Composition and Analysis of the Multiple Choice Test Question

Stem – the question.

  • Case scenario- explains the situation.
  • Issue- the specific problem or subject of the question.
  • Analysis- focus on what you know about the issue.
    • Problem
    • Procedure
    • Drug
    • Disorder
    • Behavior

Options – choice of answers.

  • Distracters- answers that don’t answer the question.
  • Keywords- words that set priority or directionalized care.
    • General keywords
      • Early
      • Late
      • Immediately after
      • Most likely
      • Least likely
      • Initial or priority nursing action
      • After several days
      • On day of admission
    • Universal Keywords
      • All
      • Only
      • Entire
      • Every
      • Always
    • Negative Keywords
      • No
      • Not
      • Never
      • Rarely
      • Least Essential
      • Lowest Priority
      • Inappropriate
      • Contraindicated

Diagram – To make a chart, graph, or drawing with labels to identify the key parts. May also need a written explanation of the parts.

Differentiate – To find the differences between two things.

Discuss – To tell everything you know about a subject. To investigate by reasoning or argument.

Enumerate – To specify one after one item after another. To list.

Evaluate – To determine or fix the value of something. A thorough, careful appraisal and study. To state the good and the bad. To give your personal opinion.

Practice critical thinking!

  • Examine the stem
  • Reframe the question
  • Critique the stem
  • Evaluate
  1. Try to construct the correct answer before you look at the options.
  2. Identify patient-centered options.
  3. Identify opposite answers first and closely — they may be distracters.
  4. Identify specific determiners in options such as always, never, all, etc.
  5. When any part of an option is wrong, the entire answer is wrong.
  6. Some questions will have a false response; the question may ask you which action is contradicted so you should look for the wrong nursing action.
  7. Identify equally plausible or unique options.
  8. Identify options that deny the patient’s feelings, concerns, or needs.
  • Watch for key words such as always, never, all or none. Qualified statements including words like these are probably false.
  • If any part of the statement is false, then the entire statement is false.
  • There are usually more true than false answers.
  • Most true statements come right out of a textbook or lecture.
  • Make yourself work quickly; don’t pause to analyze too
  1. Match the items you are sure of first. Then match the others by a process of elimination.
  2. Read directions. Find out whether you are supposed to use each answer only once or any number of times.
  3. If each phrase can only be used once, confine your search to the matches you haven’t used. In multiple use tests, give first priority to unused choices.
  4. Find out which column has the longest phrases. Work your way down that column, which means you’ll be rereading terms in the column with the shortest entries.
  • Don’t look too hard for hidden meaning. This type of question usually expects accurate recall of key words and phrases.
  • Watch the blanks to determine the length of expected answers.
  • Answer the question completely!
  • Become familiar with exam direction words, and do what the directions tell you to do.
  • Predict the questions most likely to be asked and practice answering them.
  • Plan before you answer. Make notes on the back of the exam sheet or in the margin. Outline your answer.
  • Check your outline against the question to make sure that you are answering the question asked.
  • Do not write an introduction. Answer the question directly and forcefully in the first sentence.
  • Expand on the first sentence. Put down your ideas, facts, and details to support your first sentence.
  • Use transitions. Transitions are often called “directional words.” They point to the turn in the road that the reader should take.
  • Don’t save the best for last. If it is not included in your direct answer in the first few lines, your point may never become clear to the teacher.
  • End with a summarizing sentence or two.
  • Watch the time. If you think you may run out of time, just outline your remaining points to show the instructor that you did, in fact, have the necessary material in mind.
  • Analyze – To dissect something or break it down into its different parts. To examine relationships among the parts.
  • Choose – To select freely and after consideration. To state a preference for something. You will usually need to defend your choice; in other words, you will need to back your choice up with specific examples and personal opinions.
  • Compare – To examine the qualities of two things to discover the differences between them.
  • Contrast – To examine the qualities of two things to discover the similarities between them.
  • Criticize – To consider the merits and demerits of something and judge it accordingly. To give your judgment or opinion about something. When you criticize, you look at both the good and the bad. Constructive criticism means that you might make negative comments, but that you do so as feedback to help the other person improve or change his behavior. Criticism can be predominantly positive.
  • Define – To set forth the meaning of a word or an idea.
  • Describe – To write a detailed account or verbal picture. To tell everything you know about a subject.

The first and biggest secret to passing the NCLEX is PREPARATION. But when is the best time to start preparing?

Preparing for the NCLEX exam starts the moment you walk into Nursing School and sit at your desk. Because the NCLEX is the final determining factor whether you will become a nurse, it makes sense that you should start thinking about it and preparing for it from the very beginning. Remember, the NCLEX exam is all about critical thinking and decision making, so he earlier you start the easier it becomes as you go, because habits take time to develop.

So how do you prepare for the NCLEX while in school?

  • Master the content: Make sure you pay attention in class and learn the content as it’s taught. If you don’t understand something, ask, don’t wait until the information has built up to unmanageable proportions before asking for help. You’ll end up feeling overwhelmed.
  • Practice thinking like a nurse. As you take in the content, think of patient scenarios and how what you’re learning applies practically to those situations. Your instructors will often bring these scenarios up in class, so pay attention.
  • Use your clinical sessions as learning times. This goes in tandem with the point above. While learning skills, pay attention also to how nursing decisions are made by the nurses and how your instructor critiques your decisions. Watch how tasks are prioritized and how tasks are delegated. This is crucial thinking at work.
  • Practicing NCLEX-type questions from the very beginning. Get some good NCLEX review books that have the content arranged by topic, that way you can concentrate on the topics as you learn them and answer questions that are relevant to what you are learning. As you practice answering questions, it will become easier to think like an NCLEX candidate.

How to ACE the NCLEX Essay and Multiple Choice Questions

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