Preparing for NP Certification: Test Question Analysis

by Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC

The big day is approaching! As you prepare for your certification exam, you study content and concepts. However, in order to be successful, you must apply this information by answering examination questions. While you are unlikely to pass the exam without having the needed knowledge base, your likelihood of success can increase by proper analysis of the exam questions.

Exam questions are written on a number of levels. The lowest level is usually the fact oriented or knowledge questions. It may require recalling a piece of information that has been memorized, so that you instantly recognize the correct answer. Alternatively, this type of question may be a test of generalizations, principles or theories. The following is an example of a fact-oriented question.

Pupillary constriction in reaction to light is in part a function of cranial nerve:

A.   I

B.    II

C.   III

D.   IV

Mnemonics or other memory aids may be helpful in answering a fact-oriented question. However, the certification exams will likely contain many more complex types of question that require application of clinical assessment and management skills. Examples of these include the comprehension question, where you must interpret the fact. An example of a comprehension question is as follows.

The person with Bell’s palsy has paralysis of cranial nerve:

A.   V

B.    VI

C.   VII


In order to respond correctly to this question, you must know that Bell palsy is a condition where the facial nerve (cranial nerve VII) is affected.

Likely the most common type of question found on the certification exams is the application question. In this kind of question you must analyze information in order to decide what is pertinent to the given situation. Look for key words in the stem (the question itself) that help set a priority. These include words such as first, initially, or most important action. If you are having difficulty ascertaining which action should be done first, particularly when the question poses many plausible actions, you should ask yourself. “What is the greatest risk in this situation?”  Here is an example.

You are seeing Ms. Thomas, a 53 year-old woman who presents for a health exam. She smokes cigarettes and has a strong family history of premature heart disease. The most important part of her assessment is:

A. Chest x-ray

B. Auscultation for extra heart sounds

C. Blood pressure measurement

D. Cervical examination with Pap testing

When looking at this question, you may be struck with the fact that you would certainly perform a cardiac exam and Pap test, perhaps a chest x-ray if clinically indicated, in Ms. Thomas. So, how do you set the priority of the most important part of the assessment? Starting by teasing out the facts and assumptions. Facts include 2 risk factors for cardiovascular disease: cigarette smoking and family history of premature heart disease. In addition, heart disease is the leading cause of death in American woman.  Assume she is postmenopausal, since the average woman reaches this by age 50. This gives her an additional cardiovascular risk factor. Thus, the stage is set for her to be at high risk for cardiovascular disease.  Another assumption is that the best evaluation is one that picks up early disease. Now, look at the answers offered and think what you may expect for results.

In assessing Ms. Thomas, a chest x-ray could reveal lung cancer or smoking related lung disease. However, these changes will not be evident until these diseases are rather advanced. The presence of extra heart sounds would likely indicate systolic and/or diastolic cardiac dysfunction, again a marker of significant, usually advanced cardiac problems. However, blood pressure measurement is critical, as it can detect hypertension in its asymptomatic, earliest state, which would increase Ms. Thomas’ risk of heart disease. While screening for cervical neoplasia is important, intervening in hypertension would be more likely to improve this woman’s shorter-term health.


Successfully passing your certification exam not only marks a critical right of passage, but also tangible evidence of your considerable achievement.  Make sure you do everything possible to maximize your likelihood of success.
Revised 1.25.08.

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This article originally appeared in my quarterly certification column in Advance for Nurse Practitioners and is made available here by the courtesy of Advance. For other articles of interest to Nurse Practitioners, be sure to subscribe to this outstanding journal.