greetings mark boswell boswell emergency medical education technology this video is going to go over a few things to do and some helps and some suggestions for right before you're taking your test you'll see an exam you could also apply these principles and things i'm going to talk about to most any major exam you need to take i can only speak specifically to the bcn exams as far as the cen the c pen the cfrn uh the tcrn and the cfrn exams because they are similar as far as their method and their delivery um but these there's some things you can do the last week or so before the exam um one of the big things is the way you study the way you prepare you know a month a month ahead of time versus the week before it's two different ways of studying preparing your brain works in different ways short term versus long term and as you're approaching your test date usually within about seven to ten days you're going to want to change gears as far as how you actually get ready for this test what you've been doing before this time is more of your long-term learning your long-term brain your long-term storage um you're learning up to this point has been mostly focusing on more the the underlying concepts the processes the um the pathophysiology for the conditions the reasoning for things the thought processes those deeper meanings to a lot of the topics you've been studying and it's important that you study that way because that helps build your critical thinking so when you take this test no matter how you see the test question presented to you you're able to apply that critical thinking that logic that reasoning to answer it how it is for example it would be nice if we all just saw questions like what is the normal human heart rate okay 80 to 100. that's a very fact level a very simplistic question it is a possible question on the exam they can ask things that simply but we know there's different domains of learning and different levels of learning that they can actually ask about so they could actually take the same concept of the normal human heart rate and ask in a different way with a much higher level of cognitive testing they could ask something to the extent as an example maybe a patient presents they've had some traumatic injury what might you expect their heart rate to be and then give you several choices of you know 60 to 80 80 to 100 um 100 to 120 okay so based upon your understanding of the normal human heart rate you know in that that other question i suggested to 80 to 100 your understanding of how people respond to trauma illness injury um maybe um this person's uh hypotensive from blood loss from some injury we understand the human heart rate goes up we understand that's part of that sympathetic response so that's an example of asking the same concept but in a deeper way that you have to understand more and that's what you've been learning up until this point is those concepts that you know how these big all these pieces fit together to these problems conditions things like that they're going to ask about so that was what you did the previous months before you got ready to take the exam before your exam date came up now that it's within a week or so before that um and i'd recommend people think about these things maybe about not much more than 10 to 14 days beforehand because we're gonna do some things a little bit differently as far as the learning process goes in this short term period okay there's the period right before the exam that short term period about 10 to 14 days this is not the time to go and be learning major concepts this is not the time to be reading through textbooks okay we're going to approach this a little bit differently i'm also giving you some things to do during the test to help you with your score as well too as well as to successfully get through the whole testing process all right let's start with some very simple things to do and you hear this in many presentations or other lectures or educators telling you how to be successful on tests and there are some things that are absolutely tried and true they seem kind of not that important you know when really just focusing i want to get there i want to take this test i want to pass but let's be realistic you got to know where you're going okay been there done that myself once where i actually wound up not the right address the gps was not working correctly it was working with me i had the wrong address i wound up a distance away from where i should have been thankfully i was on time i was actually running ahead of time so it's not a problem but absolutely make sure you know where you're going um i don't mean you have to drive there especially now if it's somewhere local yeah go ahead and drive there at least see where it is uh get kind of an idea um if it's further away that you're having to travel at least pull it up on google maps maybe even pull up that satellite view or you can actually see what the building looks like or the street view where you know on google you can actually like you're standing there on the street and actually see what you're looking for so you know when you get close to it you know where it is um now when i used to live in south carolina i actually test whenever you know whenever i retest all the time it was the same test center every time so i didn't do that every time i knew exactly where it was because it was the same one time after time but absolutely no you'd be surprised something just like that that you don't know where you're going can ruin your whole you know then you forfeited the money um you're now stressed out you're upset you feel like you let yourself down so something that simple very very very important and don't wait to look for it the night before somewhere in the week before the exam make sure you pull it up on the google maps or whatever gps or map program you have the next one again sounds really simple sounds basic have your stuff ready um you know some of us carry um you know little um little uh knapsacks some of us carry um little shoulder bags um a lot of the girls carry like um one of those dooney burke you know little um i don't know what you guys call them book bags or whatever let's just say that you know and every time you go to the house you have some of your stuff in there so i would get your stuff ready the day before okay i'd have even if you still have your books out and you're studying the night before at least have your book bag out set to the side have all the stuff you need for going to the test for making your drive whatever have it already set out and ready to go so when you leave for the exam it's all right there you're not having to look for last minute things again crazy things can happen last minute where did i put my car keys um oh my gosh where's that notepad i would take and review in the car ahead of time things like that have that stuff i can't emphasize this enough again we take these simple things for granted but they can be catastrophic issues if you're running behind you're late you can't find your stuff have your stuff ready arrive early okay now if you have the luxury of time i know some people you're scheduling to exam like you know you've got maybe got kids you have to take care of there or some other obligation or whatever i mean ideally you'd want to really free up at least the half of the day that you're scheduled to take your test usually the tests are scheduled either the morning part of the day or in the afternoon um try not to have other conflicting stuff going on because i do recommend you get there early what i found personally i like to do is not just get early and then review in the parking lot but to find like a a nearby restaurant or something like um here in the south waffle house is on every corner find something go in get you you don't have to you know don't have to eat get you a cup of coffee something like that and just sit and go over your stuff okay yeah you can do it in the car along comfort on the car sometimes and you kind of feel stressed i recommend being at the location you know at least at least an hour early you've got time to relax you know you've made it there got time to get your stuff together um maybe i need to shoot off an email or two to tell someone hey i'm gonna be off the radar i'm off off the grid for the next couple hours um etc go into a restaurant get some coffee maybe eat a little something if you've not eaten yet but definitely do make sure you've eaten that day as well too there's nothing worse than sitting in front of a three-hour exam and suddenly feeling hungry and your stomach's upset you know you best if this stressful exam is gonna make you like nauseated then maybe don't eat um if you feel that eating is kind of your comfort thing go ahead and do it i mean what the heck you're fixing to take a stressful test do something you enjoy before this test okay so get there early maybe find a different place like again like a restaurant or a diner or something to go into and um bring your notes in with you and look them over again another simple thing get to bed on time okay um again you know it does you no good for this task it does not help your memory or recall if you've only had three hours of sleep um i don't really recommend doing this after your shift like if you're a night shifter going to taking a morning test don't really recommend that your brain is still trying to process stuff from the previous shift um i recommend looking at your test hopefully you would figure this out by now don't do it right after your shift just a personal recommendation but get to bed on time set those alarm clocks okay um set two have a friend call you make sure you're up something some system like that to make sure you get up and get going on time and get up early nothing worse than getting a brush um and feel okay i can be out the door in 20 minutes something can always come up get up early you know if you're up that early just take it easy you know for a while hey you've got plenty of time relax okay so good sleep get up early set some double alarm clocks let's go back to the studying what you want to do um in that short term that week or 14 days before the exam again this time is more about short-term memory and being able to facilitate recall of pulling information out of your short-term memory and into your hands to demonstrate on the exam so what you don't want to be doing the last week or so is reading okay what do you mean by that i don't want you to open like an emergency nursing textbook and start reading chapters what i want you to do is just start scanning the pages and flipping pages okay about maybe five seconds per page look for those big important words look for those concepts don't read them just look at them okay all you're doing is you're giving your brain yet one just one more set of cues or keys to with seeing that information to help lock it in and help make it easier to recall it okay look at any words that are in bold in that textbook um if you see charts or tables again scan them do not memorize them okay memorization takes more than a few minutes okay scan them your brain will be picking up on stuff on those pages that it will recall it will have in your short-term memory it'll help you pull that stuff back out you may not feel that you're learning remember you don't have to learn stuff for this test you have to understand the basics behind things you can apply in different situations okay one thing a lot of people don't know is you're going to if you've not taken this before you're not you're going to get a piece of paper or a dry erase board and you can write down anything you want on it now they give you the paper when you're actually in the test center okay i'll give you a sheet or two of paper maybe a dry erase board and something to write with as you sit down that computer station um the first thing's gonna happen is the test proctor um he or she they're gonna show you how to turn the computer they're gonna make sure you're logged in they're gonna make sure they pull up the right exam for you and then they'll say okay you're good to go at that moment before you even start the test okay grab those pieces of paper and write down the things i'm fixing to tell you now you don't need to you don't need to write down what i tell you per se but the things that you've decided are important to you i will tell you my examples of what i always write down um a couple things i always write down i always draw out my 12 lead ekg i draw the 4x3 grid i label the lead names so when ekg or a stemi question comes up i can look right at it it's already there i draw out my rule of nines i draw a picture of the adult with all the nines on it and then the child or the infant with all the nines on it i write down my um parkland formula for burn fluid replacement i write down my 12 cranial nerves i write down my memory phrase for organophosphates we talk about this in the class the words muddles or sludge them i write those down those are the main ones that come to my mind right now but you get an idea of what i'm talking about these the things you're writing down are usually more visual um and maybe a few lists you've memorized like the cranial nerves or if there's some other mnemonic that you've memorized for another condition or whatever but you're not writing a comprehensive stuff you're just writing little figures facts numerical lists memory tools things like that okay these are what i call your write down items okay things that you may want to have in front of you during that you're like i want the answers in front of me but you know obviously you can't do that but these little things that draw your memory and it's better to write these down now before you actually start taking the test because you want that stuff out of your brain and on the paper and that's kind of your comfort as well too because you can look and say yeah i've got some stuff written down here i'm comfortable rather than waiting for the question to come up and go oh i got to draw that ekg now and now you've just gone through 50 questions you're stressed out you're anxious about this test and you're trying to draw an ekg it's not going to be as easy so do your write-downs before you start the test all right also i recommend practicing those at home a day or two before practice how you're going to write them down practice the ones you will use um actually do it at home on a regular blank piece of paper um studying look at your acls okay and keep it simple okay the ena exam the cn does not go all the way down the 12 levels of hell for the tachycardia algorithm okay review whatever acls you have and just focus on the first one or two line interventions the first couple things we do for each of the difference that each of the different um dysrhythmias or life or resuscitation cases okay um you know focus on just the basics the basic information you know um for a lot of people this might be right down too what's your different defibrillation settings okay there's only about four you need to know depending on the state of the patient practice writing those things down those are very fact based they're very i call them bullets means they're very straightforward simple little concepts all right so review your hcls um at least your acls because it's predominantly adult-focused if you do have time and you want to look at some pallet stuff skim through that okay there's not a lot of pediatric questions on the test there's even less pediatric cardiac emergencies on the test i'd be surprised if you even saw more than one all right you're gonna get much more bang for your buck looking at your adult acls stuff if you have a tncc book skim through that book also okay a lot of that same trauma stuff is presented on the cen exam under things like shock and trauma and other resuscitation scenarios but again skim that material scan it do not comprehensively read it okay practice problems you've probably been doing some practice problems from either the ena or the bcn up until now and that's great um that's definitely useful and it's a good learning tool um when you were doing them up until this point you're probably taking time to sit down read them answer them and read the rationales right now shortly before the test that's not what you need to be doing also your practice questions scan them okay do not sit there and try and comprehensively learn from them just scan them again you're just triggering and putting bullets of information in your brain simple little facts little concepts that you can help recall during the exam so i was like if you've got the big ena practice review book that has all the five practice questions the five practice tests i would just skim through that okay i just flip back and forth question answer question answer i'd skim the question i wouldn't even spend a lot of time reading it because what you'll do is you'll notice okay with a quick glance you'll look at the question and you'll have an idea what it's about you look at the answers you'll have an idea what they're about and you can probably connect some dots you're just re-familiarizing yourself with that concept that's in that particular question so don't spend a comprehensive amount of time going in depth into this scan i can't say that enough scan or skim the information during the test there's some things you want to do to make you more successful okay absolutely write down those things first what i call the write downs we talked about that take breaks again i can't emphasize this enough um you may not have to take a break but go ahead and take one every 30 40 minutes okay i take one about every 45 minutes i'm doing this not because i need a break but because i just want to relax kind of reset myself just kind of get out from that heavy anxious stressful test environment for a moment so you know if it's at the test center you know whatever the process is you have to let the test proctor know hey you're taking a break and they'll let you i think they actually log off your computer for you um and then they log you back on you come back there's no time limit to your break um realize this though the computer time keeps going so you know if you take a 30 minute break you just lost 30 minutes off your exam um you know make it quick maybe five or six minutes in the bigger scheme of things that's not a lot of time um and it will actually feel like a long time if you don't have to go the bathroom go on there anyways throw some water on your face a few deep breaths um collect yourself for a moment go back in all right i i i can't emphasize now now again i'm telling you something that works for me i would assume this stuff works for other people too but definitely consider taking a break right as you're going through the questions remember you do not lose points on the test for wrong answers you only get points on the test for correct answers that means if you leave one blank there's no way you get any credit for it so i tell people as you if you if you can't answer that question within a reasonable amount of time like a minute or so and that's actually a long minute believe it or not most questions you'll answer in about 15 to 20 seconds okay if you know them you only think about this even your harder questions you could actually spend about three or four minutes on and the overall average this is actually an educational standard when you design a test you allow approximately one minute for each question okay so this is a 175 question test 25 of them aren't graded they're just for research purposes you won't know which ones they are but you've got 175 questions you've got 180 minutes that is very appropriate a lot of questions i'm going to say at least a fourth or a third you'll answer in about 10 seconds another fourth or so you'll probably answer in about 20 to 30 seconds and then there's going to be those few that you have to spend maybe a minute or two on so it actually averages a lot quite quite well you've got plenty of time that being said if you can't answer that question in about a minute or so pick an answer hopefully you can at least narrow it down and throw out one or two of the answers pick a reasonable answer write down that question number on your piece of paper because you're going to come back to that question when you're at the end write down that one that you're not sure about or any you're not sure about go to the next question sometimes something another question will jog your memory to help go back and answer that one you weren't sure about okay but at least put some answer in there and write down what question number is so you know which one to go back to see some people have left them blank and they just go back to the blank ones and try to answer them here's the worst thing can happen if you leave something blank and you do run out of time you've lost the ability to even get a possible point for that question you left blank because you put nothing in it okay so i do this myself any question i want to go back and look at i'm not sure of i write down which number it is on my piece of paper and the at the end the exam the first thing i do if i made it all the way to the end the first thing i do is i look at my list of the numbers i wrote down okay and i will go back and look at those ones okay um and i'll try and decide if you know if i can figure out the answer or whatever um i may even skip it a second time put a little mark next to that number on the piece of paper so say like question 22 i wasn't sure about so then the exam i'll go back to question 22 i'll look at it maybe something helped me think about it during the rest of the exam something jarred my memory if i can answer it good i'll answer it as confident as i can i'll cross 22 off my list if i can't i'll i'll still leave it uncrossed off and go on to the next one i skipped or the next one i wrote down okay because again maybe something the other ones you're reading the second time through will help remind you um on the exam at least the last time i took it a little over a year ago you can't jump well i tell you that you may be able to jump directly to that particular question um but i remember at least one time i took it you had to use the arrow keys and basically scroll or roll back through all the questions to get number 22. i think you could scroll forward or backwards so you don't have to like review each one individually hit next next next next to get to 22. if i recall correctly you're able to use the arrow keys to rapidly you know arrow arrow you know forward forward forward forward for okay there's 22 and deal with that one and then let's go on to maybe i had to go to question 55 next i could just keep hitting the arrow key and go through there so if you've gone back and done those questions the second time that you weren't sure about and if you still have time on the clock now i recommend you go back through the entire exam and double check your work okay don't leave early this is your time um i i've heard too many times when people that didn't do well you know they said i got done in an hour and a half and they failed like you had another 90 minutes you had an hour and a half go back through that stuff now the rule about when you go back through your stuff because you should already have put an answer in every one of these do not change an answer unless you can make an absolute case why it's wrong okay you've probably heard this before your first guess is statistically the right guess okay so even if there's ones that you look at i'm really not sure about that leave what you put in there there's something about your brain that made you pick the one you did some you mean you may think it was just a random guess but there's something that your brain said pick that one um the rule about always picking the same answer um yeah there's actually some statistical validity to that it's typically not going to make the big difference if you pass or fail the exam but i do recommend pick which answer is always going to be your go-to one if you are totally totally in the air and unknowing about what the possible right if it's totally foreign to you all right for example pick letter b as your go-to answer if you know nothing else okay let's face it one fourth of the time out of four multiple choices letter b is going to be the right answer okay um just statistically because it should be random so have your that's what i call your go-to answer but do not use that unless you totally have no clue because a lot of times you can at least narrow these questions down to where one is totally wrong and you know let's say you know answer a is oh that's completely wrong that has nothing to do with this so you at least narrow it down to b c or d now that being said i have two default answers if i'm having to pick from all four then i i'll pick like b if you can narrow it down to three answers then have a second choice and say okay i'll go with letter c next if i can narrow it down to three if c is still an option and then maybe even have one last one okay i've narrowed it down to two possible answers in which case i'll go with letter d some method like that okay um because what you want you want consistency i know that's really not passing the test but hey if you want to get the points and it might make that one point difference to pass do that um a little side note another thing about multiple choice questions if you notice that two of the answers are like direct opposites of each other like let's say the question is yada yada and then answer a is hyperkalemia and b is hypokalemia and then c and d are irrelevant the answer is going to be one of those two that a or b more often than not i'm not saying always but more often than not so at least see if you can definitely narrow it down to those two or exclude the other two so all you're left with those two opposites at least you got now got statistically likely a 50 50 chance okay um yeah and don't leave early i mean you've got that gift of time i never leave early um and why because you know i take it to learn from it i take it to see what's on it to make sure i can incorporate stuff to teach people the different concepts and things like that that are on the exam and i like to double check my work too i mean i do try and get as good a score as i can it's kind of a sense of pride basically so make the most use of that time so those are the main things i really want to get and drive home to last last minute little preparation things maybe things you don't know about the test some additional strategies to help you be successful the breaks um answering all the questions going back through them using all your time i mean you know so i know you're tired you're sitting there it's like oh my gosh it's three hours hey you don't have to do this once if you pass so go ahead and use that full three hours if you can um but definitely make sure you don't leave anything blank um and never change an answer unless you can make a case for it and then also we talked about that whole short term memory the last week is just like scanning bullets facts figures just topics not comprehensive in-depth reading and highlighting and studying i mean literally just flipping pages and then be comfortable with your write-down items you may have someone work for you um i have the ones that work for me i told you about a few of them um kind of know who you are and what your learning style is and you'll notice things you know as you go through whatever book you're using you'll notice tables and pictures and graphs and your brain will kind of tell you what ones are important i mean like for example you don't need to draw a picture on your write down items of how to insert uh for a needle for needle decompression but you might write down the key landmarks you know the affected side mid clavicular line second intercostal space 14 gauge needle three and a quarter inches in length um something like that but i would not draw a picture of where it goes um but again those are some of the things i think should help you um if they do let me know if you think of something else put in the comments below here i'll be happy to share with other people and i wish you best of luck and hope to hear from you all right you got this you've studied hard um you know what to do you've read the material you've got to this point and just go do what you do all you have to do now is just show your knowledge the studying is done you just have to be able to demonstrate what you learn now good luck stay in touch