Step 1 Test Question Format
Single One Best Answer Questions
Step 1 includes only single questions with one best answer. This is the traditional, most frequently
used multiple-choice format. These items consist of a statement or question followed by three to
eleven response options arranged in alphabetical or logical order. A portion of the questions
involves interpretation of graphic or pictorial materials. The response options for all questions are
lettered (eg, A, B, C, D, E). Examinees are required to select the best answer to the question. Other
options may be partially correct, but there is only ONE BEST answer.
Strategies for Answering Single One Best Answer Test Questions

Read each question carefully. It is important to understand what is being asked.

Try to generate an answer and then look for it in the option list.

Alternatively, read each option carefully, eliminating those that are clearly incorrect.

Of the remaining options, select the one that is most correct.

If unsure about an answer, it is better to guess since unanswered questions are automatically
counted as wrong answers.

Read each question carefully. It is important to understand what is being asked.

Try to generate an answer and then look for it in the option list.

Alternatively, read each option carefully, eliminating those that are clearly incorrect.

Of the remaining options, select the one that is most correct.

If unsure about an answer, it is better to guess since unanswered questions are automatically
counted as wrong answers.
http://www.usmle.org/Examinations/step1/step1_test.html
How to select the correct “next best action”:
1. Review the clinical situation in the stem and ascertain what the problem is leaning towards: ( a
nursing diagnosis or potential complication, concepts in providing care, or identifying a change in
the client’s condition compared to the expected outcome)
2. Decide if additional data is needed, of so select an action that includes the step to assess for the
presence of a pertinent positive.
3. If you have enough data in the stem, determine if you need to initiate a monitoring protocol to
identify a trend, if so, select an action that has the nurse monitor pertinent lab/ diagnostics
4. If you have enough data (a data cluster) to support a decision select and action that has the
nursing implementing or doing something to correct the problem (assume MD orders in all
questions)
5. If the data indicates that the client’s experience is expected then select an action that supports
continued care and monitoring
6. If your data indicates that the client is experiencing a change in their condition or an unexpected
outcome then select an action that requires that you contact the health care provider or rapid
response team
How to select a statement in a question that requires additional clarification:
1. Underline the phrase “additional clarification” or a “need for further teaching”. These questions
expect you to select the item that is incredibly stupid.
2. The best approach is to read each item. Record next to each item, “Brilliant” or Stupid”
3. Only one option is stupid. The rest are all similar. My husband coined the phrase the sesame
street method in test-taking which identifies which “one of these is not like the other”
4. Double check by returning and rereading the stem
How to select a statement in a question that indicates correct understanding:
1. Underline the phrase “correct understanding “. These questions expect you to select the item
that is incredibly brilliant.
2. The best approach is to read each item. Record next to each item, “Brilliant” or Stupid”
3. Only one option is brilliant. The rest are all similar. Remember the sesame street method in testtaking which identifies which “one of these is not like the other”
4. Double check by returning and rereading the stem
How to select the client that you need to evaluate first or can defer assessment
based on the clients provided in a report:
Review the clinical situation in the stem and ascertain what the problem is leaning towards:
1. “needs to be assessed immediately” indicates that one of the client’s report reveals that there
could be a change in the client’s condition that requires clinical judgment (usually reveal a
collaborative problem that is not routine or predictable)
2. “Can be deferred” indicates that one of the client’s report reveals that their progress is routine
and expected and that the current plan of care can be continued to meet the client’s needs.
3. If more than one client report may require immediate assessment, then apply your ABC’s to
prioritize. An altered mental status from hypoxia will trump bleeding. Remember, you are not
committing to never seeing the other patients you focus on ranking who you can see first.
4. Review each item in sequence, labeling as routine or unexpected.
5. The client report labeled as routine would be the client you would defer and the client report
labeled as unexpected would be the client you would assess first.
How to select the client that you should delegate to another care provider who
is less experienced or credentialed or assign to the experienced RN:
Review the clinical situation in the stem and ascertain what the problem is leaning towards:
“assign to the experienced RN” indicates that one of the client’s report reveals that there could
be a change in the client’s condition that requires clinical judgment (usually reveal a collaborative
problem that is not routine or predictable) or collaboration
2. “Can be delegated” indicates that one of the client’s report reveals that their care is within the
scope and practice of the health care provider who can provide the care:
3. As a general rule, never delegate: planning care, teaching, assessment or collaboration with the
physician or when a client is experiencing a negative change in their condition
4. Rules of delegation include:
(https://www.ncsbn.org/323.htm#The_Five_Rights_of_Delegation)
a. Right Task
One that is delegable for a specific patient.
b. Right Circumstances
Appropriate patient setting, available resources, and other relevant factors
considered.
c. Right Person
Right person is delegating the right task to the right person to be performed on
the right person.
d. Right Direction/Communication
Clear, concise description of the task, including its objective, limits and
expectations.
e. Right Supervision
Appropriate monitoring, evaluation, intervention, as needed, and feedback.
1.
How to answer priority questions:
The purpose of these questions is to determine if the nurse knows how best to fix the problem. It
could ask you to select the priority diagnoses or action. Review the clinical situation in the stem and
ascertain what the problem is about. Recall the diagnostic cluster that correlates to the problem.
Underline key words that reveal what the nurse is managing or preventing:
Recall the priority collaborative problems and nursing diagnoses and identify the actions that
prevent or manage the problem.
2. Review each of the items and indentify what the outcome of each action would be. Rule out
actions that do not directly fix the problem.
3. Select the action that best prevents or corrects the problem. If more than one item equally
corrects or prevents the problem, use your ABC I/O Wound pain safety framework.
1.
How to answer communication problems or conflict resolution:
The purpose of these questions is to determine if the student nurse can avoid traps in
communication and aggressive or passive styles that do not bring forth a resolution. The best way
to prepare is to review the traps in client interviewing such as making judgments or providing false
reassurance. . Review the clinical situation in the stem and ascertain what the problem is about.
Determine if it is a positive or negative response question.
Conflict resolution:
a. Remember what Stephen Covey says, “Seek first to understand, and then be understood”.
Pay careful attention to items that seek additional clarification for further understanding as
your best response. This is the first step is communication and conflict resolution and usually
the best answer.
b. The next step it to explain your concerns in non-judgmental terms.
c. If this was the person’s intent, discuss how it affects you.
d. If it is unacceptable, explain what you would prefer.
e. If this is not achievable, outline the consequence if it remains uncorrected.
2. Rule out all items containing blaming or judgmental statements that are perceived to be
aggressive.
3. Rule out all items that do not fit a best solution to the problem and could be a dead end.
(passive statements)
4. Stick with assertive approaches; “I” statements that are non judgmental and lead to Win-win
solutions.
1.