How to Break Down a Test Question

The RD exam is a challenging test to ensure dietetic interns are proficient in their critical thinking skills to become certified practitioners of nutrition. Because of this, the RD exam is full of questions designed to test both comprehension and application, rather than simply memorization of facts.

For example, a question isn’t going to ask you:

Which of the following causes night blindness and is a reversible symptom of Vitamin A deficiency?

• A. Nyctalopia
• B. Xerophthalmia
• C. Bitot’s spots
• D. Conjunctiva

It is more likely to be phrased something like this:

A six-year-old child in West Africa complains of difficulty seeing at night. Which of the following reversible condition will this child likely be diagnosed with?

• A. Nyctalopia
• B. Xerophthalmia
• C. Bitot’s spots
• D. Conjunctiva

This question makes sure you know which vitamin deficiency is likely involved (Vitamin A), and which Vitamin A deficiency can lead to difficulty seeing at night (“night blindness”).

While this question can look tricky, there are several steps and strategies to choose from to help you pick the correct answer!

First, when you see the question, take a deep breath. You know this material. It’s normal to feel nervous before and during the exam. In fact, you can look at a test question and feel all your knowledge fly right out the window! Take that first deep breath to calm your nerves, and then read the question.

A six-year-old child in West Africa complains of difficulty seeing at night. Which of the following reversible condition will this child likely be diagnosed with?

• A. Nyctalopia
• B. Xerophthalmia
• C. Bitot’s spots
• D. Conjunctiva

When you’re presented with a question like the one above, it’s important to know there are a few parts to the entire question. The first part is the stem or situation. This is the main chunk of text that contains the scenario, problem, or the facts needed to solve the question. The second part is the response. These are the possible answers. The RD exam always gives four answer choices; we know there are three distracters (or incorrect answers) and one correct answer.

Let’s go back through the above question and see if we can figure it out. When you see a question like this, or any question, read it carefully. Then, read it a second time. What is it asking? It’s asking about a reversible condition for a child.

What are the key words? These are important because they add detail to support the answer. Beware! The question makers know this and will sometimes add in unnecessary details to distract you.

This question has several key words that I’ve bolded: A six-year-old child in West Africa complains of difficulty seeing at night. Which of the following reversible condition will this child likely be diagnosed with?

Try to answer the question before you look at the responses, if possible. We know that a child in a developing country can’t see at night, and it’s a reversible condition. That sounds like a Vitamin A deficiency.

The responses show that we’re right: It is likely a Vitamin A deficiency. We’re given four answer options that appear similar. However, we know three are incorrect. Is there one that is obviously incorrect?

• A. Nyctalopia
• B. Xerophthalmia
• C. Bitot’s spots
• D. Conjunctiva

Yes- Conjunctiva is obviously incorrect. The conjunctiva is a mucous membrane that covers the eye, unrelated to any vitamin deficiency. If at this point, you must completely guess, that’s okay! You’ve improved your odds of getting it right from 25% to 33%.

Let’s look at our other options though. What do these terms mean? Eliminate the ones you know are wrong.

• A. Nyctalopia — or night blindness; it is an insufficiency to see in the dark at night, that is related to Vitamin A deficiency
• B. Xerophthalmia — a condition of dry eyes and can lead to irreversible corneal scarring, caused by Vitamin A deficiency
• C. Bitot’s spots — foamy lesions that appear on the conjunctiva and are also related to Vitamin A deficiency. These are also reversible once Vitamin A deficiency is fixed
• D. Conjunctiva

A key word in the stem was reversible. Xerophthalmia leads to irreversible scarring, so that’s not the answer. Both Bitot’s spots and nyctalopia are reversible, but nyctalopia is the only choice relating to difficulty seeing at night. Choice A is the correct answer.

There are a few more strategies to help eliminate wrong answers. The test makers design these questions to have definitely incorrect, mostly correct, and correct options. These “mostly correct” responses will contain some incorrect information, not have the best answer, or are missing something important. These incorrect answers are based on common misconceptions that less proficient RDs to Be may make. The answers aren’t designed to trick you, but they are designed to make sure you’re competent.

• Echo options: If two options are opposite, it’s likely one of them is correct
• Extreme words: Never, always, only, entirely, every. If these are in an answer, they are likely the wrong answer
• Multiple elements: If there are answers with several elements to them, choose the best answer with the most correct elements
• Grammar: Make sure the stem and the response match grammatically
• True or false: Eliminate what you know is wrong and then play true/false against the remaining responses. (E.g., Is it true that xeropthalmia is reversible?)

While these are all great strategies to use, they are not definitive. Not every question will follow these exact patterns, but they are suggestions to help you through some of the more likely outcomes.

Now, let’s work through this question and see what types of responses we can find.

Elijah had an episode of hypoventilation and vomiting and attributed it to some bad fish he recently ate. The ER doctor checked his lab results and found his HCO3 at 31 and the pH at 7.5. What was Elijah diagnosed with?

• A. Respiratory acidosis
• B. Respiratory alkalosis
• C. Metabolic acidosis
• D. Metabolic alkalosis

Reading the question, what are the key words? Hypoventilation, HCO3 at 31, pH 7.5. This question is testing our knowledge of lab values and understanding the correct medical diagnosis.

In the responses, we see echo options, since there are two sets of similar answers. Knowing this answer requires knowing the difference between respiratory and metabolic, acidosis and alkalosis, and our labs. We know the HCO3 is elevated, and the pH is alkaline (>7.45). We can remove two options immediately; Elijah has a form of alkalosis. 

Since his HCO3 and pH are both raised, this indicates metabolic alkalosis.

When you’re completing practice test questions, go over these steps in your head as you answer them. Get into the practice of reading the question multiple times, making sure you understand what it’s asking, and then finding the key words that are helpful in solving the problem.

With the responses, run through any and all of the above listed strategies to help you decide your answer. At the very least, you should be able to knock out one or two responses.

A special note about math questions and number responses. Sometimes there is an outlier number, usually a very high and/or a very low number listed in the answer choices. The middle range numbers tend to be more likely to be the answer versus the outlier. However, this isn’t always the case, but can be a useful trick if you’ve got no idea what the right answer is. Remember, calculator errors are often answer choices, so double check your math!

These strategies will help your critical thinking and reading skills as you try your hand at practice tests while studying for the RD exam. Be sure to try out your new skills through RD Boot Camp’s practice tests!

Key Items to Remember:

• There are several, effective test taking strategies.
• Test questions are comprised of 3 parts: The stem, the distracters, and the correct answer.
• Take a deep breath and read the question.
• Read the question at least twice.
• Find the keywords needed to answer the question in the stem.
• Attempt to answer the question before looking at the responses.
• Read the responses and eliminate the obviously wrong ones.
• Examine the remaining responses and choose the best answer.