6 Ways to Tackle “Select All That Apply” Questions in Nursing Exams & NCLEX

NCLEX has increasing quantity of alternative format questions, but the one that is challenging for most candidates is the dreaded: “Select All That Apply” format of questions.  The main frustration is that the test candidate does not get credit for the entire question if not all the possible right answers are selected, or adding an option that is not accurate.  So here are some tried and true strategies that candidates have used and worked.

Content is King: “Select all that Apply” (SATA) format questions are very much like a “T & F” quiz you may have taken during nursing school.  Unfortunately, there is no short cut to preparing for the SATA questions, a candidate just has to have

enough content.  SATA questions reflect quantity and quality (precision) of your knowledge.  NCSBN item development writers love adding SATA questions to the NCLEX test bank; primarily, because in one question, a comprehensive evaluation of how well the candidate knows the topic can be tested. lected, or adding an option that is not accurate.  So here are some tried and true strategies that candidates have used and worked.

1. Extract Topic & Stem: Spend the time to 1^st understand what the question is asking by identifying topic & stem (what about the topic does the NCLEX want you to illustrate).  I train my candidates to actually spend more time looking and processing the question than looking over the options.  This is important so you have a clear goal in mind before you proceed with comparing each options against your goal.
2. Attack One-by-One: SATA questions is a “true or false,” “yes or no” type of question; thus, you proceed by comparing the options with your formulated topic & stem one at a time.  Go straight down the list, and respond with “yes” or “no,” “applies,” or “doesn’t apply.”  Pay attention to every detail of the option like frequency (qd, bid, q4 hrs., q2hrs., q shift, etc.; length of time (2-3 days, 4-6 months); and absolutes or extremes (at all times, complete restriction).   If you cannot recall the information and/or it does not make sense, it’s probably wrong.
   
3. No Take Backs: Do not overthink and go back to change your answer.  SATA questions are typically not application or analysis level questions so usually it does not need you to factor in anything and modify your response.  Unless there is something obvious you overlooked (oops, they were looking for negative responses, like “what is wrong,” vs. “what is right”), do not go back and change the answer.  At this point you either know the fact or data or not; no amount of marinating on the question will bring the answer forward, if you know what I mean.
4. Prepare Mentally: Anticipate 10-20 SATA questions during the NCLEX.  Knowing what is ahead makes all the difference in minimizing your anxiety as they approach you.
5. Practice, practice, practice!:  All of these tips will not work if you do not make it a habit to do so; so take those exams, especially the ones that have a lot of SATA questions.  Confront your fear head on!

Computer Adaptive Exam…What Does it Really Want From Me?

Have you ever wondered how the NCLEX is graded?  Have you ever received a CPR (Candidate Performance Report) stating: “above passing standard, near passing standard, and below passing standard?”  Here is a short and simple explanation, in our month’s NCLEX Review Concepts in Minutes, illustrating how the CAT (Computer Adaptive Test) works.  It explains how the NCLEX arrives at a decision regarding your level of competency as a nurse.

Have you ever taken an adaptive exam?  How was your experience?

Preparing Your Environment for a Successful Study Program

Are you ready to commit to an NCLEX Review Program?  Take a look at your current activities and first determine where, and if, you can cut back to make time for the preparation process.  Make sure you have the support of everyone around you: family friends, co-workers, and boss before you enroll.

1.     First think about and check off/write in the following:

a) What are your current roles?

Parent, grandparent, sibling, spouse, worker, other

b) What are your responsibilities & approximately how many hrs/week do you spend on each?

Helping children with homework/school activities___ hrs/wk

Caregiver___ hrs/wk

Housekeeper___ hrs/wk

Worker/job outside home___ hrs/wk

Other__________________________________ hrs/wk

 2.     Think about what you will need to modify/change to allow adequate time for review (keep in mind that it’s important to maintain balance and some exercise while you’re a preparing for the NCLEX).

 3.     Have a conversation with your family members to enlist their support. Choose a time which is available to everyone and not rushed (i.e., family dinner, weekend outing). Discuss your goal of passing the NCLEX. 

• Share your readiness to commit to a preparation program.
• Discuss the potential benefit to you and to your family (i.e., can result in a better job with a higher salary, better schedule and/or more flexibility).
• Explain that you’ve been thinking about how busy you are already and all the tasks you currently have. Explain that you’re not sure you will have the time to add more work to your packed day.

a) Allow family members to volunteer to pick up some of the responsibilities for the duration of the review program; or, request their help directly, i.e.,

– Daughter or son offers to prepare a meal one night/week

– Spouse offers to provide child care 2 days/week

– Mom’s going to need for each person to clean his/her own room

– I’m not going to be able to take care of the laundry for the next six weeks

– I can’t go to the movies or hang with you guys for the next month

5.     If you are unsuccessful gaining any support from your family, think about whether or not you can make enough adjustments in your other commitments to make room in your schedule (i.e., decreasing work hours or taking vacation; decreasing hours spent with friends).

Until you take the time to set up your environment and schedule to fit a review program; you may not be able to stick with a program long enough to see success in the NCLEX.  After you have completed this process, you are ready to start a review; now you can contact me if you need help creating a specific study plan that fits your schedule and goal.

What has been the most challenging for you, in preparing for the NCLEX?

NCLEX-PN & NCLEX-RN Test Plan Simplified

Only have 5 minutes to understand what the NCLEX wants you to demonstrate to pass…watch our latest video release: NCLEX Review Concepts in Minutes: NCLEX Test Plan.

3 Things to Work on to Improve Nursing Test Scores and Pass NCLEX

In order to create an accurate study plan specific to the student or candidate, we have to first identify the areas of weakness.  To be successful in any nursing exam, including the NCLEX, a student and candidate must have a strong foundation in content that can facilitate sound decision-making (critical thinking skills).  In addition, to further boost test scores, test-taking skills must also be addressed to prevent careless mistakes in the exam.  In my opinion, this is the most overlooked and underestimated area that can make the biggest difference in achieving desired results.

So, why did you get the question wrong?  Take one of the exams you have taken and ask yourself the following questions to identify your weakness(es).

Most candidates will have a combination of these.  It is critical that time is spent in each area of weakness, ensuring a ready candidate or student, who can walk confidently into any exam and pass.  On my next blog, I will discuss what you can do to address each area so that you can be ready and achieve your personal goals as a student and NCLEX candidate.  So what are your weaknesses?

Top 5 False Rumors About the NCLEX

1.    You can memorize all the commonly asked content and pass the exam. 

It is impossible to memorize all the questions that potentially could come up in the NCLEX-PN or NCLEX-RN.  The test bank is so vast and continuously updated.  Furthermore, ever since the NCLEX was converted to CAT (computer adaptive testing) candidates must be able to demonstrate abilities beyond memorization.  We will be releasing a video on how CAT works in August 2013, so stay tuned.  It will explain why there are no short cuts to passing the NCLEX…only preparing the right way.  In the meantime, it would be beneficial for you to watch my video presentation on what will actually be expected of you on the NCLEX.

2.   If the exam shuts off at 75 (NCLEX-RN) or 85 (NCLEX-PN) it means you passed.  If the exam shuts off at 205 or 265, you failed. 

The beauty about the CAT format is it allows for efficiency and mercy.  It will give you just enough questions to determine competency level and “shut off” when they have enough statistical proof that you would pass (or fail) even if they kept throwing more questions.  However, if you are swimming in deep and shallow waters (hovering back and forth between recall/ recognition/ comprehension levels and application/analysis levels) the exam will continue to give you chances to prove your level of competency.  NCLEX remains completely objective; and the data the candidate provides drives the level of difficulty for the following question(s).

“Only candidates whose performance was close to the passing standard, either just above it or just below it, had to answer the maximum number of 265 items. Fewer items were required for a precise pass−fail decision to be made for those candidates whose performance was much lower than the passing standard.”

– NCSBN, Sample Candidate Performance Report

3.   If you passed your program exit exam (HESI, ATI), you will pass the NCLEX.

While exit exams have the data to prove their ability to predict success in the NCLEX, there are many factors that still may affect the chances of failure.  For example, in California the system to approve applications to test has significant challenges due to lack of funding to adequately staff BVNPT and BRN.  Many candidates are waiting 3-5 months after graduation before being able to “sit” for the NCLEX.  What can happen between these waiting months is crucial for the candidate to pass.  Did the candidate put their books away, go on a long vacations, started working… or just simply got busy?  It is important to know that studies done by the predictor exams (ATI and HESI) have recommendations to sit for the NCLEX within 3 months of passing the exit exam.  When information is out of site and out of mind, it is more likely to escape from the mind.  There are many research studies that support continuous studying vs cramming to produce better learning outcomes, retention of information, and passing rates.

4.   The NCLEX will identify your weakness and give you more of “those” kinds of questions.

Some candidates have heard from inaccurate sources that it they are weak in OB for example, the NCLEX will throw more OB questions to them.  This is completely wrong.  The exam is no longer categorized using nursing subjects; rather, it categorizes the exam with client needs.  Can the candidate identify the needs of their clients (patients): Safe & Effective Care, Psychosocial and Physiological Integrity, or Health Promotion and Maintenance?  You can watch my video presentation of these Client Needs Categories to get an idea of what types of questions may fall in each category.  So a candidate must be able to demonstrate enough application and analysis level understanding of each category to pass the NCLEX.  This is why the NCLEX produces an exam report for the students that do not provide a numerical score; what you will receive is a CPR (Candidate Performance Report) that lists each category and states your level of competency in each category: “below passing standard,” “near passing standard,” and “above passing standard.”  A candidate must demonstrate and receive “above passing standard” in all client needs categories to pass the NCLEX.

5.   The SATA (Select all that apply) format questions are all knowledge/recall/recognition level.

While there may be more SATA format questions that are at the level of recall/recognition and comprehension levels, you may get a question in the NCLEX that will require you to select all the patients that require your immediate attention, or can wait, for example.  This type of question means you have enough knowledge to analyze each patients needs and use prioritization skills to answer the question.  NCSBN is constantly adding questions to the test bank for the NCLEX, and with the rise in attention to improving patient outcomes, you can count on more delegation and prioritization type of questions asked in alternate formats, which typically are not at the level of recall & recognition only.

Why Candidates Fail the NCLEX

The top two reasons why NCLEX candidates fail:

1. Poor or negative attitude

These are the “I’m just going to wing it” or “try it first” types of test-takers.  Anyway they have unlimited chances to take it, right?  May it stem from generational attitudes ingrained in nursing programs that allow re-takes, a candidate’s overconfidence, or a general lack of desire to really be a nurse, 50% of test takers who come to us cited these reasons for why they primarily failed?

Did you know that passing rates of multi-attempts test-takers drop, up to 50%, with each attempt?  Can you just imagine how repeated failure(s) can lead to lack of confidence and sometimes complete inability to trust your instincts?  Furthermore, after a failed attempt, a test-taker will then try to take multiple review classes, and use multiple review books that often times lead them to conflicting information and eventually confusion.

You cannot leave something like the NCLEX up to chance.  You must give it your best effort in the 1^st attempt and save yourself money and time (months, sometimes years of insecurity, heartaches, and self-doubt).

2. Lack of content and/or wrong method of preparation

There are some candidates that failed not because they did not study; rather, it was because they studied the wrong way.  This goes back to the understanding of the different levels of difficulty in test question construction (recall, comprehension, application, and analysis), as well as the understanding of the client needs categories (Safe and Effective Care, Physiologic Integrity, Health Promotion and Maintenance, and Psychosocial Integrity).  Did the candidate study by memorizing all the content of the different subjects in nursing?  Or, did the candidate study to the level of deep understanding of how nurses make decisions to meet their everyday client needs, using the basic knowledge they are able to recall?  Studying is not only collecting information; more importantly, studying requires the exercise of decision making process that a nurse is expected to be able to demonstrate in the NCLEX.

Picking Yourself Up From…Failing The NCLEX

One of the most challenging but rewarding experiences I have as an NCLEX Review Specialist is working with candidates that have failed sometimes 2, 3, 6 times (our record is a candidate who graduated 20 years ago and failed 7 times and passed with us on her 8^th attempt).  Almost at their breaking point, these candidates come to us for their last and final attempts.  These candidates invest so much time, emotion, and money into all kinds of review programs, books, etc. and find themselves in a never ending cycle of failed attempts.  For the last five years, I have coached many such candidates; most of the time, they failed not because they were not competent; but rather, they lacked the motivation and belief in themselves, or they just needed a little bit more guidance in navigating the preparation process.  I will now share what it takes to help them finally pass.

1. Commitment

It is important that a candidate makes a commitment to themselves; as the coach, I make myself open for every candidate but I will not be the one pushing and calling.  The candidate must be the one to ask for help.  The most successful NCLEX passers are the ones that followed every recommendation and have been consistent in communicating their learning needs.

2. Coach-ability

Coach-ability means that the candidate is open to working with their weaknesses in a productive way and not take any feedback as a personal attack.  The candidate must participate in a two-way discussion about how to progress through the program and be ready to take the exam.

3. Patience

Typically, when candidates fail, a lot of what needs to happen is building back the confidence.  Before I can work with the candidate on their content and critical thinking abilities, the belief has to be rebuilt.  For me to have the candidate performing at their peak abilities, I have them engage in activities that demonstrate to themselves that they are capable.  The doubts don’t disappear overnight; the candidates do not immediately get set on fire just with me saying, “You can do it.”  It takes a lot of one-on-one coaching (over time) and showing them that they can think and make a decision like a nurse by showing improved exam scores.

4. Trust

The trust is built when the candidate and I have a consistent conversations and follow-up regarding the completion of the assigned learning activities.  This is followed by consistent evaluation of their progress, being completely honest of where the candidate is in their preparation.  The candidate must also trust when it is recommended that they either postpone, or move up their exam dates based on their progress.

5. Individual Attention and Follow-Up

Time and time again, when I ask successful candidates what contributed most to helping them finally pass the NCLEX, they always mention: the individualized attention and follow-up.  These are things that help keep the candidate accountable and motivated, especially when they are confused and overwhelmed how to navigate the preparation process.  Upon registration, I check up on each candidate weekly on how they are progressing; this keeps the candidate on their toes, and feel the need to respond regularly with some progress.

Are you ready to pick yourself up from a fall?  If so, call us at D&D to set up a FREE readiness assessment with me! 

How to Decide When to Schedule Your NCLEX

NCLEX candidates often wonder when is it the right time to schedule their exam; I would recommend using the following to guide you:

1. What is your baseline, or where are you performing at this point?

Before I can help a candidate come up with a date to take their NCLEX, I have them take a diagnostic exam.  Based on years of data collection in terms of success (pass rate) and what our NCLEX Review Programs have proven to achieve (20% improvement with full compliance to our COMPLETE Program), I can get a more precise and realistic exam date to recommend.  For example, if a candidate receives a score of 48% in the diagnostic exam, then I know for a period of time (depending on the candidate’s ability to commit to the assigned study schedule), the program can get the candidate to about 68%.  If the candidate needs more time to work on content areas or test-taking and/or critical thinking exercises with the NCLEX Review Specialist, I would then schedule the candidate to come in to work with me or discuss over the phone additional strategies to get the candidate performing at the level needed to pass the NCLEX-PN or NCLEX-RN. 

Schedule your FREE diagnostic exam now.

2. What is your life like right now?  Can you fit in time for focused studying?

Like I mentioned above, “depending on the candidate’s ability to commit to the assigned study schedule,” some candidates may be able to give more time for studying versus others.  The most important thing to emphasize is the time for focused study, meaning minimal distractions.  I have worked with hundreds of students who have many excuses (valid and/or not) why they did not complete the assigned reading, video, or exam for the day.  We really cannot do anything about that.  It is impossible to get candidates focused when there is a wedding, new baby, new job, death, heartache, etc.  It is important for candidates to be aware of their limitations and be realistic about when they can really test.

Typically, I recommend at least 60 hours of studying for new grads and up to 150 hours for candidates who have failed before or graduated more than 3 months before taking the attempt.  There are some situations when a candidate may need more time based on additional challenges, I will discuss in future entries.

3. The sooner you act on this, the better.  Have a sense of urgency.

It is critical to schedule a date so that you are less likely to procrastinate when there is an end in close site.  There are many studies that support that the longer you have been out of school, the more information is lost.  It is only continued exposure to the information or exercise of nursing decision- making (achieved with working in the healthcare field or continuing your studying process) that will help facilitate retention of the information.  Of course, if possible, I would recommend shooting for the earliest date possible.  Just remember there is a formula to ensuring success.  Coming up with the date to test requires assessment of your readiness.

Ask an NCLEX Review Specialist to help you decide whether it is realistic to start your preparation now.