Family Practice and Adult Gerontology Primary Care Nurse Practitioner Certification Examination Review Questions and Strategies (Print Replica) (Ebook PDF) No Waiting Time
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                    Sharon K. Byrne, DrNP, CRNP, NP-C, AOCNP,            Denese Sabatino, MSN, ARNP-C, CCRN
                    CNE                                                  Nurse Practitioner/Clinical Educator, Department
                    Co-Chair, Department of Nursing                      of Critical Care
                    Assistant Professor, School of Nursing, Health and   Cleveland Clinic
                    Exercise Science                                     Weston, Florida
                    The College of New Jersey                            Baptist Hospital
                    Ewing, New Jersey                                    Miami, Florida
vii
        We would both like to thank the entire F. A. Davis team, especially Susan
        R. Rhyner, Senior Acquisitions Editor, for her vision, enthusiasm, and sup-
        port; Marcia L. Kelley, Developmental Editor, for her expertise, efficiency,
        and good humor; and Amanda Minutola, Echo Gerhart, Dan Clipner, and
        Christine Becker, Editorial and Production Managers, for hanging in there
        with us every step of the way!!! Day by Day!
                                                                     JW-B & LMD
viii
                    UNIT ONE                                                                          1
                    Introduction                                                                      1
                    1.    Achieving Success on a Certification Examination                             3
                          LYNNE M. DUNPHY and GARY LAUSTSEN
                    2.    Test-Taking Skills and Designing Your Study Plan for APRN Certification      9
                          LYNNE M. DUNPHY and GARY LAUSTSEN
                    UNIT TWO                                                                        25
                    Evaluation and Promotion of Client Wellness                                      25
                    3.    Health Promotion                                                            27
                          JILL E. WINLAND-BROWN
                    4.    Care of the Emerging Family                                                 55
                          DONNA C. MAHEADY and JILL E. WINLAND-BROWN
                    5.    Growth and Development                                                      85
                          LYNNE M. DUNPHY
                    6.    Health Counseling                                                          117
                          LYNNE M. DUNPHY
ix
INTRODUCTION
                       Certification Examinations
                       American Nurses Credentialing Center
                       American Academy of Nurse Practitioners Certification
                        Program
                       Achieving Success
                       References
                                                                                                             Lynne M. Dunphy
                                                                                                            and Gary Laustsen
                   With the purchase of this book, you have taken a            programs, and most states require individuals to main-
                   major step to achieving or maintaining your cer-            tain their RN license to apply for and maintain their
                   tification as an advanced practice registered nurse         APRN license. All but a few states currently require
                   (APRN). The earlier in your educational process you         certification to apply for an APRN license. In addition
                   begin preparing for the certification examination, the      to the states’ requirements of certification for licen-
                   greater your chance of success. This book will help         sure, clinical facilities, employers, and insurance pay-
                   you understand the certification process and the steps      ers require certification.
                   you need to take to succeed on the certification exam-
                   ination of your choice.
                                                                               CERTIFICATION
                                                                               Certification is the process by which a nongovern-
                   Certification and Why It Is Important                        mental agency or association grants recognition to
                                                                               an individual who has met certain predetermined
                   There are basic differences between becoming licensed       standards for practice. For APRN certification, this
                   (a process you complete with your state’s board of          is achieved through the successful passing of a cer-
                   nursing or similar entity) and becoming certified. An       tification examination. Becoming certified is the
                   understanding of these differences is important.            standard for APRN professionals. As of this writing,
                                                                               only New York, California, Indiana, and Kansas do
                                                                               not require certification prior to obtaining licensure
                   LICENSURE
                                                                               to practice as a family nurse practitioner (FNP) or
                   Licensure is a legal requirement of each state to prac-     adult-gerontology primary care nurse practitioner
                   tice nursing in that state. The purpose of licensure is     (AGPCNP).
                   to protect the public from unsafe practitioners. Legal           Certification exams, based on an analysis of cur-
                   regulation of nursing practice (whether at the RN or        rent practice, validate entry-level knowledge in an
                   APRN level) is the joint responsibility of the state leg-   advanced nursing specialty in a defined population
                   islature and the state board of nursing (and in some        area. Certification exams are competency-based ex-
                   states the board of medicine). Registered nurse (RN)        aminations that provide a valid and reliable assess-
                   licensure is a requirement for enrolling in APRN            ment of entry-level clinical knowledge and skills of a
                                                                                               APRN Specialties
                                                                 Focus of practice beyond role and population focus linked to health-care needs
                                                     Examples include but are not limited to Oncology, Older Adults, Orthopedics, Nephrology, Palliative Care
                                                                                                 Population Foci
            Licensure occurs at levels
            of role & population foci
APRN roles
Figure 1-1
                   TABLE 1-1. REQUIREMENTS TO SIT FOR                          TABLE 1-2. ANCC FAMILY NURSE
                   NURSE PRACTITIONER CERTIFICATION                            PRACTITIONER CERTIFICATION
                                                                               EXAMINATION CONTENT OUTLINE (2016)
                   ANCC                   AANP
                                                                               DOMAINS OF               NUMBER OF PERCENT OF
                   • Present final,       • Be a graduate (or imminent         PRACTICE                 QUESTIONS QUESTIONS
                     degree-conferred       graduate) of an accredited
                     transcripts            Master’s NP, post-graduate          Foundations for               64             37
                   • Present validation     NP, or DNP program                    Advanced Practice
                     of Education         • Present official final              Professional Practice         30             17
                     Form signed by         transcript with date degree         Independent Practice          81             46
                     program director/      conferred
                                                                                Total                        175            100
                     faculty              • Complete program faculty–
                                            supervised clinical clock
                                            hours
                                          • Hold a current RN license          describes the major categories and domains of practice,
                                                                               as well as related topics and subtopics, which are cov-
                                                                               ered on the examination. The examination currently
                                                                               consists of 200 questions, 175 of which are scored and
                   2015. You must keep abreast of both of these creden-        25 pilot questions that are not scored. The nonscored
                   tialing Web sites for continued and changing infor-         questions cannot be distinguished from the scored
                   mation regarding the details and processes for taking       items.
                   the certification exam. To qualify to take an examina-          The TCO includes information about how the
                   tion and become certified at the APRN level, a nurse        content is weighted—that is, how many or what
                   must (1) meet the requirements for clinical or func-        percentage of the test questions are in each of the
                   tional practice in a specialized field and (2) provide      major domains. Table 1-2 lists the major categories
                   evidence of successful completion of an approved            or domains of practice for the FNP examination and
                   Master or Doctor of Nursing Practice curriculum.            includes an approximate number of questions and
                                                                               the overall percentage for each category. To facili-
                                                                               tate understanding of each of the major domains, the
                                                                               ANCC also includes subcategories in a topical outline
                   Certification Examinations
                                                                               format. Table 1-3 provides similar information for the
                                                                               AGPCNP examination.
                   This book is geared toward the person who is seeking
                                                                                   The importance of reviewing the current handbook
                   national certification as an AGPCNP and/or FNP.
                                                                               and TCO before sitting for the examination cannot be
                   The AGPCNP certification examination is designed
                   to assess your abilities as an APRN in the delivery of
                   primary care services to an adult population, defined as    TABLE 1-3. ANCC ADULT-
                   adolescence through old age. The gerontological nurse       GERONTOLOGICAL PRIMARY CARE
                   practitioner (GNP) certification is no longer offered       NURSE PRACTITIONER CERTIFICATION
                   by either ANCC or AANPCP.                                   EXAMINATION CONTENT OUTLINE (2016)
                       The FNP certification examination is designed to
                   assess your abilities as an APRN in the delivery of pri-
                   mary care services across the life span, including pre-     DOMAINS OF               NUMBER OF PERCENT OF
                   and postpartum care, pediatric primary care, and the        PRACTICE                 QUESTIONS QUESTIONS
                   care of older adults. This spectrum of care is sometimes
                   referred to as “cradle to grave.”                            Foundations of                51            29%
                                                                                  Advanced Practice
                                                                                  Nursing
                   AMERICAN NURSES CREDENTIALING                                Professional Roles            51            29%
                   CENTER                                                       Independent Practice          73            42%
                   The ANCC Web site contains the certification hand-           Total                        175           100%
                   book, including a test content outline (TCO) that
        overstated. All questions are classified according to life   an additional 30 minutes for check-in and practice
        span and problem-focused content areas. The life span        time at the computer, including a tutorial. Because it
        dimension for the AGPCNP examination includes                is a computerized examination, you will receive your
        non–age-specific content as well as specific content         score 3 to 5 minutes after completing the examina-
        pertaining to the adolescent, the adult, and the aging       tion. A passing score is 350 or higher of a possible 500
        adult. The FNP life span dimension includes the same         points; 2014 statistics reveal 80.5% of AGPCNP and
        content as the AGPCNP examination plus content               73.8% of FNP candidates passed on their first attempt.
        relating to children, infants, and childbearing women.       If not successful, a candidate can apply to retest after
        The gerontological population is defined as persons          90 days.
        older than age 65.                                                You will need to be recertified every 5 years. At
             The last dimension is related to problem areas and      present, 500 hours of active practice must be attested
        organizes question content by body system—for exam-          over the previous 5 years. Additionally, continuing
        ple, cardiovascular, endocrine, and respiratory.             education credits and/or academic credit must be doc-
             What this means is that each test question in the       umented. If not able to clinically practice, or if there
        Foundations for Advanced Practice and the Indepen-           is a lack of continuing education and/or academic
        dent Practice domains is characterized across three          credit, a practitioner may elect to retake the certifi-
        dimensions. For example, a test question that asks           cation examination as a way of demonstrating current
        about the treatment of a 70-year-old woman with a            competency. Please check the ANCC Web site for the
        diagnosis of osteoporosis would be characterized as          most current information because guidelines for recer-
        follows:                                                     tification are subject to change.
                   for the FNP and AGPCNP exams. Examinees must be              about cultural differences and cross-cultural commu-
                   able to integrate knowledge of pathophysiology, psy-         nication, will be integrated with content concerning
                   chology, and sociology with the assessment, diagnosis,       specific aspects of diagnosis, pharmacology, and dis-
                   and treatment of patients in primary care. Knowledge         ease management.
                   of health promotion and disease prevention, as well as            Questions testing physical assessment and
                   management of acute/episodic and chronic illness in          history-taking skills, as well as content from advanced
                   the primary care setting, are tested.                        physical assessment, remain prominent. Although a
                        The AGPCNP examination tests knowledge of               certain amount of basic pharmacological content is
                   adolescent, adult, and geriatric primary care; the FNP       included, the latest drugs and pharmacological inter-
                   examination tests clinical knowledge of prenatal,            ventions may not always appear because the examina-
                   pediatric, adolescent, adult, and geriatric primary care.    tion questions are prepared and tested well in advance.
                   These examinations use growth and development                (Note: Questions about your knowledge of safe pre-
                   as the basis of age-related changes, and specific age        scribing for pregnant women almost always appear on
                   parameters are not defined for any population.               the FNP examinations.)
                        These AANPCP examinations have a pass rate                   Be careful in applying your experiences from
                   of 87.5% for FNP and 85.7% for AGPCNP according              clinical activities as a student or as a newly certi-
                   to 2014 data. They are also computer-based examina-          fying APRN. The correct answer and other answer
                   tions offered year round. You know whether you have          choices—also referred to as “distractors”—will not
                   passed or failed at the end of the examination.              necessarily correlate with what you’ve currently seen.
                                                                                Remember, the examination reflects the ideal answer
                                                                                according to the references used and the expert pan-
                   Achieving Success                                            els of the certifying body; this ideal answer may not
                                                                                always mirror the realities of specific practices. Test
                   Nurse practitioner programs often focus on assess-           answers are drawn from national guidelines and stan-
                   ment, management, and evaluation of disease. Indeed,         dards of practice promulgated by a variety of bodies.
                   this is the role most of you perform in your respec-         New national guidelines or standards may take up to a
                   tive work settings. The ability to diagnose and treat        year for questions to be developed, piloted, and then
                   disease is paramount to your safe and effective func-        included in the exam. The questions on the examina-
                   tioning as an APRN, and certification examinations           tion are looking for generalized responses and might
                   increasingly reflect this reality. However, it is import-    well reflect phenomena that you have not seen. Allow-
                   ant never to lose sight of the fact that these exam-         ing yourself to become frustrated with the distractors
                   inations are certifying your abilities as an APRN and        will not help you but rather will hinder your ability to
                   as such have an underlying commitment rooted in              succeed. This is why it is essential that you study large
                   nursing-based knowledge, health, health promotion,           numbers of sample test items (see chapter 2).
                   and human responses to health and illness. This is                Being test savvy and succeeding on a multi-
                   especially apparent on the TCO of the ANCC exam-             ple-choice examination is a far different skill from the
                   ination. Fully 37% of content is labeled “Foundations        expert skills you bring to your practice. These skills
                   of Advanced Practice.”                                       are not mutually exclusive. It is a matter of having the
                       As an APRN, your reaction to the various                 correct mind-set—one predicated on an awareness of
                   manifestations of health and illness phenomena is            the nursing base of the certification examination cou-
                   instinctively different from that of other primary           pled with an understanding of the test blueprint. Be
                   care providers. This comes up in different ways on           determined not to select an anecdotal answer based
                   each examination, but it is an important distinction         on experience from your practice experiences but
                   to keep in mind as you ponder the various ques-              rather to select an answer based on nationally recog-
                   tion responses and wonder what answer is the best.           nized, clinically based guidelines and rooted in clinical
                   Similarly, the test blueprints and types of questions        literature.
                   asked reflect a continued commitment to concepts of               You have taken the first step toward certification
                   health promotion and disease prevention as well as           by purchasing this book. Understand the essential
                   to the underlying principles of therapeutic commu-           reasons to become nationally certified. Fix the end
                   nication skills that are so essential to forging mean-       goal vividly in your mind. Imagine how you will feel
                   ingful APRN-client relationships. Nursing-based              when you receive that message on the screen saying
                   elements of growth and development, nutrition, and           PASS, knowing that you are a nationally certified
                   therapeutic communication, as well as questions              APRN.
            Take the next step on the road to success by         American Academy of Nurse Practitioners Certifi-
        turning to chapter 2. It will assist you in the devel-     cation Program description: http://www.aanp.org/
        opment of important test-taking skills and pro-            education/aanp-certification-program
        vide guidelines for creating your individualized         American Nurses Credentialing Center certification
        study plan.                                                Web page: http://www.nursecredentialing.org.
                                                                 Dunphy, LM, Winland-Brown, JE, Porter, BO, and
        References                                                 Thomas, D: Primary Care: The Art and Science of
                                                                   Advanced Practice Nursing, ed 4. FA Davis, Phila-
        Advanced Practice Registered Nurse Consensus               delphia, 2015.
          Model for Regulation: http://www.nonpf.org/default     National Organization of Nurse Practitioner Faculties:
          .asp?page=26                                             http://www.nonpf.com/
        to the pathways or channels through which you pre-          channel. Think about which of the three learning styles
        fer to absorb information. The three types of learners      discussed works best for you. Time is often at a premium
        are commonly identified as visual, auditory, and tactile    for nurses studying for certification, and capitalizing on
        (sometimes called kinesthetic).                             your preferred learning style will help you study in the
                                                                    most efficient way. Keep strategies for your preferred
        Visual Learners                                             learning style in mind as you develop your study plan.
                   TIPS FOR STUDYING                                                 preferable. Study for short periods with frequent
                                                                                     breaks.
                   Just as a cold engine will run a little rough, settling
                   down to study when one is out of the habit can be dif-          • Integrate whatever learning modalities
                   ficult. The following suggestions should make it easier           work best for you. For example, if you are an
                   to begin studying and to return to it on a regular and            auditory learner, use recordings. Listening to
                   consistent basis.                                                 recordings while you are walking is especially
                                                                                     good for tactile learners.
                        • Create a pleasant personal environment.                  • Think in terms of “bite-size” pieces and
                          This is a very basic but frequently overlooked             structure your study plan accordingly. Use the
                          requirement for successful study. Organize                 “salami” principle: Cut large tasks into smaller
                          all your study materials in one area. Try to               ones and digest them one at a time. This will
                          create a pleasant and regular work space for               keep you from becoming overwhelmed and
                          yourself. Perhaps it will be just part of a room,          defeated before you begin.
                          but make it an inviting part. Decorate it with
                                                                                   • Variety is essential. For example, divide
                          flowers, pictures, or whatever makes the area
                                                                                     your time between test question review and
                          appealing to you. For the kinesthetic learner,
                                                                                     content review, or break up the study period
                          an open area that allows free movement may
                                                                                     into a variety of different tasks. Take notes for
                          be better than a small office. Some literature
                                                                                     part of the time and read for part of the time.
                          suggests that playing classical music, especially
                                                                                     Do not keep at any one activity—even your
                          from the baroque era, in the background
                                                                                     practice exams—for longer than 45 minutes.
                          increases concentration and retention. Decide
                                                                                     Try studying with a study group part of the
                          whether background music is helpful for you or
                                                                                     time. Discussing the materials with others is an
                          distracting. Background music may be helpful
                                                                                     especially good strategy for auditory learners.
                          for an auditory learner, whereas a visual learner
                                                                                     Although a 45-minute session is ideal for most
                          may find it a distraction.
                                                                                     of your study time and for taking practice
                        • Plan your activities in advance and be                     exams, it is helpful to experience at least one
                          realistic. Plan in advance what you are going to           practice exam with many questions (~150) to
                          work on and do not be overly ambitious. Blocks             get a sense of what it will be like when you take
                          of 1 hour at most are recommended, with a                  the actual certification exam.
                          10-minute break every 45 minutes. List the
                                                                                   • Study with your purpose in mind—in this
                          tasks beforehand; otherwise, you might spend
                                                                                     case, passing the certification exam. Research
                          valuable time trying to decide what material
                                                                                     has shown that two-thirds of your study time
                          to review. Set specific targets for the time
                                                                                     will be most effectively spent taking sample test
                          available.
                                                                                     questions. Do not lose sight of this! Studying
                        • Keep focused on the goal: becoming certified!              does not necessarily mean sitting and reading
                          Keep the benefits of studying clearly in mind—in           textbooks. Reading books in a linear fashion
                          this case, the joy of receiving your passing score,        is often not the most effective way to master
                          followed by your embossed certificate in the               information. Always keep the end result in
                          mail. Visualize and imagine what it will feel like         mind.
                          when you read the word PASS on the computer.             • Leave the environment in readiness for your
                          Picture the certificate framed and hanging in              next session. Leave your work environment
                          your office. Focus on these results and how they           inviting for the next time. Put your materials
                          make you feel. Close your eyes and allow the               away so that they are easily accessible. Do not
                          feelings to flood through you!                             leave the area cluttered; instead, make it more
                        • Use your knowledge of yourself and of basic                pleasing. Spend the last few minutes of your
                          tips. There are a number of ways you can                   study time tidying up so that your environment
                          make studying more fun. Make use of your best              is all set for your next session. This is also an
                          time of day. For some, this might mean rising              excellent time to plan what you will do the
                          early while the rest of the household sleeps               next time you sit down to study. Believe it or
                          and stealing time alone, undisturbed, with a               not, these small, concrete habits can make a big
                          hot cup of tea or coffee. For others, evening is           dent in your natural tendency to procrastinate.
             • Reward yourself. Last but not least, reward              Plan time to familiarize yourself with the technol-
               yourself! Reward yourself for each study period.     ogy before the exam begins. There are simple tutorials
               You might decide that if you spend 3 hours           to “warm you up,” helping you feel more comfortable
               studying on Saturday, you will see a movie           with the computerized format before beginning the
               on Saturday evening or go to the mall or             actual exam questions.
               treat yourself to a special activity! Be good to
               yourself.
             Now that you understand yourself better and know       Test-Taking Skills: An Acquired Art
        how to approach studying for the exam, we move on
        to providing some specific information about the cer-       The ability to select the best response to each question
        tification exams.                                           is what determines your success on the exam. Knowl-
                                                                    edge of the content is, unfortunately, not enough to
                                                                    guarantee success. If you are not able to communicate
                                                                    your knowledge through the medium of the exam, you
        Nature of the Exams                                         will not succeed in becoming certified. Succeeding on
                                                                    a certification exam is not always indicative of your
        The ANCC exam consists of 175 scored questions and          actual practice ability or intellectual capability.
        25 items being piloted that do not count in your score.
        The AANP certification exams consist of 150 scored
        multiple-choice questions, 15 of which are pilot ques-      GENERAL TEST-TAKING STRATEGIES
        tions. The exam is administered on a computer at a
                                                                    Some general principles apply to preparing for and
        testing center, and you will know within a few minutes
                                                                    taking any sort of standardized test, regardless of the
        after you complete the exam if you have passed. The
                                                                    content area. Familiarize yourself with these strategies
        questions are at a variety of difficulty levels, adminis-
                                                                    listed in Box 2-1.
        tered in an integrated format. The exams are not com-
        puter adaptive at this time. Computer-adaptive testing
        is the technique used for the NCLEX-RN licensure
        exam. With computer-adaptive tests, each answer,              Box 2-1: General Strategies
        correct or incorrect, determines the difficulty level of
        the next question a participant receives, and each par-       • Avoid changing answers.
                                                                      • Develop a self-confidence mantra to recite if you
        ticipant may answer a different number of questions to          find yourself doubting your knowledge.
        meet a minimum passing level.                                 • Develop and stick to a study plan; avoid last-minute
             The AANPCP exam as of this writing is com-                 cramming.
        posed of multiple-choice questions only. The ANCC             • Do not linger too long over one question.
        exam includes four types of questions: (1) multiple           • Focus on concepts, not details, during study
                                                                        periods.
        choice, (2) multiple response, (3) drag and drop, and
                                                                      • Focus on decreasing your test-taking time.
        (4) hot spot. Most of the test questions are multiple         • Maintain objectivity; avoid adding your own
        choice. If you are planning to take the ANCC exam,              interpretation.
        it would be helpful to review on the ANCC Web                 • Read all answer options.
        site examples of the alternative type questions. This         • Read questions as though you are speaking them
        format means that you must be able to identify key              aloud in your head to avoid scanning.
                                                                      • Time yourself in practice tests; allow 45 to 60
        words or phrases on a computer screen, not on the               seconds for each question.
        traditional paper format. Many test takers feel con-          • Use concept maps.
        strained when they are unable to underline or high-           • Use practice tests to increase confidence.
        light key words and phrases. A helpful tip: Use the           • Work on self-confidence.
        scratch paper and pencil provided to you when taking
                                                                      Source: Adapted from Sides, MB, and Korchek, N:
        a computer-based exam to write down the key phrases           Successful Test-Taking Strategies, ed 3, Lippincott Williams
        if that helps you focus on the topic and/or issue being       & Wilkins, Philadelphia, 1998, p. 77; and Dickenson-Hazard,
        presented in the question. Remember that the scratch          N: Test-taking strategies and techniques. In Kopac, CA,
                                                                      and Millonig, VL (Eds), Gerontological Nursing Certification
        paper is collected by the testing center staff before you     Review Guide, revised ed, Health Leadership Associates,
        may leave the testing area; this is done to maintain          Potomac, MD, 1996, pp. 3–5.
        test question security.
                        Achieving success on a multiple-choice test is a skill;   you with a choice between assessment and implemen-
                   and like any other skill, it can be improved. Remember         tation, you should remember these basic tips. The
                   how you improve other skills, such as playing an instru-       purpose of assessment is to validate or confirm the
                   ment or a sport: practice. The same holds true for test-       problem. When considering an answer choice that
                   taking skills. The best way to succeed on the exam is          is an assessment, you should ask yourself, “Is this
                   through practice, practice, and more practice.                 an assessment that is appropriate to the topic of the
                        The more you practice answering sample test ques-         question?” If it is, you should carefully consider this as
                   tions, the better you will become at it. That is why           a very likely answer choice. If, however, you believe
                   we have written this book for you. This book provides          the correct answer choice is an implementation, you
                   over 2,000 sample test questions. Research has shown           should ask yourself, “Do I have enough information
                   that two-thirds of study time should be spent taking           to implement what the answer choice is asking me
                   sample tests, and one-third of the time should be spent        to do?” Last, if the answer choice is asking you to
                   reviewing content. A number of exam-preparation                evaluate a situation, you should ask yourself, “What
                   books are available to you; however, very few contain          would be the outcome if I choose this answer?” The
                   nearly the number of test questions you need to develop        criteria for reference are always your textbook and/or
                   and flex your test-taking muscles. This book provides          professional guidelines, and you should avoid answer
                   enough questions to enable you to do that. Addition-           choices that are too narrow or reflective of an indi-
                   ally, reading through the answers in the rationales—           vidual practice preference. Each exam publishes a set
                   the why of the reason the selected answer is correct or        of textbook references that are used in the creation
                   incorrect—is an excellent way to expand your knowl-            of the exam questions. It is a good practice to review
                   edge base in general. It also provides insight into how        this list of text references.
                   answers are keyed—why one answer is rated as correct
                   over another answer that seems to make more sense
                                                                                  Maslow’s Hierarchy of Needs
                   to you. Remember: You will not be able to argue with
                   the certifying exam creators as to your theory about           Another important tool is Maslow’s hierarchy of needs.
                   why one answer is “more correct.” Allow yourself to            It is particularly helpful in making priority decisions.
                   “tune in” to these rationales so that you become more          According to Maslow, there are five levels of human
                   familiar with the answers that are noted to be correct.        needs: physiological needs, a need for safety and secu-
                        In addition to the general strategies for test taking     rity, a need for love and a sense of belonging, a need for
                   listed earlier, there are specific tools and strategies to     self-esteem, and a need for self-actualization. Because
                   strengthen the test-taking skills you will need for certi-     survival is grounded in basic physiological needs, these
                   fication. We will review two nursing tools and give you        needs take priority over any other human needs. It
                   some specific strategies for how to use them in testing        comes down to practicality: If you do not have oxygen
                   situations.                                                    to breathe or food to eat, your focus is not really on the
                                                                                  stability of your love life. When trying to determine
                                                                                  the priority between a physiological need of a client
                   BASIC TOOLS
                                                                                  versus a psychosocial need, remember the priority is
                   Two basic tools that are used in nursing—and that you          to meet the physical needs of the client. This doesn’t
                   should employ when taking the certification exam—are           imply that the correct answer is never psychosocial; it
                   the nursing process and Maslow’s hierarchy of needs.           simply means that survival of the species requires us
                                                                                  to address physiological needs first, before we advance
                                                                                  through the other stages of human needs. Always
                   The Nursing Process
                                                                                  think ABCs—Airway, Breathing, Circulation. Care-
                   The nursing process is a great tool when taking your           fully evaluate each item and ask yourself “What level
                   certification exam because it can guide you through            of need is the question addressing? Physiological? Need
                   problem-solving. The AANP certification exam                   for self-esteem?”
                   structures very specific pieces of information around
                   these areas (see the table of contents on the Web
                                                                                  SPECIFIC STRATEGIES
                   site). As you recall from your basic nursing educa-
                   tion program, the steps of the nursing process include         The following specific strategies should help in
                   assessment, diagnosis, planning, implementation,               answering the multiple-choice questions on the cer-
                   and evaluation (ADPIE). When a question provides               tification exam.
        Strategy #1: Understand and Analyze the                      is in the form of an incomplete statement, is in bold
        Anatomy of a Test Question                                   print.
        A multiple-choice test question consists of three parts:     EXAMPLE 1
             • An introductory statement, which sets up the          A 32-year-old woman comes to your office for a routine
               clinical scenario                                     examination. Her blood pressure is 116/74. You should
             • A stem, which poses a question or incomplete          recommend that the client have her blood pressure checked
               sentence                                              again in
             • Options, from which you must select the correct
                                                                     A.   6 months.
               answer
                                                                     B.   1 year.
             The first step in analyzing a multiple-choice test
                                                                     C.   2 years.
        question is to separate what the question tells you from
        what it asks you. The introductory statement, which          D.   5 years.
        may vary considerably in length, provides informa-
        tion about a clinical scenario, a disease process, or a          The first and most important step is to identify what
        nursing response. The stem poses a specific question,        the question is asking. You cannot expect to answer the
        which you must answer on the basis of your advanced-         question correctly until you understand the topic of
        practice nursing knowledge. Stems are worded in dif-         the question. The introductory statement of Example
        ferent ways but always contain enough information to         1 gives you information about the clinical situation—a
        answer the question. Some stems are in the form of           32-year-old female client came to your office for a rou-
        a question; others are in the form of an incomplete          tine exam and has a normal blood pressure; these are
        statement that you must complete. You must then              the topics. The stem asks you for a clinical judgment
        select the one option that best answers the question         based on your knowledge of clinical guidelines—when
        or completes the incomplete statement from a num-            should she have her blood pressure checked again? You
        ber, usually four, of potential options, sometimes called    must select the option that provides the most accurate
        distractors.                                                 response—in this case, option C is correct according
             Here are a few additional considerations in under-      to current guidelines. This question is an example of
        standing the format of questions:                            a recall (memory-based) question, sometimes called
                                                                     a knowledge-based question. You need to know and
             1. Answer options on certification exams will           recall the guidelines concerning the frequency of blood
                not include “All of the above” or “None of the       pressure measurements under different circumstances
                above.”                                              and within different populations.
             2. Answer options often have very similar                   Other test questions assess comprehension.
                wording with only a few of the words or              This is defined as “drawing inferences from informa-
                phrases distinguishing the correct answer from       tion without necessarily relating inferences to other
                the incorrect options.                               material”—in other words, using only the information
             3. Questions are not phrased “negatively.” That         that is present in the question. Test takers often fall
                means you will not have to choose an answer in       into the trap of “reading into” these types of questions—
                which the correct response is not to do something.   thinking about information that is not requested in the
                                                                     question.
             4. Abbreviations (except a few standard ones) are
                always spelled out.                                  EXAMPLE 2
             5. There are no fill-in-the-blank questions.
                                                                     A 41-year-old man comes to your office complaining of
             6. Generic drug names are used with some trade          having hit his head. While assessing his eyes, you note that
                names appearing in parentheses after the             the left pupil constricts simultaneously when the right pupil
                generic name. Don’t learn just trade names.          receives direct light. His left pupil exhibits which reaction?
             Knowing these components will assist you in ana-        A.   Direct papillary reaction
        lyzing the information presented and in focusing on
                                                                     B.   Consensual papillary reaction
        the question’s intent or issue. Let’s look at an example
        that includes an introductory statement in the form of       C.   Convergence reaction
        a clinical scenario. The stem, which in this example         D.   Corneal light reflex reaction
                        In this case, the correct answer is option B. You         Strategy #2: Identify the Questions, Critical
                   were able to comprehend the requested information              Elements, and Key Words
                   based on the exact information given in the question.
                        Nursing, however, is a practice-based discipline.         The ability to identify the critical elements and key
                   Nurses must apply knowledge to specific situations.            words in a test question is crucial to a correct inter-
                   This ability is assessed through the application ques-         pretation of the question. Critical elements, such as
                   tions designed to assess your ability to implement,            the key concepts and conditions, tend to appear in
                   solve a problem, or perform a task. Application of             the introductory statement, whereas key words usually
                   nursing knowledge is essential to safe, competency-            appear in the stem of the question. Regardless of the
                   based, entry-level advanced nursing practice. Appli-           placement of these words, remember that everything
                   cation sometimes implies analysis of information,              you need to be able to answer this question correctly is
                   meaning the question requires you to dissect and ana-          provided for you.
                   lyze information and/or distinguish between relevant                 Key words are important words or phrases that
                   and irrelevant data. The certification exam is a test          help focus your attention on what the question is spe-
                   of “minimum competency,” and simply recalling facts            cifically asking. Examples of key words include most,
                   would not provide the certification bodies with suffi-         first response, earliest, priority, on the first visit, on a sub-
                   cient information to determine your abilities. As such,        sequent visit, common, best, least, immediately, and ini-
                   you can expect the majority (up to 75%) of questions           tial. Take a look at this example.
                   to be application and analysis type questions. These
                   require you to integrate knowledge with the facts that         EXAMPLE 4
                   are presented in order to choose the single best answer        Which of the following is an example of a primary preven-
                   for each question. Review the following example.               tive intervention?
                   EXAMPLE 3                                                      A.   Blood pressure screening
                   Julie, age 18 months, is up to date with her immunizations     B.   Pap smear
                   and is due to receive her diphtheria, tetanus, and acellular   C.   Screening sigmoidoscopy
                   pertussis (DTaP) and polio vaccinations today. Her father      D.   Tetanus prophylaxis
                   is bedridden at home with AIDS. Which immunizations
                   should Julie receive today?                                        Example 4 is a recall question with a positive-
                                                                                  response stem. Although all the interventions are
                   A. DTaP only
                                                                                  preventive, the key word is primary, allowing you to
                   B. DTaP and inactivated polio vaccine (IPV)                    choose the correct answer, option D.
                   C. DTaP; IPV; and measles, mumps, and rubella                      After identifying the topic of the question, you
                      (MMR)                                                       must also identify the issue the question is asking
                   D. DTaP, OPV (oral polio vaccine), and MMR                     about. For example, the question, as in Example 5,
                                                                                  may be requesting information about a disorder.
                        You must synthesize several concepts regarding
                   immunizations to select the correct answer (option B)          EXAMPLE 5
                   for this question. You must integrate your recall knowl-
                                                                                  Mr. Williams, age 76, is seen in the ambulatory care clinic.
                   edge regarding standard and current immunization
                                                                                  He is complaining about incontinence, suprapubic pain,
                   schedules (e.g., that Julie should receive DTaP and
                                                                                  urgency, and dysuria. A urinalysis reveals the presence of
                   polio immunizations on this visit) with the specific
                                                                                  white blood cells (WBCs), red blood cells (RBCs), and
                   clinical scenario.
                                                                                  bacteria. What is your diagnosis?
                        A common error test takers make in a multiple-
                   choice testing format is to analyze the question and           A.   Pyelonephritis
                   choose the answer with their eyes. Analysis is, how-
                                                                                  B.   Nephrotic syndrome
                   ever, done with the brain. Be careful of choices that
                   “look good.” The reference for every correct answer            C.   Benign prostatic hypertrophy (BPH)
                   is grounded in textbook and/or professional guideline          D.   Cystitis
                   knowledge. A common trap that test question writers
                   use is to include answer choices that appear on the sur-          By selecting the correct answer, option D, you
                   face to be correct but are not.                                have demonstrated knowledge related to a disease
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