Most of the NCE is standard multiple choice: a stem and four options. The rest is alternate formats, and they cost points in a particular way. Students lose them not because they do not know the content, but because they meet the format for the first time on test day. Here is how each one works, straight from the NCE Handbook, and how to practice it.
Multiple correct response (MCR)
A stem with four to eight options, more than one of them correct. The stem tells you how many to choose.
- You get credit only if you select every correct option. There is no partial credit.
- Treat each option as a true or false statement about the stem. Decide on each one independently, then count.
- If the stem says “select 3” and you are sure of two, pick the third that is most defensible, not the one that sounds most impressive.
The most common MCR error is talking yourself out of an obvious correct option because it seems too easy. If it is true, select it.
Calculation
You type a number into a box.
- Enter a number, not a word. “4,” not “four.”
- Answers are usually a whole number or one or two decimal places, and the item tells you which.
- A calculator is available on screen for items that need it.
- Include only the number. Do not type the unit unless the item asks for it.
The rounding rule
The handbook is specific, and it is worth following exactly:
- Round only the final answer, never the intermediate steps.
- If the digit you are dropping is 5, 6, 7, 8 or 9, round up. If it is 0, 1, 2, 3 or 4, round down.
Rounding in the middle of a problem can move the final answer by a decimal place, which turns a correct method into a wrong answer.
Calculations worth drilling
- Drug infusion rates (mcg/kg/min to mL/hr)
- Oxygen content and delivery
- E cylinder time remaining
- Maximum local anesthetic doses
- Fluid deficits and maintenance (4-2-1)
- Allowable blood loss
- Dantrolene and sugammadex doses
- Body mass index and dosing weights
Drag and drop
You click and drag items onto targets. The handbook describes two kinds:
- Matching: each item goes to its target (a drug to its class, a nerve to its block).
- Ordering: items go in sequence (steps of a crisis algorithm, the path of gas through the machine).
Tips:
- Place the items you are sure of first. The remaining choices narrow themselves.
- For ordering, find the first and last steps before you worry about the middle.
- Check that every item is placed before you move on.
Hotspot
You click a region of an image: an anatomy diagram, a waveform, a monitor, part of the anesthesia machine. When you click, an X marks your choice, and you can change it by clicking somewhere else before you move to the next question.
- Look at the whole image first, then reread the stem. The stem usually names something precise (“the point at which,” “the structure that”).
- Click in the middle of the region you mean, not on its edge.
- Waveform hotspots often ask about a phase (the plateau of the capnogram, the dicrotic notch of the arterial line). Know the phases by shape, not just by name.
Images
Any format can include an image as the stimulus: a rhythm strip, a chest film, a capnogram, a flow volume loop. The image is part of the question. Practice reading these until the normal shape is automatic, because the abnormal one only stands out against a normal you know cold.
Rules that apply to every format
- Questions come one at a time.
- You cannot go back once you answer.
- You cannot skip a question.
- An erasable note board is provided, not scratch paper.
How to practice the formats
- Do at least a few of every format each week, especially in the last month.
- Practice calculations without a phone calculator, using a basic on screen one.
- Write out the rounding rule once and use it every time until it is a habit.
The CRNA Dojo question bank includes every NCE format, with calculation items written to the handbook’s rounding rule and hotspots on real figures. Members can filter Quick Practice to the formats they want to drill, and the free sample exam is a quick way to see where you stand first.
Sources
- NBCRNA, NCE Handbook, Description of the Examination
