The Giver Critical Thinking Questions For Nurses

The NCLEX-RN® exam is not a test about recognizing facts. You must be able to correctly identify what the question is asking. Do not focus on background information that is not needed to answer the question. The NCLEX-RN® exam focuses on thinking through a problem or situation.

Now that you are more knowledgeable about the components of a multiple-choice test question, let’s talk about specific strategies that you can use to problem-solve your way to correct answers on the NCLEX-RN® exam.

Are you feeling overwhelmed as you read these words? Don’t be! We are going teach you a step-by-step method to choose the appropriate path. The Kaplan Nursing team has developed a decision tree that shows you how to approach every NCLEX-RN® exam question.

There are some strategies that you must follow on every NCLEX-RN® exam test question. You must always figure out what the question is asking, and you must always eliminate answer choices. Choosing the right answer often involves choosing the best of several answers that have correct information. This may entail your correct analysis and interpretation of what the question is really asking. So let’s talk about how to figure out what the question is asking.


What Is Tested

Remember, the NCLEX-RN® exam is testing your ability to think critically. Critical thinking for the nurse involves the following:

Observation

Deciding what is important

Looking for patterns and relationships

Identifying the problem

Transferring knowledge from one situation to another

Applying knowledge

Discriminating between possible choices and/or courses of action

Evaluating according to criteria established

 

 

The first step to correctly answering NCLEX-RN® exam questions is to find out what each question is really asking.

  • Step 1

    Read each question carefully from the first word to the last word. Do not skim over the words or read them too quickly.

  • Step 2

    Look for hints in the wording of the question stem. The adjectives most, first, best, primary, and initial indicate that you must establish priorities. The phrase further teaching is necessary indicates that the answer will contain incorrect information. The phrase client understands the teaching indicates that the answer will be correct information.

  • Step 3

    Step 3. Reword the question stem in your own words so that it can be answered with a yes or a no, or with a specific bit of information. Begin your questions with whatwhen, or why. We will refer to this reworded version as the Reworded Question in the examples that follow.

  • Step 4

    If you can’t complete step 3, read the answer choices for clues.

Let’s practice rewording a question.

We omitted the answer choices to make you focus on the question stem this time. The answer choices will be provided and discussed later in this chapter.

Step 1. Read the question stem carefully.

Step 2. Pay attention to the adjectives. Most appropriately tells you that you need to select the best answer.

Step 3. Reword the question stem in your own words. In this case, it is, “What is the best charting for this situation?”

Step 4. Because you were able to reword the question, the fourth step is unnecessary. You didn’t need to read the answer choices for clues.

We have all missed questions on a test because we didn’t read accurately. The following question illustrates this point.

Again, just the question stem is given to encourage you to focus on rewording the question. We will discuss the answer choices for this question later in this chapter.

Step 1. Read the question stem carefully.

Step 2. Look for hints. Pay particular attention to the statement “further teaching is necessary.” You are looking for negative information.

Step 3. Reword the question stem in your own words. In this case, it is, “What is incorrect information about TB?”

Step 4. Because you were able to reword the question, the fourth step is unnecessary. You didn’t need to read the answer choices for clues to determine what the question is asking.

Try rewording this test question.

Again, just the question stem is given to encourage you to focus on rewording the question. We will discuss the answer choices for this question later in this chapter.

Step 1. Read the question stem carefully.

Step 2. Look for hints. Pay attention to the words client understands. You are looking fortrue information.

Step 3. Reword the question stem. This question is asking, “What is true about terbutaline (Brethine)?”

Step 4. Because you were able to reword this question, the fourth step is unnecessary. You didn’t need to obtain clues about what the question is asking from the answer choices.

 

Next: NCLEX Strategies: Eliminate Incorrect Answer Choices

Critical thinking . . . schmritical thinking

The term gets tossed around so much in nursing education now that it has really lost all value.  In fact, I think that rather than teaching students HOW to critically think . . . many schools are just using the word because they HAVE to.

This episode discusses what critical thinking is, what the cognitive levels of NCLEX questions are, and how to combine that knowledge to answer the questions AND be an amazing nurse.

Cognitive Levels of NCLEX Questions

We’ve talked about this a few times on the blog HERE and HERE but I think that understanding what you are up against is essential.

The NCSBN who write the NCLEX exam uses Blooms Taxonomy  to develop questions.  Essentially Blooms Taxonomy is:

A continuum of increasing cognitive complexity—from remember to create.

As you can see from the image, it is made up of 6 cognitive levels that increase in complexity as you move “up” the pyramid.

In other words, it is much easier to remember a fact than it is too create a concept . . . from a cognitive standpoint.

If you learn that the normal lab value range for sodium is 135-145 . . . all you have to do is remember that fact to get a remember question right.

Pretty simple . . . however, if you are given a question about a patient with a deteriorating neuro status and are ask what the best action would be for this patient . . . would you be able to analyze the situation and determine that a sodium level needs to be checked?

The second question takes you to a much deeper level of understanding and requires you to actually APPLY the knowledge and ANALYZE previous knowledge to best care for the patient.

This is where you need to be hanging out. . . forget simply remembering facts . . . you need to be critically thinking about patient care in order to best care for patients.

In reality, I don’t give a damn if you can tell me a sodium level is low AFTER THE FACT . . . its a bit late by then.  Can you recognize the signs of SIADH and prompt the physician to run a Na level before the patient starts declining neurologically due to hyponatremia . . . see where I went there . . . ?  Can you see the difference in the two situations?

 

What is Critical Thinking?

So let’s talk about critical thinking and how it applies to everything we are talking about here.

The NCSBN website states the following:

Since the practice of nursing requires you to apply knowledge, skills and abilities, the majority of questions on the NCLEX are written at the cognitive level of apply or higher. And these questions, by nature, require critical thinking.

Answering these correctly will require you to do something with what you have learned, to manipulate previously learned material in new ways or find connections between many facts.

Again, since the majority of NCLEX questions fall into this category, this is exactly the type of questions you need to practice answering!

There it is again . . . the BUZZ word (critical thinking) . . . but once again no tips or information on what that means or how to develop it is given.

4 Steps to Critical Thinking in Nursing

Essentially there are 4 steps to critical thinking . . . in nursing and in life . . . and developing the ability to critically think will work wonders in your life.

  • Suspend ALL Judgement
  • Collect ALL Information
  • Balance ALL Information
  • Make a Complete and Holistic Decision

You have to start by suspending all judgement.  In other words, if you walk into a patients room and see them tachycardic and armature decision would be to run and grab the metoprolol to try to drop the heart rate.

An advanced clinician will WAIT until they have more information . . . not leaving the patient untreated . . . but not jumping freakishly into the WRONG treatment because they learned that tachycardia is bad . . .

Now you must collect ALL information.  This is clutch! Don’t make a decision until you have collected every piece of data that you need to collect . . . on a tachycardic patient you can check BP, temp, run an EKG, check urine output.

Now, balance all information.  This means take all the data that you have and start weighing it to find out what is pertenant and what you can ignore.  If the temp is 98.9 . . . it’s probably not the cause.  If the BP is 74/56 are we looking at a volume issue?

Finally, make your decision . . . with all the data in and after looking over it all very closely you can begin to make your decision.

Critical Thinking in Nursing and on the NCLEX®

Lastly, I just want to talk briefly about how this applies to NCLEX questions . . .

Here is an actual practice NCLEX question from our Nursing Practice Questions Program (or NPQ, as we like to call it)!

A 56-year-old male patient has been admitted to the cardiac unit with exacerbation of heart failure symptoms. The nurse has given him a nursing diagnosis of decreased cardiac output related to heart failure, as evidenced by a poor ejection fraction, weakness, edema, and decreased urinary output. Which of the following nursing interventions are most appropriate in this situation?

42% of the students that have taken this question have selected this answer:

Administer IV fluid boluses to increase urinary output

The problem with that answer is that it is thinking at a REMEMBERING level when this question requires ANALYSIS level comprehension.

Test takers see urine output as low . . . and want to correct that quickly with fluids.

However, this is a CHFer . . . you can’t (shouldn’t) bolus your CHF patient especially during an exacerbation . . . you could send the patient into pulmonary edema and drastically impact their respiratory status.

So the lesson here. . . . in school, on the NCLEX, and on the clinical floor . . . slow down, stay calm and start thinking at an analysis level.

And I promise you this helps in “REAL” life too . . . not just in nursing.

How to Develop Critical Thinking Skills

Here are two articles and websites that talk about the development of critical thinking that will help you get to the analysis level and feel more confident with NCLEX style questions and remain calm on the nursing floor.

And as always . . . check out our NursingPracticeQuestions.com site to take a few practice NCLEX questions.

 

Your Thoughts

Ok . . . enough from me.  I want to hear your thoughts.  What are you doing to improve your critical thinking skills?

Date Published - Jan 15, 2016
Date Modified - Sep 18, 2016

Written by Jon Haws RN

Jon Haws RN began his nursing career at a Level I Trauma ICU in DFW working as a code team nurse, charge nurse, and preceptor. Frustrated with the nursing education process, Jon started NRSNG in 2014 with a desire to provide tools and confidence to nursing students around the globe. When he's not busting out content for NRSNG, Jon enjoys spending time with his two kids and wife.

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