Analysis Level Questions

Analysis level questions require that you examine/analyze information, break information into parts, identify relationships in the data, and then make inferences or draw conclusions.

Try this analysis level question

Mr. Yen is in acute renal failure and has also been diagnosed with chronic CHF. His urine output has been 84 ml in 8 hours. Which of the following lab work would you expect to find on his admission lab work? Select all that apply:

a. K+ 2.8
b. pH of 7.38
c. HCO3 of 35
d. pH of 7.50
e. CO2 of 52
f. pH of 7.29

Still with us? Usually those 4 words bring fear into the hearts of all nursing students. "Select All That Apply". Keep in mind the best strategy is to make sure that you are very clear on what the question is asking - and take one answer at a time. The topic of the question is what what lab work would be expected for a patient in renal failure and chronic heart failure. So you ask yourself

a. Is a potassium of 2.8 what I would expect for a patient in renal failure and chronic renal failure? Answer - no, patients in renal failure have an elevated potassium 2.8 is hypokalemia
Eliminate this answer

b. Is a pH of 7.38 what I would expect for a patient in renal failure and chronic renal failure? Answer - no, normal pH is 7.35-7.45. Patients in renal failure are in metabolic acidosis, so the pH would be low or less than 7.35.
Eliminate this answer.

c. Is a HCO3 of 35 what I would expect for a patient in renal failure and chronic renal failure? Answer - no, normal HCO3 is 22-26. Patients in renal failure are in metabolic acidosis, and the failing kidneys can't keep the HCO3 (bicarb) levels normal - so they should be lower than normal.
Eliminate this answer.

d. Is a pH of 7.50 what I would expect for a patient in renal failure and chronic renal failure? Answer - no, normal pH is 7.35-7.45. Patients in renal failure are in metabolic acidosis, so the pH would be low or less than 7.35.
Eliminate this answer.

e. Is a CO2 of what I would expect for a patient in renal failure and chronic heart failure? Answer - no, normal CO2 levels are 35-45. Patients in renal failure are in metabolic acidosis, so the body will try to compensate by "blowing off" CO2 (remember Kussmaul's respirations?) and you should see a lower CO2 level.
Eliminate this answer.

f. Is a pH of 7.29 what I would expect for a patient in renal failure and chronic heart failure? Answer - yes FINALLY ;0), normal pH is 7.35-7.45. Patients in renal failure are in metabolic acidosis, so the pH would be low or less than 7.35.
Select this answer.

WHEW! All that work for just one answer?

That can really happen - but just to be sure - do one final check by making sure that the one you selected is an appropriate answer to what the question was asking and you're on your way to mastering select all that apply and analysis level questions.

Why Are Nursing School Tests/Exams So Hard?

Blame a man named Benjamin Bloom. He was an educational theorist who came up with names for categories of types of questions an exams. Your faculty know who he was - and they use these categories to develop test questions for your nursing school exams.

Let's start at the bottom with the simplest types of questions (everyone wishes exams were that easy!) Knowledge is the "simplest" or most straight forward of the categories of different types of questions.

Knowledge -- is basic "regurgitation" of facts. i.e. If you can memorize - you can answer these types of questions. You won't (or shouldn't) find many of these types of questions in nursing school

How many chambers does the heart have?

a. 1

b. 2

c. 3

d. 4

Comprehension is a little trickier - but still these questions can be answered with a little late night cramming the night before the exam. A comprehension level question would be more along the lines of the following:

Put the following chambers in the correct order that a RBC would travel back to the heart to exchange CO2 for O2

a. Left Atrium, Right Atrium, Right Ventricle, Right Atrium

b. Right Atrium, Right Ventricle, Left Atrium, Left Ventricle

c. Right Ventricle, Right Atrium, Left Ventricle, Left Atrium

d. Left Atrium, Left Ventricle, Right Atrium, Right Ventricle

Best Way to Fail a Nursing School Exam

It's one of the biggest and most frustrating mistakes that nursing students make -- if you are studying for nursing school exams and only study at the level that answers knowledge and comprehension level questions -- you're not seeing the scores on the exams that you would like - or that are passing.

Nursing School exams are written at the level above comprehension - or the application and analysis levels.

Tomorrow we'll give you strategies on how to prepare to answer application and analysis level questions on your nursing school exams. Some simple changes to your study habits can reward you with much more satisfying nursing school exam scores.

LeaRNursing Nurse Consultant Team