Strategies for Mastering Exam Questions

What are the steps you should aim to incorporate into your approach to dealing with PANCE questions? They need to be generic enough to work with different kinds of questions. These steps also need to protect you from making mistakes that could hurt you. Let’s look at the approach to questions used by many good test takers and focus on why it works.

1. Read the question carefully to locate the important clues.

2. Make sure you fully understand what’s being asked.

3. Before looking at any answer choices, put the clues together with what you are being asked and allow your mind to form an answer.

4. Look at the choices offered, and if one of them fits your anticipated answer, mark it.

5. If no choice is a good fit, use general knowledge, larger concepts, and logic to eliminate as many choices as you can.

6. Select an answer from the remaining choices.

Not all of these steps will necessarily be used with every question. For example, if a question asked which bacterial organism is most commonly responsible for neonatal pneumonia and you remembered it, then the process would stop at Step 4. However, in most standardized examinations, many questions will ask you to assess specifics that you won’t be able to recall. It is in dealing with these questions that good test takers have a real advantage over those who are less adept. So, just what methods are used to get more correct answers?

Remember

 Often there is more than one right answer, but the question is asking for the best answer. Read all answer choices before jumping to a conclusion.

The arsenal of test strategies is hinted at in Step 5 above, which directs the use of general knowledge, larger concepts, and logic. Unconfident test takers are prone to an either/or mindset when they encounter questions. If, after reading the question, they aren’t sure of an answer based on what they recall, they quickly give up and guess. Good test takers use information presented in the question itself or more of their general knowledge to chip away at the question. By persevering and exploiting whatever they can to eliminate choices, they more frequently end up with correct answers. But frankly, just talking about what’s involved in abstract terms isn’t likely to make you a better test taker. To accomplish that goal, you will have to see test strategies in action.

Strategies really can’t be taught out of context. To give you a sense of how to use strategies, we are going to illustrate them with examples, followed by a discussion of how applying a strategy narrows the possible answers and, in many cases, allows a test taker to obtain correct answers by knowing something about the topic of the question but not enough to mark an answer using only recalled information.

Strategy: The use of strategies never guarantees a correct answer; however, they allow you to extrapolate from what you do recall and relate that knowledge to the specifics of a given question. In this item, if you didn’t know the answer (choice B), you could still eliminate choice E because the patient’s findings would be more severe for spina bifida. You might also reason that it wouldn’t be a cyst (choice D) because the stem of the question states that the area differs only in color, whereas with a cyst, you would expect a palpable mass. Knowing some word etymology might help you eliminate choice C (“flammeus” [flame] suggests either redness or heat, which is not mentioned in the description). This leaves choices A or B to choose from. Now you have a 50%—instead of a 20%—chance of getting the question right.

Strategy: If you recall that a left shift causes oxygen to load and a right shift causes oxygen to unload, then you can figure out the answer to this item without strategies. If you don’t recall, however, you can analyze the choices, seeking interrelationships. Look at choices B, C, D, and E, which would all occur when a person exercises. With exercise, more oxygen is needed, so you would want the body to react with a right shift. By elimination, the factor causing a left shift must be choice A, carbon monoxide poisoning, because it is the only effect not likely resulting from the oxygen demands being increased due to vigorous exercise.

Strategy: First, make sure you understand what is actually being asked. You’re dealing with someone who is potentially sexually active (any young woman of reproductive age should be assessed for pregnancy); therefore, it is always necessary to check for pregnancy before prescribing a drug that could affect a developing embryo. Knowing this, you could correctly answer this item (choice E) without knowing much, if anything, about the properties of the specific drug isotretinoin.

Strategy: This item illustrates the policy of portraying diseases in their most classic presentations on entry-level licensure examinations. The boy’s history and symptoms are textbook indications of cystic fibrosis, so the correct answer is B. Notice that examinees don’t receive credit for knowing what disease the boy has, only for reaching a correct diagnosis and then using that knowledge to answer the question posed (i.e., which test would confirm that diagnosis).

Strategy: Watch out for the item-writing tactic displayed in this question. The stem clearly states that this man has a history of addictive behavior (alcohol, drugs). But by making the patient a physician, the test writer is trying to confuse the strength of your convictions. Are you willing to hospitalize him, even though this might be a difficult step for you to take? Because the patient has responsibility for the well-being of others, it is even more important to take the tough but appropriate action so that his addiction won’t negatively affect patients’ welfare. Therefore, he should be hospitalized for detoxification (choice C).

Strategy: Item writers love to make questions look complex! A question like this becomes straightforward when you realize that rejection is the big worry in all transplants. When potential donor and recipient cells are mixed together, you would want the smallest number of lymphocytes, as it would indicate the least interaction between the cells. Therefore, the correct choice is D.

Strategy: Visualization of stem information is critically important to getting more items correct. If you picture what this patient’s face must look like and what’s already been tried, then choices A, B, C, and even E all seem unlikely to be successful. The only way to establish an airway with any certainty of success, thus keeping your patient alive for his other injuries to be treated, is choice D, which is the correct answer.

Strategy: If you visualize this patient’s injuries, it should be rather obvious that he is bleeding into the abdominal area because his blood pressure is still low (despite the IV) and his abdomen is tender and distended. This must be dealt with immediately or a rupture could kill him; there is no time for scheduling diagnostic tests (which rules out choices A and E). Choice C is clearly wrong because waiting and observing won’t stop his bleeding. You would then guess either choice B or D. In considering these final two, it would probably be smarter to pick choice D (the correct answer) because choice B also mentions waiting for cell counts.

Strategy: This is a good example of what might be called a bait-and-switch question. The item writer is hoping that you’ll assume the medical professionals’ viewpoint so that you’ll get slightly thrown off when the focus of the question is switched to the impact, not the intent, of increasing copayments. The correct answer is choice A, not choice B, because the typical citizen lacks the medical knowledge to know what is necessary and what isn’t necessary. So he or she will tend to use less of all kinds of services.

Strategy: This is another example of the bait-and-switch in the point of view. It tries to trap the test taker into evaluating the choices from the medical practitioner’s viewpoint when in actuality, the question is asked from a malpractice attorney’s viewpoint. Choice D is the correct answer because it’s the only one that mentions any concrete physical evidence for the attorney to show a jury (the sponge). This makes it the easiest case to prove legally. Recognizing the point of view saves time and leads to fewer incorrect answers in questions like these.

Strategy: Only choice C shows empathy with the boy’s feelings. By not judging his behavior, the clinician encourages the boy to confide more information and avoids provoking him into further negative emotions. When encountering questions dealing with communication skills, always search for the answer that is most likely to lead to the patient saying more. This will usually be the most open-ended, nonjudgmental question or statement on the part of the clinician. Similarly, if the question deals with an ethical situation, it makes sense to search for the choice that is most relevant or consistent with the ethical principle involved in the situation, such as patient confidentiality or patient autonomy.

Strategy: People who have struggled to do well on multiple-choice exams often carry around strong negative emotions about having to take these kinds of tests. Sometimes they feel that the items are expressly designed to trick them into choosing wrong answers. Such feelings in this case could easily lead the examinee toward avoiding answer D. The question stem lists “pancreatic calcifications”; therefore, a suspicious test taker might reason that the pancreatic calcifications clue was just to lure him or her into making a mistake. Wary test takers therefore choose another answer, the wrong one. Notice also how the wrong answers each agree with at least part of the patient’s findings. The patient drinks heavily, so choices A and E relate to this fact. The patient has abdominal symptoms, so choices B and C relate to those symptoms. In a well-written test, nearly every incorrect choice fits at least some part of the stem information, but only the correct answer fits all of the clues given in the stem.

• Rely more on general recall and concepts.

• Familiarity and life experience have validity.

• Consider what’s common versus what’s rare.

• Visualize what question stems describe.

• Use homeostasis as a guide to what the body would try to do to keep a healthy balance.

• Know important definitions.

• Rule out extreme or unrelated choices.

• Use decision rules to manage time use.

• In items with tables, seek patterns.

• In items with graphs, seek trends and anchor points.

• Always seek relationships.

• Use the whiteboard and marker to sketch or calculate.

• Use logical analysis based on concepts and information given in the question.

• Watch for hinge words in questions.

• Develop a mindset to reject choices.

• Look for the best fit with clues in the stem and with what you feel is the point of the question.