Practice testing means pulling information out of memory, by answering questions or writing a topic out on a blank page, instead of reading it again. A major 2013 review rated it one of only two “high utility” techniques out of ten, and in controlled experiments students who tested themselves remembered more a week later than students who reread. It also rehearses what nursing exams ask you to do.
Key takeaways
- Dunlosky and colleagues (2013) rated 10 common study techniques and gave only two a high utility rating: practice testing and distributed practice. Rereading and highlighting were rated low.
- In Roediger and Karpicke (2006), students who took a recall test remembered 56% of a passage one week later, versus 42% for students who restudied it.
- Rereading wins in the short run: on a test five minutes later, restudying beat testing (81% vs 75%).
- Keep quizzing what you already know. Word pairs kept in testing were recalled at about 80% a week later; pairs dropped after one correct answer, at about a third.
- The routine here: three self-quiz passes per chapter (after reading, about 48 hours later, and in the days before the exam) plus a three-column error log.
What Practice Testing Is (and Isn’t)
Practice testing is any low-stakes quiz you give yourself where you produce or choose an answer from memory, then check it. Rereading, highlighting, or looking over a question with the answer already showing is not practice testing, because nothing is being retrieved.
Practice testing vs rereading and highlighting
Rereading feels productive because the material looks familiar the second time. Familiar is not the same as retrievable, and an exam asks you to produce the knowledge with the book closed. The 2013 review by Dunlosky and colleagues found that most students report rereading and highlighting, yet neither consistently improves performance, and it recommended practice testing in place of rereading.
You still read the chapter once to learn it. After that, most review time should go into quizzing, with the book used to check answers. Our guide on how to study in nursing school shows where this fits in a weekly plan.
Retrieval practice, active recall and the testing effect
The testing effect is the research finding: taking a test on material improves how well you remember it later. Retrieval practice is the activity that produces it, and active recall is the name students use for the same study method. Retrieval practice examples for nursing courses:
- Blank-page recall: close the book, write everything you remember under one heading, then check.
- Covered drug table: hide every column except the drug name, then write the class, action, a key adverse effect and one nursing consideration.
- Teach-back: explain a pathophysiology sequence out loud, without notes.
Multiple-choice and recall formats both help, but in a summary written for teachers, Dunlosky explains that students benefit most from tests that require recalling an answer, not just recognizing it. That is why the routine below has you cover the options on some items and answer first.
What the Research Says About Practice Testing
The research is consistent: testing yourself produces better long-term retention than spending the same time rereading, even though rereading often looks better on a test taken minutes later.
Dunlosky et al. utility ratings
Dunlosky and four colleagues rated 10 techniques by whether their benefits held across learners of different ages and abilities, different materials, different kinds of tests and real classrooms. Only practice testing and distributed practice (spreading study sessions out over time) earned a high rating.
Moderate does not mean ineffective: the authors called the evidence for elaborative interrogation, self-explanation and interleaving promising but limited. The low-rated techniques had narrower or less consistent benefits, and rereading and highlighting did not consistently improve performance.
The testing-effect experiments in brief
| Study | Who and what | Compared | Delayed result |
|---|---|---|---|
| Roediger & Karpicke 2006, Exp. 1 | 120 undergraduates, short science passages | One recall test vs one restudy | 1 week: 56% vs 42% |
| Roediger & Karpicke 2006, Exp. 2 | 180 undergraduates, same passages | Study once + three tests vs study four times | 1 week: 61% vs 40% |
| Karpicke & Roediger 2008 | College students, 40 Swahili-English word pairs | Keep testing learned pairs vs drop them from testing | 1 week: about 80% vs 33 to 36% |
| Larsen, Butler & Roediger 2009 | 40 pediatric and emergency medicine residents, two neurology topics | Repeated tests with feedback vs repeated review-sheet study | About 6 months: 39% vs 26% |
In the 2006 study, students who read the passage four times predicted they would remember it best, and remembered it worst a week later. In 2008, students in every condition predicted they would recall about half the pairs, so their predictions missed the real differences entirely.
Keep the size of these results in proportion. Short passages about the sun and sea otters are easier to measure than a med-surg final. A 2018 meta-analysis by Pan and Rickard asked whether testing helps on new, different questions and found a more modest average benefit (d = 0.40). After correcting for possible publication bias, it often found no transfer unless certain conditions, covered below, were present.
Why Practice Testing Works So Well for Nursing Content
Practice testing suits nursing because exams ask you to use knowledge about a client, not recognize a sentence from the textbook. Retrieval is exactly the act of pulling knowledge up so you can use it.
Application-level questions
A nursing exam item rarely asks you to define a loop diuretic. It describes a client taking one, adds a symptom or lab result, and asks what the nurse should check or do first. You have to recall the drug’s action, connect it to the finding and choose an action, from memory. Rereading never makes you build that connection; a practice question does. As Dunlosky notes, a missed answer also tells you what needs restudying.
Transfer to clinical judgment
Pan and Rickard found that transfer to new questions was greatest in a few areas, including application and inference questions and problems involving medical diagnoses. It was more likely when:
- the correct answers on practice questions were the same as, or similar to, those on the later test;
- retrieval was elaborated, meaning learners did more than produce a brief answer or got feedback beyond the correct answer;
- learners got a fair share right during practice.
Those findings translate into three retrieval practice strategies: quiz on your own course content, explain why the right answer is right, and read before the first quiz. Next Generation NCLEX case studies test clinical judgment across a whole client scenario; see our guide to NGN question types.
A 3-Pass Chapter Self-Quiz Routine
Quiz each chapter three times: on the day you finish reading it, about 48 hours later, and in the last few days before the exam. The exact gaps are a practical choice, not a number fixed by research; what the evidence supports is spacing the passes out and retrieving instead of rereading.
| Pass | When | What you do |
|---|---|---|
| 1 | Day you finish the chapter | Blank-page recall, then chapter questions; start the error log |
| 2 | About 48 hours later | Error-log rules from memory, then fresh questions |
| 3 | 2 to 4 days before the exam | Mixed, timed questions from every exam chapter |
Pass 1 after reading
- Close the book and spend five minutes writing what you remember under each main heading. Check it.
- Answer a set of chapter questions without looking anything up, marking each answer “sure” or “guess”.
- Read every rationale. Log each miss and each lucky guess in your error log.
Pass 2 at 48 hours
Start with the error log: cover the rule column and state each rule from memory. Then answer fresh questions, or redo missed ones with the options covered. This follows Dunlosky’s advice to keep self-testing with feedback until you recall each idea correctly once, then get it right again on another day. Items you got right on pass 1 still belong here.
Pass 3 before the exam
Two to four days out, mix questions from every exam chapter and time yourself. Mixing makes you work out which concept each question tests, something a single-chapter block gives away; Dunlosky’s team rated this kind of interleaving moderate utility. Finish with a run through your rule column. Leaving pass 3 for the night before leaves no time to fix what it uncovers.
The routine needs a steady supply of chapter questions with rationales. If your course uses one of these textbooks, an edition-matched test bank covers all three passes.
- Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 15th Edition Test Bank — for med-surg courses assigned Hinkle’s 15th edition.
- Pharmacology and the Nursing Process, 9th Edition Test Bank — for pharmacology courses using Lilley’s 9th edition.
- Understanding Pathophysiology, 7th Edition Test Bank — for pathophysiology courses built on Huether’s 7th edition.
Each test bank is matched to one edition and ISBN-13. Check the number on your book before you buy.
How to Review Rationales So Mistakes Stick
Review every rationale, including those for lucky guesses, and turn each miss into a one-line rule you can quiz yourself on. In Butler and Roediger (2008), feedback after a multiple-choice test, immediate or delayed, increased correct answers on a later test and reduced the wrong options students carried forward. Without feedback, a wrong option you picked can stick as something you “know”. Our guide on how to use a nursing test bank covers the full review workflow.
The error log: wrong, why, rule
An error log records every miss in three columns: what you chose, why, and the rule that would have gotten it right. Keep one per course so passes 2 and 3 start from it.
| Wrong | Why | Rule |
|---|---|---|
| Picked a correct statement on a “needs further teaching” item | Missed the negative stem | “Needs further teaching” means find the incorrect statement |
| Mixed up two drugs from one class | Learned them on the same card | Write the one feature that tells them apart, and quiz it |
| Chose a helpful action that wasn’t the first action | Answered “what helps” instead of “what comes first” | Rank by immediate threat to the client, using your course’s priority framework |
The why column shows patterns: if most misses are reading errors, more content review won’t fix them. For clinical rules, use your program’s textbook wording and your instructor’s guidance.
Turning errors into flashcards
Each rule becomes the back of a flashcard; the front is a short cue in your own words. Write your answer before you flip. Keep the card in the deck until you get it right, then see it once more on another day before retiring it.
Common Practice-Testing Mistakes
The three common mistakes are recognizing questions instead of retrieving answers, quizzing only comfortable material, and skipping review.
Memorizing answer letters
After seeing a question twice, you may remember the answer was “C” without knowing why. That is recognition, not retrieval. Cover the options and answer first, or change one detail in the stem and ask what the new answer would be.
Quizzing only on easy chapters
The chapters you avoid are the ones your error log needs most, so spread passes across every exam chapter. Don’t drop topics after one correct answer either: in the 2008 study, items left out of later testing were forgotten far faster.
Skipping review
Answering 50 questions and checking only the score wastes most of the session. The score tells you how you did; the rationales tell you what to change.
Where to Get Good Practice Questions
Use three sources: end-of-chapter questions, an edition-matched test bank for volume and rationales, and questions you write yourself.
End-of-chapter questions
These are free and match your textbook exactly, but a chapter often has only a handful, sometimes with answers printed nearby. Treat them as the start of pass 1, not the whole pass.
Edition-matched test banks
A test bank is a set of chapter-by-chapter practice questions with rationales, matched to one textbook edition and ISBN. It is a self-assessment study aid, not your instructor’s exam, and it can’t promise a grade. Use it for self-quizzing within your school’s academic-integrity policy; our explainer on what a test bank is covers the details. You can browse nursing test banks by course, including medical-surgical test banks and pharmacology test banks.
Writing your own
Turn each chapter heading into a question, and write at least one that describes a client rather than asking for a definition. Add a two-sentence rationale; explaining an answer is close to what researchers call elaborated retrieval.
Frequently asked questions
Is practice testing better than rereading?
For remembering material days or weeks later, yes. In Roediger and Karpicke’s 2006 experiments, tested students recalled 56% of a passage after one week versus 42% for restudiers, and 61% versus 40% when testing was repeated. Rereading came out ahead only on a test given five minutes later.
What is the difference between active recall and retrieval practice?
There is no practical difference. Retrieval practice is the researchers’ term for pulling information out of memory; active recall is the popular name for the same activity. The testing effect is the result: material you retrieve is usually remembered better later than material you only reread.
How many practice questions should I do per chapter?
No study sets a fixed number. A workable rule is enough questions to touch every main heading, then keep going until each missed item has been answered correctly from memory at least once. Dunlosky’s practical advice adds one step: get it right again on a later day.
Should I practice test before I feel ready?
Yes, once you have read the material. Feeling ready is a poor guide: in Roediger and Karpicke’s study, students who reread the most predicted the best recall and had the worst. Read first, though, because getting a fair share right during practice made transfer more likely.
Does practice testing help with NCLEX-style questions?
Probably, though no study we reviewed measured NCLEX results directly. Pan and Rickard found some of the strongest transfer to application and inference questions and to problems involving medical diagnoses, and residents who were tested retained more six months later. Practice testing builds retrieval and application skill; it can’t guarantee a score.
Bottom line: start with one chapter this week
Pick the chapter your next exam leans on most. Do pass 1 on the day you finish reading it, start an error log with three columns (wrong, why, rule), and put pass 2 in your calendar for two days later. Once that loop feels normal, run it for every chapter on the exam.
Sources & further reading
- PubMed — Dunlosky et al., Improving Students’ Learning With Effective Learning Techniques (2013)
- American Educator (AFT) — Dunlosky, Strengthening the Student Toolbox: Study Strategies to Boost Learning (2013)
- PubMed — Roediger & Karpicke, Test-Enhanced Learning: Taking Memory Tests Improves Long-Term Retention (2006)
- PubMed — Karpicke & Roediger, The Critical Importance of Retrieval for Learning (2008)
- PubMed — Butler & Roediger, Feedback Enhances the Positive Effects and Reduces the Negative Effects of Multiple-Choice Testing (2008)
- PubMed — Pan & Rickard, Transfer of Test-Enhanced Learning: Meta-Analytic Review and Synthesis (2018)
- PubMed — Larsen, Butler & Roediger, Repeated Testing Improves Long-Term Retention Relative to Repeated Study (2009)
