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. Taking multiple-choice tests effectively requires a combination of test-taking strategies, time management, and a solid understanding of the subject matter. Here are some tips to help you succeed.

• Read the Instructions: Carefully read the test instructions and any specific guidelines provided by the instructor. Understand the scoring system, whether there’s a penalty for guessing, and any other important details.
• Focus on Keywords: Pay close attention to keywords in the question and answer choices. Sometimes, one word can make an option incorrect or correct.
• Question Stem: 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.
  • 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.

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%.

• 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 range for a 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.

• Use Context Clues: Consider the context of the question and the material covered in the course. Sometimes, you can infer the answer from related information.

• Using a Benchmark. After you read the first answer choice, decide if you think it sounds correct or not. If it doesn’t, move to the next choice. But if it does, mentally mark that answer choice. This doesn’t mean that you’ve decided it is the right answer. It just means it is the best one you’ve seen thus far. This answer becomes your standard by which you measure all other answers.
  • All other choices must be benchmarked against that standard. That choice is correct until you find one that is better. When you decide that no other answer is as good as the standard, make sure it answers the question before making it your final choice.
  • Valid Information. Remember that all the information in the question is valid and may be needed to determine the correct answer. This is not true for all the information in the answers. They are designed to distract you and frequently contain superfluous information. If it appears that two unrelated topics are discussed in the question, do not ignore either one. If you first determine the relationship between the topics, then you will be better able to answer the question correctly.
  • Difficult Words. Don’t choose an answer just because it is the only one with words you recognize. Test writers don’t put make-believe words on the test. If you only recognize the words in one answer, make sure it is correct and answers the question before you choose it. If you can eliminate it, then you increase your chances of getting the right answer even if you have to guess.

• Try dissecting difficult words. Notice prefixes and suffixes for clues.
  •  Notice words like may, can, will often, rarely, etc.  Often an answer choice will be wrong because it doesn’t contain these words but has definitive words like ‘exactly’ and ‘always’ which leaves no room for exception.  Be alert for “switchback words such as “but”, “although”, nevertheless” which indicate a shift in thought and alters the nature of the question. Difficult Questions  Don’t waste too much time on questions that appear too hard or difficult. Try to identify any obviously incorrect answers and guess at the remaining answer choices before giving up.   Brainstorm each possible choice independently from the other choices. Ask yourself if it is possible that it could be the correct answer. When you systematically go through each answer you are often able to discover things you might have overlooked by only scanning the answers.

• Watch for Qualifiers: Be cautious of words like “always,” “never,” “only,” and “most.” These qualifiers can change the meaning of a statement and lead you to the correct answer.
• Don’t Second-Guess Too Much: Once you’ve made your choice, stick with it unless you have a good reason to change. Overthinking can lead to incorrect answers.

• Trust Your Gut: Often, your initial instinct is correct. If you don’t know an answer right away, trust your intuition, and don’t overthink it.

• If you are uncertain, guess intelligently.
• For many of the multiple-choice questions, two answer choices can be eliminated with minimal effort. This can reduce the risk of random guessing and increase your chances for success.
• Time Management: Keep an eye on the clock. Don’t spend too much time on a single question. If you’re unsure, make an educated guess and move on. You can return to it later if you have time.

• Do not agonize over any one question. Stay within the budget for each question.
• Determine the correct answer before you even read the answer choices.

• Stay Calm: Stay calm and focused throughout the test. Anxiety can affect your performance, so take deep breaths and manage stress.
• Don’t Leave Any Questions Blank: In most cases, there’s no penalty for guessing, so make sure to answer every question. If you’re unsure, make an educated guess.
• Prepare in Advance: Effective multiple-choice test-taking begins with good preparation. Study the material thoroughly and understand the concepts, so you can approach the questions with confidence.
• Practice with Sample Tests: If you can, practice with sample multiple-choice tests to get a sense of the format and types of questions you’ll encounter.
• Sleep and Nutrition: Get a good night’s sleep before the test, and have a nutritious meal to ensure your brain is functioning at its best.

Remember that different strategies work for different people, so adapt these tips to your personal preferences and the specific requirements of your test. Practice and experience will also improve your multiple-choice test-taking skills over time.