioned earlier, you have to eliminate three distractors (75%) in order to come up with the correct answer. By doing this, here are some tips:

• Eliminating the comparative or alike options. Look for options that are similar or alike as the situation/stem of the question asks for. You can then eliminate this as the possible answer.
• Eliminate words that contain closed-ended words. Closed-ended words infer a fixed or extreme meaning and these types of options are usually incorrect. Examples of these words are: all, always, every, must, none, never, and only.
• The "odd answer out" strategy. This strategy obviously allows the examinee to look for the answer that differs from the other options. If the question is asking for assessing, your answer should have words describing the process of assessment such as identify, observe, monitor or look for. If the question asks for the best intervention, then you will look for words in the options that displays nursing skills or nursing actions.
• Look for opposites. Most often, you will see options that are written in opposite manner. For example, applying heat compress and applying ice compress, vasodialtion and vasoconstriction, etc. If you have these as your distractors, one of these options is usually correct.

Prioritizing Patient Care. This type of test question is very tricky since most of the distractors are correct but you have to apply prioritization. Here are ways to simplify this aspect:

• Use your ABCs and CABs. That's right - Airway, Breathing, and Circulation. However, the American Heart Association have recently published in October 2012 a new protocol on performing the CPR that its now promoting Circulation first, ensure adequate Airway, and lastly to provide effective Breathing in order to achieve the goal of effective tissue perfusion.
• The ever-reliable Maslow's Hierarchy of Needs. Time immemorial that this pyramid of human needs have been utilized in prioritizing patient care. It is always safe to choose physiological needs (needs for survival) first and foremost over safety and security, love and belongingness, self-esteem, and self-actualization. There are some questions, particularly that of psychiatric nursing, that answering client's needs on safety and security takes precedence over physiological needs because the client can pose harm to self and others if not duly managed.
• Of course, the Nursing Process. As nurses, we have to be religious in practicing the nursing process in all our patient care. The five steps of this process will guide us in prioritizing nursing actions: Assessment, Analysis, Planning, Interventions, Evaluation.

Final Word

Taking examinations are always a nerve-wracking experience to everyone. Even I experienced the same thing when I took my NCLEX. But as I have said, there is no easy way to ace the test than being prepared, studying most of the time, focusing on your goal that you will make it happen, and of course prayers help big time, all the time.