Wednesday, May 8, 2013


Nursing school is about seeing through the distractors to understand what the question is actually asking. While I certainly understand the point of them, I have to wonder at what level my nursing school takes this challenge.

Possible test question distractors usually include age, gender, illegal drug use, and antianxiety medication taken on the morning of the exam.

Well, these are the standard NCLEX question distractors.

At the nursing school I attend, there are other distractors though.

Distractors on the final exam for med surge also included things like “The exam is worth 30% of your grade”. This means that if you miss enough of the exam questions, you’re going to fail the class, even if you came in with a strong grade. To be perfectly honest, I was completely unworried about this distractor. I spotted it on the first day of class, and despite being painfully stupid, I managed to arrive at the final with a 90somthing% test average.

Another distractor presented was; “The 80% rule is inflexible, if you screw up, you’re screwed. Also, we don’t round here at this school. Ever. A 79.9% is a 79% and that is failing. However, on the test, when calculating medications, remember to round”.

And then there was the unforeseen ATI testing distractor. This is possibly the cruelest distractor the school has implemented. They give us NCLEX predictor tests that cover the material we’ve covered in our classes and tell us the results are kinda important because they’re accurate.

So, after studying for days, using the method I have used all semester, as well as taking the advice of my professor, the professor who presumably wrote the final exam, I arrived on test day with two sharp #2 pencils confident that I was going to kick ass and take names.

“The patient taking Vitamin C supplements arrives in the hospital wearing white shoes, bleeding from her gums after a fight with a jack russell terrier in a neighbor’s yard. Her temp is 98.3, her HR is 92, her IQ is 123 and she didn’t go to nursing school. What is the priority assessment?

First identify the distractors...
White shoes before Memorial Day – definitely a distractor.
Neighbor’s yard – what fool goes into a yard with a jack russell wearing white shoes?
She didn’t go to nursing school & her IQ is 123 – my IQ must be less than 123 because I went to nursing school...

So I read the question and I think, I know the answer. It’s to check for bleeding. HR is high normal and she’s bleeding from her gums which can indicated a clotting issue... the answer is going to be assess for BLEEDING, and if not that, it’s going to be AIRWAY.

I check the options:
a) 1 + 5 = 6 (ok... so that doesn’t make a ton of sense, but it’s a true statement)
b) 2 + 4 = 6 (also true, but again, it makes no sense in relation to this question)
c) 77 – 71 = 6 (oh crap. Where is “bleeding”? The answer is bleeding... it has to be... terrier fighting white shoe wearing non nursing students who are afebrile should be assessed for bleeding... so the answer is going to be d....)
d) The patient has bradycardia because it’s Tuesday, notify the physician and prepare the patient for a self-breast exam (uh. Anyone? Bueller?)

After 50 or so of these questions, with three right answers and no correct answer, I start to wonder if I’m smart enough to even be sitting in the room with all these smart people.

Its true. The people I go to school with must be amazingly smart.

The bad thing is, as this realization dawns, the information relating to MedSurge that normally resides in my brain decides to check out for a short break. Nausea is rolling over me in waves and my skin is prickling (~sigh~ what kind of hallucination is that?).

I can no longer read all the words, and the ones I can read don’t even make complete sense.

And at some point all I want to know is the answer to the most important question that is being presented on this test:

How does a student with a 93% in the class, who achieved a Level 3 score, in the 99th percentile, on a Med Surge ATI NCLEX predictor test, get to question 52 on her final exam with a firm grasp on the fact that she knows nothing about anything to do with nursing, and should probably just quit now?

Risk for Situational Low Self Esteem related to stupidity as evidenced by the number of questions answered wrong in the first 45 minutes of a final exam.

Once the grades posted my fears were confirmed, and I ended the semester with the belief that I am worthless in the classroom.

I am worthless. I studied. Hard. And this is the result?

I comforted myself post exam with beer and the idea that maybe this test was just hard. That it was a bad day for me. So, the test was difficult, and that’s why I struggled... people will identify with this. Hard tests result in low grades. It’s not you, it’s the test.

Or, at least I can tell myself that until my professor says, “That exam was easy, what happened?” 

I very honestly want to look her in the eye and see her reaction when I say, “ok. I’m sure it’s not the exam. If you tell me the exam was easy, and I know how I studied, then I am too stupid to be in this nursing school. I guess I better figure out if dropping out is viable, or if I am going to continue here at the risk of bringing the school down with my stupidity for another 32 weeks.”

My ATI test showed that I have a firm grasp of material, as compared to students in other programs. So if the purpose of ATI is an NCLEX predictor, what was the purpose of Med Surge Final Exam?

So far Nursing school has done a great job. I can start IVs, confidently watch O2 sats and determine when they’re for realz dropping or just fluctuating with patient position. I know when it is time to be firm, and when to hold someone’s hand.  And that challenging a question or test grade will be, to quote the professor, “a waste of your time”, despite my concern that all the test was testing was my resolve and dedication to continuing forward in my education. Today I’m going to have to diagnose myself with:

Powerlessness related to alterations in roles, relationships, and future plans as evidenced by an inability to communicate effectively...

In the mean time, I have 13 or so weeks off to recover from this insult. To convince myself that, even though the “test was easy”, it was a fluke that I scored so poorly. That I am not lacking in intellect.

That I deserve to be here.

That my worth is not tied to a number.


(Just) Trying is for Little Girls said...

I still want you to take care of me when I'm sick.

Marnee A said...

ahhh friend, I'm sorry! boo! I hope you are able to work through all that happens in the mind on this and get to the place that we all already are; and that is that you are a rockstar who can and will achieve greatness!

Linda Sherwood said...

I teach college, and when I was going to school one of my classes had us take several different types of tests on the same material.

Sometimes, the student can KNOW the material and do poorly on the test because of the test type. Multiple choice and true/false tests are the ones most likely to fail to actually test the student's knowledge.

bobbi said...

You do deserve to be there.

Your worth ISN'T tied to a number.

And you are going to make a GBA nurse. I believe it.

Running for Oreos said...

My school is the same way.

I hate that all the answers are correct, except maybe one you can throw out immediately. Then you have to really think, then you start to question yourself and the ability to identify the real issue. Then I start to question myself, "am I really ready to be a RN?"

Or maybe that is just me?