Reading Comprehension for Nursing School Entrance Exam Study Guide (page 5)

Because reading is such a vital skill, many nursing school entrance exams include a reading comprehension section that tests your ability to understand what you read. The tips and exercises in this chapter will help you improve your comprehension of written passages so that you can increase your score in this area.

As a nursing professional, you will do a lot of reading—memos, policies, and manuals, as well as medical and technical reports, charts, and procedures. Understanding written material is a key part of the job. Reading comprehension is also an essential skill for students of nursing programs—most likely, you will need to read and understand scientific and medical textbooks as part of the training for your career. As a result, nursing school entrance exams attempt to measure how well applicants understand what they read.

The reading comprehension section of your test will look much like reading comprehension segments you have encountered before on other standardized tests. You read a passage one to five paragraphs long, usually scientific in nature, and then answer one or more questions based on what you have read. You do not need to have any prior or specific knowledge to answer the questions—you need only the information presented in the passage. You will be asked to interpret passages, identify the author's purpose, look at how ideas are organized and presented, and draw conclusions based on the information in the passage.

Types of Reading Comprehension Questions

As a test taker, you have two advantages when answering multiple-choice questions about reading passages:

1. Before you start reading, you don't have to know anything about the topic of the passage.
2. You're being tested only on the information the passage provides.

The disadvantage is that you have to know where and how to find that information quickly in an unfamiliar text. This makes it easy to fall for one of the wrong answer choices, especially since they are designed to mislead you.

The best way to do well on this passage/question format is to be very familiar with the kinds of questions that are typically asked on the test. Questions most frequently ask you to:

• Identify a specific fact or detail in the passage.
• Note the main idea of the passage.
• Make an inference based on the passage.
• Define a vocabulary word from the passage.

Facts and details are the specific pieces of information that support the passage's main idea. The main idea is the thought, opinion, or attitude that governs the whole passage. Generally speaking, facts and details are indisputable—things that don't need to be proven, like statistics (18 million people) or descriptions (a green overcoat). Let's say, for example, you read a sentence that says, "After the department's reorganization, workers were 50% more productive." A sentence like this, which gives you the fact that 50% of workers were more productive, might support a main idea that says, "Every department should be reorganized." Notice that this main idea is not something indisputable; it is an opinion. The writer thinks all departments should be reorganized, and because this is his opinion (and not everyone shares it), he needs to support his opinion with facts and details.

An inference is a conclusion that can be drawn based on facts or evidence. For example, you can infer—based on the fact that workers became 50% more productive after the reorganization, which is a dramatic change—that prior to the reorganization, the department had not been efficiently organized. The fact sentence, "After the department's reorganization, workers were 50% more productive," also implies that the reorganization of the department was the reason workers became more productive. There may, of course, have been other reasons, but we can infer only one from this sentence.

As you might expect, vocabulary questions ask you to determine the meanings of particular words. If you have read carefully, you can determine the meaning of a word from its context—that is, how the word is used in the sentence or paragraph.

Because most of the texts you will read as a nursing student and professional are scientific in nature, you are most likely to find fact or detail and vocabulary questions on your entrance exam. However, because all four types of questions are important to reading comprehension (because not all scientific texts are objective fact, and because analysis and interpretation are important parts of the scientific process), you will find main idea and inference questions on the tests as well.

The following is a sample test passage, followed by four questions. Read the passage carefully, and then answer the questions, based on your reading of the text, by circling your choice. Note under your answer which type of question has been asked (fact or detail, main idea, inference, or vocabulary). Correct answers appear immediately after the questions.

Practice Passage 1:

Using the Four Question Types

The immune system, which protects the body from infections, diseases, and other injuries, is composed of the lymphatic system and the skin. Lymph nodes, which measure about 1 to 25 centimeters across, and small vessels called lymphatics compose the lymphatic system. The nodes are located in the groin, armpits, throat, and trunk, and are connected by the lymphatics. The nodes work with the body's immune system to fight off infectious agents like bacteria and fungus. When infected, the lymph nodes are often swollen and sensitive. The skin, the largest organ of the human body, is also considered part of the immune system. Hundreds of small nerves in the skin send messages to the brain to communicate pressure, pain, and other sensations. The skin encloses the organs to prevent injuries and forms a protective barrier that repels dirt and water and stops the entry of most harmful chemicals. Sweat glands in the skin help regulate the body's temperature, and other glands release oils that can kill or impede the growth of certain bacteria. Hair follicles in the skin also provide protection, especially of the skull and groin.

1. Lymph nodes are connected by
   1. blood vessels.
   2. smaller nodes.
   3. nerves.
   4. small vessels.

Question type: _______

2. According to the passage, pain in the lymph nodes most likely indicates that the
   1. skin is dirty or saturated with water.
   2. nodes are battling an infection.
   3. brain is not responding properly to infection.
   4. lymphatics are not properly connected to the nodes.

Question type: _______

3. Which of the following best expresses the main idea of the passage?
   1. The immune system is very sensitive and registers minute sensations.
   2. The skin and its glands are responsible for preventing most infections.
   3. The lymphatic system and the skin work together to protect the body from infection.
   4. Communication between the lymphatic system and the brain is essential in preventing and fighting infection.

Question type: _______

4. As it is used in this passage, the word compose most nearly means
   1. create, construct.
   2. arrange, put in order.
   3. control, pull together.
   4. form, constitute.

Question type: _______

Answers and Explanations for Practice Passage 1

Don't just look at the right answers and move on. The explanations are the most important part, so read them carefully. Use these explanations to help you understand how to tackle each kind of question the next time you come across it.

1. d.   Question type: fact or detail. The third sentence of the passage says that the nodes are connected by the lymphatics, which are defined in the second sentence as small vessels. You may know that nerves and blood vessels make a web of connections in our bodies, but the passage specifically states that lymphatics—small vessels, not blood vessels (choice a)—connect the nodes.
2. b.   Question type: inference. The passage says that when lymph nodes are infected, they are often swollen and sensitive. Thus, if nodes are painful, they are probably swollen and sensitive, and they are swollen and sensitive because they are fighting an infection. This is also the best answer because none of the other answers are clearly connected to pain in the lymph nodes. Dirty or saturated skin (choice a) may indeed result in infection, but that is not what the question is asking. Choices c and d describe malfunctions of the immune system, a subject that is not discussed in the passage.
3. c.   Question type: main idea. The idea that the lymphatic system and the skin work together to protect the body from infection is the only answer that can serve as a "net" for the whole passage. The other three answers are limited to specific aspects of the immune system and therefore are too restrictive to be the main idea. For example, choice b refers only to the skin, so it does not encompass all of the ideas in the passage.
4. d.   Question type: vocabulary. Although all of the answers can mean compose in certain circumstances, choice d is the only meaning that really works in the context of the passage, which says that the lymph nodes and the lymphatics "compose the lymphatic system." The passage makes it clear that the lymph nodes and the lymphatics are the two parts of the lymphatic system. Thus, they form or constitute the lymphatic system. They don't create it, arrange it, or control it; they are it.

Detail and Main Idea Questions

Detail or fact questions and main idea questions both ask you for information that is right there in the passage. All you have to do is find it.

Detail or Fact Questions

In detail or fact questions, you have to identify a specific item of information from the text. This is usually the simplest kind of question. You just have to be able to separate important information from less important information. However, the choices may often be very similar, so you must be careful not to get confused.

Be sure you read the passage and questions carefully. In fact, it is usually a good idea to read the questions first, before you even read the passage, so you will know what details to look out for.

Main Idea Questions

The main idea of a passage, like that of a paragraph or a book, is what it is mostly about. The main idea is like an umbrella that covers all of the ideas and details in the passage, so it is usually something general, not specific. For example, in Practice Passage 1, question 3 asked about the main idea, and the correct answer was the choice that said the skin and the lymphatic system work together to prevent infection. This is the best answer because it is the only one that includes both the skin and the lymphatic system, both of which are discussed in the passage.

Sometimes, the main idea is stated clearly, often in the first or last sentence of the passage. The main idea is expressed in the first sentence of Practice Passage 1, for example. The sentence that expresses the main idea is often referred to as the topic sentence.

At other times, the main idea is not stated in a topic sentence but is implied in the overall passage, and you will need to determine the main idea by inference. Because there may be a lot of information given in the passage, the trick is to understand what all that information adds up to—the gist of what the author wants you to know. Often, some of the wrong answers on main idea questions are specific facts or details from the passage. A good way to test yourself is to ask, "Can this answer serve as a net to hold the whole passage together?" If not, chances are you have chosen a fact or detail, not a main idea.

Practice answering main idea and detail questions by working on the questions that follow this passage. Check your answers against the key that appears immediately after the questions.

Practice Passage 2: Detail and Main Idea Questions

Because the body responds differently to different allergens, allergic reactions have been divided into four categories. Type I allergies, the most common, are characterized by the production of immunoglobulin E (IgE), a type of antibody the immune system releases when it thinks a substance is a threat to the body. IgE releases chemicals called mediators, like histamine, which cause blood vessels to dilate and release fluid into the surrounding tissues, usually resulting in a runny nose and sneezing. Type I allergies include allergic asthma and hay fever as well as reactions to insect stings and dust. Type II allergies, far more rare, are usually reactions to medications and can cause liver and kidney damage or anemia. The body sends immunoglobulin M (IgM) and immunoglobulin G (IgG) to the site to fight the infection. Type III allergies are usually caused by reactions to drugs like penicillin. The body releases IgM and IgG, but these allergens cause IgM and IgG to bind away from cell surfaces. This creates clumps of allergens and antibodies that get caught in the tissues and cause swelling, which can affect the kidneys, joints, and skin. Type IV allergies cause the release of mediators that create swelling as well as itchy rashes. These are usually skin reactions to irritants like poison ivy, soaps, cosmetics, and other contact allergens.

1. Which type(s) of allergic reactions result in swelling?
   1. Types I and III
   2. Types III and IV
   3. Type III only
   4. Types II and IV
2. IgE, IgG, and IgM can be classified as
   1. allergens.
   2. mediators.
   3. antibodies.
   4. medications.
3. Which of the following would be the best title for this passage?
   1. Preventing Allergic Reactions
   2. Determining the Causes of Allergies
   3. Allergens and the Human Body
   4. Four Types of Allergic Reactions
4. Which of the following best expresses the main idea of the passage?
   1. Allergies cause different responses in the body.
   2. People should avoid things that may cause allergic reactions.
   3. Type I allergies affect the most people.
   4. Mediators play an important role in allergic reactions.

Answers and Explanations for Practice Passage 2

1. b.   The passage says that both Type III and Type IV allergic reactions cause swelling. In Type III allergies, IgM and IgG bind away from cell surfaces. This creates clumps of allergens and antibodies that… cause swelling. Type IV allergies also cause the release of mediators that create swelling as well as itchy rashes.
2. c.   The passage says that immunoglobulin E (IgE) is a type of antibody the immune system releases. The Ig in IgE, IgG, and IgM stands for immunoglobulin; all three are different types of immunoglobulin and therefore different types of antibodies. The immunoglobulins then release the mediators, like histamine, so choice b is incorrect. Further, immunoglobulins are produced in response to allergens, so choice a cannot be correct. And the passage clearly indicates that immunoglobulins are produced by the body, so choice d is also incorrect.
3. d.   Titles generally reflect the main idea of a passage and must therefore be general enough to cover everything in that passage. The passage does not discuss how to prevent allergic reactions, so choice a is not a good answer. The passage does discuss what causes allergic reactions, but that is only part of what the passage covers, and it does not discuss how to determine the specific causes of a reaction, so choice b is incorrect. Choice c is not right because the passage does not focus on allergens; in fact, specific allergens aren't even mentioned for Type II allergies. Finally, it is clear that choice d is the best answer because the first sentence in the passage is a topic sentence: Because the body responds differently to different allergens, allergic reactions have been divided into four categories. This indicates that the passage is primarily about the four types of allergic reactions and not about allergens.
4. a.   This choice best expresses the main idea of the passage because it restates the topic sentence, which tells us the body responds differently to different allergens. Choice b is not a good answer because the passage does not discuss ways to avoid allergic reactions, and although choices c and d are mentioned in the passage, they are too specific to encompass the whole passage. Remember, the main idea should be general enough to include all of the ideas in the passage.

Inference and Vocabulary Questions

Questions that ask you about the meaning of vocabulary words in the passage and those that ask what the passage suggests or implies (inference questions) are different from detail or main idea questions. In vocabulary and inference questions, you usually have to pull ideas that are not expressly stated in the passage, sometimes from more than one place in the passage.

Inference Questions

Inference questions can be the most difficult to answer because they require you to draw meaning from the text when that meaning is implied rather than directly stated. Inferences are conclusions that we draw based on the clues the writer has given us. When you draw inferences, you have to be something of a detective, looking for clues such as word choice, tone, and specific details that suggest a certain conclusion, attitude, or point of view. You have to read between the lines in order to make a judgment about what an author is implying in the passage.

A good way to test whether you have drawn an acceptable inference is to ask, "What evidence do I have for this inference?" If you can't find any, you probably have the wrong answer. You need to be sure that your inference is logical and that it is based on something that is suggested or implied in the passage itself—not by what you or others might think. Like a good detective, you need to base your conclusions on evidence—facts, details, and other information—not on random hunches or guesses.

Vocabulary Questions

There are generally two types of vocabulary questions. The first tests to see how carefully you have read a passage that may contain a number of new or technical terms and definitions. If you see that a passage has a number of unfamiliar terms, mark each term as it is defined. This will make it easier for you to go back and find the right answer.

The second type of vocabulary question is designed to measure how well you can figure out the meaning of a word from its context. Context refers to how the word is used in the sentence—how it works with the words and ideas that surround it. If the context is clear enough, you should be able to substitute a nonsense word for the one being sought, and you would still make the right choice because you could determine meaning strictly from the sense of the sentence. For example, you should be able to determine the meaning of the following italicized nonsense word based on its context:

The speaker noted that it gave him great terivinix to announce the winner of the Outstanding Leadership Award.

In this sentence, terivinix most likely means

1. pain.
2. sympathy.
3. pleasure.
4. anxiety.

Clearly, the context of an award makes choice c, pleasure, the best answer. Awards don't usually bring pain, sympathy, or anxiety.

When confronted with an unfamiliar word, try substituting a nonsense word and see if the context gives you the clue. If you are familiar with prefixes, suffixes, and word roots, you can also use this knowledge to help you determine the meaning of an unfamiliar word.

More often, however, you will be asked about how familiar words or phrases are used in context. These questions can be very tricky because words often have more than one acceptable meaning. Your job is to figure out which meaning makes the most sense in the context of the sentence. For example, the word manipulate can mean either (a) to handle or manage skillfully or (b) to arrange or influence cleverly or craftily. The meaning of this word depends entirely upon the context in which it is used, as you can see from the following sentences.

1. The patient manipulated the wheelchair around the obstacles.
2. The media's manipulation of the facts has a powerful effect on politics.

Sentence a uses the first definition of the word, while sentence b uses the second.

When you are confronted with this type of question, your best bet is to take each possible answer and substitute it for the word in question in the sentence. Whichever answer makes the most sense in the context of the sentence should be the correct answer.

The questions that follow this passage are strictly vocabulary and inference questions. Circle the answers to the questions, and then check your answers against the key that appears immediately after the questions.

Review: Putting It All Together

A good way to solidify what you have learned about reading comprehension questions is for you to write the questions. Here is a passage, followed by space for you to write your own questions. Write one question of each of the four types: fact or detail, main idea, inference, and vocabulary.

In the years since it was first proposed, the free radical theory of aging has gained wide acceptance. But hypotheses that attempt to explain exactly how free radicals are involved in the aging process are muddled by the lack of a clear definition of aging. Is aging a programmed stage of cellular differentiation, or is it the result of physiological processes impaired by free radical or other damage to cells? Despite the want of a clear definition, few question that free radical damage to cell nucleic acids and lipids are an important factor in aging. A recent study shows that oxygen free radicals cause approximately 10,000 DNA base modifications per cell per day. Perhaps the accumulation of unrepaired damage of this type accounts for the deterioration of physiological function. A new theory, however, indicates that free radicals also damage cell proteins and that the accumulation of oxidized protein is an important factor in aging.

1. Detail question: __________
   1.  
   2.  
   3.  
   4.  
2. Main idea question: __________
   1.  
   2.  
   3.  
   4.  
3. Inference question: __________
   1.  
   2.  
   3.  
   4.  
4. Vocabulary question: __________
   1.  
   2.  
   3.  
   4.  

Possible Questions

Here is one question of each type based on the previous passage. Your questions may be very different, but these will give you an idea of the kinds of questions that could be asked.

1. Detail: DNA modification can occur
   1. 10,000 times in the life of a cell.
   2. 1,000 times every second.
   3. thousands of times a day.
   4. once a day.
2. Main idea: Which sentence best sums up this passage?
   1. There are many theories, but no one knows how free radicals really affect aging.
   2. Free radicals are deadly.
   3. Scientists need a clearer definition of aging.
   4. Free radicals will lead scientists to the fountain of youth.
3. Inference: The passage suggests which of the following about the aging process?
   1. A clear definition of aging must be found in order to determine the cause of aging.
   2. DNA controls the aging process.
   3. Free radical damage to proteins increases with age.
   4. Aging is somehow related to free radical damage to cells.
4. Vocabulary: The phrase want of as used in the fourth sentence most nearly means
   1. desire for.
   2. lack of.
   3. requirement of.
   4. request for.

Answers

1. c.
2. a.
3. d.
4. b.

Additional Resources

Here are some other ways you can build the vocabulary and knowledge that will help you do well on reading comprehension questions.

• Practice asking the four sample question types about passages you read for information or pleasure.
• Using a computer search engine such as Google or Yahoo!, search out articles and forums related to the career you would like to pursue. Exchange views with others through online forums and message boards. All of these exchanges will help expand your knowledge of job-related material that may appear in a passage on the test.
• Begin now to build a broad knowledge of your potential profession. Get in the habit of reading articles in newspapers and magazines on job related issues. Keep a clipping file of those articles. This will help keep you informed of trends in the profession and familiarize you with pertinent vocabulary.
• Consider reading or subscribing to professional journals. They are usually available for a reasonable annual fee. They may also be available in your library.
• If you need more help building your reading skills and taking reading comprehension tests, consider Reading Comprehension Success in 20 Minutes a Day, 4th Edition, published by LearningExpress.