Date of Award


Document Type


Degree Name

Master of Science in Nursing (MSN)


Nursing (Graduate)

First Advisor

Anne B. Woods

Second Advisor

Louann B. Zinsmeister


Achieving minimum NCLEX-RN® pass rates is problematic for many nursing programs. Much research focuses on determining predictors of NCLEX-RN® success and preventing failure. Schools implement standardized content assessments to provide computerized test taking practice and identify at risk students. Using standardized content assessments as predictors allows for early remediation. Although many studies demonstrate a reactionary, multifaceted approach, proactive remediation potentially prevents a problem. However, current research provides poor indication of effective, generalizable techniques. Test-taking strategies typically combined with other interventions, show potential benefit, but limited research is available on effective methods. Cognitive behavioral test taking techniques and Mayfield’s Four Questions©

(M4Q) strategy appear promising. However, stronger evidence on effective test taking strategy education is necessary. This pilot study examined the effect of M4Q© test-taking strategy education on Kaplan Medical-Surgical 1 integrated exam results by comparing non- equivocal groups. Students enrolled a junior level Medical-Surgical nursing course during the 2016 spring semester received the opportunity to participate in an educational intervention. The participants’ de-identified exam scores were compared to de-identified outcomes from the previous spring semester. Preliminary data analysis demonstrated no potential confounders to consider. An independent samples t test revealed no statistically significant difference in the group means for raw scores and percentile ranking. However, anecdotal comments from students indicated potential benefit. Therefore, additional research to evaluate the M4Q© and other test-taking strategies is needed. Tests are an integral aspect of nursing education and proactive remediation techniques, such as test-taking strategies, should be evidence-based.


This is an evidence-based practice capstone project submitted to the faculty of the graduate program in nursing in partial fulfillment of the requirements for the degree Master of Science in Nursing.