STRATEGIES &

TECHNIQUES
IN TAKING THE EXAM
Irene M. Magbanua, RN
Professional Review Specialist
St. Paul University Manila
 FIRST- FIRST IN THE TEST QUESTION:
 F
 I
 R
 S
 T

Sample Question:
The nurse is caring for a patient in the emergency
department with a gunshot wound to the chest. The nurse
observes carefully for signs and symptoms of tension
pneumothorax. Which of the following will be seen FIRST:

A. Pallor
B. Crackles sound audible on inspection
C. Restlessness, sudden onset of persistent chest pain and
tracheal deviation
D. Hypertension
 MOST IMPORTANT- IN THE TEST QUESTION
 P
 S
 L
 S
 S

Sample Question:
A client diagnosed with Bipolar disorder exhibits square
dancing, unkempt appearance and have not slept for 36
hours. The MOST IMPORTANT nursing care appropriate for
this client during manic episodes will be:

A. Confront the client’s inappropriate dancing and bad body

odor
B. Send client to chestboard game to divert client’s energy
C. Let the client lad a singing group
D. Provide the client high caloric finger foods
 INITIAL- IN THE TEST QUESTION
 A
 A
 O
 P
 I
 E
Sample Question:
A child with Insulin Dependent Diabetes Mellitus (IDDM)
develops weakness and cold clammy skin. Which of the
following should the nurse do initially?

A. Give subcutaneous glucagons

B. Administer the prescribed insulin
C. Increase recommended carbohydrate in the diet
D. Check capillary blood glucose and give a glass of orange
juice
 BEST- IN THE TEST QUESTION
 M

 M

 T

Sample Question:
A client with admitting symptoms of occipital headache in
the morning, palpitations and epistaxis has been diagnosed
with HYPERTENSION. Medical and nursing management will
be based on:

A. Diet
B. Diet and regular exercise
C. Diet, regular exercise and antihypertensive
medications
D. Diet, regular exercise, antihypertensive medications
and avoidance of alcohol
 MEMORIZATION-MNEMONICS Assessment of pain/ABC’s
 P
 Q
 R
 S
 T
Sample Question:
Interventions for COPD (Chronic Obstructive Pulmonary
Disease) are the following:

A. Propranolol, 6L oxygen and rest

B. Aminophylline, Bronchodilators, Chest physiotherapy,
Deliver O2 2L, Expectorants and Force fluids
C. Bronchodilators, Betablockers and Buspar
D. Increase fluids, increase oxygen and decrease chest
physiotherapy
 RULE OF 2’S- AS A WAY TO REMEMBER TOXICITY LEVEL
 Acetaminophen -

 Dilantin -

 Aminophylline -

 Lithium -

 Digitalis -

Sample Question:
A client’s digoxin blood level is 2.2 ng/dL. The MOST
APPROPRIATE nursing actions:

A. withdraw blood and check electrolyte level

B. withhold digoxin, assess for toxicity and notify the
provider immediately
C. give client citrus juice to replace the lost of potassium
D. increase the IV, client will manifest diuresis
 NEGATIVE MODIFIERS- word or words that would make
the option incorrect

Sample Question:
The nurse is counseling a parent about the management of her 6-
year-old child who has chickenpox. Which statement by the parent
indicates that the teaching by the nurse has NOT BEEN
EFFECTIVE?

A. “I will keep my child’s fingernails cut short.”

B. “I will never send my child in school again.”
C. “If one of the chickenpox becomes swollen and ooze
yellow drainage, I will call the doctor.”
D. “I will give my child diphenhydramine (Benadryl) if the itching
becomes severe.
 POSITIVE MODIDIFIERS- Words that would
make the option correct

Sample Question:
A client who have undergone episiotomy asked the
nurse when she can resume sexual intercourse. The
appropriate response of the nurse would be:

A. “It is impossible for you to indulge in sex since it will

cause injury to the wound.”
B. “Why don’t you ask the doctor for this?”
C. Usually, it will take about 4 to 6 weeks and until
lochia ceases.”
D. “Anytime you are ready.”
 COMMONALITY
Sample Question:
A client has undergone
thyroidectomy. Which of the following
symptom is considered the
HALLMARK SIGN of THYROID STORM

A. hypotension
B. hypothermia
C. hypoglycemia
D. uncontrolled fever, 100 to 106 degree F
 PRIORITY- use ABC
Sample Question:

Which assessment area would the nurse

give the highest PRIORITY when
admitting a client to the emergency
department?

A. nutritional status
B. airway status
C. elimination status
D. psychotic status
Sample Question:
A client with a spinal cord injury at the
level of C4 has a weakened respiratory
effort, ineffective cough, and is using
accessory muscles in breathing. The
nurse carefully monitors of the following
nursing diagnoses?

A. Ineffective breathing pattern

B. Risk for impaired skin integrity
C. Risk for injury
D. Risk for infection
Sample Question:
A client for whom NARDIL was prescribed for
depression is brought to the ER with severe
occipital headaches for eating pepperoni pizza for
lunch. Which of the following interpretation is it
important for the nurse to make regarding these
findings?

A. Allergic reaction related to ingestion of processed

food
B. Hypertensive crisis related to drug and food
reaction
C. Panic anxiety related to unresolved issues,
uncontrolled anxiety
D. Ineffective individual coping related to MAOI
treatment
 THERAPEUTIC COMMUNICATIONS:
- Silence
- Stay with the patient
- Listening
- Broad openings
- Open-ended questions
- Clarifying
- Focusing on the client’s feeling
- Explore the client’s feeling
- Validate the client’s feeling
- Orientation to reality
Sample Question:
A nurse finds a newly admitted patient to the
psychiatric unit in her
room clutching her knees close to her and staring
blankly ahead.
When the nurse greets the patient, she responds in
incomprehensible
words. What would be the nurse’s INITIAL
intervention?

A. Ask the client, “Why you were brought here?”

B. Provide information regarding the whole activities of
the hospital.
C. Tell the patient, “I will stay with you until you calm
down.”
D. Begin the saying, “I will now take your history.”
Process of Elimination (POE)
 Criteria for eliminating the remaining
incorrect answer choice:
1. Choices that contain absolutes (i.e., always,
all) are more likely to be incorrect
2. Choices with qualifiers in them (i.e.,
commonly, possibly) are more likely to be
correct
3. Information repeated from the question
may be repeated in the correct response
Use Common Sense
 This requires understanding concepts, not
memorizing diseases.
Sample Question:
A client is admitted to the emergency room in a
HONKC. After ascertaining that her airway is
patent and her heart rhythm is sinus, the nurse
should assess:
A. Neurological status
B. Urine output
C. Family’s coping mechanism
D. Skin integrity
Use of Prefixes and Suffixes
 Example:
If a question contains the word hemopoiesis,
you do not need to memorize what it means.
Just think about it.
Hemo = blood
-poiesis = making,forming
Prioritization
 Priority questions may take a few
forms on the exam. They might ask
you:
1. What is the most important?
2. What is the initial (first) action of the
nurse?
3. What is the best nursing action?
4. Which client would the nurse care for
first?
Here are a few hints that can help you
find the
correct answers to priority questions.

1. Use Maslow’s Hierarchy of Needs. The

hierarchy includes (in
descending order) 1)physiological
needs (survival); 2) safety needs (both
physical and psychological); 3) a
priority question, you need to choose
the response that ranks the highest in
the hierarchy.
2. Use the Nursing Process
(APIE) to establish priorities.
You must first assess, then
plan, then implement, and
finally evaluate. Select
responses in which you assess
the client before you implement
the care.
 3. Use ABC’s. When you
encounter a question that requires
you to establish priorities, think
airway, breathing, and then
circulation. Your first priority in an
emergency situation would be to
establish a patient airway.
4. Use RACE. When you see
priority questions that deal with
fires, think: remove the clients, the
sound the alarm, call the fire
department, and finally extinguish
the fire. The safety of the clients is
the first priority.