Most nursing school exams, use a multiple-choice format, however, you might also see multiple answer format, hot spot (or point at the answer on an image), or a case study format. Before taking an application exam, students need to develop some test-taking savvy.

The question stem consists of the necessary “background” information or context then a question or an unfinished statement.

The stem begins with a patient scenario or other key information which usually includes the central idea, problem, concept, definition, or procedure. Images could also be included. In an application-level question, information in the stem covers the context to help you understand what is occurring.

Example:
Mr. G is 87 years old; he has been admitted with congestive heart failure and pulmonary edema. He has been on a nonrebreather mask at 15 liters/minute. Today his oxygen saturation levels have been dropping to less than 87%.

After the student has read the context, a question is posed. The student must decide how to answer based on the answer choices provided.

The question is usually worded in one of two basic formats: (1) a question, or (2) a partial sentence (sentence fragment). Let’s look at some example questions.

What would you tell Mr. G’s wife?
or You should explain this situation to Mr. G’s wife as …

Therefore, the patient scenario (i.e., what is happening), along with the question, constitutes the entire stem.

The answer options

In a multiple-choice test item, there are several options. Usually, there are 4 options, but occasionally there are 3 or 5 options. There are two kinds of options within one exam item: The correct answer, and the distractors.

The correct answer. One option is the correct answer.

Distractors. The other options are called distractors. A distractor is an incorrect response used to give you other possibilities to answer.

The example (#4 above) is an application-level question. Why? The question asks you to make a decision based on a case scenario. First, you must know what a normal pulse ox is. Second, you must know how many liters/minutes of oxygen given in a

nonrebreather mask is the maximum.

Learn how to deal with keywords in the stem

An exam item about the MOST urgent action, the BEST response, or the FIRST step implies that more than one of the options listed might be appropriate. But only one is most, or best, or first. Very frequently, application-level exam questions have keywords in the stem.

I recommend circling that keyword or writing it down on scratch paper.