Sample Exam: Nursing


Read the following two multiple choice exams and compare and contrast the questions and answers. Which exam targeted higher level thinking? Which one made it easier to get a correct response by guessing? Both exams test students? knowledge and understanding of Public Health.

Form A

  1. Which of these is not a characteristic of alcoholism?
  2. a. High blood pressure
    b. Swollen and irritated liver
    c. Acute sensitivity in hands and feet
    d. Increase in heart size

  3. The emotional cycling between good moods accompanied by high energy and euphoria and bad moods accompanied by low energy and despair is characteristic of:
  4. a. Depression
    b. Dissociation
    c. Bi-polar disorder
    d. Borderline personality

  5. An imbalance in electrolytes can be quickly restored by:
  6. a. Getting adequate sleep for at least one week
    b. Increasing one?s exercise regiment
    c. Drinking fluids such as juices or sport beverages
    d. Increasing the amount of fiber in one?s diet

  7. Migraine headaches are often triggered by:
  8. a. Lack of regular exercise
    b. Food allergies and stress
    c. Excessive consumption of vitamins
    d. Hyperthyroid activity

  9. According to the National Center for Victims of Crime, which statement is false regarding elder abuse?
  10. a. Approximately a half a million people over age 65 are abused per year
    b. Women are more likely to be abused than men
    c. Over 80% of the abuse took the form of care-giver neglect
    d. Many elders are financially abused by family members

Form B

  1. The nurse makes a home visit to a 48-year old female recovering from hip surgery. Which finding has the greatest implications for the client?s care?
  2. a. The only food in the house is that which has been delivered by take-out restaurants
    b. The client has placed a portable toilet in the same room as her bed
    c. The client has a neighbor who routinely mows his lawn at 7:00 AM on Thursdays
    d. The client has some rosacea around her nose and cheeks and an empty bottle of vodka in the trash

  3. A conscious 24-year client is admitted to the emergency room after being involved in a car accident. While tending the client?s injuries, the nurse notices scarring on the clients forearms and that the client has difficulty looking the nurse in the eye, which should alert the nurse to:
  4. a. Ask the client how he or she is feeling and be prepared to contact a psychiatrist
    b. See that the client has had a tetanus shot recently
    c. Monitor heart rate and blood pressure to detect tachycardia
    d. Make sure the patient?s vision has not been adversely affected by the trauma

  5. Following a client?s colonoscopy, the most important thing for the nurse to attend is:
  6. a. The client?s comfort level in passing air from the colon
    b. The client?s level of fluids and electrolytes
    c. The administration of antibiotics
    d. Ensure the client is breathing properly

  7. A 42-year old client enters the emergency room complaining of severe head pain and vomiting. The nurse documents an elevated blood pressure, asks the client to squeeze his or her hand, and escorts the client to a room where the client will wait for the doctor. What additional information is important for the nurse to report to the doctor who will see the client?
  8. a. Whether the client was recently assaulted or injured by others
    b. Whether the client has any allergies or is sensitive to light
    c. Whether the client has a family or friend to sit with the client
    d. Whether the client exercises on a regular basis

  9. A nurse makes a visit with a friend to the friend?s father, a 78-year old widowed man with Type-Two diabetes who lives alone. While in the man?s home, the nurse detects the smell of urine and notices that the man?s home is littered with unwashed dishes and dirty laundry. The most responsible and professional thing for the nurse to do is:
  10. a. Ask his or her friend why he or she is not helping the man to care for himself
    b. Make an offer to clean the house and be sure the man?s blood sugar is tested daily
    c. Express care and concern to his or her friend and offer information about in-home care
    d. Contact the county office to report that elderly abuse may be occurring in the home

Reading Comprehension

Read the following passages and answer the questions that follow.
The International Center for the Study of Psychiatry and Psychology (ICSPP) estimates that between five and nine percent of all children in the United States suffer from Attention Deficit Hyperactivity Disorder (ADHD). The disorder is characterized by the inability to sustain one?s attention or focus on an idea or task for a prolonged period. Children who suffer from ADHD are likely to have difficulty learning in traditional, formal school settings, as they are easily bored and distracted. Many also experience behavior disorders including aggressiveness towards others and impulsivity. ADHD has generated considerable concern as its causes are not completely understood and its treatments have unknown implications for those who undertake them.

In a study that examined the prevalence of ADHD world-wide, Dr. Stephen Faraone and his colleagues found that ADHD seems to be more prevalent in the United States and Great Britain than in other nations. Australia, Sweden, Iceland, and Italy reported lower incidents of ADHD than what were found in the United States, causing researchers to question the role of culture as a causal agent. Some claim that differences among national prevalence is due to the frequency and precision of diagnostic procedures. While the causes of ADHD are not known, scientists believe that contributing factors include genetics, the mother?s use of alcohol and cigarettes while pregnant, diet, and socialization.

Many scientists believe that regardless of the cause, children with ADHD are over-medicated in the United States. Dr. Peter Breggin, Director of the ICSPP, claims that treating children with stimulants, such as Ritalin, Dexedrine, and Adderall creates toxic brains and that the side effects can be deadly. Breggin reports that pharmaceutical companies have profited handsomely from the public?s willingness to rely on psychotropic drugs to solve complex behavior problems. He notes that ADHD might be better addressed through improved parenting and educational reforms. Dr. Gretchen LaFever of Eastern Virginia medical School found in a state-wide study that 84% of the children in Virginia diagnosed with ADHD took medication for their condition and that of those children, 70% were taking two different prescriptions to treat ADHD. She also found that those who were not taking medication for their condition were children without health insurance.

  1. The purpose of the first four sentences of the essay is:
  2. a. To create an interest in and compassion for the suffering of children with ADHD
    b. To provide a general understanding of the topic discussed in the essay
    c. To prove that pharmaceutical interventions for ADHD is justified
    d. To raise the reader?s awareness of legal implications regarding ADHD treatment

  3. What is the implication of the second and third sentence of the third paragraph?
  4. a. That treatment for ADHD should involve more changes in culture and behavior
    b. That treatment for ADHD in America is inconsistent with what other nations do
    c. That pharmaceutical companies have no sincere interest in children?s health
    d. That in the United States many parents do not know how to raise children

  5. An appropriate title for this reading might be:
  6. a. Bad Schools, Bad Health
    b. Getting the Diagnosis Right
    c. Psychiatric Community Challenges Corporate Medicine
    d. The ADHD Controversy

  7. The last two sentences of the essay offers evidence for which assertion?
  8. a. That parents can cause illness by not providing health care
    b. That countries with socialized medicine have less children with ADHD
    c. That Virginia has the highest rate of ADHD in the United States
    d. That insurance companies may be profiting from high rates of prescriptions

  9. The third sentence in the second paragraph suggests that:
  10. a. Many countries do not have the technology to accurately test for ADHD
    b. Some countries have a poor system of filing and tracking health records
    c. The world-wide prevalence of ADHD might increase due to better testing
    d. Repeated testing for ADHD tends to inflate the actual prevalence rates

Discussion Points

  1. Form A tended to prompt recall of facts, while Form B tended to prompt clinical judgment.1
  2. As with multiple choices tests in other subjects, multiple choice tests in nursing leaves open the possibility that students will guess correctly. Supplementing multiple choice exams with writing components offers instructors the means of understanding how well students understand procedures and how to manage situations that may be exceptions to established rules. Some prompts for one to six paragraph essays might include:
  3. a. On your hospital rotation, you are to care for a 62-year old female who had just had a bowl resection. Describe the steps you take when you first meet the patient and how you will administer care over the next 72 hours. Identify your chief priorities, how you will meet them, and which variables may cause you to alter your course of action and why.
    b. While at work at the hospital, you notice a fellow nurse taking narcotics from storage and placing it in his or her pocket. Describe what action you would take, step by step, and why.

  4. Critical reading exercises may also accompany multiple choice tests in nursing. These exercises allow the instructor to detect the degree to which students read comprehensively and critically. Multiple choice questions stemming from a reading may target the student?s ability to draw inferences, identify implications, perceive bias or perspective, discern main and peripheral ideas, detect lacunae, assess the strength or credibility of assertions and evidence, recognize proper and improper clinical procedures, and recognize ethical and professional obligations related to nursing.
  5. Following up with students after the test is important to learning. A careful review of the exam will reveal not only how well students performed in general, but allow for students to examine the rational for each test question, why some plausible answers are incorrect, and to discuss the significance of a particular idea or discrete information. Reviewing the test provides an opportunity for instructors to clarify information and deepen students? understanding. The process also alerts instructors to potential revisions that need to be made in order to proceed with the course in ways that will improve student learning.

  1. Morrison, S. and Walsh, K. (2001). "Writing Multiple-Choice Test Items that Promote and Measure Critical Thinking." Journal of Nursing Education, 40, 17-24.

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