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The “Anatomy” of an Exam

Most certification or licensure exams, including the IBLCE Exam, use a multiple-choice format. Before taking a multiple-choice exam, everyone needs to develop some test-taking savvy. To do that, it’s helpful to know the “anatomy” of the exam item.

The Stem

The stem consists of the necessary “background” information, along with a question or an unfinished statement.

The stem begins with a statement, photo, diagram, graph, etc., which typically includes the central idea, problem, concept, definition, or procedure that is being presented. In an application-level question, information in the stem covers what I like to call “this is what is going on.”

Here’s an example:
Baby John is 17 days old, and he is being exclusively breastfed. During the past 5 days, he has passed two stools each day. The stools are shown in the accompanying photo.

Note that half or more of the IBLCE Exam questions are based on images — mostly clinical photos but diagrams, graphs, etc. are all fair game so learning more about images is key.

After the examinee has read what is going on, a question is posed. At least on the IBLCE Exam, the question boils down to: What are you going to do about it?

The question is worded in one of two basic formats: (1) the simple question, or (2) the partial sentence (sentence fragment). There are some variations. The question might be:

What would you tell baby John’s mother?
You need to tell baby John’s mother that…

Hence, this description of what is going on, along with the question, constitutes the entire stem.

The options

In a multiple-choice test item, there are several options. Usually, there are 4 options, but occasionally there are 3 or 5 options.There are two kinds of options within one exam item: The key, and the distractors.


One option is the key. That is, of course, the correct answer. (Hopefully, you will pick that one!) I would argue that the key always comes down to four main ideas.


The other options are called distractors. A distractor is an incorrect response. I like to remind exam-takers that there’s a reason why experts call those options distractors. It’s because they distract you from picking the right answer!

The example I just gave is an application-level question. Why so? Because the question requires you to make a decision based on two major concepts. First, you must know what a normal stool looks like for a breastfed infant. Second, you must know how many stools a day are normal at that age.

This is just an introduction to understanding how exams are constructed. But to develop some test-taking savvy, you’ll need to know how to carefully read the stem and all of the options. It’s especially important to know how to deal with qualifiers.

If you need more than test-taking strategies, it’s not too late to order our fabulously-popular Picture Perfect Workbook to help you understand how to decipher the pictures in The Breastfeeding Atlas. You might also like our Online Lactation Review.

I really want to see you pass this exam! What can I help you with? Tell me in the comments below!

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