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Ep47: How to Dissect an NCLEX® Question

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I am struggling with knowing how to break down the questions. I feel like I study and study, but I can’t get good grades on my exams and quizzes. I just started nursing school and I am in nursing basics and nursing assessment.

Types of NCLEX Questions

One of the best ways to defeat the NCLEX® is to know going into it what types of questions are going to be asked.

The NCLEX® is based on a set method for writing questions known as “Bloom’s Taxonomy for the Cognitive Domain“.

In fact in the NCLEX®-RN test plan the NCSBN states:

“Bloom’s taxonomy . . . is used as a basis for writing and coding items for the examination”

So, what exactly is Bloom’s taxonomy?

Essentially it is nothing more than a method for classifying learning objectives and organizing them into levels of intellectual behavior and cognitive ability.

Originally it was developed to provide a congruent framework for teachers to write test questions and to serve as a groundwork in developing learning goals for students.

It is important to understand that each succeeding level in the taxonomy builds upon the previous (ie it is impossible to create if you do not understand).  In other words from remember to create, the learner is required to call upon a higher level of cognitive ability.

blooms taxonomy nursing nclex

This classification was originally developed in 1956 but was revised in 2001 to include the following categories from simple to complex (Anderson & Krathwohl, 2001).

  • Remember
  • Understand
  • Apply
  • Analyze
  • Evaluate
  • Create

The NCSBN further states that:

“Since the practice of nursing requires application of knowledge, skills and abilities, the majority of items are written at the application or higher levels of cognitive ability, which requires more complex thought processing.”

It’s for this reason the rumor goes around that if you have a lot of SATA (select all that apply) questions on your test then you must be doing well as these are considered to be at the evaluate level.

It is for this reason that nursing educators repeat the catch phrase “critical thinking” . . . over, and over, and over . . . . and over.

Schools UNDERSTAND that it is important for students to critically think in order to do well on nursing exams and the but they often fail in educating students past the REMEMBER level of Bloom’s taxonomy . . . (see what I did there?).

Hence the 2 hour lectures with 4,746 slides that the instructor just glazes over. Or the “read pages 2-876 tonight and your test will be tomorrow”

Unfortunately, there are a couple things wrong with nursing education that limit the students ability to progress toward the ANALYSIS level:

  • There is WAY too much to learn in nursing school in just a couple short years
  • Professors know how to say Critical Thinking, but they are not instructed on how to teach it
  • Students aren’t taught or encouraged on HOW to ask the right questions

Without getting into the changes that need to occur in nursing education too much, I will simply say that as a student it is your job to do a couple things:

  • Learn how to ask GOOD questions (your professors says Steroids cause osteoporosis . . . WHY???)
  • Learn to cut the clutter (look at each chapter . . . what is the essential information to know?)

You now have a secret weapon. . .

You know exactly what TYPES of questions the NCLEX® is going to contain.

Begin now to train yourself to think at the analysis level. Take harder questions.  This is the reason we have created analysis level questions right into the our massive bank of NCLEX Questions!.

Try Our NRSNG Academy for $1

Parts of an NCLEX® Question

Now that you know what type of questions to expect on test day, let’s move on to the actual questions themselves.

The NCLEX® is composed entirely of multiple choice questions.  Your ability to work as a nurse comes down to a single test with multiple choice answer options.

Think it’s important to understand a bit more about these questions?

Basically you have two options:

  1. Complain about the tests, the questions, and the answers.
  2. Learn everything you can about the questions and how to dissect them and demolish them.

Since only one of these options is going to get you closer to RN, let’s focus on learning how to dissect the questions.

anatomy of an nclex question

So let’s break down the anatomy of the question:

  • Item: the entire question and answer
  • Stem: the actual question, what is being asked
  • Options: possible responses
  • Correct answer: umm, the correct answer
  • Distractors: incorrect answers

Stem:

The stem will have a few characteristics that you must consider.

Complete sentence

Incomplete sentence – becomes complete with the correct answer

Positive – asks a question regarding what is true

Negative – asks a question regarding what is false.  Be very careful with these questions.  These tend to be missed more often simply because students fail to read the entire question. ALWAYS read the entire stem carefully and completely.

Look for these words when determining if the stem is negative:

  • Except
  • Not
  • Never
  • Further
  • Least
  • Avoid
  • Contraindicated

Sometimes these items will be identified with bold or italic lettering but ultimately it is your job as the student to read the question and identify what is actually being asked . . . so read carefully.

The Nursing Process

The nursing process is the foundation to everything we do for our patients.  Like it or not, understanding the nursing process is key to your success in nursing school and on the .

So what is the nursing process anyway?

ADPIE . . . sound familiar?

It should . . . if those 5 letters mean nothing to you, then it is time to crack open your fundamentals book and review the nursing process.

A- assessment

D- diagnosis

P- plan

I- implement

E- evaluate

Because problem solving and critical thinking require a framework to conduct appropriately, nursing has developed the ADPIE framework to aid in decision making with regards to patient care.

For the purpose of the it is important to treat ADPIE as a rigid set of steps . . . meaning that you don’t implement a plan until you have assessed the patient.  You don’t make a plan until you have a working diagnosis.

When reading a question it is important to identify which component of the nursing process the question is actually referring to and to select an answer that is in line with that component.

It is also essential that you work through the nursing process step by step as discussed above.

NCLEX Practice Questions

Now that you know HOW to break down NCLEX questions, it’s time to start practicing.  To help you with this we have opened up our entire bank of nursing practice questions.

Try NPQ for $1

This resource is called Nursing Practice Questions and provides you with feedback, detailed rationales, global ranking and so much more to help you know exactly how you are doing.

Putting it together

These three elements are not the end all be all to answering questions, but when used together, these three strategies will help you to identify what is actually being asked, and help you eliminate incorrect answers.

References:

Anderson, L.W. & Krathwohl, D.R. (Eds). (2001). A taxonomy for learning, teaching and assessing. A revision of Bloom’s taxonomy of educational objectives. New York: Addison Wesley Longman, Inc.

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Podcast Transcription

Welcome to the “NRSNG.com Podcast,” the podcast created by nurses, for nurses. Are you ready to take your learning to the next level? Sit back, and crank up the volume. Here’s your host, Jon Haws.

 

This is Jon with the NRSNG.com Podcast. Today, we’re going to answer another question for a student. We actually have a couple of questions that are very similar, so I’m going to address both of them quickly, and hopefully be able to help a couple of students at the same time. I know a lot of people struggle with what we’re going to talk about today. I, myself did, as well, during nursing school, until I found a couple tricks that helped. It’s not an end all, be all, but these 3 tricks are going to help you, okay?

 

Here’s the question. “I am struggling with knowing how to breakdown the NCLEX questions. I feel like I study, and study, but I can’t get good grades on my exams and quizzes. I just started nursing school and I’m in Nursing Basics, and Nursing Assessment. The basics class is my biggest issue. I like to learn through audio/visual and tactile. Whatever help I can get would be great, because a lot of knowledge isn’t going to get me anywhere if I can’t pass the tests. School has tutors, but they’re all taken. Trying to figure out how to study is another issue because there is so much information, it’s overwhelming.”

 

I want to focus on how to breakdown NCLEX questions. This is a struggle for a lot of students, because normally, on a lot of exams, prior to nursing school, we’re used to questions that are just basic knowledge questions, questions that ask if you understand or know material. What happens with nursing questions, however, is that they’re a very different type of question, and understanding what they are and how to break them down, and what’s being asked, is a very complicated task. I’m not going to lie. What we’re going to talk about today is I’m going to give you 3 tips to help you with your nursing questions. The first is the types of questions. I’m going to talk about what types of questions there are, and why they’re being asked, then we’re going to talk really quickly about the parts of multiple choice NCLEX style question, and then we’re also going to talk about the nursing process very briefly.

 

These 3 things combined are going to help you greatly with your exams. The first thing that I want to talk about is knowing what is going to be asked on the NCLEX. In order to know what’s going to be asked on the NCLEX, you need to understand that the NCLEX is based on a set method for writing questions known as Bloom’s Taxonomy, for the cognitive domain. In fact, the NCLEX-RN test site from NCSBN actually states, “Bloom’s Taxonomy is used as a basis for writing and coding items for the examination.” If the Bloom’s Taxonomy is so essential to the NCLEX, it’s important to know what Bloom’s Taxonomy is. What exactly is it?

 

Essentially, it’s nothing more than a method for classifying learning objectives, and organizing them into levels of intellectual behavior and cognitive ability. Originally, it was developed back in the 1950’s or so to provide a congruent framework for teachers to write test questions and to serve a groundwork in developing learning goals for students. Really, it was just a way for teachers in different areas, they were teaching in the same subjects, to be able to organize questions, but it’s also important to understand that each succeeding level of taxonomy builds upon the previous level. For example, it’s impossible to reach the analysis or the create level if you don’t have the basic understanding, if you can’t remember facts and things like that.

 

In other words, from the remember to create, the learner has to acquire higher levels of cognitive ability. Let’s go over what the levels are of Bloom’s Taxonomy. First is “remember,” next is “understand,” third is “apply,” fourth is “analyze,” fifth is “evaluate,” and sixth is “create.” Now, the NCLEX likes to test at the analysis level or above, so they’re not going to test a lot of questions about what you remember, or what you understand. What they’re going to want to do is evaluate what you can analyze. Here’s another quote from NCSBN. It says, “Since the practice of nursing requires application of knowledge, skills, and abilities, the majority of items are written at the application of higher levels of cognitive ability, which requires more complex thought process.”

 

I really believe that, especially with math, a lot of our math classes growing up, or our English test, things like that, they’re much more based on what we remember and what we understand. Do you remember how to add? Do you remember how to divide? Do you … Even in anatomy classes, how many bones are in the body? What’s their name? That’s all remembering and understanding, where once we enter nursing school, we’re being tested at an analysis level. We don’t care how many bones are in the body, we want you to be able to evaluate and understand when something is wrong, and what needs to be done. That’s what the Bloom’s Taxonomy is, and that’s how it applies.

 

It’s for this reason that the rumor goes around that if you’re getting a lot more [inaudible 00:05:29] “apply” type questions on the NCLEX that you must be doing well on the test, because those questions are considered to be at the evaluate type level. I hope this is making sense. It’s this exact reason that nursing instructors repeat the catchphrase “critical thinking” over and over and over and over again, because schools understand that it’s important for students to learn how to critically think in order to do well on nursing exams, but they often fail in educating students passed the “remember” level of Bloom’s Taxonomy. Schools get it, nursing instructors get it, that it’s important, but the problem is they don’t know how to teach critical thinking, and this is why there’s 2 hour lectures with 4746 slides, that the instructor just glazes over, and “Read pages 2 to 876 tonight, and your test will be tomorrow.”

 

They’re trying to give you all this information, but what they’re doing is they’re just giving you this information, and they’re not showing you how to analyze, how to think at a higher level. What they’re really doing is they’re feeding you facts to remember, and facts to cram into your head at a very low level of Bloom’s Taxonomy, and at the same time, they’re saying, “You’ve got to critically think.” Well, I think that’s a failure in nursing education, and a failure in nursing school. They need to be giving you the facts that you need to know, and the framework that you need, in order to critically think. That can be done with changing the way that students think. You have to be teaching students how to ask “why.” I really believe that this is something that’s wrong with nursing education.

 

There’s way too much to learn in nursing school, in just a couple of short years. Professor know how to say “critically thinking,” but they are not instructed on how to teach it, and students aren’t taught or encouraged on how to ask the right questions. What happens a lot in nursing school is we’re asking, “What’s on the test? What’s on the test? What’s on the test? What’s on the test? What chapter should I read? What should I learn?” The problem is, what we need to be doing instead is learn how to ask good questions that dig in deeper into the why. As a nursing student, if you’re professors aren’t going to support this, and a lot of them will, a lot of them want you to learn and want you to develop this skill, but if your professors don’t, you need to learn how to do this on your own.

 

Learn how to ask good questions. If your professor says, “Steroids causes osteoporosis,” don’t write that down. What you need to do is say, “Why? Why do steroids cause osteoporosis? Why do steroids raise blood sugars?” It does you know real good to memorize that fact if you don’t understand the process behind it. That’s our whole goal at NRSNG.com. We want you to understand the processes. Once you understand the process, you don’t need mnemonics. You don’t need copious notes, you don’t need to read 4 million chapters, because you understand what’s going on. You are able to analyze. The second you have a patient who’s getting steroids, you know not only that it’s going to raise the blood sugars, but why, and how, and you can dig in deeper, and put the whole puzzle together, because as nurses, we don’t have a patient who has 1 complication. We have a patient who has multiple complications, so we have to understand at a deeper level.

 

You need to learn how to cut the clutter from your reading. Look at each chapter, and analyze what is essential for you to know. You can’t read 400 pages a night, that’s impossible to do, especially if you’re going to try to learn the information, so you need to learn how to cut the clutter, cut through that. You now have this secret weapon. You know what’s going to be asked, you know exactly the types of question the NCLEX is going to ask. Begin now to train yourself to think at this “analysis” level, take harder questions. This is the reason that on our app, “RN Crush,” if you go to RNCrush.com, you can see it and learn more about it. We are creating most of our questions at the analysis level. It’s important to do, and that’s why it’s important to take as many questions as you can.

 

Let’s move on. The next thing I want to talk about are the parts of a multiple choice question. The NCLEX is based entirely on multiple choice questions for the most part. You’re going to be given a question, you’re going to be given a couple of options, and you’re expected to get the right answer. It’s important that you understand the multiple choice question. Your ability to work as a nurse, your ability to get the “RN” after your name, your ability to graduate nursing school comes down to multiple choice questions. There’s 75 to 265 questions is going to be what you’re graded on, and your ability to become a nurse. You have 2 options with this. Number 1, you can complain about the test, the questions, and the answers, or number 2, you can learn everything you can about the questions and how to dissect them and demolish them.

 

We’re going to go for option number 2. We’re going to learn about these questions, and we’re going to learn how to demolish them because that’s the only option that’s going to get you closer to RN, so let’s focus on that. Let’s break the questions down. Questions are broken down into a few parts. The entire question and the answer included is called “The Item.” The stem is the actual question part, options are the possible responses, then you have a correct answer, which is obviously the correct answer, and then you have distractors. Every answer that’s not the correct answer is just a distractor. Understanding those parts will help you be able to know what’s going on. The stem will have a few characteristics that you must consider. There’s a couple different types of stems. There’s a complete sentence.

 

“Which best describes a primary goal of nursing management?” Okay, that’s a complete sentence. Then, there’ll be an incomplete sentence. The sentence becomes complete once you select the correct answer. Other types of stems, you can have a positive stem where it asks a question regarding what is true. Then you can also have a negative stem. Negative stems can be much more difficult for students, and for me, I tend to get in a rush when I take tests. I get in a mode, and I just start slamming out answers. What can happen with that is that you can glance over these negative stems and miss what the questions actually asking.

 

The best way to defeat these negative questions is to understand how to recognize them and more important than that even is just to slow down enough and read every question completely because a lot of times, these negative questions, you’ll identify it as a negative question with the last couple of words of the question. Always, always, always read the entire stem carefully and completely. Here’s some words you need to look for to identify a question, a stem, as a negative stem. Words like “accept,” “not,” “never,” “further,” “least,” “avoid,” and “contraindicated.” Those are some of the words you need to look for when identifying a question as negative. “accept,” “not,” “never,” “further,” “least,” “avoid,” “contraindicated.” When that’s in there, you’re really looking for the one answer that doesn’t fit that disease process or whatever.

 

Just read the questions carefully, okay? The last thing we’re going to talk about really quick today is just the nursing process. The nursing process is the foundation to everything we do for our patients. Like it or not, understanding the nursing process is key to your success in nursing school and on the NCLEX, and in reality, as a nurse. What is the nursing process? Well, it’s the “ADPIE.” ADPIE. A-d-p-i-e. If that doesn’t sound familiar, it’s time to crack open the “Nursing Fundamentals” book and go read ADPIE again. Go read about the nursing process, and make sure you understand it really well. Surely you do, because that’s what our care plans are based on, and that’s really what we’re doing, but for the NCLEX, the nursing process becomes very important. The nursing process is “assess,” “diagnose,” “plan,” “implement,” “evaluate.”

 

Problem solving and critical thinking require some sort of framework in order to do them properly, and nursing uses the ADPIE framework to aide in decision making with regards to our patient care. As you walk into a nursing question, it’s important to understand what component of the nursing process the question is actually asking. If it’s asking an assessment type question, you need to not … Don’t select an implementation answer. Never skip a step in the nursing process. A lot of times, the best option is going to be an assessment type option. If you just walk into a question, and the questions asking you a problem with a patient, something’s going on with a patient, the first or the best answer is probably going to be an assessment type question. You need to assess to get the information that you need to make the best diagnosis and plan for that patient.

 

Stick to the nursing process. We’re taught it for a reason, and the NCSBN and just nursing education in general believes that this is a very important process to taking the best care of your patient. When putting this all together, it’s just important to understand that these 3 elements aren’t the end all be all to getting every question right on the NCLEX, but if you understand Bloom’s Taxonomy, and you understand how to ask the right questions, that’s going to condense your learning process. If you understand what questions are made of, that’s going to help you dissect the question, and understand better what’s being asked, and lastly, if you understand the nursing process, you’re going to be able to select the best options, options that don’t jump ahead or do something that doesn’t need to be done at the right time.

 

That’s really it for today. This is just a brief overview to answer your question. We’ll have more information coming soon, but one thing that I would really suggest would be to go to Amazon and get the book “Test Success: Test-Taking Techniques for Beginning Nursing Students.” You can get the old version for a penny plus shipping and handling on Amazon. That will really help you work through these questions, but I would say spend time understanding the questions, and spend time learning how to understand what’s been asked on nursing questions, because that is important. Your RN is completely dependent on you passing a multiple choice test, so it’s important to understand these tests, understand how to take them, and spend more time doing that than grade grubbing for an extra point on a single exam.

 

All right, you guys. You can do this. It’s possible. Nursing school is very hard, nursing is hard, as well, but it’s a very fulfilling career and it’s possible. You guys can do this, okay? Head over to NRSNG.com and you can find out more about some of our resources available for you there, as well our books and apps, and everything that we have for you. All right, guys. Have a great day.

 

Want a free 20 page sample of the eBook, “140 Must Know NCLEX Meds?” Visit MedOfTheDay.com to download your free PDF sample today. That’s MedOfTheDay.com.

 

Date Published - Apr 6, 2015
Date Modified - Dec 1, 2016

Jon Haws

Written by Jon Haws

Jon RN CCRN is a critical care nurse at a Level I Trauma center in Dallas, TX. His passions include learning about anatomy and physiology and teaching. When he isn't busting out content for NRSNG.com he loves spending time with his family.

15 Comments

  1. Kayla

    I am an instructor and I was sent to this website by a student during our discussion. I am a different type of instructor. I believe in “teaching” material instead of just “talking” about it. There are some topics, sometimes a lot of topics, that don’t get covered due to time and in these cases the students are needing to teach themselves. I am glad this website is here to help with this issue. I also know that everyone doesn’t learn the same way. Trying to educate using different avenues can be challenging. I feel for these students that have had horrible experiences in the classroom. I will be sending students to this site for any extra help they need. It is now a world where instructors are to “flip the classroom” and have the students teach themselves. I find this difficult to do for my class.
    TO ALL STUDENTS-please work hard and understand what you read, it makes things so much better than memorizing. Keep working hard. Thank you to Jon Haws for building this amazing site.

    Reply
    • Jon Haws

      Jon Haws

      wow. Thank you so much Ms Gaffey. I am SO happy to hear from such a motivated and sincere instructor. Thank you for all you do and for teaching students on the front lines!

      Reply
  2. Atsede Bogale

    please, can you post about blood transfusion.

    I love your work.

    Reply
  3. SB

    I was an RN student too. I had to withdraw from a college that nursing topics were taught by instructors who just read from powerpoints and did not teach the topics well so that they would be easier to understand. And yes, students are also always to be blamed by instructors, heard it enough that instructors saying i.e. it is an application issue or you must have an test anxiety issue, etc..when failing their tests. So, yes, my school also weeded people out…..only the book-smart are staying. Too bad because we all have tried so hard just to get into the nursing school. What a waste of time and especially money to go into that RN-program.
    I found Jon Haws and he does explain nursing topics so detailed, even the super hard ones, and if you have listened or watched his videos before, you will find that his type of teaching is really breaking down to details that no other instructors could or would have done better than that. I love the way he teaches and he gives a lot of freebies which is awesome. Thank you so much Jon!

    Reply
    • Jon Haws

      Jon Haws

      Shirleen,

      Thanks so much for the kind words. I am so happy to hear that our teaching is helping you and giving you confidence.

      Reply
  4. Beth Smith

    I have waited years to go to college and earn my RN. I have never been so disgusted in my life with the things that have gone on and the abuse. I don’t understand weeding out people and having a test on 13 chapters and then be tested on something irrelevant to what we learned, How we are told to not cram and that is all we have done. What about the quality of learning? Seems like everyone is just worried about getting high scores on the NCLEX to keep from being on probation and not worrying about the people trying their best to keep up. I started in the RN program with a 4.0, and now I struggle to keep in the B range. We all earned the right to be in the class and from day one, I feel I have been punished and I don’t know what I have done. I have absolutely no respect for most of the instructors, for they read the power points and then smirk when we fail a test. I have never seen anything like it. If I were to be a patient in a hospital and see one of my instructors come in to work…they’d never be allowed in my room!
    People are thinking about leaving the school and taking the NCLEX for the LPN and then changing to another school to get their RN. I want to pass and I want a good teacher. Don’t think I am a teenager complaining, I am a grandmother and I am flat disgusted.

    Reply
    • Bamabelle2118

      I have the same issue with my instructors at my school. They also ask for our feedback on how they can improve the program or teaching but when we give them feedback, they just turn around and say the class did poorly on the exam due to test anxiety. Ummm no, the entire class does not do poorly because of test anxiety; they did poorly because the material wasn’t taught well and the test questions didn’t correlate to what was taught point blank.

      Reply
      • Jon Haws

        Jon Haws

        It is frustrating when entire classes are blamed for poor test grades. I believe it is important, as an instructor, to continually evaluate HOW we teach to insure students are learning.

  5. Jenny Hopkins

    Thank you – very much appreciate the quality

    Reply
  6. Cathy378

    I believe this site will be most beneficial. Thanks.

    Reply
  7. Gena

    I absolutely love the insight and information THANK YOU ALL
    I would like to comment that some typos, example in the second paragraph under the Nursing Process, I’m sure it’s just because you were excited (lol)
    Thanks again for all of the valuable information.

    Reply
  8. Alyson Carter

    I found Mr. Haws’ books and resources on Amazon and purchased almost all of them so far in the Kindle for PC format. I do not have a Kindle, but the books are GREAT! I will be working on the NCLEX stuff through school Kaplan prep material in the next two weeks and have already begun my clinical rotations. Some of these resources have already proven invaluable to me!

    THANK YOU!

    Reply