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7 Suggestions to Deal with Application-Level Exam Questions

Student hand filling in exam paper with pencil.

A career-critical exam differs greatly from an end-of-semester exam. One major difference is that a licensure or certification exam seeks to determine if you are minimally competent — safe — to perform your job. Therefore, to prepare yourself to deal with application-level exam questions, take my 7 suggestions:

1. Learn the anatomy of any exam item

The items on the IBLCE exam are constructed in a very similar way. Check out my post on the anatomy of an exam item.

2. Differentiate between recall and application-level exam questions

If you have acquired knowledge and facts, you can answer a simple recall question. Here are some examples.

  • What is the usual causative organism for mastitis?
  • Where on the breast is mastitis usually located?
  • What is the drug of choice to treat mastitis?
  • When is mastitis most likely to show up?

(If you’re just reciting the facts, I can give you plenty about mastitis!)

True, you do need to know this information. But don’t waste your time practicing how to handle these questions. You will see few such questions on the IBLCE exam.

3. Learn how to deal with qualifiers in the stem

An exam item about the MOST urgent action, or the BEST response, or the FIRST step implies that more than one of the options listed might be appropriate. But only one is most, or best, or first. Very frequently, application-level exam questions have qualifiers in the stem.

4. Be prepared to know more than one concept

Lower-level items require knowledge only. However, application-level exam questions usually involve some sort of a scenario. The scenario requires you to apply knowledge using more than one concept, fact, technique, and/or rule.

Below are two test items. The first is a knowledge-level item. The second is an application-level item.

Which of these speeds, stated in miles per hour, is the typical limit on many or most U.S. highways?

  1. 35-40
  2. 45-50
  3. 55-60
  4. 65-70
  5. 75-80

Of course, you know that the answer is D, 65-70 miles per hour. Therefore, this is a simple recall question. You either know it, or you don’t.

Here, you’ll see how you must know more than one rule or fact in order to answer a question. This is more akin to a clinical vignette:

Marie is an experienced driver. She has a late-model car, and is driving north on Interstate 95 to Baltimore. During her trip, snow begins falling at a rate of about two inches per hour. What is the highest speed Marie should be driving?

  1. 45-50
  2. 55-60
  3. 65-70

You’ll need to recall that the speed limit on most Interstate Highways is 65 or 70 mph. But recall would not be adequate to answer the question. You would also need to know that snowfall of 2 inches per hour is a lot. (At that rate, a foot of snow would drop within 6 hours!) Generally, application-level exam questions require the candidate to use several facts to come to some kind of judgment, recommendation, decision, or similar action. And, if you grew up in a snow belt (as I did!) having experience helps you to know that the correct answer is option A.

5. Develop critical-thinking abilities while on the job

Facts and knowledge are considered “lower-level” knowledge. Hence, critical thinking involves “higher-level knowledge.” Technically, “higher level” knowledge is application, analysis, or evaluation. For simplicity’s sake in this post, however, I’ll talk focus on application-level exam questions, because I do believe that’s most of what you’ll see on the IBLCE exam. But do not be surprised if you see exam items that pertain to any of these classical pillars of critical thinking:

  • Decision-making
  • Problem-solving
  • Reasoning
  • Analyzing
  • Evaluating

Exam candidates need to do critical thinking to perform on-the-job roles and responsibilities. Using those classical pillars of critical thinking, you are likely to encounter exam questions that reflect:

  • Prioritizing
  • Comparing
  • Determining
  • Predicting
  • Adapting
  • Confirming
  • Performing

Therefore, expect to see questions such as:

  • (Prioritizing) In your clinic, Mrs. R. has just been diagnosed with mastitis. In developing a plan of care for her, a priority would be…
  • (Comparing) Which of these two methods will take less time to work?
  • (Determining) What question would you ask in order to determine if Mrs. S. needs medical follow up?
  • (Predicting) Given these circumstances, you could predict that…
  • (Confirming) Mrs. L. reports all of these signs and symptoms. Which observation  is MOST reliable in confirming that she is having a successful milk-ejection reflex? (Note the use of a qualifier here, which is frequently seen in application-level exam questions..)
  • (Adapting) In talking with Mrs. M., you discover she has some cultural beliefs that conflict with the standard plan of treatment. How would you individualize the plan of care for her?
  • (Performing) When assembling a [piece of equipment], which would be your FIRST step?

6. Be able to recognize clinical conditions

Oh, right! Recognizing the typical presentation of a clinical condition is a sneaky way of making sure that you can apply two separate concepts. First, you’ll need visual recognition of the typical presentation. Then, you’ll need to know what to do about it. Half or more of the IBLCE exam items are based on photos. Therefore, you’ll need to recognize the clinical condition in a photo. If you want to truly master this, the best resource I know of is our workbook on decoding and interpreting photos.

7. Think about what makes the situation “different”

This is tough to explain. But when I am creating a test with application-level exam questions, I ask myself, “What could I throw at them that would make the situation — and therefore the correct answer — different?” This is also a way of integrating the two-concept idea. Here, you can see some examples.

  • Twins and HOMs: The amount of milk a mother would have for twins or HOMs would be different than for singletons.
  • Baby’s age: A pacifier might be therapeutic for a preterm baby, but completely inappropriate for a full-term newborn.
  • Location: Mastitis is usually unilateral, whereas engorgement is usually bilateral. The question might ask you what to do. If it’s typical of mastitis, referral for medical help is more appropriate. If it’s typical of engorgement, helping the mother to move the milk and reduce her discomfort is more appropriate.
  • History: If a woman has an allergy to peanuts, suggesting fenugreek is not a good idea. (“Which of these suggestions would be LEAST appropriate for Mrs. T?”)

In conclusion, I find that most people don’t have a clue about the difficulty level of the IBLCE exam items. To try your hand at all of this, get our practice exams, which past exam candidates have said “feel” about as difficult as the real IBLCE exam.

If you found this post helpful, please forward it to everyone you know who is preparing for the upcoming IBLCE exam!

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