Med-Surg Success: NCLEX-Style Q&A Review Third Edition

Book Preface

INTRODUCTION
This book is part of a series of books published by the F.A. Davis Company designed to assist the student nurse to be successful in nursing school. This book focuses on critical thinking in regard to test taking. There are the usual test questions found in review books, but the test taker will also find test-taking hints in 19 of 20 chapters. Table 1-1 indicates the breakdown of the content found on the NCLEX-RN. This book has attempted to follow this blueprint. The 2016–2019 NCLEX-RN blueprint includes additional types of alternative test ques-tions. The end of each chapter includes these new graphic types of test questions.
The most important aspect of taking any examination is to become knowledgeable about the subject matter the test will cover. There is no substitute for studying the material.
Book one of this series—Fundamentals Success: A Q & A Review Applying Critical Thinking to Test Taking, 4th edition, by Patricia M. Nugent and Barbara A. Vitale—defines critical thinking and the RACE model for applying critical thinking to test-taking skills, and the specific topics in that volume will not be repeated in this book. This book will also assist the test taker to apply critical-thinking skills directly to the questions found on nursing examinations.
GUIDELINES FOR USING THIS BOOK
This book is designed to assist the nursing student when preparing for and taking medical- surgical examinations as well as the graduate nurse who is preparing to take the national licensure examination. The book is divided into chapters according to body systems and includes chapters on pharmacology, end-of-life issues, emergency nursing, and alternative therapy; a 100-question final examination; and the DavisPlus site containing 150 additional questions. Chapters 2 through 18 are further divided into disease processes to more easily help the test taker identify specific content. A comprehensive final including other content areas as well as disease processes is included at the end of each chapter.
In the Answers and Rationales sections of the chapters, an explanation for the correct answer as well as the incorrect distracters is provided. In Chapters 2 through 18, a Test-Taking Hint is provided for every question in the content area. Each question is coded according to Bloom’s Taxonomy for categorizing levels of abstraction required for the test taker to arrive at the correct answer. As specified by the National Council of State Boards of Nursing ( NCSBN) testing information, the questions are coded by Content, Integrated Nursing Process, Client Needs, Cognitive Level (Bloom’s Taxonomy), and Concept. There are no test-taking hints provided for the comprehensive final examinations or the questions on DavisPlus. In Chapter 19, the pharmacology chapter, the test-taking hints are discussed in the beginning of the chapter.

PREPARING FOR LECTURE
In preparation for attending class on a specific topic, the student should have read the as-signment and prepared notes to take to class. Any information the student does not under-stand should be highlighted in order to clarify the information if the instructor does not cover it in class or if, after the lecture, the student still does not understand the concept.
A piece of paper, or study guide, divided into categories of information should be suf-ficient for most disease processes. If the student is unable to limit the information to one page, the student is probably not being discriminatory when reading. The idea is not to rewrite the textbook but rather to glean from the textbook the important, need-to-know information.

written in the different color pen or pencil. The student should reread the information in the textbook that was included in lecture but was not included on the study guide. When studying for the examination, the student can identify the information obtained from the textbook and the information obtained in class. The information on the study guide that is highlighted represents information that the student thought was important from reading the textbook and the instructor emphasized during the lecture. This is important, need-to-know information for the examination. Please note, however, the instructor may not emphasize laboratory tests and values but still expects the student to realize the importance of this information.
The completed study guides can be carried with the student in a folder and reviewed dur-ing children’s sports practices, when waiting for an appointment, or at any time the student finds a minute that is spent idly. This is making the most of limited time. The study guides should also be carried to clinical assignments to use when caring for clients in the hospital.
Students who prepare before attending class will find the lecture easier to understand and, as a result, those students will score higher on examinations. Being prepared allows the student to listen to the instructor and not sit in class trying to write every word from the overhead presentation.
The student should recognize the importance of the instructor’s hints during the lecture. The instructor may emphasize information by highlighting areas on overhead slides, re-peating information, or emphasizing a particular fact, which usually means the instructor thinks the information is very important. Important information usually finds its way onto tests at some point.
PREPARING FOR AN EXAMINATION
Study
The student should plan to study three (3) hours for every one (1) hour of class. For example, a course that is three (3) hours of credit requires nine (9) hours of study each week. Cram-ming immediately before the test usually indicates the student is at risk for being unsuc-cessful on the examination. The information acquired during cramming is not learned and will be quickly forgotten. Nursing examinations include material required by the registered nurse when caring for clients at the bedside. The knowledge required to care for clients builds on ALL previous knowledge as well as information newly acquired.
Understanding What the Test Taker Does Not Know
The first time many students realize they do not understand the information is during the examination, when it is too late. Nursing examinations contain high-level application ques-tions requiring the test taker not only to have memorized information but also to be able to interpret the data and make a judgment as to the correct course of action. Test takers must recognize their own areas of weakness before seeing an examination for the first time. This book is designed to assist test takers to identify their areas of weakness before the examination.
Two (2) to three (3) days before the examination, the student should compose a practice test and take the examination. If a topic of study proves to be an area of strength, as evi-denced by selecting the correct answer to the question, then the student should proceed to study other areas identified as weaknesses. Missing the question identifies a weakness. If the test taker does not understand the rationale for the correct answer, the test taker should read the appropriate textbook and try to understand the rationale for the correct answer. The test taker should be cautious about reading rationales for the incorrect distracters. During the examination, the test taker may remember reading the information but could become confused about whether the information applied to the correct answer or to the incorrect distracter.

The Night Before the Exam
The night before the examination, the student should quit studying by 6:00 to 7:00 p.m. The student should do something fun or relaxing up until bedtime and get a good night’s rest before taking the examination. Studying until bedtime or in an all-night cram session leaves the student tired and sleepy during the examination, which is just when the mind should be at its top performance.
The Day of the Exam
The student should eat a meal before an examination; a source of carbohydrate for energy along with a protein source makes a good meal. Skipping a meal before the examination leaves the brain without nourishment. A bagel with peanut butter and milk is an excel-lent meal; it provides a source of protein and sustained release of carbohydrates. Do not eat donuts or drink soft drinks. The energy from these is quickly available but will not last throughout the time required for an examination. Excessive fluid intake may cause the need to urinate during the examination and make it hard for the test taker to concentrate.
Test-Taking Anxiety
If the student has test-taking anxiety, then it is advisable for the student to arrive at the test-ing site 45 minutes before the examination. Find a seat for the examination and place books there to reserve the desk. The student should walk for 15 minutes at a fast pace away from the testing site and at the end of the 15 minutes the student should turn and walk back. This exercise literally walks anxiety away.
If other test takers getting up and leaving the room bothers the test taker, the test taker should try to get a desk away from the group, in front of the room or facing a wall. Most schools allow students to wear hunter’s ear plugs during a test if noise bothers the student. Most NCLEX-RN test sites will provide ear plugs if the graduate requests them.
TAKING THE EXAM
During the examination, if the test taker finds a question that contains totally unknown in-formation and the test taker is taking a pencil-and-paper test, the test taker should circle the question and skip it. Another question may help to answer the skipped question. Delaying moving on and worrying over a question will place the next few questions in jeopardy. The mind will not let go of the worry, and the test taker may miss important information in the subsequent questions.
During the NCLEX-RN computerized test, the test taker should take some deep breaths and then select an answer. The computer does not allow the test taker to return to a question.
Test takers who become anxious during an examination should stop, put their hands in their lap, shut their eyes, and take a minimum of five (5) deep breaths before resuming the examination. The test taker must become aware of personal body signals that indicate in-creasing stress levels. Some people get gastrointestinal symptoms and others feel a tighten-ing of muscles.