by Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC
In the course of talking to candidates for certification, I occasionally speak with NPs who are among the approximately 13% of exam takers who do not pass the NP exam. What have I learned from these conversations? This is a group of intelligent people who completed a course of rigorous graduate study. In spite of this, they were unsuccessful at an exam that usually dictates whether the NP can practice. This can be a devastating blow. However, in retrospect, most can say what got in the way of success. Here is what they have shared.
I expected to read a question and instantly recognize the answer.
While this may happen with a low level, fact oriented question, such as one identifying an anatomic landmark, you should not expect the majority of the questions to be of this type. Most items test your ability to assess or develop a plan of intervention for a clinical situation, requiring synthesis of the information critical to choosing the correct answer. Therefore, you should expect to apply clinical decision-making skills to the test question. Make sure you think through each question. In particular, bear in mind how the pathophysiology of the condition affects the presentation and treatment, how the application of evidence-based practice modifies the course of disease and how to evaluate patient care outcomes.
I could not figure out what the question was asking.
Sometimes identifying the verb in the question can help you determine the purpose of the question. In addition, look at the information presented, and then ask yourself
, “Is this question a test of the ability to gather subjective or objective information? Is it a test of the ability to develop a diagnosis or to plan a course of intervention?” Answering these questions will help focus your thought process as you chose the answer.
More than one answer was applicable to the situation presented. I was not sure which response was correct.
Take another look at the question, and then choose the response most specific to the given situation. Also, sometimes questions that relate to presentation of disease have more than one applicable answer. However, the response with the most common presentation is likely to correct. For example, an adult with bacterial meningitis can present with nuchal rigidity and papilledema. However, since nuchal rigidity is seen in the majority of adults with this diagnosis, and papilledema are found far less often, nuchal rigidity is a better choice. In addition, childhood development questions often have more than one correct response. For example, a healthy 4½-month-old infant is expected to roll stomach to back and smile. However, smiling is a developmental milestone achieved by age 2 months, while rolling is typically not seen until the baby is 4 months old. Therefore, rolling stomach to back is the best response.
I work in an acute care setting. The scenarios and treatment options presenting in the questions were quite different than what I am accustomed to seeing in my RN practice. I had a hard time choosing the best answer.
Many new NPs are seasoned RNs. It is important to remember that, in the acute care setting, you are typically seeing the “worst case scenario” of a disease state, rather than how it would present in primary care, the practice setting of most NPs. Recall that the NP certification exam is a test of entry-level NP knowledge. The acute care nurse is accustomed to seeing exceptions; the exam is likely to present situation that is more the rule. For example, the chest pain associated with acute coronary syndrome (ACS), including unstable or preinfarction angina, can last for hours and is often present at rest. Since the acute care nurse likely has experience in caring for patients with ACS, this presentation may become the nurse’s mindset of the typical presentation of angina pectoris. However, the chest pain episode of the community- dwelling elder with stable angina pectoris is usually infrequent, lasts less than 10 minutes and is usually precipitated by increased physical activity or other provoking activity. Relief of symptoms usually occurs promptly and is relieved with rest or cessation of the provoking activity. For the FNP and ANP exams, the test taker needs to apply primary care, not acute care rules.
You have worked hard and sacrificed much to become an NP. Passing the NP certification exam marks another landmark achievement. Make it a successful part of the journey.
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