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 Contributors

Marlene Brennan, DNP, FNP-BC, PMHNP-BC Sandra Ripper-Brown, DNP

Assistant Professor Neuroscience Program
Christine E. Lynn College of Nursing St. Mary’s Medical Center
Boca Raton, Florida West Palm Beach, Florida

Sharon K. Byrne, DrNP, CRNP, NP-C, AOCNP, Denese Sabatino, MSN, ARNP-C, CCRN
CNE Nurse Practitioner/Clinical Educator, Department
Co-Chair, Department of Nursing of Critical Care
Assistant Professor, School of Nursing, Health and Cleveland Clinic
Exercise Science Weston, Florida
The College of New Jersey Baptist Hospital
Ewing, New Jersey Miami, Florida

Denise Vanacore, PhD, CRNP, ANP-BC,

Karin Klause, MSN, FNP-C PMHNP-BC
Florida Community Health Centers, Inc. Director, NP and DNP Programs
Fort Pierce, Florida Gwynedd Mercy University
Gwynedd Valley, Pennsylvania
Gary Laustsen, PhD, FNP-BC, FAANP, FAAN
Assistant Dean, Academic Practice and Innovation Kenneth Winland, MS
Assistant Dean, Practice and Community Engagement Warren, Rhode Island
Associate Professor/FNP
Oregon Health & Science University Karen Wisdom-Chambers, DNP, FNP-BC
School of Nursing Portland Campus Instructor, NP Program
Portland, Oregon Christine E. Lynn College of Nursing
Florida Atlantic University
Donna Maheady, EdD, APRN-BC Boca Raton, Florida
President, www.exceptionalnurse.com
Adjunct Faculty We would also like to thank the following individuals
Utica College for contributions to previous editions:
St. Petersburg, Florida Sandra Allen
Lisa J. Bedard
Denise Coppa
Kymberlee A. Montgomery, DrNP, WHNP-BC, Marcia Gardner
CNE Diane Gerzevitz
Drexel University Allison M. Jedson
College of Nursing and Health Professions Janice S. Hayes
Philadelphia, Pennsylvania Deborah A. Raines
Karen Rugg
Lynne Palma, DNP, FNP-BC, CDE Lorraine M. Schwartz
Associate Professor Susan Elaine Sloan
Christine E. Lynn College of Nursing Douglas H. Sutton
Florida Atlantic University Sharon A. Thrush
Boca Raton, Florida Marcella R. Thompson

vii

4469_Winland-Brown_FM_i-x.indd vii 3/21/17 3:04 PM

 Acknowledgments

We would both like to thank the entire F. A. Davis team, especially Susan
R. Rhyner, Senior Acquisitions Editor, for her vision, enthusiasm, and sup-
port; Marcia L. Kelley, Developmental Editor, for her expertise, efficiency,
and good humor; and Amanda Minutola, Echo Gerhart, Dan Clipner, and
Christine Becker, Editorial and Production Managers, for hanging in there
with us every step of the way!!! Day by Day!
JW-B & LMD

viii

4469_Winland-Brown_FM_i-x.indd viii 3/21/17 3:04 PM

 Contents

UNIT ONE 1
Introduction 1
1. Achieving Success on a Certification Examination 3
LYNNE M. DUNPHY and GARY LAUSTSEN
2. Test-Taking Skills and Designing Your Study Plan for APRN Certification 9
LYNNE M. DUNPHY and GARY LAUSTSEN

UNIT TWO 25
Evaluation and Promotion of Client Wellness 25
3. Health Promotion 27
JILL E. WINLAND-BROWN
4. Care of the Emerging Family 55
DONNA C. MAHEADY and JILL E. WINLAND-BROWN
5. Growth and Development 85
LYNNE M. DUNPHY
6. Health Counseling 117
LYNNE M. DUNPHY

UNIT THREE 155

Assessment and Management of Client Illnesses 155
7. Neurological Problems 157
JILL E. WINLAND-BROWN and SANDRA RIPPER-BROWN
8. Integumentary Problems 183
JILL E. WINLAND-BROWN and KARIN T. KLAUSE
9. Head and Neck Problems 209
KAREN W. CHAMBERS and LYNNE M. DUNPHY
10. Respiratory Problems 239
JILL E. WINLAND-BROWN and KARIN T. KLAUSE
11. Cardiovascular Problems 265
DENESE SABATINO and JILL E. WINLAND-BROWN
12. Abdominal Problems 299
JILL E. WINLAND-BROWN and KENNETH WINLAND
13. Renal Problems 325
JILL E. WINLAND-BROWN and KENNETH WINLAND
14. Male Genitourinary Problems 351
SHARON K. BYRNE and LYNNE M. DUNPHY
15. Female Genitourinary Problems 377
KYMBERLEE A. MONTGOMERY and JILL E. WINLAND-BROWN

ix

4469_Winland-Brown_FM_i-x.indd ix 3/21/17 3:04 PM

 x CONTENTS

16. Musculoskeletal Problems 407

SHARON K. BYRNE and LYNNE M. DUNPHY
17. Endocrine and Metabolic Problems 437
LYNNE PALMA and JILL E. WINLAND-BROWN
18. Hematological and Immune Problems 467
LYNNE M. DUNPHY and JILL E. WINLAND-BROWN

UNIT FOUR 495

Issues in Primary Care 495
19. Issues in Primary Care 497
LYNNE M. DUNPHY and MARLENE BRENNAN

UNIT FIVE 527

Practice Examination 527
Comprehensive Practice Examination 529
JILL E. WINLAND-BROWN and LYNNE M. DUNPHY

4469_Winland-Brown_FM_i-x.indd x 3/21/17 3:04 PM

 UNIT ONE

INTRODUCTION

4469_Winland-Brown_Ch01_001-008.indd 1 3/18/17 12:58 PM

4469_Winland-Brown_Ch01_001-008.indd 2 3/18/17 12:58 PM
 Chapter 1: Achieving Success
on a Certification Examination
Certification and Why It Is Important
Licensure
Certification
Your Role

Certification Examinations
American Nurses Credentialing Center
American Academy of Nurse Practitioners Certification
Program

Achieving Success
References
Lynne M. Dunphy
and Gary Laustsen

With the purchase of this book, you have taken a programs, and most states require individuals to main-
major step to achieving or maintaining your cer- tain their RN license to apply for and maintain their
tification as an advanced practice registered nurse APRN license. All but a few states currently require
(APRN). The earlier in your educational process you certification to apply for an APRN license. In addition
begin preparing for the certification examination, the to the states’ requirements of certification for licen-
greater your chance of success. This book will help sure, clinical facilities, employers, and insurance pay-
you understand the certification process and the steps ers require certification.
you need to take to succeed on the certification exam-
ination of your choice.
CERTIFICATION
Certification is the process by which a nongovern-
Certification and Why It Is Important mental agency or association grants recognition to
an individual who has met certain predetermined
There are basic differences between becoming licensed standards for practice. For APRN certification, this
(a process you complete with your state’s board of is achieved through the successful passing of a cer-
nursing or similar entity) and becoming certified. An tification examination. Becoming certified is the
understanding of these differences is important. standard for APRN professionals. As of this writing,
only New York, California, Indiana, and Kansas do
not require certification prior to obtaining licensure
LICENSURE
to practice as a family nurse practitioner (FNP) or
Licensure is a legal requirement of each state to prac- adult-gerontology primary care nurse practitioner
tice nursing in that state. The purpose of licensure is (AGPCNP).
to protect the public from unsafe practitioners. Legal Certification exams, based on an analysis of cur-
regulation of nursing practice (whether at the RN or rent practice, validate entry-level knowledge in an
APRN level) is the joint responsibility of the state leg- advanced nursing specialty in a defined population
islature and the state board of nursing (and in some area. Certification exams are competency-based ex-
states the board of medicine). Registered nurse (RN) aminations that provide a valid and reliable assess-
licensure is a requirement for enrolling in APRN ment of entry-level clinical knowledge and skills of a

4469_Winland-Brown_Ch01_001-008.indd 3 3/18/17 12:58 PM

 4 unit one: INTRODUCTION

APRN REGULATORY MODEL

APRN Specialties
Focus of practice beyond role and population focus linked to health-care needs
Examples include but are not limited to Oncology, Older Adults, Orthopedics, Nephrology, Palliative Care

Population Foci
Licensure occurs at levels
of role & population foci

Family/Individual Women’s Health/ Psychiatric-

Adult-Gerontology Neonatal Pediatrics
Across Life Span Gender-Related Mental Health

APRN roles

Nurse Clinical Nurse Nurse

Anesthetist Nurse-Midwife Practitioner
Specialist

Figure 1-1

nurse practitioner. This certification aligns with the

Box 1-1: Purposes of National Certification
Consensus Model for APRN Regulation: Licensure,
Accreditation, Certification, and Education (LACE). • Required for advanced nursing practice licensure in
Certification exams are administered through testing all but a few states
divisions of professional associations. These include • Indicates specific advanced role and population-
the American Nurses Association (ANA) subsidiary, the based competencies at an entry level building on
foundational nursing knowledge
American Nurses Credentialing Center (ANCC),
• Required for third-party reimbursement in Medicare
and the American Association of Nurse Practitioner’s populations as well as by most other insurers
American Academy of Nurse Practitioners Certifi- • Often required for institutional credentialing
cation Program (AANPCP). National certification • Required by the U.S. Department of Veterans
examinations by these bodies designate an APRN Affairs and the U.S. Armed Forces
role in a specific population (see Fig. 1-1), serve as • Required to obtain a National Provider Identifier
(NPI)
eligibility for licensure to practice in most states, and
are required for most third-party reimbursement, as
well as institutional credentialing. For a list of some
of the main purposes of national certification, review Box 1-2: Recognized Nursing Associations
Box 1-1. and Organizations Offering Advanced-Practice
In summary, the candidate for certification as an Nursing Certification for the Nurse Practitioner
APRN should recognize that certification is a formal Role
process conducted by nongovernmental organizations
to validate entry-level APRN knowledge, skills, and American Academy of Nurse Practitioners Certification
Program (AANPCP): http://www.aanpcert.org
competencies, based on predetermined standards and
practice analysis, and is a part of the requirement in American Nurses Credentialing Center (ANCC):
most states to obtain licensure and status as an APRN. http://www.nursecredentialing.org
See Box 1-2 for recognized certifying organizations for
FNP or AGPCNP practice.
retesting. The purpose of this book is to help you
achieve that goal, but your role in this process requires
YOUR ROLE
a commitment in time and effort to be successful.
You are making an important decision to become Table 1-1 lists the requirements for nurse prac-
an APRN or to maintain your certification through titioner certification by the ANCC and AANP as of

4469_Winland-Brown_Ch01_001-008.indd 4 3/18/17 12:58 PM

 chapter 1: ACHIEVING SUCCESS ON A CERTIFICATION EXAMINATION 5

TABLE 1-1. REQUIREMENTS TO SIT FOR TABLE 1-2. ANCC FAMILY NURSE
NURSE PRACTITIONER CERTIFICATION PRACTITIONER CERTIFICATION
EXAMINATION CONTENT OUTLINE (2016)
ANCC AANP
DOMAINS OF NUMBER OF PERCENT OF
• Present final, • Be a graduate (or imminent PRACTICE QUESTIONS QUESTIONS
degree-conferred graduate) of an accredited
transcripts Master’s NP, post-graduate Foundations for 64 37
• Present validation NP, or DNP program Advanced Practice
of Education • Present official final Professional Practice 30 17
Form signed by transcript with date degree Independent Practice 81 46
program director/ conferred
Total 175 100
faculty • Complete program faculty–
supervised clinical clock
hours
• Hold a current RN license describes the major categories and domains of practice,
as well as related topics and subtopics, which are cov-
ered on the examination. The examination currently
consists of 200 questions, 175 of which are scored and
2015. You must keep abreast of both of these creden- 25 pilot questions that are not scored. The nonscored
tialing Web sites for continued and changing infor- questions cannot be distinguished from the scored
mation regarding the details and processes for taking items.
the certification exam. To qualify to take an examina- The TCO includes information about how the
tion and become certified at the APRN level, a nurse content is weighted—that is, how many or what
must (1) meet the requirements for clinical or func- percentage of the test questions are in each of the
tional practice in a specialized field and (2) provide major domains. Table 1-2 lists the major categories
evidence of successful completion of an approved or domains of practice for the FNP examination and
Master or Doctor of Nursing Practice curriculum. includes an approximate number of questions and
the overall percentage for each category. To facili-
tate understanding of each of the major domains, the
ANCC also includes subcategories in a topical outline
Certification Examinations
format. Table 1-3 provides similar information for the
AGPCNP examination.
This book is geared toward the person who is seeking
The importance of reviewing the current handbook
national certification as an AGPCNP and/or FNP.
and TCO before sitting for the examination cannot be
The AGPCNP certification examination is designed
to assess your abilities as an APRN in the delivery of
primary care services to an adult population, defined as TABLE 1-3. ANCC ADULT-
adolescence through old age. The gerontological nurse GERONTOLOGICAL PRIMARY CARE
practitioner (GNP) certification is no longer offered NURSE PRACTITIONER CERTIFICATION
by either ANCC or AANPCP. EXAMINATION CONTENT OUTLINE (2016)
The FNP certification examination is designed to
assess your abilities as an APRN in the delivery of pri-
mary care services across the life span, including pre- DOMAINS OF NUMBER OF PERCENT OF
and postpartum care, pediatric primary care, and the PRACTICE QUESTIONS QUESTIONS
care of older adults. This spectrum of care is sometimes
referred to as “cradle to grave.” Foundations of 51 29%
Advanced Practice
Nursing
AMERICAN NURSES CREDENTIALING Professional Roles 51 29%
CENTER Independent Practice 73 42%
The ANCC Web site contains the certification hand- Total 175 100%
book, including a test content outline (TCO) that

4469_Winland-Brown_Ch01_001-008.indd 5 3/18/17 12:58 PM

 6 unit one: INTRODUCTION

overstated. All questions are classified according to life an additional 30 minutes for check-in and practice
span and problem-focused content areas. The life span time at the computer, including a tutorial. Because it
dimension for the AGPCNP examination includes is a computerized examination, you will receive your
non–age-specific content as well as specific content score 3 to 5 minutes after completing the examina-
pertaining to the adolescent, the adult, and the aging tion. A passing score is 350 or higher of a possible 500
adult. The FNP life span dimension includes the same points; 2014 statistics reveal 80.5% of AGPCNP and
content as the AGPCNP examination plus content 73.8% of FNP candidates passed on their first attempt.
relating to children, infants, and childbearing women. If not successful, a candidate can apply to retest after
The gerontological population is defined as persons 90 days.
older than age 65. You will need to be recertified every 5 years. At
The last dimension is related to problem areas and present, 500 hours of active practice must be attested
organizes question content by body system—for exam- over the previous 5 years. Additionally, continuing
ple, cardiovascular, endocrine, and respiratory. education credits and/or academic credit must be doc-
What this means is that each test question in the umented. If not able to clinically practice, or if there
Foundations for Advanced Practice and the Indepen- is a lack of continuing education and/or academic
dent Practice domains is characterized across three credit, a practitioner may elect to retake the certifi-
dimensions. For example, a test question that asks cation examination as a way of demonstrating current
about the treatment of a 70-year-old woman with a competency. Please check the ANCC Web site for the
diagnosis of osteoporosis would be characterized as most current information because guidelines for recer-
follows: tification are subject to change.

• Dimension 1—Clinical Management

AMERICAN ACADEMY OF NURSE
• Dimension 2—Life Span: Older Adult PRACTITIONERS CERTIFICATION
• Dimension 3—Problem Area: Musculoskeletal PROGRAM
Be aware that the TCO may change from exam- The AANPCP currently offers competency-based
ination to examination, so you need to review your national certification examinations for the AGPCNP
handbook carefully for the most current content and FNP. Reflecting APRN knowledge and exper-
breakdown. tise, the content areas of these examinations include
To assess each examinee’s level of specialty knowl- health promotion, disease prevention, and diagnosis
edge independent of the group taking the examina- and management of acute and chronic diseases. The
tion, a criterion-referenced standard is used. In this examinations given by the AANPCP were developed
approach, each examinee’s score is compared with an in conjunction with the Professional Examination
absolute number determined by the content experts Service, a not-for-profit organization with more than
who develop the examination. You need to answer 50 years of experience in developing and administer-
every question. Even if you have no idea of the answer, ing national licensing and certification examinations
by sheer chance alone you stand a 25% chance of in health-related fields.
guessing the correct answer. You are not penalized for In order to take either certifying examination,
incorrect answers. candidates must possess a master’s or doctoral degree
The test-development committee determines (DNP) from an accredited program. This certification
the passing score after careful consideration of the program is fully accredited by the National Commis-
content of the test questions. The passing score is sion for Certifying Agencies (NCCA).
always expressed in terms of the number of questions The AANPCP, in conjunction with the Pro-
you must correctly answer on the total test. Diag- fessional Examination Service, conducted a role-
nostic feedback is given if the examinee fails the delineation study to determine areas of clinical
certification exam. Additional statistical examina- knowledge to be tested. As a result of this study,
tion of the pilot questions is assessed for inclusion the examination was structured around assessment
in the final graded pool of test questions on the next (approximately 48 questions, or 36%), diagnosis
examination. (approximately 33 questions, or 24%), formulation/
Your performance on the total test determines planning/implementation of treatment plans (approxi-
your success or failure. The examination is adminis- mately 31 questions, or 23%), evaluation and follow-up
tered year round in a computerized testing center. You (approximately 24 questions, or 17%). The Web site
are permitted 3.5 hours to answer 200 questions. Plan and handbook also provide a list of knowledge areas

4469_Winland-Brown_Ch01_001-008.indd 6 3/18/17 12:58 PM

 chapter 1: ACHIEVING SUCCESS ON A CERTIFICATION EXAMINATION 7

for the FNP and AGPCNP exams. Examinees must be about cultural differences and cross-cultural commu-
able to integrate knowledge of pathophysiology, psy- nication, will be integrated with content concerning
chology, and sociology with the assessment, diagnosis, specific aspects of diagnosis, pharmacology, and dis-
and treatment of patients in primary care. Knowledge ease management.
of health promotion and disease prevention, as well as Questions testing physical assessment and
management of acute/episodic and chronic illness in history-taking skills, as well as content from advanced
the primary care setting, are tested. physical assessment, remain prominent. Although a
The AGPCNP examination tests knowledge of certain amount of basic pharmacological content is
adolescent, adult, and geriatric primary care; the FNP included, the latest drugs and pharmacological inter-
examination tests clinical knowledge of prenatal, ventions may not always appear because the examina-
pediatric, adolescent, adult, and geriatric primary care. tion questions are prepared and tested well in advance.
These examinations use growth and development (Note: Questions about your knowledge of safe pre-
as the basis of age-related changes, and specific age scribing for pregnant women almost always appear on
parameters are not defined for any population. the FNP examinations.)
These AANPCP examinations have a pass rate Be careful in applying your experiences from
of 87.5% for FNP and 85.7% for AGPCNP according clinical activities as a student or as a newly certi-
to 2014 data. They are also computer-based examina- fying APRN. The correct answer and other answer
tions offered year round. You know whether you have choices—also referred to as “distractors”—will not
passed or failed at the end of the examination. necessarily correlate with what you’ve currently seen.
Remember, the examination reflects the ideal answer
according to the references used and the expert pan-
Achieving Success els of the certifying body; this ideal answer may not
always mirror the realities of specific practices. Test
Nurse practitioner programs often focus on assess- answers are drawn from national guidelines and stan-
ment, management, and evaluation of disease. Indeed, dards of practice promulgated by a variety of bodies.
this is the role most of you perform in your respec- New national guidelines or standards may take up to a
tive work settings. The ability to diagnose and treat year for questions to be developed, piloted, and then
disease is paramount to your safe and effective func- included in the exam. The questions on the examina-
tioning as an APRN, and certification examinations tion are looking for generalized responses and might
increasingly reflect this reality. However, it is import- well reflect phenomena that you have not seen. Allow-
ant never to lose sight of the fact that these exam- ing yourself to become frustrated with the distractors
inations are certifying your abilities as an APRN and will not help you but rather will hinder your ability to
as such have an underlying commitment rooted in succeed. This is why it is essential that you study large
nursing-based knowledge, health, health promotion, numbers of sample test items (see chapter 2).
and human responses to health and illness. This is Being test savvy and succeeding on a multi-
especially apparent on the TCO of the ANCC exam- ple-choice examination is a far different skill from the
ination. Fully 37% of content is labeled “Foundations expert skills you bring to your practice. These skills
of Advanced Practice.” are not mutually exclusive. It is a matter of having the
As an APRN, your reaction to the various correct mind-set—one predicated on an awareness of
manifestations of health and illness phenomena is the nursing base of the certification examination cou-
instinctively different from that of other primary pled with an understanding of the test blueprint. Be
care providers. This comes up in different ways on determined not to select an anecdotal answer based
each examination, but it is an important distinction on experience from your practice experiences but
to keep in mind as you ponder the various ques- rather to select an answer based on nationally recog-
tion responses and wonder what answer is the best. nized, clinically based guidelines and rooted in clinical
Similarly, the test blueprints and types of questions literature.
asked reflect a continued commitment to concepts of You have taken the first step toward certification
health promotion and disease prevention as well as by purchasing this book. Understand the essential
to the underlying principles of therapeutic commu- reasons to become nationally certified. Fix the end
nication skills that are so essential to forging mean- goal vividly in your mind. Imagine how you will feel
ingful APRN-client relationships. Nursing-based when you receive that message on the screen saying
elements of growth and development, nutrition, and PASS, knowing that you are a nationally certified
therapeutic communication, as well as questions APRN.

4469_Winland-Brown_Ch01_001-008.indd 7 3/18/17 12:58 PM

 8 unit one: INTRODUCTION

Take the next step on the road to success by American Academy of Nurse Practitioners Certifi-
turning to chapter 2. It will assist you in the devel- cation Program description: http://www.aanp.org/
opment of important test-taking skills and pro- education/aanp-certification-program
vide guidelines for creating your individualized American Nurses Credentialing Center certification
study plan. Web page: http://www.nursecredentialing.org.
Dunphy, LM, Winland-Brown, JE, Porter, BO, and
References Thomas, D: Primary Care: The Art and Science of
Advanced Practice Nursing, ed 4. FA Davis, Phila-
Advanced Practice Registered Nurse Consensus delphia, 2015.
Model for Regulation: http://www.nonpf.org/default National Organization of Nurse Practitioner Faculties:
.asp?page=26 http://www.nonpf.com/

4469_Winland-Brown_Ch01_001-008.indd 8 3/18/17 12:58 PM

 Chapter 2: Test-Taking Skills and
Designing Your Study Plan for APRN
Certification
Study Habits: Know Yourself
What Is Your Preferred Learning Style?
Active Versus Passive Studying
Getting Started
Tips for Studying

Nature of the Exams

Test-Taking Skills: An Acquired Art
General Strategies
Basic Tools
Specific Strategies

Designing Your Study Plan

Assess and Diagnose
Plan and Implement
Evaluate

Last-Minute Preparations: Relaxed and Ready

References
Lynne M. Dunphy
and Gary Laustsen

This chapter has several parts. The first part actively

assists you in assessing your study and testing style. It Study Habits: Know Yourself
prepares you to develop an individualized study plan
that will enable you to achieve your goal: becoming a There are several approaches to developing good study
nationally certified advanced-practice registered nurse habits and effective test-taking skills. Among them are
(APRN). Another part reviews the nature of the adult- recognizing what your preferred learning style is, real-
gerontology primary care nurse practitioner and family izing the importance of active versus passive studying,
nurse practitioner certification examinations (we use the and following basic tips for getting started and devel-
term “exam” from this point on) and how that translates oping test-taking skills.
to actual test questions. The remaining parts deal with
the specifics of answering multiple-choice test questions WHAT IS YOUR PREFERRED
and the skills necessary to succeed on a multiple-choice
LEARNING STYLE?
exam. Evaluating test-taking skills, developing a for-
mal study plan, and being ready on exam day are also Awareness of your learning style will guide you in
covered. selecting study strategies. Learning styles are related

4469_Winland-Brown_Ch02_009-024.indd 9 3/18/17 1:16 PM

 10 unit one: INTRODUCTION

to the pathways or channels through which you pre- channel. Think about which of the three learning styles
fer to absorb information. The three types of learners discussed works best for you. Time is often at a premium
are commonly identified as visual, auditory, and tactile for nurses studying for certification, and capitalizing on
(sometimes called kinesthetic). your preferred learning style will help you study in the
most efficient way. Keep strategies for your preferred
Visual Learners learning style in mind as you develop your study plan.

Visual learners learn better from reading and writing

than from hearing and talking about information. ACTIVE VERSUS PASSIVE STUDYING
They usually find background noise, such as music and Regardless of your personal learning style, the more
television, distracting rather than helpful. Following actively you are engaged in the material, the better
are strategies for visual learners: your ability to retain and comprehend content. For
• Read texts in a quiet place. example, many of us have had the experience of read-
ing an entire chapter, or listening to a review CD, only
• Watch appropriate videos.
to find that our mind drifted away sometime earlier
• Use visual study aids such as concept maps, and we have difficulty recalling even the most basic
flash cards, and charts. information. Time is a precious commodity, so it is far
• Use highlighting markers or colored paper to more efficient to learn actively the first time than to
take notes. reread or relisten to an entire chapter a second time.
Tips used to improve active learning include taking
Auditory Learners notes while reading and pausing after each heading or
subheading to summarize the content. Can you iden-
Auditory learners grasp information most effectively tify the main idea that the author was attempting to
by listening and talking. Combining information with impart? Did you pass over new terms without taking
music often works well for auditory learners. Following the time to become familiar with them? As you read a
are strategies for auditory learners: summary, do you realize that you really need to go back
• Read texts aloud. to a more detailed reference because your knowledge
is insufficient? Although active engagement may slow
• Listen to audiotapes of course material. you down initially, it will save you time in the long
• Make up a song about the content and sing run because now you are involved in active learning
it aloud (especially helpful for assimilating and not simply hoping that something will stick as you
difficult content). speed by.
• Listen to background music or other noise.
• Talk about the content with a study partner. GETTING STARTED
Studying, like regular exercise, is good for the brain.
Tactile or Kinesthetic Learners As a health-care professional, you will find that it will
Tactile or kinesthetic learners prefer to learn “hands always be your job to keep abreast of the professional
on.” They have difficulty sitting still for long periods. literature and spend some time studying. To recer-
During study sessions, they should stand and move tify, you are mandated to keep your practice current
around or take frequent stretch breaks. Integrating through a combination of clinical hours and continu-
physical activity with study works well for these learn- ing education options. The earlier you begin to plan
ers. Following are strategies for tactile learners: for certification or recertification, the better.
The principles of effective study are simple—
• Move around while studying. worthwhile studying takes time and effort. And in
• Read while exercising on a stationary bicycle. today’s world, time is a precious commodity. There-
• Listen to tapes of learning material while fore, if you want to study, you need to set aside ade-
walking or biking. quate time and plan accordingly. Be prepared to delay
the start of new projects until this one is complete and
• Rewrite or type notes.
you have successfully taken the exam. There is no way
Although almost everyone is capable of learning around the hours involved. There are no shortcuts.
through all their sensory pathways, most have a preferred But you need to make it easy to begin.

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 chapter 2: TEST-TAKING SKILLS AND DESIGNING YOUR STUDY PLAN FOR APRN CERTIFICATION 11

TIPS FOR STUDYING preferable. Study for short periods with frequent
breaks.
Just as a cold engine will run a little rough, settling
down to study when one is out of the habit can be dif- • Integrate whatever learning modalities
ficult. The following suggestions should make it easier work best for you. For example, if you are an
to begin studying and to return to it on a regular and auditory learner, use recordings. Listening to
consistent basis. recordings while you are walking is especially
good for tactile learners.
• Create a pleasant personal environment. • Think in terms of “bite-size” pieces and
This is a very basic but frequently overlooked structure your study plan accordingly. Use the
requirement for successful study. Organize “salami” principle: Cut large tasks into smaller
all your study materials in one area. Try to ones and digest them one at a time. This will
create a pleasant and regular work space for keep you from becoming overwhelmed and
yourself. Perhaps it will be just part of a room, defeated before you begin.
but make it an inviting part. Decorate it with
• Variety is essential. For example, divide
flowers, pictures, or whatever makes the area
your time between test question review and
appealing to you. For the kinesthetic learner,
content review, or break up the study period
an open area that allows free movement may
into a variety of different tasks. Take notes for
be better than a small office. Some literature
part of the time and read for part of the time.
suggests that playing classical music, especially
Do not keep at any one activity—even your
from the baroque era, in the background
practice exams—for longer than 45 minutes.
increases concentration and retention. Decide
Try studying with a study group part of the
whether background music is helpful for you or
time. Discussing the materials with others is an
distracting. Background music may be helpful
especially good strategy for auditory learners.
for an auditory learner, whereas a visual learner
Although a 45-minute session is ideal for most
may find it a distraction.
of your study time and for taking practice
• Plan your activities in advance and be exams, it is helpful to experience at least one
realistic. Plan in advance what you are going to practice exam with many questions (~150) to
work on and do not be overly ambitious. Blocks get a sense of what it will be like when you take
of 1 hour at most are recommended, with a the actual certification exam.
10-minute break every 45 minutes. List the
• Study with your purpose in mind—in this
tasks beforehand; otherwise, you might spend
case, passing the certification exam. Research
valuable time trying to decide what material
has shown that two-thirds of your study time
to review. Set specific targets for the time
will be most effectively spent taking sample test
available.
questions. Do not lose sight of this! Studying
• Keep focused on the goal: becoming certified! does not necessarily mean sitting and reading
Keep the benefits of studying clearly in mind—in textbooks. Reading books in a linear fashion
this case, the joy of receiving your passing score, is often not the most effective way to master
followed by your embossed certificate in the information. Always keep the end result in
mail. Visualize and imagine what it will feel like mind.
when you read the word PASS on the computer. • Leave the environment in readiness for your
Picture the certificate framed and hanging in next session. Leave your work environment
your office. Focus on these results and how they inviting for the next time. Put your materials
make you feel. Close your eyes and allow the away so that they are easily accessible. Do not
feelings to flood through you! leave the area cluttered; instead, make it more
• Use your knowledge of yourself and of basic pleasing. Spend the last few minutes of your
tips. There are a number of ways you can study time tidying up so that your environment
make studying more fun. Make use of your best is all set for your next session. This is also an
time of day. For some, this might mean rising excellent time to plan what you will do the
early while the rest of the household sleeps next time you sit down to study. Believe it or
and stealing time alone, undisturbed, with a not, these small, concrete habits can make a big
hot cup of tea or coffee. For others, evening is dent in your natural tendency to procrastinate.

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 12 unit one: INTRODUCTION

• Reward yourself. Last but not least, reward Plan time to familiarize yourself with the technol-
yourself! Reward yourself for each study period. ogy before the exam begins. There are simple tutorials
You might decide that if you spend 3 hours to “warm you up,” helping you feel more comfortable
studying on Saturday, you will see a movie with the computerized format before beginning the
on Saturday evening or go to the mall or actual exam questions.
treat yourself to a special activity! Be good to
yourself.
Now that you understand yourself better and know Test-Taking Skills: An Acquired Art
how to approach studying for the exam, we move on
to providing some specific information about the cer- The ability to select the best response to each question
tification exams. is what determines your success on the exam. Knowl-
edge of the content is, unfortunately, not enough to
guarantee success. If you are not able to communicate
your knowledge through the medium of the exam, you
Nature of the Exams will not succeed in becoming certified. Succeeding on
a certification exam is not always indicative of your
The ANCC exam consists of 175 scored questions and actual practice ability or intellectual capability.
25 items being piloted that do not count in your score.
The AANP certification exams consist of 150 scored
multiple-choice questions, 15 of which are pilot ques- GENERAL TEST-TAKING STRATEGIES
tions. The exam is administered on a computer at a
Some general principles apply to preparing for and
testing center, and you will know within a few minutes
taking any sort of standardized test, regardless of the
after you complete the exam if you have passed. The
content area. Familiarize yourself with these strategies
questions are at a variety of difficulty levels, adminis-
listed in Box 2-1.
tered in an integrated format. The exams are not com-
puter adaptive at this time. Computer-adaptive testing
is the technique used for the NCLEX-RN licensure
exam. With computer-adaptive tests, each answer, Box 2-1: General Strategies
correct or incorrect, determines the difficulty level of
the next question a participant receives, and each par- • Avoid changing answers.
• Develop a self-confidence mantra to recite if you
ticipant may answer a different number of questions to find yourself doubting your knowledge.
meet a minimum passing level. • Develop and stick to a study plan; avoid last-minute
The AANPCP exam as of this writing is com- cramming.
posed of multiple-choice questions only. The ANCC • Do not linger too long over one question.
exam includes four types of questions: (1) multiple • Focus on concepts, not details, during study
periods.
choice, (2) multiple response, (3) drag and drop, and
• Focus on decreasing your test-taking time.
(4) hot spot. Most of the test questions are multiple • Maintain objectivity; avoid adding your own
choice. If you are planning to take the ANCC exam, interpretation.
it would be helpful to review on the ANCC Web • Read all answer options.
site examples of the alternative type questions. This • Read questions as though you are speaking them
format means that you must be able to identify key aloud in your head to avoid scanning.
• Time yourself in practice tests; allow 45 to 60
words or phrases on a computer screen, not on the seconds for each question.
traditional paper format. Many test takers feel con- • Use concept maps.
strained when they are unable to underline or high- • Use practice tests to increase confidence.
light key words and phrases. A helpful tip: Use the • Work on self-confidence.
scratch paper and pencil provided to you when taking
Source: Adapted from Sides, MB, and Korchek, N:
a computer-based exam to write down the key phrases Successful Test-Taking Strategies, ed 3, Lippincott Williams
if that helps you focus on the topic and/or issue being & Wilkins, Philadelphia, 1998, p. 77; and Dickenson-Hazard,
presented in the question. Remember that the scratch N: Test-taking strategies and techniques. In Kopac, CA,
and Millonig, VL (Eds), Gerontological Nursing Certification
paper is collected by the testing center staff before you Review Guide, revised ed, Health Leadership Associates,
may leave the testing area; this is done to maintain Potomac, MD, 1996, pp. 3–5.
test question security.

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 chapter 2: TEST-TAKING SKILLS AND DESIGNING YOUR STUDY PLAN FOR APRN CERTIFICATION 13

Achieving success on a multiple-choice test is a skill; you with a choice between assessment and implemen-
and like any other skill, it can be improved. Remember tation, you should remember these basic tips. The
how you improve other skills, such as playing an instru- purpose of assessment is to validate or confirm the
ment or a sport: practice. The same holds true for test- problem. When considering an answer choice that
taking skills. The best way to succeed on the exam is is an assessment, you should ask yourself, “Is this
through practice, practice, and more practice. an assessment that is appropriate to the topic of the
The more you practice answering sample test ques- question?” If it is, you should carefully consider this as
tions, the better you will become at it. That is why a very likely answer choice. If, however, you believe
we have written this book for you. This book provides the correct answer choice is an implementation, you
over 2,000 sample test questions. Research has shown should ask yourself, “Do I have enough information
that two-thirds of study time should be spent taking to implement what the answer choice is asking me
sample tests, and one-third of the time should be spent to do?” Last, if the answer choice is asking you to
reviewing content. A number of exam-preparation evaluate a situation, you should ask yourself, “What
books are available to you; however, very few contain would be the outcome if I choose this answer?” The
nearly the number of test questions you need to develop criteria for reference are always your textbook and/or
and flex your test-taking muscles. This book provides professional guidelines, and you should avoid answer
enough questions to enable you to do that. Addition- choices that are too narrow or reflective of an indi-
ally, reading through the answers in the rationales— vidual practice preference. Each exam publishes a set
the why of the reason the selected answer is correct or of textbook references that are used in the creation
incorrect—is an excellent way to expand your knowl- of the exam questions. It is a good practice to review
edge base in general. It also provides insight into how this list of text references.
answers are keyed—why one answer is rated as correct
over another answer that seems to make more sense
Maslow’s Hierarchy of Needs
to you. Remember: You will not be able to argue with
the certifying exam creators as to your theory about Another important tool is Maslow’s hierarchy of needs.
why one answer is “more correct.” Allow yourself to It is particularly helpful in making priority decisions.
“tune in” to these rationales so that you become more According to Maslow, there are five levels of human
familiar with the answers that are noted to be correct. needs: physiological needs, a need for safety and secu-
In addition to the general strategies for test taking rity, a need for love and a sense of belonging, a need for
listed earlier, there are specific tools and strategies to self-esteem, and a need for self-actualization. Because
strengthen the test-taking skills you will need for certi- survival is grounded in basic physiological needs, these
fication. We will review two nursing tools and give you needs take priority over any other human needs. It
some specific strategies for how to use them in testing comes down to practicality: If you do not have oxygen
situations. to breathe or food to eat, your focus is not really on the
stability of your love life. When trying to determine
the priority between a physiological need of a client
BASIC TOOLS
versus a psychosocial need, remember the priority is
Two basic tools that are used in nursing—and that you to meet the physical needs of the client. This doesn’t
should employ when taking the certification exam—are imply that the correct answer is never psychosocial; it
the nursing process and Maslow’s hierarchy of needs. simply means that survival of the species requires us
to address physiological needs first, before we advance
through the other stages of human needs. Always
The Nursing Process
think ABCs—Airway, Breathing, Circulation. Care-
The nursing process is a great tool when taking your fully evaluate each item and ask yourself “What level
certification exam because it can guide you through of need is the question addressing? Physiological? Need
problem-solving. The AANP certification exam for self-esteem?”
structures very specific pieces of information around
these areas (see the table of contents on the Web
SPECIFIC STRATEGIES
site). As you recall from your basic nursing educa-
tion program, the steps of the nursing process include The following specific strategies should help in
assessment, diagnosis, planning, implementation, answering the multiple-choice questions on the cer-
and evaluation (ADPIE). When a question provides tification exam.

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 14 unit one: INTRODUCTION

Strategy #1: Understand and Analyze the is in the form of an incomplete statement, is in bold
Anatomy of a Test Question print.
A multiple-choice test question consists of three parts: EXAMPLE 1
• An introductory statement, which sets up the A 32-year-old woman comes to your office for a routine
clinical scenario examination. Her blood pressure is 116/74. You should
• A stem, which poses a question or incomplete recommend that the client have her blood pressure checked
sentence again in
• Options, from which you must select the correct
A. 6 months.
answer
B. 1 year.
The first step in analyzing a multiple-choice test
C. 2 years.
question is to separate what the question tells you from
what it asks you. The introductory statement, which D. 5 years.
may vary considerably in length, provides informa-
tion about a clinical scenario, a disease process, or a The first and most important step is to identify what
nursing response. The stem poses a specific question, the question is asking. You cannot expect to answer the
which you must answer on the basis of your advanced- question correctly until you understand the topic of
practice nursing knowledge. Stems are worded in dif- the question. The introductory statement of Example
ferent ways but always contain enough information to 1 gives you information about the clinical situation—a
answer the question. Some stems are in the form of 32-year-old female client came to your office for a rou-
a question; others are in the form of an incomplete tine exam and has a normal blood pressure; these are
statement that you must complete. You must then the topics. The stem asks you for a clinical judgment
select the one option that best answers the question based on your knowledge of clinical guidelines—when
or completes the incomplete statement from a num- should she have her blood pressure checked again? You
ber, usually four, of potential options, sometimes called must select the option that provides the most accurate
distractors. response—in this case, option C is correct according
Here are a few additional considerations in under- to current guidelines. This question is an example of
standing the format of questions: a recall (memory-based) question, sometimes called
a knowledge-based question. You need to know and
1. Answer options on certification exams will recall the guidelines concerning the frequency of blood
not include “All of the above” or “None of the pressure measurements under different circumstances
above.” and within different populations.
2. Answer options often have very similar Other test questions assess comprehension.
wording with only a few of the words or This is defined as “drawing inferences from informa-
phrases distinguishing the correct answer from tion without necessarily relating inferences to other
the incorrect options. material”—in other words, using only the information
3. Questions are not phrased “negatively.” That that is present in the question. Test takers often fall
means you will not have to choose an answer in into the trap of “reading into” these types of questions—
which the correct response is not to do something. thinking about information that is not requested in the
question.
4. Abbreviations (except a few standard ones) are
always spelled out. EXAMPLE 2
5. There are no fill-in-the-blank questions.
A 41-year-old man comes to your office complaining of
6. Generic drug names are used with some trade having hit his head. While assessing his eyes, you note that
names appearing in parentheses after the the left pupil constricts simultaneously when the right pupil
generic name. Don’t learn just trade names. receives direct light. His left pupil exhibits which reaction?
Knowing these components will assist you in ana- A. Direct papillary reaction
lyzing the information presented and in focusing on
B. Consensual papillary reaction
the question’s intent or issue. Let’s look at an example
that includes an introductory statement in the form of C. Convergence reaction
a clinical scenario. The stem, which in this example D. Corneal light reflex reaction

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 chapter 2: TEST-TAKING SKILLS AND DESIGNING YOUR STUDY PLAN FOR APRN CERTIFICATION 15

In this case, the correct answer is option B. You Strategy #2: Identify the Questions, Critical
were able to comprehend the requested information Elements, and Key Words
based on the exact information given in the question.
Nursing, however, is a practice-based discipline. The ability to identify the critical elements and key
Nurses must apply knowledge to specific situations. words in a test question is crucial to a correct inter-
This ability is assessed through the application ques- pretation of the question. Critical elements, such as
tions designed to assess your ability to implement, the key concepts and conditions, tend to appear in
solve a problem, or perform a task. Application of the introductory statement, whereas key words usually
nursing knowledge is essential to safe, competency- appear in the stem of the question. Regardless of the
based, entry-level advanced nursing practice. Appli- placement of these words, remember that everything
cation sometimes implies analysis of information, you need to be able to answer this question correctly is
meaning the question requires you to dissect and ana- provided for you.
lyze information and/or distinguish between relevant Key words are important words or phrases that
and irrelevant data. The certification exam is a test help focus your attention on what the question is spe-
of “minimum competency,” and simply recalling facts cifically asking. Examples of key words include most,
would not provide the certification bodies with suffi- first response, earliest, priority, on the first visit, on a sub-
cient information to determine your abilities. As such, sequent visit, common, best, least, immediately, and ini-
you can expect the majority (up to 75%) of questions tial. Take a look at this example.
to be application and analysis type questions. These
require you to integrate knowledge with the facts that EXAMPLE 4
are presented in order to choose the single best answer Which of the following is an example of a primary preven-
for each question. Review the following example. tive intervention?
EXAMPLE 3 A. Blood pressure screening
Julie, age 18 months, is up to date with her immunizations B. Pap smear
and is due to receive her diphtheria, tetanus, and acellular C. Screening sigmoidoscopy
pertussis (DTaP) and polio vaccinations today. Her father D. Tetanus prophylaxis
is bedridden at home with AIDS. Which immunizations
should Julie receive today? Example 4 is a recall question with a positive-
response stem. Although all the interventions are
A. DTaP only
preventive, the key word is primary, allowing you to
B. DTaP and inactivated polio vaccine (IPV) choose the correct answer, option D.
C. DTaP; IPV; and measles, mumps, and rubella After identifying the topic of the question, you
(MMR) must also identify the issue the question is asking
D. DTaP, OPV (oral polio vaccine), and MMR about. For example, the question, as in Example 5,
may be requesting information about a disorder.
You must synthesize several concepts regarding
immunizations to select the correct answer (option B) EXAMPLE 5
for this question. You must integrate your recall knowl-
Mr. Williams, age 76, is seen in the ambulatory care clinic.
edge regarding standard and current immunization
He is complaining about incontinence, suprapubic pain,
schedules (e.g., that Julie should receive DTaP and
urgency, and dysuria. A urinalysis reveals the presence of
polio immunizations on this visit) with the specific
white blood cells (WBCs), red blood cells (RBCs), and
clinical scenario.
bacteria. What is your diagnosis?
A common error test takers make in a multiple-
choice testing format is to analyze the question and A. Pyelonephritis
choose the answer with their eyes. Analysis is, how-
B. Nephrotic syndrome
ever, done with the brain. Be careful of choices that
“look good.” The reference for every correct answer C. Benign prostatic hypertrophy (BPH)
is grounded in textbook and/or professional guideline D. Cystitis
knowledge. A common trap that test question writers
use is to include answer choices that appear on the sur- By selecting the correct answer, option D, you
face to be correct but are not. have demonstrated knowledge related to a disease

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 16 unit one: INTRODUCTION

process, the issue about which this question requested and states, “I’m afraid of having a mammogram.” Your
information. Other examples of issues include drugs, initial response is
such as antibiotics or immunizations; diagnostic tests,
such as urinalysis or serum glucose; toxic effects of A. “You must have the mammogram.”
a drug, such as rash or vomiting; problems, such as B. “Don’t worry; I’m sure it is nothing.”
knowledge deficit or substance abuse; procedures, C. “Wonderful advances have been made in breast
such as bone marrow aspiration or cardiac catheter- cancer research.”
ization; behaviors, such as agitation or overeating;
D. “You’re feeling scared?”
and, occasionally, a combination of these. Consider
this example.
The correct answer is option D. This example of
therapeutic communication acknowledges the cli-
EXAMPLE 6
ent’s fear and encourages her to verbalize her feelings.
Which drug is used in the treatment of acute gout? Table 2-1 reviews communication techniques that
facilitate therapeutic communication and those that
A. An NSAID (e.g., indomethacin) block therapeutic communication.
B. A xanthine oxidase inhibitor (e.g., allopurinol) Another important component in selecting the
C. An antibiotic (e.g., cephalexin) correct answer to questions that address your ability
to communicate therapeutically is prioritization of
D. A topical numbing agent (e.g., lidocaine spray)
responses. More than one option may contain a ther-
This is a recall/knowledge-based question based apeutic response. But which is the first, best, or most
on your understanding of the pharmacological treat- therapeutic response in that situation? Communica-
ment options for an acute disease. The correct answer tion theory emphasizes that it is a priority to address
is option A. the client’s feelings first. Validate, validate, validate.
“You seem to be very sad today, Mr. George.” “I can
see that you are upset.” “You seem very anxious, Mrs.
Strategy #3: Use Therapeutic Smith.” This should always be done before clarifying
Communication or presenting information. Is there a need to address
the feelings? If so, this takes priority. Empathy, restate-
In communication-type questions, you are always look-
ment, reflection, and being silent, as well as remain-
ing for a therapeutic response, the cornerstone of the
ing with the client are all excellent nursing strategies
nurse-client relationship. To communicate therapeuti-
that can potentially validate client’s feelings. The only
cally, you need to use communication tools and avoid
exception to this rule would be the presence of a press-
communication blocks. Remember your basic thera-
ing or interfering physical problem.
peutic nursing role. The nurse, whether at a generalist
or advanced-practice level, is always therapeutic. Your
role is not that of an authority figure. This may cause Strategy #4: Identify the Person Who Is the
some confusion for practitioners from other cultures Focus of the Question
in which health-care providers are conceptualized as
authority figures who give directions. Remember, this Another critical element is your ability to identify the
is a nursing-based exam. Your initial response is always person who is the focus of the question. This person
the therapeutic response—the acknowledgment and might be the client who has the health-care prob-
validation of the client’s feelings. This is really a safety lem, a family member or neighbor of the person with
issue. Are your responses to clients and families safe? the health-care problem, or another member of the
In acknowledgment of the importance of this aspect health-care team. Take a look at this example.
of advanced nursing practice, therapeutic communica-
tion and the nurse-client relationship are included in EXAMPLE 8
the ANCC and AANP test content outlines and are
Mr. Boyd, age 84, has dementia and is being evaluated in
critical aspects of all nursing practice.
a long-term care facility. His daughter and son-in-law are
visiting. As they get ready to leave and begin to say good-
EXAMPLE 7
bye, Mr. Boyd grabs his daughter’s arm and begins to cry,
Ms. Dortney, age 55, is very fearful because of a breast saying, “Don’t leave me here. I will die in this place.” As
lump the NP has just identified. The patient begins to cry she leaves the room, his daughter is visibly upset and asks

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 chapter 2: TEST-TAKING SKILLS AND DESIGNING YOUR STUDY PLAN FOR APRN CERTIFICATION 17

TABLE 2-1. COMMUNICATION TECHNIQUES

TECHNIQUES THAT FACILITATE THERAPEUTIC COMMUNICATION

Techniques Examples
Offering self “I’ll stay with you.”
Showing empathy “I see you are upset.”
Silence Remaining present but silent
Giving information “You need to take this drug two times a day.”
Restatement “You feel hurt?”
Clarification “You are saying that …”
Reflection “You seem to be anxious.”

TECHNIQUES THAT BLOCK THERAPEUTIC COMMUNICATION

Techniques Examples
False reassurance “Everything will be OK.”
Disapproval “That was wrong.”
Approval “That was right.”
Requesting an explanation “Why did you do that?”
Giving advice “I think you should …”
Deferring “You need to talk with your doctor about that.”
Defensiveness “We are understaffed!”
Devaluing feelings “That’s silly; don’t be upset!”

the NP if she should visit again soon because it has upset Strategy #5: Determine the Best Response
her father. The best reply for you to make is
There may be more than one option in a test question
A. “You might try telephoning next time instead that is correct. But which is the best, first, or most
of visiting. Your father will know that you are therapeutically sound response to the question posed?
thinking of him then.” Application/analysis-based test questions often involve
B. “I will give you the number of the social worker. decision making, which is based on prioritization.
She will be able to arrange a team conference and Therapeutic communication skills teach the acknowl-
family meeting.” edgment of feelings first. Teaching and learning theory
C. “This is a very upsetting time for all of you. reminds us that unless the client is motivated to learn,
However, it is important that you continue to no client teaching will be successful. If the client is not
visit regularly. For now, I will go in and sit with motivated, this issue must be addressed first.
your father for a little while.” To assist you in the correct answer selection, use
the following tips:
D. “He needs time to adjust to this new setting.
Perhaps it might be easier on you all if you just • Assessment always comes before diagnosis and
didn’t visit for a few days.” treatment.
In this question, the person who is the focus of the • The key word initial usually implies the need to
question is Mr. Boyd’s daughter, not Mr. Boyd. The key prioritize.
word in the stem is best reply. It is also helpful to iden-
• Remember Maslow’s hierarchy of needs.
tify the issue the question is asking about. The issue in
this question is one of therapeutic communication— • In communication-based questions, you must
specifically, Mr. Boyd’s daughter’s feelings of concern address the client’s feelings first.
about her father. Option C is the correct response • In teaching and learning situations, learning is
because it validates the daughter’s feelings first. contingent upon motivation.

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 18 unit one: INTRODUCTION

As stated earlier, according to Maslow, physio- your exam. You have answered a few questions easily,
logical needs always come first. In determining which but now you have come to a test question to which you
physiological needs have priority, you might recall do not know the answer. You have identified the intro-
the ABCs for basic cardiopulmonary support—A for ductory statement and the stem and have read through
airway, B for breathing, and C for circulation. This is the options. You have identified the issue and the person
handy to remember for questions that present a sudden who is the focus of the question. But you are still uncer-
emergency situation or any situation that is potentially tain of the answer. If this happens, follow these tips:
life threatening for the client. Once basic physiologi-
• Eliminate incorrect options. This is very
cal needs are met, safety is the next priority, followed
important. Frequently, you will be able to
by psychosocial needs.
eliminate two choices easily. If even a small
part of the answer choice is incorrect, the
Strategy #6: Avoid Common Pitfalls whole answer choice is incorrect, and you
must eliminate it from further consideration.
A very common cause of test-taking errors is misread-
Eliminating incorrect answer choices improves
ing the test question. To avoid common pitfalls, follow
your chances of choosing the correct response
these tips:
even when you are unsure of the exact answer
• Ask yourself, “What is this question really choice. The key is to not panic. It is not
asking?” realistic to expect to know everything that
• Look for the key words. you will be tested on, but through careful
preparation, use of test-taking tools and
• Restate the question in your own words. strategies, and analysis of the content presented
Eliminate any options that require you to make in the question, you will improve your chances
assumptions about information that is not of successfully answering the question and
presented in the case scenario and any options passing the certification exam on the first
that contain information not presented in attempt—a noteworthy goal!
the scenario. Do not read anything new into or
overanalyze the test question! Go with your first, • Select the most global response option. The
most straightforward response. It is usually your option that offers the most comprehensive or
best bet for answering the test question correctly. general statement is often a better answer than
an option that is more specific and thus more
• Carefully review the question using the limited.
systematic format and strategies suggested in
this book. • Eliminate similar options. If two options say
essentially the same thing, neither can be correct.
• Make a decision about each option as you If three of the four options sound similar, the
read it; this is an efficient approach to test “odd” one should win out. In other words, look
taking. Do not go back to that option once for patterns or relationships within the answer
you have eliminated it, do not overcomplicate choices to help you select the best answer.
the case scenario presented, and do not rely
on anecdotal data from your own practice. • Look for words or phrases in the option
These are national exams with testing content that are similar to those in the introductory
based on national standards of practice and
commonly used textbook references.
• After choosing an option, read the selected Box 2-2: Key Test-Taking Tips
response “back into the question.” This will
• Eliminate options you know are incorrect. If you
help clarify whether the selected response
can eliminate two options, even a guess has a 50%
makes sense in the context of the question. chance of being correct.
• Answer all questions as if the situations were ideal.
• Read the test question carefully.
Strategy #7: Select the Best Answer When • Separate what the question tells you from what it is
You Do Not Know the Answer asking.
• Select the most global response.
We now discuss some more specific strategies for select- • Be alert to information relevant to answering the
ing the best answer. Certification exams do not penal- question in the stem or in earlier questions.
ize you for guessing. Imagine that you are beginning

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 chapter 2: TEST-TAKING SKILLS AND DESIGNING YOUR STUDY PLAN FOR APRN CERTIFICATION 19

statement or stem. Try this strategy if you need the questions you did. Failure to analyze why you
to guess. missed a specific question is a commonly missed
• Be alert to relevant information from earlier opportunity to improve your skills. Simply comparing
questions. your answer choice to the correct answer choice is a
passive learning process. However, analyzing why you
To summarize, key test-taking tips are given in missed a question (assessment) and actively creating
Box 2-2. a strategy to correct the knowledge or skills deficit
(implementation) will help you achieve the outcome
you are seeking. For example, did you miss the cor-
Designing Your Study Plan rect answer because you did not know or remember
the content? This is a knowledge deficit. Or did you
In creating your individual study plan, review and miss a key word, read too much into the test question,
apply the phases of the nursing process: assess, diag- or change your answer? If so, you need to continue
nose, plan, implement, and evaluate. to work on test-taking skills. You must become pro-
ficient at both—content knowledge and test-taking
skills. Recognizing where you are vulnerable and then
ASSESS AND DIAGNOSE
taking steps to improve in that area gives you a sig-
Begin by taking some sample exams. You might first try nificant edge in preparing for your exam and building
taking one of the practice exams that are in the back of your confidence. These objectives are best achieved
this book. Do only 150 questions and then assess your through ongoing self-testing with sample exam ques-
score. This will give you an idea of your baseline and how tions such as the ones provided for you in this book.
intensive your study plan needs to be. Then, move on to Evaluate what percentage of questions you missed
the specific content areas in this book, beginning with because of (1) content issues, (2) testing errors, or (3)
your weakest areas first. For example, if your assessment confidence issues. Design your study plan accordingly.
of your practice test score indicates a specific weakness As you study, use the analysis of scoring to continue
in male genitourinary content, begin with that chapter. to track your progress.
Reflect, as part of your assessment, on your pre- Aim for an 85% grade on your practice exams to
ferred learning style and personality. Remember, speed demonstrate a good level of mastery of each content
is not necessarily your best friend, and overanalyzing area. Begin working on areas in which your knowl-
can lead you to an incorrect answer choice, but careful edge may be lacking and progress to areas in which
analysis of each question is a prerequisite to success on you are stronger. Opening a book and beginning on
the exam. The union of knowledge and strategy is what page 1 may not serve you well. However, recognizing
is needed to achieve a successful outcome on the certifi- that you may be weak in cardiovascular content and
cation exam. One complements the other, and both are prioritizing your study time to concentrate on that
imperative if you are to attain your goal of becoming a content area to eliminate knowledge deficits will be
board-certified advanced-practice registered nurse. very helpful.
Use the analysis of scoring in Table 2-2 to help Any test score below 85% indicates a need to ini-
you make an accurate assessment of why you missed tiate a more aggressive and intensive exam review.

TABLE 2-2. ANALYSIS OF SCORING

Review the sample test questions that you answered incorrectly and keep track of what caused you to select
the incorrect answer. Look for a pattern.

Missed Did not Read Misread or Changed Had Forgot or Applied

key read “into” the misunderstood the content did not the
word all the question the question answer weakness recognize wrong
distractors or concept
carefully understand or
the content rationales

4469_Winland-Brown_Ch02_009-024.indd 19 3/18/17 1:16 PM

 20 unit one: INTRODUCTION

A score of 85% or higher, however, does not mean review class is an additional way to shore up your
that you don’t need to prepare. You should still aim knowledge base.
to review 2,000 to 3,000 sample test questions before
sitting for the exam, as well as do some basic con-
PLAN AND IMPLEMENT
tent review. An initial score below 80% means you
should aim to review a minimum of 5,000 sample test The certification exam time line and study calendar
questions before the exam, as well as complete an (Table 2-3) provide a suggested 6-week time line,
intensive content review. Attending a certification providing a countdown to exam time from the day

TABLE 2-3. CERTIFICATION EXAM TIME LINE AND STUDY CALENDAR

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

Commitment
• Register for the exam.
• Evaluate your preferred learning style.
• Take assessment exam.
• Evaluate exam with analysis of scoring.
• Develop study plan and gather study materials.
• Fill out study calendar and begin.
• Make arrangements for going to the exam.

(Dates)
WEEK 1 Content: Content: Content: Content: Content: Content:
Score: Score: Score: Score: Score: Score:
(Dates)
WEEK 2 Content: Content: Content: Content: Content: Content:
Score: Score: Score: Score: Score: Score:

Perseverance
• Continue studying.

(Dates)
WEEK 3 Content: Content: Content: Content: Content: Content:
Score: Score: Score: Score: Score: Score:
(Dates)
WEEK 4 Content: Content: Content: Content: Content: Content:
Score: Score: Score: Score: Score: Score:

Focus and Reward

• Focus on content areas in which you scored less than 80% on sample questions.
• Make final arrangements for going to the exam.

(Dates)
WEEK 5 Content: Content: Content: Content: Content: Content:
Score: Score: Score: Score: Score: Score:
(Dates)
WEEK 6 Content: Content: Content: Content: Content: Content:
Score: Score: Score: Score: Score: Score:

Source: Adapted from Hoefler, P: Successful Problem-Solving and Test-Taking for Beginning Nursing Students, ed 3. MEDS, Silver Spring,
MD, 1997, p. 111.

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 chapter 2: TEST-TAKING SKILLS AND DESIGNING YOUR STUDY PLAN FOR APRN CERTIFICATION 21

you register for your exam. Study a little every day. Using content maps is another approach to mas-
Improve your self-image. Believe you are a knowledge- tering content. Figure 2-1 is an example of a con-
able and competent nurse practitioner and behave like tent map approach to reviewing disease processes.
one. Stick to your study plan. Set clear-cut goals and A content map is a picture or pattern of informa-
objectives and follow them. tion. It also shows relationships between pieces of
Answer approximately 100 test questions in a spe- information. Developing content maps can help
cific content area. Assess your score. If it is above 85%, you find content areas in which you are weak and
move on. Feel confident—but continue to review sam- avoid studying content you already know. People
ple test questions. If your score is lower than 85%, use are drawn to study what they already know. They
the Analysis of Scoring in Table 2-2. feel comfortable with that information, whereas
As noted in chapter 1, both the ANCC and new information can produce anxiety. In the long
AANP exams cover pathophysiological content orga- run, however, this is not a good strategy. Few peo-
nized by body system. This is how you should organize ple can read a book and visualize the exact page,
your study time: by body system, by content areas asso- word for word, in their minds. A content map helps
ciated with populations (usually age-driven), and by you find the information in your memory, where it
the specified domains on the exam. The body system is usually stored in patterns related to other mem-
content is specified by the chapter title. We suggest ories. Using this structure, you can find out what
following the table of contents of this book, which is areas you may not completely understand. Content
modeled on the practice domains spelled out by both maps start with general information and move to
certifying bodies. After assessing your baseline knowl- specifics. They can be helpful for people who spend
edge through use of the integrated practice exams pro- so much time studying the details that they miss the
vided in this book, move on to the content areas in bigger picture.
which you scored the lowest. This will allow you to
customize your study plan and make the best use of
CONTENT MAP
your time. Remember, for some people, this might be
the neurological content; for others, it might be the
endocrine or psychiatric content, and so on.
To review disorders and help you prioritize, use the
following tips:

• Organize content by body system.

• Begin with the system you find the most
difficult.
• Review the pathophysiology of that system, if
necessary.
• List pertinent disorders of that system.
• Review incidence and contributing factors.
• Review early and late disease manifestations.
• Review the sequelae, prognoses, and life-
threatening complications.
• Determine treatment; adjust for age and/or
comorbidities.
• Review associated teaching and learning needs.
• Review coping techniques, prevention, and
health promotion.
• Remember that the certification exam focuses
on common diseases and disorders; use this
information as a tool for success and avoid
studying topics that are rarely seen in a primary
care setting. Figure 2-1

4469_Winland-Brown_Ch02_009-024.indd 21 3/18/17 1:16 PM

 22 unit one: INTRODUCTION

EVALUATE
Last-Minute Preparations: Relaxed
To help you evaluate your progress, consider these tips: and Ready
• Take a sample test and use the analysis of
scoring. Review one of your sample content Well, you are finally there! The day of the exam has
area tests. Why did you answer some questions arrived. Several tried-and-true techniques can help
incorrectly? Remember, active learning you get through this day with success and confidence.
improves retention. The night before the exam, get a good night’s sleep.
Last-minute all-night study sessions are not recom-
• If you forgot some content, use a content review.
mended. Since your exam will focus on comprehension
Did you not recognize or remember the content?
and analysis, cramming the night before is not a test-
If not, this would indicate a need to review
taking strategy, and it often results in increased anxiety
content using a book of condensed information
and lower test scores. However, taking time to review a
or an outline-review text, or attending a
few notes is acceptable. It might be better to do some-
certification review. It does not mean that you
thing relaxing and enjoyable like going to a movie.
should return to your textbook or class notes.
Locate the exam site before the day of the actual
• If you misunderstand a rationale, go back exam. For some, you may need to travel and stay in a
to textbooks. Did you not comprehend the hotel the night before taking the exam. Give yourself
content? For example, perhaps your basic plenty of time to travel and arrive at a reasonable time
understanding of the cardiac cycle was not in the city where you will be taking the exam. On the
thorough enough to include the severity and day of the exam, plan for possible traffic delays or bad
implications of various murmurs (i.e., which weather. Becoming lost or finding yourself stuck in traffic
ones are relatively normal physiological will only increase your anxiety. Find out how long it will
events and which ones are indicative of more take to get there and where to park when you arrive.
severe pathology). This would indicate a The day of the exam, do a few exercises to get your
need to go back to one of your textbooks or blood pumping to your brain. Eat lightly, but do have
perhaps obtain audio and/or video recordings something before taking the exam. Bring identifica-
with more detailed content and review basic tion, your registration for the exam, and a watch. Dress
pathophysiological processes. in layers. Avoid stimulants and depressants. Go light
• If the error is in test taking or you need to on the caffeine. Find the restroom and use it before
build confidence, continue to take the sample beginning the exam.
exams. Did you answer a question incorrectly Pay careful attention to the instructions and tuto-
because you missed a key word? Did you not rial for computer testing. Do deep-breathing and pos-
read all the options carefully enough? Did you itive relaxation exercises to calm yourself. In a testing
read something into the question? Did you center, others will be taking different exams and will
change an answer? Did you choose the correct have started at different times, so do not panic if peo-
answer but mark an incorrect response? All of ple come and go while you are testing. Stay focused!
these are indications of test-taking errors and Pace yourself, do not spend too long on any one
indicate an ongoing need for you to continue test question, and go with your first answer choice.
practicing your skills using sample exams. If The certification exams are not computer adaptive,
you are consistently scoring well on practice meaning that you will be able to mark a question
exams, it will make you feel more confident and and return to it later if time permits. (In computer-
comfortable with testing. adaptive exams, like the NCLEX-RN, after submitting
• Practice, practice, practice sample test your answer choice, you are not permitted to return to
questions. First use the analysis of scoring as a question and change your response.)
you grade yourself on an integrated exam. Use test-taking strategies when you do not know
Follow this with exams for specific body-system the answer. Identify distractions, such as backache
content, which will enable you to design and or neck ache, noise, reading the same questions over
update an individualized study plan that has and over, feeling tired, or thinking of your vacation.
specificity and relevance for you. For example, If these occur, stop, take a few deep breaths, refocus,
you may need to spend a week on neurological then get back on track. Mental fatigue can certainly
content but only a day on cardiac content. You play a factor when you are taking a lengthy exam.
can succeed in becoming certified! We recommend that you pace yourself accordingly.

4469_Winland-Brown_Ch02_009-024.indd 22 3/18/17 1:16 PM

 chapter 2: TEST-TAKING SKILLS AND DESIGNING YOUR STUDY PLAN FOR APRN CERTIFICATION 23

For example, prepare ahead of time to rest between References

each set of 25 questions or so. Allow yourself to disen-
gage even for 1 minute; then, you will be better able Advanced Practice Registered Nurse Consensus
to refocus and continue answering questions. Stretch Model for Regulation: http://www.nonpf.org/default
as needed. Practice positive visualization if your mind .asp?page=26
begins to drift and you find it difficult to concentrate, American Academy of Nurse Practitioners Certifi-
thus reducing your ability to identify key words and cation Program description: http://www.aanp.org/
topics and increasing your likelihood of answering a education/aanp-certification-program
question incorrectly. Do not overcomplicate or over-
American Nurses Credentialing Center certification
analyze the test questions—everything you need to
Web page: http://www.nursecredentialing.org
know to answer the question correctly is included in
the question stem or answer choices. Move on! Think Dunphy, LM, Winland-Brown, JE, Porter, BO, and
positively about your success. Stay focused on your Thomas, D: Primary Care: The Art and Science of
goal: becoming a nationally certified advanced prac- Advanced Practice Nursing, ed 4. FA Davis, Phila-
tice registered nurse. delphia, 2015.
Begin now by using this book as suggested. After Miller, SK: Adult Nurse Practitioner Review and Resource
all, the longest journey begins with a single step. Take Manual, ed 3. American Nurses Credentialing Cen-
that step now. Turn the page and begin. ter, Silver Spring, MD, 2008.

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4469_Winland-Brown_Ch02_009-024.indd 24 3/18/17 1:16 PM
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