In the spirit of our Question Bank release here recently, I’m spending this episode picking apart some of the actual practice questions included in our new resource. I know none of you want any big surprises on exam day, and this is exactly what will help you feel confident when the day comes.
If you’re a long-time listener, you’ll know how much I love practice questions. It helps you exercise not only your knowledge of the material you’ve invested so much time in learning but also helps you test those anxiety management skills that are crucial for your success.
So join me this week as I’m giving you a preview of our Question Bank by dissecting three questions and walking you through the process for answering them correctly. If you’re a student about to take your board exam, there is nothing better to help you feel equipped than getting your hands on a question bank, and it is available for you now!
Welcome to Becoming a Stress-Free Nurse Practitioner, a show for new NPs and students that want to pass their board exam the first time and make that transition from RN to NP as seamless as possible. I’m your host Sarah Michelle. Now, let’s dive into today’s episode.
Hey there my friends. In the spirit of the question bank release here recently I wanted to do an episode where we pick apart a few of the actual practice questions included in the new bank. And I’m going to start off this episode really quickly with an introduction here before we dive into these questions together.
So, for those of you unaware we did just release a 1,000 question bank that is broken up into both body systems and testing domains. And a lot of people have no idea what I mean by testing domain, and so testing domains are so if you struggle in a particular area on the exam such as assessment or diagnosis, for example, then you can just do questions related to that area, which is a super cool and unique feature.
So for those of you out there who haven’t purchased it yet, or you intend to do so in the future when the time comes, I want to set the intention with you from the beginning that we purposely made our question bank to try and be tougher than the actual exam. This serves two purposes.
Number one, when you get to the exam ideally you’re going to be exposed to the complexity of the exam ahead of time and therefore feel like your exam is easy. So we’ve already gotten this exact feedback from multiple students already, and we are so, so excited about that.
Number two, we want you to practice your anxiety management skills before your big exam day. This is a critical mistake made by so many students out there and then they walk into their exams, and they’re blind-sided by major anxiety, and they struggle to finish and ultimately pass their exams. We do not want any big surprises on exam day. Instead, we want you to practice those anxiety skills with us at home before the big day.
So with all of that being said, let’s jump into a few questions from the bank together and I’ll walk you through some tools to figure these out. Definitely please, please, please take a second or two to pause after I read the question and the answer choices to see what your gut thinks it is and then we can work through the correct answer together.
Question number one, and y’all, we have gotten so many emails about this one, so I am super excited to start out with this one in this episode. So here it is, an elderly adult male presents with a tremor that occurs during voluntary movement and does not occur at rest. The patient also states that he notices a decrease in the amount of tremors he experiences whenever he drinks alcohol with his dinner.
Which of the following would not be appropriate to include in his plan of care? Would it be initiate a prescription for propranolol, also known as Inderal? Educate the patient that antiemetics often make this condition worse and therefore should be avoided. Instruct the patient to begin completing regular physical activity to reduce the amount of tremors. Or initiate a prescription for the combination Carbidopa-Levodopa, also known as Sinemet?
All right, so really pause and think on this one. Even re-listen to it if you have to rewind a little bit and then give it your very best guess in your head before you let me tell you the answer, okay? So once you’ve got it, start this episode back up with me.
So with this question, if you’re taking the ANCC and you have that really cool highlight feature, this is an excellent time to highlight one massive keyword in the stem of your actual question. And that keyword is going to be inappropriate. We are looking for the answer that choice that would not be a good choice for this particular patient’s plan of care.
Once we have identified the negative stem in this question, now is when we need to put on our critical thinking hat and really decide what is going on with this particular patient. To be able determine an adequate plan of care we absolutely need the correct diagnosis first. And so this question actually gives us two great clues.
Number one, the tremor does not occur at rest. This is huge because it is an immediate identifier that this is not a Parkinson’s disease tremor. In addition, the second clue that is given aligns with the same thought, the tremor decreases with alcohol. Which is also letting us know, hey, this is not a Parkinson’s disease tremor This is an essential tremor.
So we have a lot of clues in this question that this is an essential tremor. And we know that with essential tremors, they want to avoid those antiemetics if possible. Beta-blockers, like propranolol, can be helpful and exercise can actually be helpful as well.
But the reason we have been getting so much feedback about this particular question is that students are anxious and are moving really fast through the question. So they see that keyword of tremor in the question, they accidentally skip over the word inappropriate. And then they see Sinemet as an option and immediately pick it without looking back.
If this happened to you while you were listening, please do not feel bad at all. I mean, we’ve probably gotten 100 emails about this one question, but it’s a really great insight for you to slow down and ideally use the exam features at hand if you can.
And you can actually still do this too even if you’re taking AANP and you can’t highlight on the screen itself. Instead, what you can do is anytime that you recognize there’s a negative stem in the question, just simply write down that negative word to bring awareness to it on your scrap sheet. So even just that small visual reminder is going to help keep your brain focused on what you’re actually looking for in the answer choices.
All right, so that’s ties up question number one. Question number two, and y’all know I’m going to pick a select all that apply because so many of you out there hate those so much. But they are absolutely nothing to be afraid of because if you know your material, it should not play a factor in your success, I truly believe that with those select all that apply questions.
And honestly, on my own ANCC exam the select all that apply, and picture questions were some of my favorites, just because they really broke up the monotony of taking such a long exam. These are always long exams, no matter how you swing it.
But to get to our actual question here, the question is a minor presents by herself to the office requesting to be seen. For which of the following scenarios do you not need parental consent to treat the patient? Select all that apply.
The answer choices are, the patient thinks she may have gotten chlamydia from her boyfriend and would like to be tested. The patient has had a positive urine pregnancy test but does not want you to tell her parents. The patient is complaining of extremely painful period cramps and moderate bleeding and is requesting treatment. The patient is sexually active and would like to be started on a birth control pill. And finally, the patient has recently enlisted in the military and needs a complete physical exam.
So I really would like for you guys to tackle these select all that apply questions with a routine process every single time. That will make them feel so much less intimidating and overwhelming. And so my process for these is to write down what I know about the topic that I think will help me answer the question. And then I go answer choice by answer choice, seeing if it fits what I initially wrote down and knew for sure that I knew.
Doing this the same way every time just made it seem like another question, no big deal, something I have practiced a million times. It kept my anxiety down. And so with this question, you have to know the base information from the courses that minors do not need parental consent for care regarding pregnancy, contraception, or sexually transmitted infections.
Additionally, minors who are active duty military or legally married are considered to be emancipated minors, and would therefore not need that parental consent either. And so now we just take that answer by answer and see if it matches up.
So for this question, your correct answers would literally be everything but the adolescent seeking treatment for painful period cramps, as that is not related to pregnancy, contraception, or a sexually transmitted infection. That is dysmenorrhea treatment, we are going to need parental consent for that.
And one last question here for us to walk through, question number three, you are evaluating a 66 year old who complains of new onset of dizziness, numbness, tingling, and palpations. Labs are ordered for this patient for further evaluation. Based on these presenting symptoms, what do you anticipate his mean corpuscular volume, or MCV, being if this were related to anemia?
And the answer choices here are 64, 82, 95, and 110. So this question is truly trying to tease apart whether you can apply and not just memorize the information. That’s where some students really get stuck on the exam and that’s why we spend so much time talking about exposing yourself to a lot of practice questions and testing out your own ability to critically think through the material.
And so in this question to choose correctly, we need to know two base facts. The first of which is his symptoms indicate what type of anemia? And the second of which is once we know the anemia type, what is the associated MCV? And so with these anemia questions, students just want to get flustered. They’re like, “Oh my gosh, I don’t know. There’s so many pieces.” All this stuff, your brain just gets all in a mess.
But guys, you know that foundational information. You’ve got this question. And there are a couple of symptoms listed that can guide you to the right diagnosis right away, and that is numbness and tingling, otherwise known as paresthesia, you could see either on your exam. And so we know that when we are seeing those neurological symptoms pop up, it’s what type of anemia? B12 deficiency.
And what B12 deficiency anemia, what does that MCV look like? And so if you’ve done my courses, you know we talk a little bit about the mnemonics, lit and fad to help you remember these, I’m not going to dive into these here. But B12 deficiency is going to be a macrocytic anemia, we know that MCV value is going to be high. A normal MCV is 80 to 100, and so the correct answer here is going to be that MCV value of 110.
And so I want to tie this episode with saying get your hands on a question bank. Whether you’re a student or about to take your board exam, doing lots of practice questions is a great way to see whether you are able to actually use the material that you have spent all this time invested in learning.
Part of why I love practice questions so much is that if you do enough of them, you’re so likely to see something similar or even identical on your exam day, which I promise is going to be a massive confidence boost when you do. I did so many questions before my own exam and it really gave me that little bit of reassurance to know, hey, I can do this. I know my material.
And like we talked about in my previous podcast episode about practice questions in general, you ideally will use a harder and an easier source of questions. I know it’s tough when you feel like you’re not scoring as well as you would like to be on that harder source, but I promise it is so worthwhile to test out that anxiety plan, increase that exposure to questions, and ultimately, you’re going to do better on your exam because of it. I’ve seen it time and time again.
And that’s why our big internal project for 2021 was writing all of these questions for you guys. These are all from me and my team. We knew this was a resource that you needed, and I am so excited to finally be able to provide it to you. It can be accessed via my website at any time.
And even more exciting, we are going to be adding questions this year. So, more and more questions as we go throughout the year. And we’re going to be writing new questions every month so that at least once a quarter, if not more frequently, we can make these new additions and keep the questions fresh for you guys too.
But that is it for this week. If you’re loving the question bank, I would love to hear all about it. If you haven’t purchased it yet, it’s on my website. And I’ll be talking to you guys soon.
As an extra bonus, friends, if you’re looking for support no matter what phase of your nurse practitioner journey that you’re currently in I have communities available for both students and new nurse practitioners. In these communities, we work to uplift one another and grow this profession together every single day. Links to join will be included for you in the show notes.
Thanks for listening to Becoming a Stress-Free Nurse Practitioner. If you want more information about the different types of support we offer to students and new NPs, visit https://www.npreviews.com/resources. See you next week.