Apply Thinking Skills to Multiple Choice Questions

Multiple-choice questions contain a stem and four options, three are distracters and
one is the correct answer.
Each question has key concept being tested ( from the exam competencies)
sk yourself, what is happening and what should ! do as a beginning nurse
Example:
patient has "ust returned from the operating room with a #oley $atheter, an !% and
an oral airway and is still unresponsi&e. 'hich nursing assessment should be made
first(
a. $heck the surgical dressing to ensure that it is still intact
b. $onfirm placement of airway
c. Examine !% site for infiltration
d. )bser&e #oley for drainage
*he key concept is priority of care for postop patient
'hat is happening( +,postop patient, oral airway, unresponsive
'hat should the nurse do( assessment, and should be made first
nother way to ask the question is what assessment takes priority when caring
for an unresponsi&e postop patient with an oral airway(
'hat would the nurse need to know in order to answer this question(
-.
.atent airway is necessary
/$ used for priority setting
$ommon response to anesthesia is lack of gag reflex
$orrectly placed oral airways will maintain an open airway.
&oid reading into the question
0tudy the rationales for the right and wrong answers of the question that you get
wrong
!dentify key words that set a priority and use principles based on theory1
.hysiologic needs need to be met first before higher le&el needs (Maslow
2ierarchy of 3eeds)
4isbelief and denial are usually a person5s first response to news of a loss or
anticipated loss
Meeting needs of patient comes first o&er other tasks
.atient readiness to learn must be assessed first before teaching
patient5s emotional status must be assessed as part of the nursing process
3urses need to use inter&iewing techniques to effecti&ely communicate in a non-
threatening way
*he nurse must deli&er care in a non-"udgmental manner
Maintain an airway is always a priority
.atient5s safety is always a priority
ssessment first before inter&ention (nursing process)
$lues in the stem- sometimes a word is used intentionally in both the stem and one of the
options.
!dentify the central person-sometimes it is not the patient but family, child or spouse
!dentify patient-centered options-nursing pro&ides both physical and emotional care to
people, so the focus should be the patient5s concern
Example6
'hen assisting a patient with 7 amputation, the patient begins to cry and says, ,! am
useless with one leg.8 'hat is the nurses5 best response(
a. ,9ou still ha&e one good leg8
b. ,:osing a leg can be difficult8
c. , prosthesis will make a big difference8
d. ,9ou will feel better when you can use crutches8
)ption ; denies feelings1 option < is patient centered focusing on feelings by using an
inter&iewing technique of reflection1 )ption = and > pro&ide false reassurances
!dentify specific determiners in options such as always, never, all, every, only-usually
wrong option as something is rarely ,always8.
!dentify equally plausible distracters - usually both can be eliminated
!dentify facts that are incorrect, the eliminate all options that mention it
System:
;. ?ead 0tem-underline important words, do not add information from your experience,
do not read between the lines
<. ?ead all )ptions- eliminate wrong options
=. ?eread the stem and refer back to underlined key words