Test Preparation for Nursing Assistant/Nurse Aide Exam

Step 2: Get Information

Knowledge is power. Therefore, first, you have to find out everything you can about the nursing assistant exam. Once you have your information, the next steps will show you what to do with it.

Part A: Straight Talk about the Nursing Assistant Exam

Why do you have to take this exam? One of the major objectives of OBRA was to better the quality of care given to residents of long-term care facilities. Thus, OBRA requires that all nursing assistants who wish to work in a long-term care facility complete a training program and pass an exam to ensure they have the necessary knowledge and skills to provide adequate care. Individual states may or may not require certification to work in acute care facilities (such as hospitals), so you need to check your state’s requirements before embarking on the certification process.

It is important for you to remember that your score on the written exam does not determine how smart you are or even whether you will make a good nursing assistant. There are all kinds of things a written exam like this can’t test: whether you are likely to show up late or call in sick a lot, whether you can be patient with a trying client, or whether you can be trusted with confidential information about people’s health. Those kinds of things are hard to evaluate on a written exam. Meanwhile, it is easy to evaluate whether you can correctly answer questions about the job duties of a nurse aide.

This is not to say that correctly answering the questions on the written exam is not important! The knowledge tested on the exam is knowledge you will need to do your job, and your ability to enter the profession you have trained for depends on your passing this exam. And that’s why you are here—to achieve control over the exam.

Part B: What’s on the Test

The certification exam tests the skills, knowledge, and attitudes needed to perform as a nursing assistant. These areas include communications, client rights, legal and ethical issues, the healthcare team, grooming and dressing, hygiene, hydration and nutrition, elimination, comfort, rest and sleep, infection control and handwashing, safety, emergencies, therapeutic and technical procedures, data collection and reporting, prevention, self-care and independence, mental health and emotional needs, and spiritual and cultural needs.

The passing score varies by state, but the range is usually from 70 to 80 percent on the written exam. The acceptable score on the clinical skills portion of the exam also varies by state from 70 to 100 percent. Check with your state agency to obtain information about its specific requirements.

Step 3: Conquer Test Anxiety

Having complete information about the exam is the first step in getting control of the exam. Next, you have to overcome one of the biggest obstacles to test success: test anxiety. Test anxiety can not only impair your performance on the exam itself; it can even keep you from preparing! In this step, you will learn stress management techniques that will help you succeed on your exam. Learn these strategies now, and practice them as you complete the exams in this book so that they will be second nature to you by exam day.

Combatting Test Anxiety

The first thing you need to know is that a little test anxiety is a good thing. Everyone gets nervous before a big exam, and if that nervousness motivates you to prepare thoroughly, so much the better. Many wellknown people throughout history have experienced anxiety or nervousness—from performers such as actor Sir Laurence Olivier and singer Aretha Franklin to writers such as Charlotte Brontë and Alfred Lord Tennyson. In fact, anxiety probably gave them a little extra edge—just the kind of edge you need to do well, whether on a stage or in an examination room.

Stress Management before the Test If you feel your level of anxiety rising in the weeks before the test, here is what you need to do to bring the level down again:

• Get prepared. There’s nothing like knowing what to expect and being prepared for it to put you in control of test anxiety. That’s why you are reading this book. Use it faithfully, and remind yourself that you are better prepared than most of the people taking the test.
• Practice self-confidence. A positive attitude is a great way to combat test anxiety. This is no time to be humble or shy. Stand in front of the mirror and say to your reflection, “I’m prepared. I’m full of self-confidence. I’m going to ace this test. I know I can do it.” If you hear it often enough, you will come to believe it.
• Fight negative messages. Every time someone starts telling you how hard the exam is or how it is almost impossible to get a high score, start telling them your self-confidence messages. If the someone with the negative messages is you, telling yourself you don’t do well on exams or you just can’t do this, don’t listen.
• Visualize. Imagine yourself reporting for duty on your first day as a certified nursing assistant. Think of yourself helping patients and making them more comfortable. Imagine coming home with your first paycheck. Visualizing success can help make it happen—and it reminds you of why you are working so hard to pass the exam.
• Exercise. Physical activity helps calm down your body and focus your mind. Besides, being in good physical shape can actually help you do well on the exam. Go for a run, lift weights, go swimming—and do it regularly.

Stress Management on Test Day

There are several ways you can bring down your level of test anxiety on test day. They will work best if you practice them in the weeks before the test, so you know which ones work best for you.

• Deep breathing. Take a deep breath while you count to five. Hold it for a count of one, then let it out for a count of five. Repeat several times.
• Move your body. Try rolling your head in a circle. Rotate your shoulders. Shake your hands from the wrist. Many people find these movements very relaxing.
• Visualize again. Think of the place where you are most relaxed: lying on the beach in the sun, walking walking through the park, or whatever makes you feel good. Now close your eyes and imagine you are actually there. If you practice in advance, you will find that you only need a few seconds of this exercise to experience a significant increase in your sense of well-being.

When anxiety threatens to overwhelm you right there during the exam, there are still things you can do to manage the stress level.

• Repeat your self-confidence messages. You should have them memorized by now. Say them silently to yourself, and believe them!
• Visualize one more time. This time, visualize yourself moving smoothly and quickly through the test answering every question correctly and finishing just before time is up. Like most visualization techniques, this one works best if you have practiced it ahead of time.
• Find an easy question. Skim over the test until you find an easy question, and answer it. Getting even one circle filled in gets you into the test- taking groove.
• Take a mental break. Everyone loses concentration once in a while during a long test. It is normal, so you shouldn’t worry about it. Instead, accept what has happened. Say to yourself, “Hey, I lost it there for a minute. My brain is taking a break.” Put down your pencil, close your eyes, and do some deep breathing for a few seconds. Then you will be ready to go back to work.

Try these techniques ahead of time, and see if they work for you!

Step 4: Make a Plan

Activity: Construct a study plan. Maybe the most important thing you can do to get control of yourself and your exam is to make a study plan. Too many people fail to prepare simply because they fail to plan. Spending hours poring over sample test questions the day before the exam not only raises your level of test anxiety, but also will not replace careful preparation and practice over time.

Don’t fall into the cram trap. Take control of your preparation time by mapping out a study schedule. On pages 26 and 27 are two sample schedules, based on the amount of time you have before you take the written exam. If you are the kind of person who needs deadlines and assignments to motivate you for a project, here they are. If you are the kind of person who doesn’t like to follow other people’s plans, you can use the suggested schedules to construct your own.

Even more important than making a plan is making a commitment. You can’t review everything you learned in your nursing assistant course in one night. You need to set aside some time every day for study and practice. Try for at least 20 minutes a day. Twenty minutes daily will do you much more good than two hours on Saturday—divide your test preparation into smaller pieces of the larger work. In addition, making study notes, creating visual aids, and memorizing can be quite useful as you prepare. Each time you begin to study, quickly review your last lesson. This act will help you retain all you have learned and help you assess whether you are studying effectively. You may realize you are not remembering some of the material you studied earlier. Approximately one week before your exam, try to determine the areas that are still most difficult for you.

Don’t put off your study until the day before the exam. Start now. A few minutes a day, with half an hour or more on weekends, can make a big difference in your score.

Learning Styles

Each of us absorbs information differently. Whichever way works best for you is called your dominant learning method. If someone asks you to help them construct a bookcase they just bought that may be in many pieces, how do you begin? Do you need to read the directions and see the diagram? Would you rather hear someone read the directions to you—telling you which part connects to another? Or do you draw your own diagram?

The three main learning methods are visual, auditory, and kinesthetic. Determining which type of learner you are will help you create tools for studying.

Visual learners need to see the information in the form of maps, pictures, text, or math problems. Outlining notes and important points in colorful highlighters and taking note of diagrams and pictures may be key in helping you study.

Auditory learners retain information when they can hear directions, the spelling of a word, a math theorem, or poem. Repeating information aloud or listening to your notes on a tape recorder may help. Many auditory learners also find working in study groups or having someone quiz them is beneficial.

Kinesthetic learners must do! They might need to draw diagrams, write directions or build a model. Rewriting notes on index cards or making margin notes in your textbooks also helps kinesthetic learners to retain information.

Mnemonics

Mnemonics are memory tricks that help you remember what you need to know. The three basic principles in the use of mnemonics are imagination, association, and location. Acronyms (words created from the first letters in a series of words) are common mnemonics. One acronym you may already know is HOMES, for the names of the Great Lakes (Huron, Ontario, Michigan, Erie, and Superior). ROY G. BIV reminds people of the colors in the spectrum (Red, Orange, Yellow, Green, Blue, Indigo, and Violet). Depending on the type of learner you are, mnemonics can also be colorful or vivid images, stories, word associations, or catchy rhymes such as “Thirty days hath September . . .” created in your mind. Any type of learner, whether visual, auditory, or kinesthetic, can use mnemonics to help the brain store and interpret information.

Step 5: Learn to Manage Your Time

First, you will take control of your time on the exam. Most nursing assistant exams have a time limit, which may give you more than enough time to complete all the questions—or may not. It is a terrible feeling to hear the examiner say, “Five minutes left,” when you are only three-quarters of the way through the test. Here are some tips to keep that from happening to you.

• Follow directions. If the directions are given orally, listen to them. If they are written on the exam booklet, read them carefully. Ask questions before the exam begins if there’s anything you don’t understand. If you are allowed to write in your exam booklet, write down the beginning time and the ending time of the exam.
• Pace yourself. Glance at your watch every few minutes, and compare the time to how far you have gotten in the test. When one-quarter of the time has elapsed, you should be a quarter of the way through the test, and so on. If you are falling behind, pick up the pace a bit.
• Keep moving. Don’t spend too much time on one question. If you don’t know the answer, skip the question and move on. Circle the number of the question in your test booklet in case you have time to come back to it later.
• Keep track of your place on the answer sheet. If you skip a question, make sure that you also skip the question on the answer sheet. Check yourself every 5–10 questions to make sure that the number of the question still corresponds with the number on the answer sheet.
• Don’t rush. Though you should keep moving, rushing won’t help. Try to keep calm and work methodically and quickly.

Step 6: Learn to Use the Process of Elimination

After time management, your next most important tool for taking control of your exam is using the process of elimination wisely. It is standard test-taking wisdom that you should always read all the answer choices before choosing your answer. This helps you find the right answer by eliminating wrong answer choices. And, sure enough, that standard wisdom applies to your nursing assistant exam, too.

Let’s say you are facing a question that goes like this:

Which of the following lists of signs and symptoms indicates a possible heart attack?

1. headache, dizziness, nausea, confusion
2. dull chest pain, sudden sweating, difficulty breathing
3. wheezing, labored breathing, chest pain
4. difficulty breathing, high fever, rapid pulse

You should always use the process of elimination on a question like this, even if the right answer jumps out at you. Sometimes the answer that jumps out isn’t right after all. Let’s assume, for the purpose of this exercise, that you are a little rusty on your signs and symptoms of a heart attack, so you need to use a little intuition to make up for what you don’t remember. Proceed through the answer choices in order.

Start with choice a. This one is pretty easy to eliminate; none of these signs and symptoms is likely to indicate a heart attack. Mark an X next to choice a so you never have to look at it again.

On to choice b. “Dull chest pain” looks good, though if you are not up on your cardiac signs and symptoms, you might wonder if it should be “acute chest pain” instead. “Sudden sweating” and “difficulty breathing”? Check. And that’s what you write next to choice b—a check mark, meaning “good answer, I might use this one.”

Choice c is a possibility. Maybe you don’t really expect wheezing in a heart attack victim, but you know “chest pain” is right, and let’s say you are not sure whether “labored breathing” is a sign of cardiac difficulty. Put a question mark next to c, meaning “well, maybe.”

Choice d is also a possibility. “Difficulty breathing” is a good sign of a heart attack. But wait a minute. “High fever?” Not really. “Rapid pulse?” Well, maybe. This doesn’t really sound like a heart attack, and you have already got a better answer picked out in choice b. If you are feeling sure of yourself, put an X next to this one. If you want to be careful, put a question mark. Now your question looks like this:

Which of the following lists of signs and symptoms indicates a possible heart attack?

X a. headache, dizziness, nausea, confusion

→ b. dull chest pain, sudden sweating, difficulty breathing

? c. wheezing, labored breathing, chest pain

? d. difficulty breathing, high fever, rapid pulse

You have just one check mark, for a good answer. If you are pressed for time, you should simply mark choice b on your answer sheet. If you have the time to be extra careful, you could compare your check mark answer to your question-mark answers to make sure that it is better.

It is good to have a system for marking good, bad, and maybe answers. We recommend this one:

X = bad

→ = good

? = maybe

If you don’t like these marks, devise your own system. Just make sure you do it long before test day— while you are working through the practice exams in this book—so you are comfortable using it during the test.

Key Words

Often, identifying key words in a question will help you in the process of elimination. Words such as always, never, all, only, must, and will often make statements incorrect. Here is an example of an incorrect statement:

When a nursing assistant is preparing to ambulate a client, making sure the client is wearing proper footwear will always prevent them from falling.

The word always in this statement makes it incorrect. Nursing assistants must also take other measures, in addition to providing proper footwear, when ambulating a resident, such as proper body mechanics and providing support to the client.

Words like usually, may, sometimes, and most may make a statement correct. Here is an example of a correct statement:

Clients of healthcare facilities and hospitals may need help with tasks such as being fed and bathed.

The word may makes this statement correct. There are clients in facilities who may be too ill or weak to perform daily tasks such as feeding and bathing themselves.

Even when you think you are absolutely clueless about a question, you can often use the process of elimination to get rid of at least one answer choice. If so, you are better prepared to make an educated guess, as you will see in Step 7. More often, you can eliminate choices until you have only two possible answers. Then you are in a strong position to guess.

Step 7: Know When to Guess

Armed with the process of elimination, you are ready to take control of one of the big questions in test taking: Should I guess? The answer is Yes. Some exams have what’s called a “guessing penalty,” in which a fraction of your wrong answers is subtracted from your right answers—but nursing assistant exams don’t tend to work like that. The number of questions you answer correctly yields your raw score. So you have nothing to lose and everything to gain by guessing.

The more complicated answer to the question “Should I guess?” depends on you—your personality and your “guessing intuition.” There are two things you need to know about yourself before you go into the exam:

1. Are you a risk-taker?
2. Are you a good guesser?

You will have to decide about your risk-taking quotient on your own.

Step 8: Reach Your Peak Performance Zone

To get ready for a challenge like a big exam, you have to take control of your physical, as well as your mental, state. Exercise, proper diet, and rest in the weeks prior to the test will ensure that your body works with, rather than against, your mind on test day and during your preparation.

Exercise

If you don’t already have a regular exercise program going, the time during which you are preparing for an exam is actually an excellent time to start one. And if you are already keeping fit—or trying to get that way—don’t let the pressure of preparing for an exam fool you into quitting now. Exercise helps reduce stress by pumping feel-good hormones called endorphins into your system. It also increases the oxygen supply throughout your body, including your brain, so you will be at peak performance on test day.

A half hour of vigorous activity—enough to raise a sweat—every day should be your aim. If you are really pressed for time, every other day is OK. Choose an activity you like and get out there and do it. Jogging with a friend always makes the time go faster, or take a portable music player.

But don’t overdo it. You don’t want to exhaust yourself. Moderation is the key.

Diet

First of all, cut out the junk. Go easy on caffeine and nicotine, and eliminate alcohol from your system at least two weeks before the exam. What your body needs for peak performance is simply a balanced diet. Eat plenty of fruits and vegetables, along with protein and carbohydrates.

Make sure to eat a healthy breakfast the day of the exam. Be sure to include protein, complex carbohydrates, and some fat. Complex carbohydrates, such as whole-grain toast or oatmeal, help you feel energized throughout the day.

Rest

You probably know how much sleep you need every night to be at your best, even if you don’t always get it. Make sure you do get that much sleep, though, for at least a week before the exam. Moderation is important here, too. Extra sleep will just make you groggy.

If you are not a morning person and your exam will be given in the morning, you should reset your internal clock so that your body doesn’t think you are taking an exam at 3 a.m. You have to start this process well before the exam. The way it works is to get up half an hour earlier each morning, and then go to bed half an hour earlier that night. Don’t try it the other way around; you will just toss and turn if you go to bed early without having gotten up early. The next morning, get up another half an hour earlier, and so on. How long you will have to do this depends on how late you are used to getting up.

Step 9: Get Your Act Together

You are in control of your mind and body; you are in charge of test anxiety, your preparation, and your testtaking strategies. Now it is time to take charge of external factors, like the testing site and the materials you need to take the exam.

Find Out Where the Test Is and Make a Trial Run

The testing agency or your nursing assistant instructor will notify you when and where your exam is being held. Do you know how to get to the testing site? Do you know how long it will take to get there? If not, make a trial run, preferably on the same day of the week at the same time of day. Make note, on the Final Preparations worksheet on page 25, of the amount of time it will take you to get to the exam site. Plan on arriving at least 10–15 minutes early so you can get the lay of the land, use the bathroom, and calm down. Then figure out how early you will have to get up that morning, and make sure you get up that early every day for a week before the exam.

Gather Your Materials

The night before the exam, lay out the clothes you will wear and the materials you have to bring with you to the exam. Plan on dressing in layers; you won’t have any control over the temperature of the examination room. Have a sweater or jacket you can take off if it is warm.

Don’t Skip Breakfast

Even if you don’t usually eat breakfast, do so on exam morning. A cup of coffee doesn’t count. Don’t eat doughnuts or other sweet foods, either. A sugar high will leave you with a sugar low in the middle of the exam. A mix of protein and complex carbohydrates is best: Cereal with milk, or eggs with whole-grain toast, will do your body a world of good.

Step 10: Do It!

Ace the nursing assistant exam! Fast forward to exam day. You are ready. You made a study plan and followed through. You practiced your test-taking strategies while working through this book. You are in control of your physical, mental, and emotional states. You know when and where to show up and what to bring with you. In other words, you are better prepared than most of the other people taking the nursing assistant exam with you. You are psyched.

Just one more thing. . . When you are done with the exam, you deserve a reward. Plan a celebration. Call up your friends and plan a party, or have a nice dinner for two—whatever your heart desires. Give yourself something to look forward to.

And then do it. Go into the exam, full of confidence, armed with test-taking strategies you have practiced until they are second nature. You are in control of yourself, your environment, and your performance on the exam. You are ready to succeed. So do it. Go in there and ace the exam. And look forward to your future career as a nursing assistant!