1. Billings, Diane M. EdD, RN, FAAN


These steps will help you perform at your peak throughout your nursing career.


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Tests are a fact of academic and professional life. As a student, you take tests that evaluate your understanding of course concepts. At the end of a program of study, you'll take tests to become licensed or certified, and once you have launched your career as a professional, you will take them to demonstrate your continued competency. Developing a plan for test-taking success will be useful throughout your career.


Test-taking success involves both preparation and execution; they are equally important. Use the following seven steps before, during, and after each test, as indicated.



1. Understand the purpose of the test and know its date, time, location, and scope. Preparing for the test begins when you learn that you will be taking it!! If the test is part of an academic course or program, you will likely learn about it on the first day of class. If the test is administered to assess competency or as part of the licensing or certification process, be sure you understand the time frame in which the test is offered.


Be sure you also understand the scope of the content that will be tested. For example, will the test cover only the most recent module or the entire course? Find out where the test will be given (in a classroom, at a test center, or online, for example), the type of examination being given (written examination, clinical simulation using a mannequin or patient surrogate, or clinical practice with a patient surrogate, for example), and the length of time allotted. Find out how the test will be weighted in terms of the total grade or competency assessment. Know, too, what's at stake; for instance, is it a course final or licensing examination, the results of which will determine whether you pass the course or become licensed to practice? Learn as much as you can about the test as soon as possible.


2. Determine what types of questions will be asked. If you'll be taking a written test, it's helpful to know what kinds of questions are likely to be asked. Although essay and short-answer tests are not uncommon, most teacher-written and standardized tests use multiple-choice questions and variations thereof. The following are examples of the types of questions currently used on the National Council Licensure Examination-RN (NCLEX-RN)1:


* multiple-choice (four possible answers to a question are provided, but only one is correct; you must choose the one correct answer)


* multiple-response (four to seven possible answers to a question are provided, of which one or more is correct; you must select all that are correct)


* fill-in-the-blank (a question requiring a calculation is presented; you must enter a numeric answer. For example, you may be asked to supply a drug dosage, iv drip rate, or intake-output values.)


* "hot-spot" (an illustration is provided and you are asked to identify a particular feature; you must use the mouse to click on the correct response. For example, you might be asked to identify a particular feature on an anatomic chart.)


* chart or exhibit (a scenario and a patient's chart are presented; you must find and interpret the relevant data in the chart to make a clinical decision)


Many faculty members integrate all of these types of questions into their own course-specific examinations.


3. Prepare. Learning nursing content and application for critical thinking and clinical decision making requires focused study-as much as two to three hours for every course credit. Studying should start the day you know you will be taking a test. Here is a list of student-tested study strategies-find the ones that will be most helpful to you and make them part of your plan for test-taking success.


* Attend class and participate actively: take notes during class, review them immediately afterward, and add any missing information. Develop your own test questions after each class to evaluate your understanding and ability to apply the content.


* Review your notes often. Studying for short periods on a regular basis leads to better retention than "cramming."


* Find a "study buddy" or form a pretest study group. In my experience, students indicate that studying for examinations with others allows them to save time, pool resources, and clarify their understanding of and ability to apply the content. It's best to keep study groups small-four to six members usually works well-and to establish an expectation that everyone will come prepared to study not only the specific course content, but also its application to clinical situations.


* Identify your preferred learning style, and use this knowledge to your advantage. For example, auditory learners learn best by listening. If you're an auditory learner, consider taping the class (with the instructor's permission) or taping yourself reading your notes aloud and listening to the tape after class. Visual learners learn readily when they see things. If this is your style, taking notes and creating diagrams or presentation slides will help you retain what you learn. Kinesthetic learners learn best by touching and moving. If you're a kinesthetic learner, use mannequins and models and draw concept "maps." Using a variety of methods across learning styles also reinforces learning.


* Practice taking tests that are similar to the one you will be taking. For example, if the test is a multiple-choice test to be administered online, practice using the online testing system (most faculty members have created practice tests for this purpose). Review books for licensing or certification examinations, which usually come with a CD-ROM, typically provide practice questions in written and electronic formats.


* Use practice questions that are of the complexity level of those on the test. Most nursing examinations require the test taker to apply information to clinical practice, analyze data to make a nursing diagnosis or clinical decision, and adapt clinical practices for individual patients. If you study only to memorize facts, you won't be prepared for tests that require you to analyze data and make decisions.


* Study major concepts and nursing implications. High-stakes examinations test your ability to think and act like a nurse, so you should approach studying in terms of what a nurse-not a physician or another health care provider-would do. At the same time, you must also consider the role of the nurse in relation to the rest of the health care team; ask yourself questions such as "What can a nurse delegate to unlicensed personnel?" and "When should the nurse make a referral to another health care professional?"


* Attend pretest review sessions. Review sessions may be offered by faculty before course examinations and, in the case of licensing or certification examinations, by commercial or professional organizations.



4. Read the test directions and questions carefully. First, if possible, skim the entire test. Note whether some questions have a greater point value. If the test is administered electronically, be sure you understand how to mark, change, and submit your answers. Next, be sure you understand the components of each test question. For example, all multiple-choice questions have a scenario (essential data on the patient or situation), a stem (the question), and several possible answers, one or more of which is correct and others that are incorrect. Here's one approach to answering a multiple-choice question:


* Read the scenario and focus on the data provided.


* Read the stem-the question-and paraphrase it to be sure you understand what is being asked.


* Answer the question before looking at the answers.


* Read all of the provided answers.


* Choose the correct answer; if you aren't sure, eliminate the incorrect answers to isolate the correct response.


* Verify that your answer is correct-skim all possible responses and double-check that you've marked the response you had intended to.


* Mark the answer as instructed. If you are taking a computer-administered test that requires you to select an answer and then click "submit," be sure to do both.


If you cannot answer a question quickly or use logic to arrive at a plausible answer, move on to the next question. Most tests have a time limit; don't spend valuable time trying to solve difficult questions until you have answered all those that you can answer quickly.


5. Manage anxiety. All test takers experience some degree of anxiety. If anxiety is too great, however, it can interfere with performance. Anxiety can be managed by being prepared and by coming to the test well rested and after having eaten. If anxiety mounts, try these suggestions to help yourself stay calm:


* Use positive self-talk.


* Breathe deeply.


* Try smiling, which is relaxing.


* Answer the easier questions first (you will gain confidence as you go along).



6. Obtain your results and follow up. Immediately after the test, reflect on what went well and what you would have done differently. Consider both how well you prepared and how well you performed during the test. Look up answers to questions that you aren't sure you answered correctly. Then, relax and await the results.


Your instructor or the testing agency will let you know when and how results will be made available. Do not ask for your results earlier, and don't assume that a delay means you did poorly. Once the results are available, find out as much as you can about what questions you missed and look for patterns that may reveal areas of difficulty. Ask yourself which test preparation strategies were effective and which may need to be modified. If possible, review the test itself. If there is a posttest review session, attend it. Make an appointment with your instructor to review the test if necessary.


7. Evaluate and revise your test-taking skills. Use the results of each test you take to reassess your test-taking capabilities and improve your preparation for and performance on the next one.


Taking teacher-written, standardized, and licensing or certification exams is an important part of becoming a nurse and advancing your career. If you use them, these seven steps will allow you to perform at your best in test situations throughout your career.




1. National Council of State Boards of Nursing. NCLEX alternative items: fast facts about alternate item formats and the NCLEX examination. The Council. 2006. [Context Link]