Eliminate Incorrect Answer Choices

Now that you’ve mastered rewording the question, let’s examine how to select the correct answer.

Remember the characteristics of unsuccessful test takers? One of their major problems is that they do not thoughtfully consider each answer choice. They react to questions using feelings and hunches. Unsuccessful test takers look for a specific answer choice. The following strategy will enable you to consider each answer choice in a thoughtful way.

Step 1. Do not look at any of the answer choices except answer choice (1).

Step 2. Read answer choice (1). Then repeat THE REWORDED QUESTION after reading the answer choice. Ask yourself, “Does this answer THE REWORDED QUESTION?” If you know the answer choice is wrong, eliminate it. If you aren’t sure, leave the answer choice in for consideration.

Step 3. Repeat the above process with each remaining answer choice.

Step 4. Note which answer choices remain.

Step 5. Reread the question to make sure you have correctly identified THE REWORDED QUESTION.

Step 6. Ask yourself, “Which answer choice best answers the question?” That is your answer.

Let’s practice the elimination strategy using the same questions.

1. A preschooler with a fractured femur is admitted to the pediatric unit. When asked how the injury occurred, the child’s parents state that she fell off the sofa. On examination, the LPN/LVN finds old and new lesions on the child’s buttocks. Which of the following statements most appropriately reflects how the LPN/LVN should document these findings?
   1. “Six lesions noted on buttocks at various stages of healing.”
   2. “Multiple lesions on buttocks due to child abuse.”
   3. “Lesions on buttocks due to unknown causes.”
   4. “Several lesions on buttocks caused by cigarettes.”

THE REWORDED QUESTION: “What is good charting?”

Step 1. Do not look at any of the answer choices except for answer choice (1). Thoughtfully consider each answer choice individually.

Step 2. Read answer choice (1). Does it answer the question, “What is good charting for this situation?”

1. “Six lesions noted on buttocks at various stages of healing.” Is this good charting? Maybe. Leave it in for consideration.

Step 3. Repeat the process with each remaining answer choice.

1. “Multiple lesions on buttocks due to child abuse.” Is this good charting? No, because the nurse is making a judgment about the cause of the lesions.
2. “Lesions on buttocks due to unknown causes.” Is this good charting? Maybe. Leave it in for consideration.
3. “Several lesions on buttocks caused by cigarettes.” Is this good charting? No. The question does not include information about how the burns occurred.

Step 4. Answer choices (1) and (3) remain.

Step 5. Reread the question to make sure you have correctly identified THE REWORDED QUESTION. This question asks you to identify good charting.

Step 6. Which is better charting? “Six lesions noted on buttocks at various stages of healing,” or “Lesions due to unknown causes”? Good charting is accurate, objective, concise, and complete. It must reflect the client’s current status. The correct answer is (1).

Some students will select answer (3), thinking, “How can I be sure about the stages of healing?” But the purpose of this question is to test your ability to select good charting. Select the answer choice that shows you are a safe and effective nurse. Remember, questions on the NCLEX-PN^® exam are not designed to trick you. Stay focused on the question.

Let’s select the correct answer for the second question.

1. A construction worker is admitted to the hospital for treatment of active tuberculosis (TB). The LPN/LVN reinforces a teaching plan for the client about TB. Which of the following statements by the client indicates to the LPN/LVN that further teaching is necessary?
   1. “I will have to take medication for 6 months.”
   2. “I should cover my nose and mouth when coughing or sneezing.”
   3. “I will remain in isolation for at least 6 weeks.”
   4. “I will always have a positive skin test for TB.”

THE REWORDED QUESTION: What is incorrect information about TB?

Step 1. Do not look at any of the answer choices except answer choice (1).

Step 2. Read answer choice (1). Does it answer THE REWORDED QUESTION, “What is incorrect (or wrong) information about TB?”

1. “I will have to take medication for 6 months.” Is this wrong information? No, it is a true statement. The client will need to take a medication, such as isonicotinyl hydrazine (INH), for 6 months or longer. Eliminate this choice.

Step 3. Repeat the process with each remaining answer choice.

1. “I should cover my nose and mouth when coughing or sneezing.” Is this wrong information about TB? No, this is a true statement. TB is transmitted by droplet contamination. Eliminate it.
2. “I will remain in isolation for at least 6 weeks.” Is this wrong information about TB? Maybe. Leave it in for consideration.
3. “I will always have a positive skin test for TB.” Is this a wrong statement about TB? No, this is true. A positive skin test indicates that the client has developed antibodies to the tuberculosis bacillus. Eliminate this choice.

Step 4. Only answer choice (3) remains.

Step 5. Reread the question to make sure you have correctly identified THE REWORDED QUESTION. The question is, “What is incorrect information about TB?”

Step 6. The correct answer is (3). You “know” this is the correct answer because you’ve eliminated the other three answer choices. The client does not need to be isolated for 6 weeks. The client’s activities will be restricted for about 2–3 weeks after medication therapy is initiated.

A couple of things to remember when using this strategy:

• Eliminate only what you know is wrong. However, once you eliminate an answer choice, do not retrieve it for consideration. You may be tempted to do this if you do not feel comfortable with the one answer choice that is left. Resist the impulse!
• Stay focused on THE REWORDED QUESTION. How many of you have missed a question that asked for negative information because you selected the answer choice that contained correct information?

Here’s another question.

1. A woman admitted to the hospital in premature labor has been treated successfully. The client is to be sent home on an oral regimen of terbutaline. Which of the following statements by the client indicates to the LPN/LVN that the client understands the discharge teaching about the medication?
   1. “As long as I take my medication, I can be sure I will not deliver prematurely.”
   2. “It is important that I count the fetal movements for one hour, twice a day.”
   3. “I may feel a rapid heartbeat and some muscle tremors while on this medication.”
   4. “Bed rest is necessary in order for the medication to work properly.”

THE REWORDED QUESTION: What is true about terbutaline (Brethine)?

Step 1. Do not look at any of the answer choices except answer choice (1).

Step 2. Read answer choice (1). Does it answer the question, “What is true about terbutaline?”

1. “As long as I take my medication, I can be sure I will not deliver prematurely.” Is this true about terbutaline? No. Terbutaline will inhibit uterine contractions, but there is no guarantee that there won’t be a premature delivery. Eliminate it.

Step 3. Repeat the process with each remaining answer choice.

1. “It is important that I count the fetal movements for one hour, twice a day.” Is this true about terbutaline? Maybe. Clients are told to be aware of fetal movement. Keep it as a possibility.
2. “I may feel a rapid heartbeat and some muscle tremors while on this medication.” Is this true of terbutaline? Yes. Terbutaline is a smooth-muscle relaxant. Side effects include increased maternal heart rate, palpitations, and muscle tremors. Leave this choice in for consideration.
3. “Bed rest is necessary in order for the medication to work properly.” Is this true about terbutaline? No. Terbutaline will work whether the client is on bedrest or not. Eliminate it.

Step 4. Note that only answer choices (2) and (3) remain.

Step 5. Reread the question to make sure you are answering the right question. The question is, “What is true about terbutaline?”

Step 6. Which choice best answers the question, (2) or (3)? If you are focused on the question, you will select (3). Some students focus on the background information (pregnancy). This question has nothing to do with pregnancy. If you chose (2), you fell for a distracter.

Remember: Focus on the question, and not the background information. If you can answer the question—“What is true about terbutaline?”—without considering the background information (pregnancy), do it. Many students answer a question incorrectly because they don’t focus on THE REWORDED QUESTION. Don’t fall for the distracters.

At this point you’re probably thinking, “Will I have enough time to finish the test using these strategies?” or “How will I ever remember how to answer questions using these steps?” Yes, you will have time to finish the test. Unsuccessful test takers spend time agonizing over test questions. By using these strategies, you will be using your time productively. You will remember the steps because you are going to practice, practice, practice with test questions. You will not be able to absorb this strategy by osmosis; the process must be practiced repeatedly.