CHAPTER 2
All About the Exams
You have decided that a nursing career is right for you, and you are getting ready to apply to nursing school. Soon it will be up to you to succeed on the entrance exam. Nursing schools across America use many different exams to assess student applicants. Four of the most widely used exams are the following:
• National League for Nursing Pre-Admission Examination (NLN PAX-RN)
• Test of Essential Academic Skills (TEAS)
• Psychological Services Bureau (PSB) Nursing School Aptitude Examination (RN)
• Evolve Reach (HESI) Admission Assessment Exam
Which test you take depends on which exam is required by the school or schools to which you are applying. When you start the application process, be sure to find out which test each school requires, so that you can focus your preparation accordingly. Note that in most cases, the school to which you are applying will tell you when and where to take the admission exam.
This chapter will present important information about these different exams. You will find out what kinds of questions are on each exam, what topics are covered, and how the different exams are scored. Now let’s look in depth at each of these exams.
NATIONAL LEAGUE FOR NURSING PRE-ADMISSION EXAMINATION (NLN PAX-RN)
Format of the Test
The NLN PAX-RN is administered by the National League for Nursing, a leading professional organization for nurse faculty and others involved in nursing education. It is designed to measure your abilities in the academic areas that are central to nursing education. The NLN exam is available in two forms: a traditional paper-and-pencil test and a computer-based version. Which format you will see depends on where your test is administered. Check with your testing center. All of the questions on the NLN PAX-RN exam are multiple-choice items, each with four answer choices. The format of the test is shown in Table 2.1.
Table 2.1. NLN PAX-RN Format
How the Test Is Scored
For each section of the NLN PAX-RN exam, you receive a “raw score” based on how many items you answered correctly. Some questions on the exam are included for experimental reasons and are therefore not scored. You will also receive a “composite score” that is a weighted combination of your scores on the separate test sections. Composite scores may range from 0 to 200. In addition, you receive percentile scores for each test section and for the test as a whole. These scores are developed using a statistical process. They show what portion of a so-called “norms group” of similar test-takers earned raw scores that are lower than yours. For example, if you earned a raw score of 52 on the Verbal Ability section with a corresponding percentile score of 85, that means that 85 percent of the test-takers in the norms group earned raw scores that were lower than yours. The NLN says that for each section, percentiles ranging from about 40 to 60 indicate average performance on the exam.
Note that there is no official passing score on this exam. The schools that require applicants to take the NLN PAX-RN establish their own criteria about what scores are considered acceptable for admission.
Types of Questions
On the NLN PAX-RN exam, the Verbal Ability questions are of two types. First, there are vocabulary questions that test your understanding of specific words. These questions may look like this:
The candidates engaged in an acrimonious debate. Acrimonious means
(A) polite.
(B) public.
(C) meaningless.
(D) combative.
Answer: D. Acrimonious means “combative.”
The second type of Verbal Ability question is reading comprehension. In this type of question, you are given a reading passage of 400 to 500 words. The passage is usually on a topic in science or medicine. Following the passage are six questions about its content. Each question has four answer choices. You must pick the best answer choice based on your understanding of the passage. Here is an example:
The “food pyramid” is a visual representation of how the different food groups can be combined to form a healthy diet. Although it has been a vital part of dietary guidelines for years, the pyramid is constantly undergoing analysis and revision as additional studying is done in nutritional fields. Recently, the pyramid has undergone another change regarding the unique dietary needs of seniors.
According to an article published in the January 2008 issue of the Journal of Nutrition, modifications in the pyramid for older adults include an emphasis on fiber and calcium, as well as on vitamins D and B12. By incorporating these changes, the pyramid now indicates that the nutrients found in a person’s routine daily consumption typically are not enough for seniors. Seniors need supplementation.
As people age, they tend to move less and thus need fewer calories to maintain their weight. Because seniors tend to eat a more limited amount, dietitians urge them to choose wisely. They are urged to eat nutrient-rich meals featuring such food as fruits, vegetables, low-fat dairy products, and high-fiber whole grains. Some experts recommend that older people purchase packaged versions of perishables because such foods last longer than the fresh kind. For example, dried and frozen fruit have a much longer shelf life, as do frozen or canned vegetables. Having a supply of these in the cupboard means fewer trips to the grocery store and less risk of running out of nutritional snacks.
The newly designed pyramid also focuses on the importance for older people of ingesting adequate amounts of fluids on a daily basis. This helps ensure proper digestion and prevent any possibility of dehydration.
Finally, the revised pyramid includes information on incorporating exercise and other physical activities into the lives of older adults. Suggestions include swimming, walking, or simple yard work. Because recent reports have stated that obesity levels for people older than 70 years of age are climbing, performing some type of regular exercise is more essential than ever.
1. The best title for this selection is
(A) America’s Seniors Need Exercise.
(B) A New Food Pyramid for Seniors.
(C) Finding Supplementation for Aging.
(D) Dietary Changes in Older Americans.
2. The purpose of updating the food pyramid as described in the passage is to
(A) change how seniors eat.
(B) increase food supplement sales.
(C) encourage people to eat more fruit.
(D) convince older people to start swimming.
3. The passage says that seniors should support their digestion by
(A) taking vitamin D.
(B) eating fewer calories.
(C) drinking adequate fluids.
(D) incorporating some exercise into their regular routine.
4. Dried and frozen fruit is often recommended by dietitians because it is
(A) delicious.
(B) easier to store.
(C) more nutritional than fresh fruit.
(D) known to have a much longer shelf life.
5. The reason that the author of the passage suggests exercise such as swimming, walking, and yard work is because those activities are
(A) ways to interact with other people.
(B) things that can be done alone.
(C) low impact in nature and relatively safe.
(D) useless for burning up calories.
6. The author’s purpose in writing this passage was primarily to
(A) alert people to the different dietary needs of seniors.
(B) encourage students to study the pyramid’s requirements.
(C) inform nurses about what supplements are most essential.
(D) educate physicians on the differences between dried and fresh fruit.
Answers: 1. B; 2. A; 3. C; 4. D; 5. C; 6. A
The questions in the Mathematics section of the test are also multiple-choice items with four answer choices. Here is an example:
The number 1,200 is what percent of 1,500?
(A) 20%
(B) 40%
(C) 60%
(D) 80%
Answer: D. The number 1,200 is 80 percent, or 80%, of 1,500.
The questions in the Science portion of the exam are likewise multiple-choice items. Here is an example:
Which of the following transports oxygen in human blood?
(A) phagocytes and white blood cells
(B) hemoglobin in red blood cells
(C) platelets
(D) lymph from lymph nodes
Answer: B. Hemoglobin in the red blood cells transports oxygen in human blood.
Note that some of the questions in the Science portion of the exam include tables, charts, or illustrations. Sometimes two or more questions are based on the same chart or illustration.
TEST OF ESSENTIAL ACADEMIC SKILLS (TEAS)
Format of the Test
The TEAS is administered by the Assessment Technologies Institute, a private testing company based in Leawood, Kansas. It is designed to measure entry-level verbal and math skills that have been deemed appropriate for nursing school applicants by a panel of nursing program curriculum experts. The TEAS is administered by computer. All of the questions on the TEAS are multiple-choice items, each with four answer choices. Table 2.2 shows the format of the test.
Table 2.2. TEAS Format
How the Test Is Scored
After you take the TEAS, you receive a score in each of the four general test areas. In addition, you receive 16 subscores covering specific content categories within the main test areas.
Note that there are no official passing scores on this exam. The schools that require the applicants to take the TEAS establish their own criteria about what scores are considered acceptable for admission.
Types of Questions
In the reading questions on the TEAS, you may be given a reading passage, or you may be given some kind of graphic—a chart, a map, a diagram, or a graph. You are then given two or three questions based on the information in the passage or graphic. The questions may ask you to do any one of the following:
• Identify the main idea of the passage
• Locate important details
• Draw a conclusion based on the passage or graphic
• Apply a conclusion to a new situation
• Identify the author’s tone or attitude
• Tell the meaning of a word based on its context
• Distinguish between fact and opinion and identify bias
• Evaluate an author’s argument
You must pick the choice that best answers the question. Here is an example using the following chart:
According to the chart, which of the following cities is experiencing the greatest fluctuation in temperature today?
(A) Cleveland
(B) New York
(C) Denver
(D) Minneapolis
Answer: D. Minneapolis is experiencing a temperature fluctuation of 19°F, which is more than any of the other three cities listed as answer choices.
Mathematics questions on the TEAS cover the topics of numbers, operations, ratio and proportion, fractions and percents, basic algebra, basic geometry, measurements and conversions, and interpreting data from graphs and diagrams. Many of the questions are word problems based on everyday situations. Here is an example:
A customer bought two grilled cheese sandwiches, one order of potato salad, and two iced teas. How much did the customer’s purchases cost?
(A) $6.20
(B) $7.94
(C) $8.45
(D) $11.27
Answer: D. $3.25+$3.25+$1.79+$1.49+$1.49=$11.27
Science questions on the TEAS cover life science (living systems, evolution, and similar topics), human physiology, chemistry (atomic structure, compounds and solutions, and similar topics), and physics (force, motion, and similar topics). In some of the questions, you will be asked to interpret charts, diagrams, or similar graphics. Here are some examples of typical TEAS science questions:
1. The retina transmits nerve impulses to the brain via the
(A) optic nerve.
(B) cranial nerve.
(C) cardiac nerve.
(D) esophagus.
Answer: A. Optic refers to the eye, where the retina is located.
2. The arteries are part of the __________ system.
Which of the following correctly completes the sentence above?
(A) nervous
(B) endocrine
(C) lymphatic
(D) cardiovascular
Answer: D. The arteries carry blood away from the heart.
English and Language Usage questions on the TEAS cover punctuation and capitalization, grammar, spelling, sentence structure, and vocabulary. Here are some typical sample questions:
1. That book is his masterpiece; I have always enjoyed __________ wry humor and sly irony.
Which of the following words correctly completes the sentence above?
(A) it’s
(B) its’
(C) it is
(D) its
Answer: D. The possessive pronoun its is correct here.
2. Because of the apathy of her party’s voters, our governor lost her campaign for reelection.
What is the simple subject of the sentence above?
(A) voters
(B) governor
(C) campaign
(D) reelection
Answer: B. Governor is the simple subject of the sentence.
3. Which of the following words is written correctly?
(A) wellliked
(B) counter-act
(C) end-less
(D) antibiotic
Answer: D. Antibiotic is spelled without a hyphen.
4. The radiologist pointed to a prominence on the bone. Prominence means
(A) important.
(B) shaded area.
(C) protrusion.
(D) depression.
Answer: C. In this context, a prominence is a protrusion such as a bulge or growth that sticks out from the surface.
5. Susan bought a stamp to send a “get well” card to her sick friend at the post office.
Which phrase is misplaced in the sentence above?
(A) bought a stamp
(B) to send a “get well” card
(C) to her sick friend
(D) at the post office
Answer: D. The sentence as originally written is ambiguous: Is the sick friend at the post office? The sentence should be rewritten as follows: “Susan bought a stamp at the post office to send a ‘get well’ card to her sick friend.”
PSYCHOLOGICAL SERVICES BUREAU (PSB) NURSING SCHOOL APTITUDE EXAMINATION (RN)
Format of the Test
The PSB examination (RN) is administered by the Psychological Services Bureau, a private testing firm specializing in entry-level examinations for various health professions. The Nursing School Aptitude Examination (RN) is designed to measure a person’s capability to successfully complete the educational requirements for becoming an RN. The format of the test is shown in Table 2.3.
Table 2.3. PSB Nursing School Aptitude Examination (RN) Format
How the Test Is Scored
After you take the PSB Nursing School Aptitude Examination (RN), you receive an Academic Aptitude Total Score based on the combined raw scores earned on the Vocabulary, Arithmetic, and Nonverbal subtests in the Academic Aptitude section. You also receive raw scores on each of the other four sections of the test. Each raw score represents the number of questions you answered correctly in that particular test section.
Each raw score is also translated by statistical methods into a percentile score. The percentile score shows how your results compare with the results achieved by others who took the same exam. For example, a percentile score of 65 on a particular test section shows that you scored higher than 65 percent of others who took the same test section.
Types of Questions
The questions in the Academic Aptitude section of the test are of three types: vocabulary, arithmetic, and nonverbal. The arithmetic questions test skills and concepts normally learned in school up through eighth grade. The nonverbal questions are of a type that may be unfamiliar to you. They show you pictures of objects, then they may ask you to spot the difference between one object and another. They may ask you to mentally “manipulate” an object; that is, turn it around or upside down, and then pick the answer choice that shows the object in the new position.
The questions in the Spelling section measure your ability to spell words correctly based on the rules of standard written English. The questions in the Reading Comprehension section measure your ability to understand and interpret what you read. You may be asked to identify the meaning of a specific statement, to locate a particular item of information, or to identify the author’s purpose in writing. The questions in the Natural Sciences section cover basic biology, chemistry, health, and safety.
The questions in the Vocational Adjustment Index section are designed to determine whether you have any feelings, attitudes, opinions, or behavioral traits that might not be desirable in a professional nurse.
EVOLVE REACH (HESI) ADMISSION ASSESSMENT (A2)
Format of the Test
The Evolve Reach (Hesi A2) is a computer-based exam that is divided into seven academic modules within three broad content areas: English language, mathematics, and science. In addition, the A2 includes a personality profile and an evaluation of learning style. It may also include a section evaluating your critical thinking skills. Some administrations of the text may include a section on Physics, which may eventually be added to the group of tests but as of this printing is still in the experimental phase. Most nursing programs require some of the modules and not others. It is important to know the requirements for the program you wish to enter.
Table 2.4 shows the number of items (which may vary year to year) and time suggested for each section. Because the test is given online, the times given are only suggestions that will allow you to complete the entire test within a reasonable time.
Table 2.4. Evolve Reach (HESI) A2 Format
How the Test Is Scored
Your scores may be reported in three ways—as a percentage score for each module administered; as a subject-area composite score (for all science modules, for example); and as a composite score (the average score for all the modules you complete). Whether your score is acceptable depends on the program to which you are applying. Some nursing programs have specific cut-off points for each module. Others require a certain composite score.
Types of Questions
Reading items on the A2 test your comprehension of informational reading passages. You will be asked to read a short, multi-paragraph passage and answer a variety of questions about it. The passages used for A2 all have a science or health theme and may be typical of the type of reading you will do in your professional life.
Here is an example of an A2 Reading Comprehension question. On the test itself, most reading passages will be longer than this one.
Counterfeit medicine may be contaminated, or it may contain the wrong or no active ingredient. Counterfeit medicine is illegal and may be dangerous. The quality, safety, and efficacy of counterfeit medicines are not known. Counterfeit medicine is often sold illegally over the Internet or by illegal operators posing as licensed pharmacies.
What is the author’s primary purpose in writing this passage?
(A) To inform
(B) To persuade
(C) To entertain
(D) To analyze
Answer: A. The author defines counterfeit medicine and presents some facts about it, which indicates that the purpose is to inform.
The Vocabulary section of the test includes terms that appear regularly in health care contexts as well as in general and academic use. You may be asked to select a word or phrase that defines an underlined word in a sentence, as shown below, or to identify a synonym for a given word.
Select the correct definition of the underlined word.
The patient received a potent dose of sleeping medication.
(A) Average
(B) Invasive
(C) Powerful
(D) Initial
Answer: C. Potent means “strong,” so a potent dose is a strong, or powerful, dose.
The Grammar section requires you to identify sentences that are grammatically correct, words or phrases that are not used correctly, and words that best complete a sentence to make it grammatically correct.
Select the word or phrase that makes this sentence grammatically correct.
Could you please hand _____ the tongue depressors?
(A) myself
(B) me
(C) I
(D) ourselves
Answer: B. The pronoun required is an object pronoun (it receives the action of the verb), so only me completes the sentence correctly.
Mathematics on the A2 is much like math on any other entrance exam, except that a few items in the section may be short answer, meaning that you must compute the answer rather than choosing from four possible responses. Here is an example:
How many fluid ounces are in a pint? (Enter numeric value only.) _____
Answer: 16. There are 8 ounces in a cup and 2 cups in a pint, so the answer is 16.
Biology, Chemistry, Anatomy and Physiology, and Physics are typical multiple-choice tests. Unlike some other exams, the A2 uses few diagrams, graphs, or other illustrations. The example here is from the chemistry module.
What is the expected pH of orange juice?
(A) Between 3.0 and 4.0
(B) Between 6.0 and 7.0
(C) Between 8.0 and 9.0
(D) Between 11.0 and 12.0
Answer: A. Orange juice is fairly acidic, meaning that it would fall toward the lower end of the pH scale.
The Critical Thinking, Learning Style, and Personality Profile segments of the A2 are required by certain programs that want to know more about your common sense in given nursing scenarios, your preferred learning style and what it means about how you should study, and your level of introversion or extroversion. The only one that may affect your entry into a program is the Critical Thinking test. Some nursing programs use it as a pre- and post-test to see how well students improve over the course of training. Others require a particular score for entry. Like all of the A2 modules, these are required by some nursing programs and not by others.