If math questions types repeat, does this mean you don't know the topic? This didn't happen often, but I got a few TPN types. It wasn't the exact same question though. Jsut a variation - I think to test whether I paid attention to time being asked about and amount received.
I would say that it depends. Usually when you miss something, it can go in several ways For example: You get a TPN scenario asking to calculate how many total calories a TPN provides. It's a fill in the answer type of question. For this you have to calculate protein, carbs and fat calories. You get it wrong and the next question (or a few questions later) will probably have the same scenario and similar numbers and may ask you to select the total calories provided by the TPN from 5 options. That's usually a sign you missed it. If you miss that second chance, then the adaptive system based on your answer may try to figure out which one of the 3 calorie sources you messed up with and may ask you to calculate each one or the one that you likely messed up on. After that 3 time, it should stop and move on. These are all hypotheticals and I am speculating about how the adaptive system may establish your level of ability. I don't work for NABP, though. I just know that the adaptive system did that on mine.
The registration bulletin says that every question has a set level of ability and the same goes for answer choices. For laughs, let's say this is a scenario. (Note: I made this up.)
Mr. Jones has congestive heart failure and the physician noted pulmonary edema. *The patient is experiencing serious decompensation. The patient is not taking any medications for CHF. The physician asks you the best course of action. For laughs, let's say these are your options:
*Don't know if guidelines have changed. So for all purposes let's pretend that e. is the best course of action.
You recommend:
a.
Osmitrol to clear the pulmonary edema. (
Level of ability: Clueless. Osmitrol is mannitol. The name gives away it is an osmotic diuretic and as you know, it worsens pulmonary edema.)
b.
Inspra instead of
Aldactone to clear the pulmonary edema because patient is male.(
Level of ability: Low. Inspra won't do much but at least you chose a diuretic.)
c. A combination of
Microzide and
Inspra. (
Level of ability: medium. The patient should be on an ACE inhibitor, thiazide and a potassium sparing diurect long term. So you got really close to the best answer.)
d. immediate oral administration of
Lasix to clear the pulmonary edema and strongly advise initiating a combination of
Zestril, Microzide and Inspra for long term management of congestive hear failure. (Level of ability: medium-high. This is STILL not the best answer, though. It's a serious case of decompensation and administration should be IV and you did not provide oral Lasix as needed to manage fluid retention once discharged)
e. immediate intravenous administration and careful titration of
Bumex and strongly advise initiating a combination of
Zestril, Microzide and Inspra for long term management of congestive heart failure and
Lasix as needed to manage edema. (
Level of ability: High. Clearly, the best answer.
Bumex is very potent and should be titrated carefully. You covered all your bases with those 4 discharge meds.)
So let's say the question is set for a high level of ability. And you chose e., which shows a high level of ability. So then the system likely computes the level of ability of the question AND your answer. In other words, did you only show a high level of ability on questions that were easy? That's a failing score right there. It averages them out.
The system also has to account for the number of questions that are remaining. For example, you show a medium-high to high level of ability up to question 110. So it still has to throw at you another 75 questions.
Let's assume 35 of those are experimental because you have not gotten any yet and 40 questions that will count. So basically, you have already passed the Naplex but still have to finish the test. So you can expect a mix of 35 very hard questions that are experimental and 30 rather easy questions that will count. The system has to make your last 40 questions that count very easy because you've earned more than enough points to pass.
So for laughs, let's assume the level of ability you've shown on those
110 questions you've answered, has earned you a
130 scaled score and you have not even finished the test. The system has to distribute "20 scaled points" among 40 questions. It has no other choice but to give you easy questions.
Again, I am sure the algorithm is way more complex than that but to me, it makes sense that my speculation applies to some level. All the best to you and let us know how you did.
Best,
Apotheker2015