Multiple-Choice Test Questions

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Multiple-choice questions with four answer options may take the form of a traditional text-based question, or may be in the form of an alternate question that includes an exhibit/chart, is based on an audio clip, or contains graphics in place of some of the text. No matter the form, to effectively apply the strategies discussed in this book, you need to understand the components of an NCLEX-PN^® multiple-choice question. They are as follows:

• The stem of the question. The stem includes the situation that describes the client, his or her problems or health care needs, and other relevant information. It also includes a question or an incomplete statement. This is the question that you must answer.
• Three incorrect answers, referred to here as distracters.
• The correct answer.

The three distracters will probably sound logical to you. They may even be based on information provided in the stem, but they don’t really answer the question. Other incorrect answers may be actions that are common nursing practice but not ideal nursing practice.

The correct answer is the only choice that is recognized as correct by the NCLEX-PN^® exam, so you need to learn to select it. Remember that most answer choices are written on the application level: you will not be able to select answers based on recognition or recall. You must understand the whys of nursing care in order to select the correct response.

Read the following exam-style question. In addition to selecting an answer, identify the components of this question.

1. The LPN/LVN plans care for a 4-year-old girl who has been sexually abused by her father. Play therapy is scheduled. The LPN/LVN knows that the PRIMARY goal of play therapy for a 4-year-old is which of the following?
   1. Provide her with the opportunity to express anger and hostility by playing with dolls.
   2. Promote communication because she may lack the emotional and intellectual capacity to express her perceptions verbally.
   3. Assess whether she is functioning at an age-appropriate developmental level.
   4. Reveal through direct observation of her at play what type of abuse has been experienced.

The Components

• The stem:
  • 4-year-old girl
  • Sexually abused by her father
  • Play therapy is scheduled
  • What is the primary goal of play therapy for a 4-year-old?
• The answer choices:
  1. Opportunity to express anger and hostility. Play therapy will allow children to express anger and hostility if that’s what they want to communicate. Some students select this answer because they focus on the treatment of sexual abuse mentioned in the situation. This is a distracter.
  2. Promote communication. Play is the universal language of children. The purpose of play therapy is to give children the opportunity to communicate using their own “language.” This is the correct answer.
  3. Assess her developmental level. The nurse might be able to assess whether a child is functioning at an age-appropriate level, but this is not the primary purpose of play therapy. This is a distracter.
  4. Find out what type of abuse she has experienced. The child might communicate the type of abuse she has experienced if that is what she chooses to communicate. The nurse should focus on the purpose of play therapy, not the type of abuse. This is a distracter.

Let’s try another question.

1. A client is being treated for heart failure with diuretic therapy. Which of the following assessments BEST indicates to the LPN/LVN that the client’s condition is improving?
   1. The client’s weight has remained stable since admission.
   2. The client’s systolic blood pressure has decreased.
   3. There are fewer crackles heard when auscultating the client’s lungs.
   4. The client’s urinary output is 1,500 mL per day.

The Components

• The stem:
  • Heart failure
  • Treatment is diuretic therapy
  • How do you know the client’s condition is improving?
• The answer choices:
  1. Weight has remained stable. The client’s weight should decrease because he is taking a diuretic. Weight addresses issues involved with diuretic therapy. However, it is not the best indication of improvement in a client with heart failure. This is a distracter.
  2. The systolic blood pressure has decreased. Decreased blood pressure may be the result of diuretic therapy, but the reduction could also be due to other causes (change of position, calm rather than an excited state, etc.). This is not the best indication of an improvement in a client with heart failure. This is a distracter.
  3. There are fewer crackles. A client with heart failure has crackles due to pulmonary edema. Diuretics are given to promote excretion of sodium and water through the kidneys. Decreased crackles would indicate that the pulmonary edema is improving. This is the correct answer.
  4. Urinary output of 1,500 mL in 24 hours. This is within normal limits. Although a normal output addresses diuretic therapy, it is not the best indication of improvement of heart failure. This is a distracter.