71. Why are Nursing Exams so hard?

You study hard, take notes, listen to lecture…then STILL fail exams or get borderline grades. What’s the disconnect? Why is it so hard? How can you better understand what those NCLEX-style questions are really asking you?

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Transcript for Episode 71

It’s getting near the end of the semester for many nursing students, and that means final exams. Unfortunately, it’s a highly stressful time of year! But it doesn’t have to be…while exams should always cause a little bit of stress, it should be the the GOOD kind of stress. The “eustress” that you learn about in Fundamentals of nursing, that motivates you to try hard and do your best. 

It should NOT be the kind of DIStress that causes you to have a panic attack, or even even pass out come exam time. And yes, I DO hear real stories from instructors who have students literally pass out from the stress during exams. I don’t want you to have to experience that!

And there’s really no need…IF you prepare throughout the semester, master the information as it’s presented to you, and learn to connect the dots and think about it the way that experienced nurses would. At that point, the final exam simply because a review of what you’ve already learned, instead of a giant monster that stands between you and your nursing dreams.

Of course, that probably sounds easier said than done to you! Which is no surprise, since most nursing schools accidentally put too much emphasis on you studying WHAT to learn…but then they turn around and TEST you on how to THINK about that content. 

Which brings me to the point of today’s discussion…why are nursing exams so hard? They’re hard because they use higher level question types, that require higher level critical thinking skills. But chances are, you’re still studying in a way that only prepares you to answer the lower-level type exam questions that are more common outside of nursing school. 

This hierarchy of exam difficulty questions is called Bloom’s Taxonomy…and since the NCLEX is based off of it, it means that your nursing school exams will be based off of it too. 

That’s why today, I’m going to explain exactly what Bloom’s Taxonomy is, why it makes nursing exams feel so hard, and what you can do to improve at answering them so you can get better grades. I’ll be sharing part of a training that’s included in my VIP Tutoring Membership to explain the different types of question difficulties, and then I’ll finish up this episode by sharing some study advice for how to better prepare yourself to answer them correctly.

As usual, today’s episode is brought to you by my VIP Tutoring Membership, which is an affordable way to get tutoring, mentorship, and the help you need to effectively navigate your nursing journey. I can guide you through any point of your nursing journey, from pre-nursing, to current student, to passing NCLEX, or even getting through your first 1-2 years as a new nurse. We are proud to include members from all ages and all walks of life…many are adult learners in their 30’s, 40’s, 50’s or even 60’s, and others are straight out of high school. Some of previous healthcare experience, others have none. Some students are working towards their LPN, others are pursuing RN. One thing that every member has in common, though, is that you are fully committed to becoming a nurse, and doing it while surrounded by a positive and encouraging community, and committed to learning an effective and efficient way of studying that helps you fit nursing school into your everyday life.

If you’d like to connect with me to get more help, read the transcript for today’s episode, or find links for any of the resources I mention, you can get that information on the show notes page at www.YourNursingTutor.com/episode71

Enjoy today’s episode!

Okay, if you’ve been in nursing school for a while, then you probably are familiar with the different difficulty levels of questions, the NCLEX types questions that you see. And you’ve probably heard the names thrown around of, you know, recall versus recognition, understanding application analysis, but you might not really understand what they are. And so I want to kind of go through that with you. Because understanding how you are tested in nursing school, will give you a lot of insight on how you need to start thinking like a nurse.

So first of all, recall and recognition. Those are the very basic type questions, and honestly, they’re probably the types of questions you’ve always gotten in the past for multiple choice questions, you know, through school from, you know, first grade on up, even through college, you know, if you’ve been to college for another degree other than nursing they may have, you may even be more familiar with the recall recognition type multiple choice questions from another major. These are questions like, What is fill in the blank, or I know it when I see it type of questions. So you might not know the answer if I just asked you. But if you were able to look at the list of the answer choices, you could pick out the right answer.

One of the things that people get confused about with recall and recognition that they spent, sometimes even teachers because as we’ll talk about the application analysis, those harder questions are really hard to write. They take a long time, recall and recognition and understanding type questions are pretty easy, easier questions for teachers to write. And so sometimes by accident, teachers might use those types of questions to test you, even though that’s not going to help you in the long run. Now, the recall and recognition, a couple of things you should know about them is even if you have like a question that looks like a paragraph, it’s really long. If the paragraph ends with a question something like, you know, what symptom does? Do you see liver disease? Okay? That no matter how long the question is, that’s a recall recognition question, because it’s specifically asking you what about what the something is? It’s a what is that?

Now, you probably are going to be good at recall and recognition type questions if you’re good at focusing only on the details, and not like the bigger picture concepts. And if you’re also, if your main study techniques are memorization and highlighting, or even flashcards, then you’re probably going to be pretty good at these types of questions. But like I said, if you’re good at these types of questions, that doesn’t really matter in nursing school, because when you’re ultimately going to be tested on are these higher level questions. So the next level of types of questions is understanding. And sometimes this level is called comprehension.

So you might see it as understanding or comprehension. These are sort of the why types of questions. If you’re using your basic sciences, especially your anatomy and physiology to answer questions, then you’re going to start getting better at these comprehension understanding types questions, it’s really important to be able to do these kinds, because like I said, it helps you understand why for a lot of things. Here’s the trick NCLEX writers, the people who write the questions for NCLEX, they assume that you can do recall recognition and understanding type questions. They just don’t they just assume. So if that’s all you can do, you’re gonna fail NCLEX.

That’s why they rarely ask these types of questions, because they just figure you, you should have the knowledge to be able to answer those anyway. So they’re not going to test you using those types of questions. Instead, they’re going to start using these, they are going to use these higher level questions, the application and the analysis types questions. So what are they application type questions are, I kind of put it in terms of it’s like an A, B, C, it’s a pathway, okay? So if you know a leads to B, and B leads to C, but the thing is, they don’t give you b, they’ll give you a, and they’ll give you a C. So you need to be able to in order to an application question you need to be able to figure out what b is, and you need to be able to use B to get to C. So the answer is not going to be very straightforward. And that’s why it gets confusing for a lot of nursing students and that’s why they nursing students tend to lose confidence on these types of questions.

Because they look at it they don’t immediately recognize the answer. And so they think they don’t know it. But in reality, you probably do. Okay, you just need to think about added a different way. So let me give you kind of a silly example just to illustrate what I’m talking about. So if I give you an answer a question that says, Which of the following if observed by the nurse would indicate someone wanted to eat more food? Okay, silly question. If I was writing an answer for at the comprehension or understanding level, one of the answer choices would be the patient says he is hungry. Okay, that’s very straightforward.

There’s really no surprises there. If you saw that, you would know well, if the patient says he’s hungry, that means he will see more food, that’s obviously the correct answer. But when we get to an application level, that answer is not going to be there. What they would put instead is going to be something like the patient’s stomach is growling. Okay? That is going to be a better answer, or that’s going to be because it’s not straight out telling you that the patient is hungry. But if his stomach is growling, then we know that if someone’s stomach is growling, that usually makes their means they’re hungry. So that’s where you’re kind of using your critical thinking, to figure out B. So A is we want to know how to somebody, how do we know if somebody wants to eat more food, that’s your A, B, in this case is going to be their stomach is growling. And C is going to be if their stomach is growling, that means that they’re going to be hungry.

So so you can see that the question doesn’t give us all of those, you just need to figure it out. granted a silly example. So bear with me, but but really, the trick is that knowing that that growling stomach represents a hungry person, is how we do these sorts of application questions. Now, in the analysis level is even harder than the application level. And this is where a lot of nursing students say that the writers try to trick you, okay. And they do sort of, but if you’re, again, if you’re confident, and you have the basic knowledge, then they can’t trick you. So they’re really just testing you. Basically, it takes information that you know, and they put it in a situation where they try to make you doubt yourself. Okay. And so the first step to answering analysis questions is, Don’t second guess yourself. I can’t tell you how many nursing students come to me and say, hey, you know, my biggest problem is that I can narrow it down to two answer choices.

And then I always pick the wrong one. And a lot of nursing students who do that say, and the worst part is, I picked the right one first, and then I changed my answer. So if you’re one of those, one of the first steps is starting to be more confident in your nursing knowledge. And knowing that they’re trying to trick you in this way, they’re trying to make you not confident, because when you’re a nurse, you have to be confident in your decisions that you’re doing the right thing. So let me give you an example. That’s a little bit less silly. This is more of a nursing example of what an analysis type question is. It would be you know, if the patient, say you have a patient who’s 16 hours post op, of an abdominal surgery, and the incision site is read with a few drops of blood on the bandage. And the patient is complaining of incisional pain.

What would you do? So you hear something like that, you know, what do you think? What do you think about a question like that, think about the scenario. Is that normal? Is it not normal? Well, in actuality, it is normal. Because you have this patient is only 16 hours post up surgery, a couple drops of blood is fine. I mean, they have an incision in their body. And it hasn’t been that long and incisional pain, totally normal. I mean, they just got cut into so obviously, they’re going to still have some pain. So what are you going to do? You’re going to do something normal? So whatever the answer choices are, maybe you just document maybe you offer their Pyrenean pain med, maybe you you know, just assess the site, you know, take vital signs, you know, nothing serious, okay, you don’t have to do anything serious for this because everything that is described is something that would be expected. But here’s the problem is that nursing students who are not confident in their knowledge, will read this question and be like, Oh, no. Well, if they’re asking me about it, then something must be wrong.

Okay. Here’s the but they’re just trying to trick you. They’re trying to see can you recognize what normal is, in this case? So So then, you know, so if you recognize yourself and some of these problems that you’re having know that you’re not alone, and there are ways to improve the first Same way, it’s just identifying that you’re having these problems and the types of problems that you’re having. So now we want to ask how do we get good at solving these application analysis problems, since those are the type that we really need to get good at to be successful? The first step is that we need to study, okay? Because studying is our practice, but we need to study in the right ways. Okay. Like if I was, wanted to be a soccer player, but I practice baseball, that’s not going to help me become a good soccer player. And it’s the same way with nursing.

If you want to be a good nurse, and you’re stuck, but you’re studying using techniques that are not techniques for studying nursing, then you’re not going to get good at nursing. And so we’re going to be talking about how to study using techniques that will help you get better at nursing. But there’s one more factor that you need. That’s really important. And that time, okay. So you need to study over time. And not just any studying, but the studying, that’s going to help you get better at nursing over time. That means you’re not going to see immediate results, you’re not going to watch this video and tomorrow as your Nursing exam.

But you’re going to start each week and you’re gonna start adding one or two things to your study routine, or the way you think about nursing or the way you answer exam questions. That’s going to start improving your skills. And before you know it, you’re going to be thinking like a nurse, you’re gonna wake up one day and be taking an exam be like, hey, that wasn’t that bad. I must be doing something right now. Okay, because it’s a process, and then it’s just going to click. Alfred manda wrote a book called logic for the millions and then it he says Thinking is skilled work. It is not true that we are naturally endowed with the ability to think clearly and logically without learning how or without practicing.

People with untrained minds should no more expect to think clearly and logically than people who have never learned and never practice can expect to find themselves good carpenters, golfers bridge players or pianists. And really, a lot of times, sometimes nursing faculty, forget this. Okay, if you find that your teachers get a little frustrated with you, because they’ll be talking about something and they’re like, why don’t you just get it? It’s because they’re already good carpenters, good golfers, good bridge players, good pianists, good nurses, because they’ve been doing it a long time. They’re experts. You are not an expert yet.

And you are not expected to be an expert yet. What you’re supposed to do by the end of nursing school is be a safe, beginner nurse. Okay, not an expert. If you’re in clinicals, and you see nurses who have been doing it for years, or even decades, and you just feel like you can’t do it as well as them. It’s because you can’t is because they’ve been doing nursing for years or even decades, and you are still in nursing students. Okay? So go easy on yourself. But recognize that thinking does take practice and learning to think like a nurse takes practice. And the people that are more experienced are better at it because they’ve practiced, you can get there too.

Now that you hopefully have a better idea and understanding of what the different levels of difficulty are for the types of questions you’re gonna see in nursing school, let me give you a couple of tips on how you can begin practicing for those difficulty level questions while you study. Because that’s really the most important thing you can be doing in order to see success in nursing school on your exams.

Now, one of the things that I really emphasize in my VIP tutoring membership is how you study because just as I said, in my explanation of the difficulty levels, you need to be practicing in the way that you’re going to be testing, it’s training, just like any sport, this is a mental sport. Okay, thinking like a nurse is like a mental sport, in so many ways, anyway. So the way I usually describe it, is, there’s two phases of studying that you need to make sure that you’re doing in order to be successful.

Most students only study in phase one, and then they’re being tested in phase two. But that’s the first time that they’ve experienced that sort of thing. So obviously, it doesn’t work out as well as you would hope. But if you’re studying both in phase one and phase two, then when you get tested on Phase Two stuff later, it’s not gonna be as big a deal, because it’s not the first time you’ve seen it, it’s not the first time you’ve thought that way, it’s going to be a lot easier. We want to make our mistakes, mistakes, and the the wrestling with the information during our study time, not during our exam time.

So we never want our exam to be the first time that we do something in including the first time we think a certain way. So what are these two phases. Phase one is what to study. This is going to be your content. And so I think you can see why I say that most nursing students just sort of hanging out here in phase one. And this gets encouraged a lot in nursing school, unfortunately, unintentionally, but unfortunately, and you see this encouraged with all of the, you know, the nursing memberships that really emphasize helping you just learned the material, all the YouTube videos and channels that nursing students search for that explain the content, all the you know, the common study techniques of listening to the lecture over and over or reviewing the PowerPoints over and over or asking your instructor what’s going to be on the exam and being told, You’re responsible for everything in the textbook, which is literally impossible.

By the way, you will never hear me tell you that you might be responsible for the concepts, the major concepts in the textbook, but not even the textbook writers know everything in the textbook, because textbooks are written by many, many people, dozens of people, okay, so don’t feel like that as a student, you literally have to know everything in the textbook because you don’t, you need to learn how to think about the concepts in the textbook, though. And that’s where we move on to phase two.

Phase two is where we start thinking about the content we learned in phase one. Because it is important, we can only study in phase two, because we do it is important to have something to think about. So we have to have the content, you know what they call the most important information. We have to have that in our brains and organized in a way that now we can practice thinking about it in a structured logical way. Now I teach nursing students to do this using the silver bullet study system. It’s a four step process that I developed, based on my over 12 years of experience, 14 years of experience. I remember getting it wrong, over 14 years of experience as a professional nursing tutor. Where I just noticed these patterns. I analyzed the way I think I analyzed the way other experienced nurses think, and I tried it with real students.

And when students study this way, it’s easier to make connections, it’s easier to have those light bulb moments. And more importantly, it’s easier to apply this decision making structure to clinical scenarios including test questions. So you learn to think like a nurse faster. And the way this looks in the silver bullet study system is steps one and two or phase one. Step one is we’re building our foundational information stuff that’s normal that you have to know a lot of this comes from prereq classes. A lot of it’s probably fuzzy from your prereq classes, so you have to review it, but it guides you through how to review it so that you don’t spend all of your time doing it. But this is a step that most often gets skipped completely in nursing school because you feel like you don’t have enough time because you’re instant tractors just assume you know it already.

You probably you might even assume you know it already, but you may not know it at the level of detail that you need to in order to be able to apply it for the for the phase two, study. And then there’s step, step two in the Silverbolt study system, which I say is, you know what’s changed or what’s broken. This is really quite easy to apply to like a med surg concept. Sometimes students have trouble understanding how to apply this to more normal topics like in fundamentals or health assessment and things like that. So I do a lot of tutoring and coaching in our live group Toad coaching in our live group tutoring sessions in the VIP tutoring membership, helping students to navigate this, because it’s, you know, it’s, it’s, it’s a new skill, it’s going to be challenging to learn.

And it always helps to have a coach who can give you feedback, walk you through it, give you examples, and to help you master it faster. But after step two, we really have to move on to phase two of studying. So as we move into step three of the silver bullet study system, I know this might be confusing, I’m talking about phases and steps. But phases is phase one, and phase two steps are 1234, of the silver bullet study system. So the steps one and two are in phase one, steps three and four of the silver bullet study system, we’re in phase two. So as we transition from step two to three are transitioning the way we study, and this can feel a little messy.

And this is where a lot of students lose confidence. And, you know, if they don’t have somebody who’s helping them to learn how to study this way. But when you get to step three, we’re going to talk about what happens next. You know, if we’re talking med surg, like, what are the symptoms that are going to happen as a result of whatever pathophysiology you’re studying? Most students try to study these are sorry to memorize these, they try to memorize these, if you’re trying to memorize them, you’re keeping yourself locked into phase one, you can’t do that if you want to be successful and make nursing school easier for you, you have to switch to phase two, which means you need to look at the information and the content that you’ve been studying.

And step one and two. And you need to build on that to predict what’s going to happen next. So if you know what’s normal, you know what’s changed or broken, you should know what’s going to happen next. An example I use a lot of times is if you have a stream flowing down a hill. And if you block that up with a dam, what’s going to happen to the water, it’s gonna stop flowing downhill, and it’s gonna pull up behind the dam. You know, you have the critical thinking skills, you need to be able to do this, you just need to practice doing it with nursing content. And so that’s pretty much what we’re doing. If you know what’s normal.

And the a&p, for example, you know, what’s broken in the a&p, what’s your pathophysiology, then you can go on to step three and say, Well, what’s going to happen next inside the body. And so this is when you’re doing this can feel a little messy, that’s okay. It’s supposed to, it’s practicing the concepts. This is what’s going to save you on exams, because the exams, as you learned, when you learned about Bloom’s Taxonomy, is not testing you on the content, they’re not going to ask you. What symptoms do you see for XYZ pathophysiology, they’re gonna say, symptom has these symptoms? What are you going to tell them?

You know, and you have to back up and say, well, what could cause these symptoms? Or what do we need to do to correct these symptoms based on what’s gone wrong? Or, you know, you have to do these application and analysis that requires you to have previous knowledge. And that’s connected to the information in the question and answer. And then we move on to step four of the silver bullet study system, which is also a phase two, we’re continuing to practice how to think about the content. And this is going to be finally our nursing care. I love medical care in there, too. And we’re going to say, what are we going to do next? You know, my stream example, we say, what do we do next? Well, you can remove the dam, you know, we can correct the underlying What’s wrong or what’s changed, and that can fix the problem.

We might just need to deal with the symptoms. That could be another answer, you know, and so with our stream problem, we could say, Well, why do we need the stream to run down the hill? Maybe a village down below needs some water? Could we get water another way? Could we dig a well, could we get water from another village? You know, so there’s different ways to solve that problem. But if you’re so focused on studying steps, three and four through the phase one lens of just knowing what to study, instead of how to think about it, then you’re going to be looking in your textbook trying to memorize okay, I can remove the dam, okay. I can dig a well, okay. I can ship in water from another village.

Okay. And then we’re going to on your test, none of those answers are going to be on the test. And instead there’s going to be an answer that says, A drone come In dropships, some water. And that’s gonna be the correct answer. But you’ve never seen that because it’s not in the text. But does it solve the problem? Yes, it does. But if you’ve already practiced thinking this way, you’re going to be able to look at that answer choice and evaluate it and say, Yeah, that’s plausible. That would solve the problem of the village not having water. So that must be the best answer in the situation. And this happens all the time.

When you you can study and study forever what’s in the textbook, but the answers choices on your test aren’t going to be pulled exactly from your textbook. They’re going to be applied questions or analysis questions where you have to use the concepts that you’re drawing out from the textbook in order to evaluate the scenario and decide, is this plausible? Is this a good response? So those are my tips, and that’s why it’s so important to move from phase one to phase two. When you study, and I can help you do that with the silver bullet study system too. 

Remember, you can get more information about the VIP Tutoring Membership, OR access any other resource we discussed on today’s episode, by going to the show notes page at www.YourNursingTutor.com/episode71

Now before we finish, would you mind doing me a 30-second favor? Would you go to Apple Podcasts and write a 2-sentence Review for Navigating Nursing School with Your Nursing Tutor? Simply tell me where you’re at on your nursing journey, and why you like listening to this podcast. It’s one small way that you can support the mission of Your Nursing Tutor by helping other nursing students discover that it IS possible for “normal people”, just like you, to get through nursing school without completely sacrificing your family, your job, or even your sanity. 

Until next episode, good luck on your nursing journey!

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